AB100-engrossed,2104,65
149.15
(5) The
commissioner department may, by rule, establish additional
6powers and duties of the board.
AB100-engrossed,2104,109
149.15
(6) If any provision of this
subchapter chapter conflicts with s. 625.11
10or 625.12, this
subchapter chapter prevails.
AB100-engrossed, s. 4882
15Section
4882. 619.16 (3) (a) of the statutes is renumbered 149.16 (3) (a) and
16amended to read:
AB100-engrossed,2104,1817
149.16
(3) (a) The
administering carrier plan administrator shall perform all
18eligibility and administrative claims payment functions relating to the plan.
AB100-engrossed, s. 4883
19Section
4883. 619.16 (3) (b) of the statutes is renumbered 149.16 (3) (b) and
20amended to read:
AB100-engrossed,2104,2321
149.16
(3) (b) The
administering carrier plan administrator shall establish a
22premium billing procedure for collection of premiums from insured persons. Billings
23shall be made on a periodic basis as determined by the
board department.
AB100-engrossed, s. 4884c
24Section 4884c. 619.16 (3) (c) of the statutes is renumbered 149.16 (3) (c), and
25149.16 (3) (c) (intro.), as renumbered, is amended to read:
AB100-engrossed,2105,3
1149.16
(3) (c) (intro.) The
administering carrier plan administrator shall
2perform all necessary functions to assure timely payment of benefits to covered
3persons under the plan, including:
AB100-engrossed, s. 4886
5Section
4886. 619.16 (3) (e) of the statutes is renumbered 149.16 (3) (e) and
6amended to read:
AB100-engrossed,2105,147
149.16
(3) (e) The
administering carrier plan administrator, under the
8direction of the department, shall pay claims expenses from the premium payments
9received from or on behalf of covered persons under the plan. If the
administering
10carrier's plan administrator's payments for claims expenses exceed
the portion of
11premiums allocated by the board for payment of claims expenses
premium
12payments, the board
shall forward to the department, and the department shall
13provide to the
carrier plan administrator, additional funds for payment of claims
14expenses.
AB100-engrossed, s. 4890
18Section
4890. 619.165 (1) (a) of the statutes is renumbered 149.165 (1) and
19amended to read:
AB100-engrossed,2105,2320
149.165
(1) The board Except as provided in s. 149.146 (2) (a), the department 21shall reduce the premiums established
by the commissioner under s.
619.11 149.11 22in conformity with ss.
619.14 (5) 149.143 and
619.17 149.17, for the eligible persons
23and in the manner set forth in
pars. (b) to (d) subs. (2) and (3).
AB100-engrossed, s. 4891
24Section
4891. 619.165 (1) (b) of the statutes is renumbered 149.165 (2), and
25149.165 (2) (intro.), as renumbered, is amended to read:
AB100-engrossed,2106,5
1149.165
(2) (intro.) If the household income, as defined in s. 71.52 (5) and as
2determined under
par. (d) sub. (3), of an eligible person is equal to or greater than
3the first amount and less than the 2nd amount listed in any of the following, the
4board department shall reduce the premium for the eligible person
, as established
5by the commissioner, to the rate shown after the amounts:
AB100-engrossed, s. 4891c
6Section 4891c. 619.165 (1) (d) of the statutes is renumbered 619.165 (1) (d) 1.
7and amended to read:
AB100-engrossed,2106,108
619.165
(1) (d) 1.
The Subject to subd. 2., the board shall establish and
9implement the method for determining the household income of an eligible person
10under par. (b).
AB100-engrossed, s. 4891r
11Section 4891r. 619.165 (1) (d) of the statutes, as affected by 1997 Wisconsin
12Act .... (this act), is renumbered 149.165 (3), and 149.165 (3) (a) and (b) (intro.), as
13renumbered, are amended to read:
AB100-engrossed,2106,1614
149.165
(3) (a) Subject to
subd. 2., the board par. (b), the department shall
15establish and implement the method for determining the household income of an
16eligible person under
par. (b) sub. (2).
