AB100, s. 4828 22Section 4828. 619.12 (1m) (intro) and (a) of the statutes are consolidated,
23renumbered 149.12 (1m) and amended to read:
AB100,1808,224 149.12 (1m) The board or administering carrier plan administrator may not
25certify a person as eligible under circumstances requiring notice under sub. (1) (a)

1to (d) if the required notices were issued by one of the following: (a) An an insurance
2intermediary who is not acting as an administrator, as defined in s. 633.01.
AB100, s. 4829 3Section 4829. 619.12 (1m) (b) of the statutes is repealed.
AB100, s. 4830 4Section 4830. 619.12 (2) of the statutes is renumbered 149.12 (2), and 149.12
5(2) (b) 1. and (e) 2. c., as renumbered, are amended to read:
AB100,1808,96 149.12 (2) (b) 1. Except as provided in subd. 2., no person who is covered under
7the plan and who voluntarily terminates the coverage under the plan, is again
8eligible for coverage unless 12 months have elapsed since the person's latest
9voluntary termination of coverage under the plan.
AB100,1808,1410 (e) 2. c. The board finds that the person is eligible for coverage under the plan
11after a review process, determined by the commissioner department by rule under
12s. 619.123 149.123, that evaluates and approves the certification by the physician
13that the person has a severe and chronic or long-lasting physical or mental illness
14or disability.
AB100, s. 4831 15Section 4831. 619.12 (3) of the statutes is renumbered 149.12 (3), and 149.12
16(3) (c), as renumbered, is amended to read:
AB100,1808,2017 149.12 (3) (c) The commissioner, in consultation with the board, department
18may promulgate rules specifying other deductible or coinsurance amounts that, if
19paid or reimbursed for persons, will not make the persons ineligible for coverage
20under the plan.
AB100, s. 4832 21Section 4832. 619.123 of the statutes is renumbered 149.123 and amended to
22read:
AB100,1809,2 23149.123 Rules for review of physician certification. The commissioner
24department shall promulgate rules that establish the procedure to be used by the
25board under s. 619.12 149.12 (2) (e) 2. c. The rules shall provide for an insurer that

1would be affected by the decision of the board to participate in the review process to
2contest or support the physician's certification.
AB100, s. 4833 3Section 4833. 619.125 of the statutes is renumbered 149.125 and amended to
4read:
AB100,1809,7 5149.125 Health insurance risk-sharing plan fund. There is created a
6health insurance risk-sharing plan fund, under the management of the board
7department, to fund administrative expenses.
AB100, s. 4834 8Section 4834. 619.13 (title) of the statutes is renumbered 149.13 (title).
AB100, s. 4835 9Section 4835. 619.13 (1) (a) of the statutes is renumbered 149.13 (1) (a) and
10amended to read:
AB100,1809,1511 149.13 (1) (a) Every insurer shall participate in the cost of administering the
12plan, except the commissioner may by rule exempt as a class those insurers whose
13share as determined under par. (b) would be so minimal as to not exceed the
14estimated cost of levying the assessment. The commissioner shall advise the
15department of the insurers participating in the cost of administering the plan.
AB100, s. 4836 16Section 4836. 619.13 (1) (b) of the statutes is renumbered 149.13 (1) (b) and
17amended to read:
AB100,1809,2418 149.13 (1) (b) Except as provided by a rule promulgated under s. 619.145 (4),
19every
Every participating insurer shall share in the operating, administrative and
20subsidy expenses of the plan in proportion to the ratio of the insurer's total health
21care coverage revenue for residents of this state during the preceding calendar year
22to the aggregate health care coverage revenue of all participating insurers for
23residents of this state during the preceding calendar year, as determined by the
24commissioner.
AB100, s. 4837 25Section 4837. 619.13 (1) (c) of the statutes is repealed.
AB100, s. 4838
1Section 4838. 619.13 (1) (d) of the statutes is renumbered 149.13 (1) (d), and
2149.13 (1) (d) 2., as renumbered, is amended to read:
AB100,1810,93 149.13 (1) (d) 2. If the department or the commissioner finds that the
4commissioner's authority to require insurers to report under chs. 600 to 646 and 655
5is not adequate to permit the department, the commissioner or the board to carry out
6the department's, commissioner's or the board's responsibilities under this
7subchapter chapter, the commissioner may shall promulgate rules requiring
8insurers to report the information necessary for the department, commissioner and
9the board to make the determinations required under this subchapter chapter.
AB100, s. 4839 10Section 4839. 619.13 (2) of the statutes is renumbered 149.13 (2).
AB100, s. 4840 11Section 4840. 619.135 (title) of the statutes is renumbered 149.135 (title).
AB100, s. 4841 12Section 4841. 619.135 (1) (a) of the statutes is renumbered 149.135 (1) (a) and
13amended to read:
AB100,1810,2114 149.135 (1) (a) Whenever a person becomes eligible for and obtains coverage
15under the plan as a result of receiving a notice under s. 619.12 149.12 (1) (am), (b)
16or (c), the commissioner shall levy an assessment of $1,750 against the insurer that
17issued the notice, except that the commissioner may not levy an assessment if the
18notice of cancellation under s. 619.12 149.12 (1) (am) was issued on one of the
19permissible grounds under s. 631.36 (2) (a). The commissioner shall notify the
20department if an assessment is not levied under this paragraph because a notice of
21cancellation was issued on permissible grounds.
AB100, s. 4842 22Section 4842. 619.135 (1) (b) of the statutes is renumbered 149.135 (1) (b).
AB100, s. 4843 23Section 4843. 619.135 (1) (c) of the statutes is renumbered 149.135 (1) (c) and
24amended to read:
AB100,1811,4
1149.135 (1) (c) If an assessment levied under par. (a) is not paid within the time
2prescribed, the commissioner shall impose a penalty against the insurer in an
3amount established by the commissioner by rule, in consultation with the
4department
.
AB100, s. 4844 5Section 4844. 619.135 (1) (d) of the statutes is renumbered 149.135 (1) (d) and
6amended to read:
AB100,1811,87 149.135 (1) (d) All assessments and penalties collected under this subsection
8shall be credited to the appropriation under s. 20.145 (7) (g) 20.435 (5) (hp).
AB100, s. 4845 9Section 4845. 619.135 (2) of the statutes is renumbered 149.135 (2) and
10amended to read:
AB100,1811,2111 149.135 (2) If the moneys under s. 20.145 (7) (a) and (g) 20.435 (5) (ah), (g) and
12(hp)
are insufficient to reimburse the plan for premium reductions under s. 619.165
13149.165 and deductible reductions under s. 619.14 149.14 (5) (a), or the commissioner
14department determines that the moneys under s. 20.145 (7) (a) and (g) 20.435 (5)
15(ah), (g) and (hp)
will be insufficient to reimburse the plan for premium reductions
16under s. 619.165 149.165 and deductible reductions under s. 619.14 149.14 (5) (a),
17the department shall notify the commissioner. In consultation with the department,
18the
commissioner shall, by rule, increase the amount of the assessment under sub.
19(1) (a) or levy an assessment against every insurer, or a combination of both,
20sufficient to reimburse the plan for premium reductions under s. 619.165 149.165
21and deductible reductions under s. 619.14 149.14 (5) (a).
AB100, s. 4846 22Section 4846. 619.135 (3) of the statutes is renumbered 149.135 (3) and
23amended to read:
AB100,1812,524 149.135 (3) In addition to the assessments under subs. (1) (a) and (2), in
25consultation with the department
the commissioner may, by rule, establish an

1assessment to be levied against each insurer that issues a notice of rejection under
2s. 619.12 149.12 (1) (a) to a person who becomes eligible for and obtains coverage
3under the plan as a result of receiving the notice. Any assessments levied and
4collected under this subsection shall be credited to the appropriation under s. 20.145
5(7) (g)
20.435 (5) (hp).
AB100, s. 4847 6Section 4847. 619.14 (title) of the statutes is renumbered 149.14 (title).
AB100, s. 4848 7Section 4848. 619.14 (1) of the statutes is renumbered 149.14 (1), and 149.14
8(1) (b), as renumbered, is amended to read:
AB100,1812,139 149.14 (1) (b) If an individual terminates medical assistance coverage and
10applies for coverage under the plan within 45 days after the termination and is
11subsequently found to be eligible under s. 619.12 149.12, the effective date of
12coverage for the eligible person under the plan shall be the date of termination of
13medical assistance coverage.
AB100, s. 4849 14Section 4849. 619.14 (2) of the statutes is renumbered 149.14 (2).
AB100, s. 4850 15Section 4850. 619.14 (3) of the statutes is renumbered 149.14 (3), and 149.14
16(3) (intro.) and (c) 1. and 3., as renumbered, are amended to read:
AB100,1813,317 149.14 (3) Covered expenses. (intro.) Except as restricted by cost containment
18provisions under s. 619.17 149.17 (4) and except as reduced by the board under s.
19619.15 (3) (e)
, covered expenses shall be the usual and customary allowable charges
20paid under the medical assistance program under ss. 49.45 to 49.47 for the services
21provided by persons licensed under ch. 446 and certified under s. 49.45 (2) (a) 11.
22Except as restricted by cost containment provisions under s. 619.17 149.17 (4) and
23except as reduced by the board under s. 619.15 (3) (e)
, covered expenses shall also be
24the usual and customary allowable charges paid under the medical assistance
25program under ss. 49.45 to 49.47
for the following services and articles when if the

1service or article is
prescribed by a physician who is licensed under ch. 448 or in
2another state and who is certified under s. 49.45 (2) (a) 11. and if the service or article
3is provided by a provider certified under s. 49.45 (2) (a) 11.
:
AB100,1813,74 (c) 1. Inpatient treatment in a hospital as defined in s. 632.89 (1) (c) or in a
5medical facility in another state approved by the board,
licensed under s. 50.35 for
6up to 30 days' confinement per calendar year due to alcoholism or drug abuse and up
7to 60 days' confinement per calendar year for nervous and mental disorders.
AB100,1813,108 3. Subject to the limits under subd. 2. and to rules promulgated by the
9commissioner department, services for the chronically mentally ill in community
10support programs operated under s. 51.421.
AB100, s. 4851 11Section 4851. 619.14 (4) of the statutes is renumbered 149.14 (4), and 149.14
12(4) (d) and (m), as renumbered, are amended to read:
AB100,1813,1713 149.14 (4) (d) That part of any charge for services or articles rendered or
14prescribed by a physician, dentist or other health care personnel which exceeds the
15prevailing charge in the locality where the service is provided allowable charge paid
16under the medical assistance program under ss. 49.45 to 49.47
or any charge not
17medically necessary.
AB100,1813,1918 (m) Experimental treatment, as determined by the board or its designee
19department.
AB100, s. 4852 20Section 4852. 619.14 (5) (title) of the statutes is renumbered 149.14 (5) (title).
AB100, s. 4853 21Section 4853. 619.14 (5) (a) of the statutes is renumbered 149.14 (5) (a) and
22amended to read:
AB100,1814,1723 149.14 (5) (a) The plan shall offer a deductible in combination with appropriate
24premiums determined under this subchapter chapter for major medical expense
25coverage required under this section. For coverage offered to those persons eligible

1for medicare, the plan shall offer a deductible equal to the deductible charged by part
2A of title XVIII of the federal social security act, as amended. The deductible
3amounts for all other eligible persons shall be dependent upon household income as
4determined under s. 619.165 149.165. For eligible persons under s. 619.165 (1) (b)
51.
149.165 (2) (a), the deductible shall be $500. For eligible persons under s. 619.165
6(1) (b) 2.
149.165 (2) (b), the deductible shall be $600. For eligible persons under s.
7619.165 (1) (b) 3. 149.165 (2) (c), the deductible shall be $700. For eligible persons
8under s. 619.165 (1) (b) 4. 149.165 (2) (d), the deductible shall be $800. For all other
9eligible persons who are not eligible for medicare, the deductible shall be $1,000.
10With respect to all eligible persons, expenses used to satisfy the deductible during
11the last 90 days of a calendar year shall also be applied to satisfy the deductible for
12the following calendar year. The schedule of premiums shall be promulgated by rule
13by the commissioner department. The commissioner department shall set rates at
1460% of the operating and administrative costs of the plan, except that a rate may not
15exceed 200% of the rate that a standard risk would be charged under an individual
16policy providing substantially the same coverage and deductibles as are provided
17under the plan
.
AB100, s. 4854 18Section 4854. 619.14 (5) (b) of the statutes is renumbered 149.14 (5) (b) and
19amended to read:
AB100,1814,2420 149.14 (5) (b) Except as provided in par. (c), if the covered costs incurred by the
21eligible person exceed the deductible for major medical expense coverage in a
22calendar year, the plan shall pay at least 80% of the allowable charges paid under
23the medical assistance program under ss. 49.45 to 49.47 for
any additional covered
24costs incurred by the person during the calendar year.
AB100, s. 4855
1Section 4855. 619.14 (5) (c) of the statutes is renumbered 149.14 (5) (c) and
2amended to read:
AB100,1815,93 149.14 (5) (c) If the aggregate of the covered costs not paid by the plan under
4par. (b) and the deductible exceeds $500 for an eligible person receiving medicare,
5$2,000 for any other eligible person during a calendar year or $4,000 for all eligible
6persons in a family, the plan shall pay 100% of the allowable charges paid under the
7medical assistance program under ss. 49.45 to 49.47 for
all covered costs incurred by
8the eligible person during the calendar year after the payment ceilings under this
9paragraph are exceeded.
AB100, s. 4856 10Section 4856. 619.14 (5) (d) of the statutes is renumbered 149.14 (5) (d) and
11amended to read:
AB100,1815,1712 149.14 (5) (d) Notwithstanding pars. (a) to (c), the board department may
13establish different deductible amounts, a different coinsurance percentage and
14different covered costs and deductible aggregate amounts from those specified in
15pars. (a) to (c) in accordance with cost containment provisions established by the
16commissioner department under s. 619.17 (4) (a) and for individuals who enroll in
17an alternative plan under s. 619.145
149.17 (4).
AB100, s. 4857 18Section 4857. 619.14 (5) (e) of the statutes is renumbered 149.14 (5) (e) and
19amended to read:
AB100,1815,2520 149.14 (5) (e) Using the procedure under s. 227.24, the commissioner
21department may promulgate rules under par. (a) for the schedule of premiums for the
22period before the effective date of any permanent rules promulgated under par. (a)
23for the schedule of premiums, but not to exceed the period authorized under s. 227.24
24(1) (c) and (2). Notwithstanding s. 227.24 (1) and (3), the commissioner department
25is not required to make a finding of emergency.
AB100, s. 4858
1Section 4858. 619.14 (6) of the statutes is repealed.
AB100, s. 4859 2Section 4859. 619.14 (7) of the statutes is renumbered 149.14 (7), and 149.14
3(7) (b) and (c), as renumbered, are amended to read:
AB100,1816,74 149.14 (7) (b) The board department has a cause of action against an eligible
5participant for the recovery of the amount of benefits paid which are not for covered
6expenses under the plan. Benefits under the plan may be reduced or refused as a
7setoff against any amount recoverable under this paragraph.
AB100,1816,118 (c) The board department is subrogated to the rights of an eligible person to
9recover special damages for illness or injury to the person caused by the act of a 3rd
10person to the extent that benefits are provided under the plan. Section 814.03 (3)
11applies to the department under this paragraph.
AB100, s. 4860 12Section 4860. 619.145 of the statutes is repealed.
AB100, s. 4861 13Section 4861. 619.15 (title) of the statutes is renumbered 149.15 (title).
AB100, s. 4862 14Section 4862. 619.15 (1) of the statutes is renumbered 149.15 (1) and amended
15to read:
AB100,1817,416 149.15 (1) The plan shall operate subject to the supervision and approval of a
17have a board of governors consisting of representatives of 2 participating insurers
18which are nonprofit corporations, 2 other participating insurers, and 3 public
19members, appointed by the commissioner secretary for staggered 3-year terms. In
20addition, the commissioner, or a designated representative from the office of the
21commissioner, and the secretary, or a designated representative from the
22department,
shall be a member members of the board. The public members shall not
23be professionally affiliated with the practice of medicine, a hospital or an insurer.
