LRB-4297/1
RAC&PJK:kmg:ijs
1997 - 1998 LEGISLATURE
December 18, 1997 - Introduced by Representatives Musser, Robson, Gronemus,
Hebl, Goetsch, Plouff, Porter, Meyer, Baumgart, Otte, Hanson, La Fave,
Travis, Hasenohrl, Ryba and Hutchison, cosponsored by Senators Moen,
Roessler, Adelman, Plache and Clausing. Referred to Committee on Small
Business and Economic Development.
AB662,1,9
1An Act to repeal 13.94 (1) (p), 15.07 (1) (b) 21., 15.165 (5), 20.515 (2) (title),
220.515 (2) (a), 20.515 (2) (g) and subchapter X of chapter 40 [precedes 40.98];
3to amend 40.02 (26) (intro.), 40.02 (26) (intro.), 40.02 (28) and 40.02 (28); and
4to create 13.94 (1) (p), 15.07 (1) (b) 21., 15.165 (5), 20.515 (2) (title), 20.515 (2)
5(a), 20.515 (2) (g) and subchapter X of chapter 40 [precedes 40.98] of the
6statutes;
relating to: requiring the department of employe trust funds to
7establish a health care coverage plan for employers in the private sector,
8creating a private employer health care coverage board and making an
9appropriation.
Analysis by the Legislative Reference Bureau
This bill requires the department of employe trust funds (DETF) to design,
establish and administer a health care coverage plan for employers in the private
sector that provides coverage beginning not later than January 1, 2000. The bill also
creates a private employer health care coverage board (PEHCCB) that is responsible
for approving the health care coverage plan before DETF may implement the plan.
The membership of the PEHCCB consists of the secretary of employe trust funds and
the secretary of health and family services, a member who represents health
maintenance organizations, a member who represents hospitals, a member who
represents insurance agents, a member who represents insurers, 2 employes who are
eligible to receive health care coverage under the plan and whose employer employs
not more than 50 employes, 2 members who represent employers that employ not
more than 50 employes and who are eligible to offer health care coverage under the
plan, one member who is a physician and 2 members who represent the public
interest.
The key features of the private employer health care coverage plan are as
follows:
1. Any employer in the private sector that employs 2 or more employes is
eligible to participate in the plan.
2. Any employer that participates in the plan must offer health care coverage
to all of its permanent employes who have a normal work week of 30 or more hours
and may offer coverage under the plan to any of its other employes.
3. Any employer that participates in the plan must provide health care
coverage to at least 50% of its permanent employes who have a normal work week
of 30 or more hours and who do not otherwise receive health care coverage as a
dependent under any other plan that is not offered by the employer. The employer
is also required to pay for each employe insured under the plan at least 50% of the
lowest premium rate that would be available to the employer for the employe's
coverage under the plan.
4. Any employer that provides coverage under the plan and that voluntarily
terminates coverage under the plan is not eligible to participate in the plan for at
least 3 years from the date that coverage is terminated.
5. Any insurer that submits a bid to offer health care coverage for state
employes is required to submit a bid to offer health care coverage under the plan in
those counties in which the insurer bids to provide health care coverage to state
employes.
6. Any insurer that offers the plan must provide coverage under the plan to any
employer that applies for coverage, without regard to the health condition or claims
experience of any individual who would have coverage, as long as the employer pays
the premium and agrees to comply with plan requirements.
7. The health care coverage plan is subject to all provisions of the state
insurance code to the same extent as any other group health benefit plan that is
offered in the private sector.
8. The plan may only be sold by licensed insurance agents in this state, but an
insurance agent may not sell coverage under the plan on behalf of an insurer unless
he or she is employed by the insurer or has a contract with the insurer to sell the
coverage on behalf of the insurer.
9. DETF is prohibited from selling any health care coverage under the plan or
enrolling any employe under the plan, but DETF may publicize the availability of the
health care coverage plan for employers.
10. DETF is authorized to contract with any person to provide services relating
to the administration of the health care coverage plan.
11. The commission rate at which an insurer must compensate insurance
agents for the sale of the plan is set by the PEHCCB.
12. DETF is required to charge employers who participate in the plan a fee to
cover the costs of designing, establishing and administering the plan.
13. The plan is sunset on January 1, 2007.
Under the bill, the PEHCCB is required to report annually to the governor and
the legislature on the operation of the plan. In addition, no later than August 1, 2005,
the PEHCCB must submit a report to the governor and the legislature that offers
recommendations as to whether DETF should continue to administer the plan,
whether a different state agency should administer the plan or whether the plan
should be administered by a private nonprofit organization. If the PEHCCB
recommends that a different state agency administer the health care coverage plan
or that the health care coverage plan be administered by a private nonprofit
organization, the PEHCCB shall submit proposed legislation relating to the
recommendation at the time that the PEHCCB submits its report.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB662, s. 1
1Section
1. 13.94 (1) (p) of the statutes is created to read:
AB662,3,52
13.94
(1) (p) No later than January 1, 2004, prepare a program evaluation audit
3of the private employer health care coverage plan established under subch. X of ch.