AB100-engrossed,2106,2017
(b) (intro.) In determining household income under
par. (b), the board sub. (2),
18the department shall consider information submitted by an eligible person on a
19completed federal profit or loss from farming form, schedule F, if all of the following
20apply:
AB100-engrossed,2106,2422
619.165
(1) (d) 2. In determining household income under par. (b), the board
23shall consider information submitted by an eligible person on a completed federal
24profit or loss from farming form, schedule F, if all of the following apply:
AB100-engrossed,2106,2525
a. The person is a farmer, as defined in s. 102.04 (3).
AB100-engrossed,2107,2
1b. The person was not eligible to claim the homestead credit under subch. VIII
2of ch. 71 in the preceding taxable year.
AB100-engrossed,2107,96
149.165
(4) The
commissioner shall forward to the board moneys received
7under s. 20.145 (7) (a) and (g) in an amount sufficient to department shall reimburse
8the plan for premium reductions under sub.
(1) (2) and deductible reductions under
9s.
619.14 149.14 (5) (a)
with moneys from the appropriation under s. 20.435 (5) (ah).
AB100-engrossed,2107,1514
149.17
(1) Subject to
s. 619.14 (5) (a) ss. 149.143 and 149.146 (2) (b), a rating
15plan calculated in accordance with generally accepted actuarial principles.
AB100-engrossed,2107,1918
149.17
(2) A schedule of premiums, deductibles and coinsurance payments
19which complies with all requirements of this
subchapter chapter.
AB100-engrossed,2107,2423
149.17
(4) Cost containment provisions established by the
commissioner 24department by rule
, including managed care requirements.
AB100-engrossed,2108,7
3149.175 Waiver or exemption from provisions prohibited. Except as
4provided in s.
619.13 (1) (a) 149.13 (1), the
commissioner department may not waive,
5or authorize the board to waive, any of the requirements of this
subchapter chapter 6or exempt, or authorize the board to exempt, an individual or a class of individuals
7from any of the requirements of this
subchapter chapter.
AB100-engrossed,2108,12
10149.18 Chapters 600 to 645 applicable. Except as otherwise provided in this
11subchapter chapter, the plan shall comply and be administered in compliance with
12chs. 600 to 645.
AB100-engrossed,2108,2115
628.34
(3) (a) No insurer may unfairly discriminate among policyholders by
16charging different premiums or by offering different terms of coverage except on the
17basis of classifications related to the nature and the degree of the risk covered or the
18expenses involved, subject to ss. 632.365
and, 632.745
and 632.748. Rates are not
19unfairly discriminatory if they are averaged broadly among persons insured under
20a group, blanket or franchise policy, and terms are not unfairly discriminatory
21merely because they are more favorable than in a similar individual policy.
AB100-engrossed,2109,524
628.34
(3) (b) No insurer may refuse to insure or refuse to continue to insure,
25or limit the amount, extent or kind of coverage available to an individual, or charge
1an individual a different rate for the same coverage because of a mental or physical
2disability except when the refusal, limitation or rate differential is based on either
3sound actuarial principles supported by reliable data or actual or reasonably
4anticipated experience, subject to ss.
632.745, 632.747, 632.749, 635.09 and 635.26 5632.746 to 632.7495.
AB100-engrossed,2109,127
628.36
(2) (b) 1. Except for health maintenance organizations, preferred
8provider plans
, and limited service health organizations
and the small employer
9health insurance plan under subch. II of ch. 635, no health care plan may prevent
10any person covered under the plan from choosing freely among providers who have
11agreed to participate in the plan and abide by its terms, except by requiring the
12person covered to select primary providers to be used when reasonably possible.
AB100-engrossed,2109,1814
628.36
(2) (b) 3. Except as provided in subd. 4., no provider may be denied the
15opportunity to participate in a health care plan, other than a health maintenance
16organization, a limited service health organization
,
or a preferred provider plan
or
17the small employer health insurance plan under subch. II of ch. 635, under the terms
18of the plan.
AB100-engrossed,2109,2420
628.36
(2) (b) 5.
Except for the small employer health insurance plan under
21subch. II of ch. 635 to the extent determined by the small employer insurance board
22under s. 635.23 (1) (b), all All health care plans, including health maintenance
23organizations, limited service health organizations and preferred provider plans are
24subject to s. 632.87 (3).
AB100-engrossed,2110,11
1631.01
(4) Annuities and group policies for eleemosynary institutions. This
2chapter
, and ch. 632
and the health insurance mandates under ch. 632 that apply to
3the plan under subch. II of ch. 635 do not apply to annuities or group policies that
4are provided on a basis as uniform nationally as state statutes permit to educational,
5scientific research, religious or charitable institutions organized without profit to
6any person, for the benefit of employes of such institutions. The commissioner may
7by order subject such contracts issued by a particular insurer to this chapter
, or ch.
8632
or the health insurance mandates under ch. 632 that apply to the plan under
9subch. II of ch. 635 or any portion of those provisions upon a finding, after a hearing,
10that the interests of Wisconsin insureds or creditors or the public of this state so
11require.
AB100-engrossed,2110,1613
631.36
(7) (a) 2. Unless the notice contains adequate instructions to the
14policyholder for applying for insurance through a risk-sharing plan under
subch. I
15of ch. 619, if a risk-sharing plan exists under
subch. I of ch. 619 for the kind of
16coverage being canceled or nonrenewed, except as provided in par. (b).
AB100-engrossed,2110,21
20632.745 Coverage requirements for group and individual health
21benefit plans; definitions. In this section and ss. 632.746 to 632.7495:
AB100-engrossed,2110,24
22(1) "Affiliation period" means the period which, under the terms of health
23insurance coverage offered by a health maintenance organization, must expire
24before the health insurance coverage becomes effective.
AB100-engrossed,2111,2
1(2) "Beneficiary" has the meaning given in section 3 (8) of the federal Employee
2Retirement Income Security Act of 1974.
AB100-engrossed,2111,4
3(3) "Bona fide association" means an association that satisfies all of the
4following:
AB100-engrossed,2111,55
(a) The association has been actively in existence for at least 5 years.
AB100-engrossed,2111,76
(b) The association has been formed and maintained in good faith for purposes
7other than obtaining insurance.
AB100-engrossed,2111,108
(c) The association does not condition membership in the association on any
9health status-related factor of an individual, including an employe of an employer
10or a dependent of an employe.
AB100-engrossed,2111,1311
(d) The association makes health insurance coverage offered through the
12association available to all members, regardless of any health status-related factor
13of those members or individuals eligible for coverage through a member.
AB100-engrossed,2111,1514
(e) The association does not make health insurance coverage offered through
15the association available other than in connection with a member of the association.
AB100-engrossed,2111,1816
(f) The association meets any additional requirements that are imposed by a
17rule of the commissioner designed to prevent the use of an association for risk
18segmentation.
AB100-engrossed,2111,20
19(4) (a) Except as provided in par. (b), "creditable coverage" means coverage
20under any of the following:
AB100-engrossed,2111,2121
1. A group health plan.
AB100-engrossed,2111,2222
2. Health insurance.
AB100-engrossed,2111,2323
3. Part A or part B of title XVIII of the federal Social Security Act.
AB100-engrossed,2111,2524
4. Title XIX of the federal Social Security Act, except for coverage consisting
25solely of benefits under section 1928 of that act.
AB100-engrossed,2112,1
15. Chapter 55 of title 10 of the United States Code.
AB100-engrossed,2112,32
6. A medical care program of the federal Indian health service or of an
3American Indian tribal organization.
AB100-engrossed,2112,44
7. A state health benefits risk pool.
AB100-engrossed,2112,55
8. A health plan offered under chapter 89 of title 5 of the United States Code.
AB100-engrossed,2112,76
9. A public health plan, as defined in regulations issued by the federal
7department of health and human services.
AB100-engrossed,2112,98
10. A health coverage plan under section 5 (e) of the federal Peace Corps Act,
922 USC 2504 (e).