24At least 2 of the public members shall be individuals reasonably expected to qualify
25for coverage under the plan or the parent or spouse of such an individual. The

1commissioner secretary or the commissioner's secretary's representative shall be the
2chairperson of the board. Board members, except the commissioner or the
3commissioner's representative and the secretary or the secretary's representative,
4shall be compensated at the rate of $50 per diem plus actual and necessary expenses.
AB100, s. 4863 5Section 4863. 619.15 (2) of the statutes is renumbered 149.15 (2) and amended
6to read:
AB100,1817,127 149.15 (2) Annually, the board shall make a report to the members of the plan
8and to the chief clerk of each house of the legislature, for distribution to the

9appropriate standing committees under s. 13.172 (3), and to the members of the plan
10summarizing the activities of the plan in the preceding calendar year. The annual
11report shall define the cost burden imposed by the plan on all policyholders in this
12state.
AB100, s. 4864 13Section 4864. 619.15 (3) (intro.) of the statutes is renumbered 149.15 (3)
14(intro.) and amended to read:
AB100,1817,1515 149.15 (3) (intro.) The board shall do all of the following:
AB100, s. 4865 16Section 4865. 619.15 (3) (a) of the statutes is renumbered 149.15 (3) (a).
AB100, s. 4866 17Section 4866. 619.15 (3) (b) of the statutes is repealed.
AB100, s. 4867 18Section 4867. 619.15 (3) (c) of the statutes is renumbered 149.15 (3) (c).
AB100, s. 4868 19Section 4868. 619.15 (3) (d) of the statutes is renumbered 149.15 (3) (d).
AB100, s. 4869 20Section 4869. 619.15 (3) (e) of the statutes is repealed.
AB100, s. 4870 21Section 4870. 619.15 (4) (intro.) of the statutes is renumbered 149.15 (4)
22(intro.) and amended to read:
AB100,1817,2323 149.15 (4) (intro.) The board may do any of the following:
AB100, s. 4871 24Section 4871. 619.15 (4) (a) of the statutes is renumbered 149.15 (4) (a).
AB100, s. 4872 25Section 4872. 619.15 (4) (b) of the statutes is renumbered 149.15 (4) (b).
AB100, s. 4873
1Section 4873. 619.15 (4) (c) of the statutes is renumbered 149.15 (4) (c) and
2amended to read:
AB100,1818,103 149.15 (4) (c) In addition to assessments imposed under sub. (3) (c), levy
4interim assessments, at the request of the department, to ensure the financial ability
5of the plan to cover claims expense and administrative expenses incurred or
6estimated to be incurred in the operation of the plan prior to the end of the calendar
7year end or other fiscal year end established by the board. Interim assessments shall
8be due and payable within 30 days of receipt by an insurer of an interim assessment
9notice. Interim assessments shall be credited against each insurer's annual
10assessment.
AB100, s. 4874 11Section 4874. 619.15 (4) (d) of the statutes is repealed.
AB100, s. 4875 12Section 4875. 619.15 (4) (e) of the statutes is repealed.
AB100, s. 4876 13Section 4876. 619.15 (5) of the statutes is renumbered 149.15 (5) and amended
14to read:
AB100,1818,1615 149.15 (5) The commissioner department may, by rule, establish additional
16powers and duties of the board.
AB100, s. 4877 17Section 4877. 619.15 (6) of the statutes is renumbered 149.15 (6) and amended
18to read:
AB100,1818,2019 149.15 (6) If any provision of this subchapter chapter conflicts with s. 625.11
20or 625.12, this subchapter chapter prevails.
AB100, s. 4878 21Section 4878. 619.15 (7) of the statutes is renumbered 149.15 (7).
AB100, s. 4879 22Section 4879. 619.16 (title) of the statutes is repealed.
AB100, s. 4880 23Section 4880. 619.16 (1) of the statutes is repealed.
AB100, s. 4881 24Section 4881. 619.16 (2) of the statutes is repealed.
AB100, s. 4882
1Section 4882. 619.16 (3) (a) of the statutes is renumbered 149.16 (3) (a) and
2amended to read:
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