440. The legislative audit bureau shall file a copy of the audit report under this
5paragraph with the distributees specified in par. (b).
AB662, s. 2
6Section
2. 13.94 (1) (p) of the statutes, as created by 1997 Wisconsin Act ....
7(this act), is repealed.
AB662, s. 3
8Section
3. 15.07 (1) (b) 21. of the statutes is created to read:
AB662,3,99
15.07
(1) (b) 21. Private employer health care coverage board.
AB662, s. 4
10Section
4. 15.07 (1) (b) 21. of the statutes, as created by 1997 Wisconsin Act
11.... (this act), is repealed.
AB662, s. 5
12Section
5. 15.165 (5) of the statutes is created to read:
AB662,4,5
115.165
(5) Private employer health care coverage board. (a) There is created
2in the department of employe trust funds a private employer health care coverage
3board consisting of the secretary of employe trust funds or his or her designee, the
4secretary of health and family services or his or her designee and the following
5members appointed for 3-year terms:
AB662,4,66
1. One member who represents health maintenance organizations.
AB662,4,77
2. One member who represents hospitals.
AB662,4,88
3. One member who represents insurance agents, as defined in s. 628.02 (4).
AB662,4,109
4. Two members who are employes eligible to receive health care coverage
10under subch. X of ch. 40 and whose employer employs not more than 50 employes.
AB662,4,1111
5. One member who represents insurers.
AB662,4,1412
6. Two members who are, or who represent, employers that employ not more
13than 50 employes and who are eligible to offer health care coverage under subch. X
14of ch. 40.
AB662,4,1515
7. One member who is a physician, as defined in s. 448.01 (5).
AB662,4,1616
8. Two members who represent the public interest.
AB662,4,1817
(b) The secretary of employe trust funds or his or her designee and the secretary
18of health and family services or his or her designee shall be nonvoting members.
AB662, s. 6
19Section
6. 15.165 (5) of the statutes, as created by 1997 Wisconsin Act .... (this
20act), is repealed.
AB662, s. 7
21Section
7. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
22the following amounts for the purposes indicated:
-
See PDF for table ![PDF](https://docs.legis.wisconsin.gov/assets/image/file_acrobat.gif)
AB662, s. 8
1Section
8. 20.515 (2) (title) of the statutes is created to read:
AB662,5,22
20.515
(2) (title)
Private employer health care coverage plan.
AB662, s. 9
3Section
9. 20.515 (2) (title) of the statutes, as created by 1997 Wisconsin Act
4.... (this act), is repealed.
AB662, s. 10
5Section
10. 20.515 (2) (a) of the statutes is created to read:
AB662,5,96
20.515
(2) (a)
Private employer health care coverage plan; start-up costs. The
7amounts in the schedule for the start-up costs for designing, establishing and
8administering the private employer health care coverage plan under subch. X of ch.
940.
AB662, s. 11
10Section
11. 20.515 (2) (a) of the statutes, as created by 1997 Wisconsin Act ....
11(this act), is repealed.
AB662, s. 12
12Section
12. 20.515 (2) (g) of the statutes is created to read:
AB662,5,1613
20.515
(2) (g)
Private employer health care coverage plan. All moneys received
14under subch. X of ch. 40 from employers who elect to participate in the private
15employer health care coverage plan under subch. X of ch. 40, for the costs of
16designing, establishing and administering the plan.
AB662, s. 13
17Section
13. 20.515 (2) (g) of the statutes, as created by 1997 Wisconsin Act ....
18(this act), is repealed.
AB662, s. 14
19Section
14
. 40.02 (26) (intro.) of the statutes is amended to read:
AB662,6,8
140.02
(26) (intro.) "Employe" means any person who receives earnings as
2payment for personal services rendered for the benefit of any employer including
3officers of the employer
, except as provided in subch. X. An employe is deemed to
4have separated from the service of an employer at the end of the day on which the
5employe last performed services for the employer, or, if later, the day on which the
6employe-employer relationship is terminated because of the expiration or
7termination of leave without pay, sick leave, vacation or other leave of absence. A
8person shall not be considered an employe if a person:
AB662, s. 15
9Section
15. 40.02 (26) (intro.) of the statutes, as affected by 1997 Wisconsin
10Act .... (this act), is amended to read: