AB927: Bill Text

AB927,26,15 609.91 (1) (title) Immunity of enrolled participants enrollees and policyholders. (intro.) Except as provided in sub. (1m), an enrolled participant enrollee or policyholder of a health maintenance organization insurer is not liable for health care costs that are incurred on or after January 1, 1990, and that are covered under a policy or certificate issued by the health maintenance organization insurer, if any of the following applies:

AB927, s. 70 Section 70. 609.91 (1) (b) 2. of the statutes is amended to read:

AB927,26,19 609.91 (1) (b) 2. Is physician services provided under a contract with the health maintenance organization insurer or by a selected participating provider of the health maintenance organization insurer.

AB927, s. 71 Section 71. 609.91 (1) (b) 3. of the statutes is amended to read:

AB927,26,23 609.91 (1) (b) 3. Is services, equipment, supplies or drugs that are ancillary or incidental to services described in subd. 2. and are provided by the contracting provider or selected participating provider.

AB927, s. 72 Section 72. 609.91 (1m) of the statutes is amended to read:

AB927,27,5 609.91 (1m) Immunity of medical assistance recipients. An enrolled participant enrollee, policyholder or insured under a policy issued by an insurer to the department of health and family services under s. 49.45 (2) (b) 2. to provide prepaid health care to medical assistance recipients is not liable for health care costs that are covered under the policy.

AB927, s. 73 Section 73. 609.91 (2) of the statutes is amended to read:

AB927,27,12 609.91 (2) Prohibited recovery attempts. No person may bill, charge, collect a deposit from, seek remuneration or compensation from, file or threaten to file with a credit reporting agency or have any recourse against an enrolled participant enrollee, policyholder or insured, or any person acting on their behalf, for health care costs for which the enrolled participant enrollee, policyholder or insured, or person acting on their behalf, is not liable under sub. (1) or (1m).

AB927, s. 74 Section 74. 609.91 (3) of the statutes is amended to read:

AB927,27,18 609.91 (3) Deductibles, copayments and premiums. Subsections (1) to (2) do not affect the liability of an enrolled participant enrollee, policyholder or insured for any deductibles, copayments or premiums owed under the policy or certificate issued by the health maintenance organization insurer or by the insurer described in sub. (1m).

AB927, s. 75 Section 75. 609.91 (4) (intro.) of the statutes is amended to read:

AB927,27,23 609.91 (4) (intro.) Conditions not affecting the immunity. The immunity of an enrolled participant enrollee, policyholder or insured for health care costs, to the extent of the immunity provided under this section and ss. 609.92 to 609.935, is not affected by any of the following:

AB927, s. 76 Section 76. 609.91 (4) (a) of the statutes is amended to read:

AB927,28,6 609.91 (4) (a) An agreement, other than a notice of election or termination of election in accordance with s. 609.92 or 609.925, entered into by the provider, the health maintenance organization insurer, the insurer described in sub. (1m) or any other person, at any time, whether oral or written and whether implied or explicit, including an agreement that purports to hold the enrolled participant enrollee, policyholder or insured liable for health care costs.

AB927, s. 77 Section 77. 609.91 (4) (b) of the statutes is amended to read:

AB927,28,12 609.91 (4) (b) A breach of or default on an agreement by the health maintenance organization insurer, the insurer described in sub. (1m) or any other person to compensate the provider, directly or indirectly, for health care costs, including health care costs for which the enrolled participant enrollee, policyholder or insured is not liable under sub. (1) or (1m).

AB927, s. 78 Section 78. 609.91 (4) (c) of the statutes is amended to read:

AB927,28,22 609.91 (4) (c) The insolvency of the health maintenance organization insurer or any person contracting with the health maintenance organization insurer or provider, or the commencement or the existence of conditions permitting the commencement of insolvency, delinquency or bankruptcy proceedings involving the health maintenance organization insurer or other person, including delinquency proceedings, as defined in s. 645.03 (1) (b), under ch. 645, despite whether the health maintenance organization insurer or other person has agreed to compensate, directly or indirectly, the provider for health care costs for which the enrolled participant enrollee or policyholder is not liable under sub. (1).

AB927, s. 79 Section 79. 609.91 (4) (cm) of the statutes is amended to read:

AB927,29,6 609.91 (4) (cm) The insolvency of the insurer described in sub. (1m) or any person contracting with the insurer or provider, or the commencement or the existence of conditions permitting the commencement of insolvency, delinquency or bankruptcy proceedings involving the insurer or other person, including delinquency proceedings, as defined in s. 645.03 (1) (b), under ch. 645, despite whether the insurer or other person has agreed to compensate, directly or indirectly, the provider for health care costs for which the enrolled participant enrollee, policyholder or insured is not liable under sub. (1m).

AB927, s. 80 Section 80. 609.91 (4) (d) of the statutes is amended to read:

AB927,29,12 609.91 (4) (d) The inability of the provider or other person who is owed compensation for health care costs to obtain compensation from the health maintenance organization insurer, the insurer described in sub. (1m) or any other person for health care costs for which the enrolled participant enrollee, policyholder or insured is not liable under sub. (1) or (1m).

AB927, s. 81 Section 81. 609.92 (5) of the statutes is amended to read:

AB927,29,18 609.92 (5) Provider of physician services. A provider who is not under contract with a health maintenance organization insurer and who is not a selected participating provider of a health maintenance organization insurer is not subject to s. 609.91 (1) (b) 2. with respect to health care costs incurred by an enrolled participant enrollee of that health maintenance organization insurer.

AB927, s. 82 Section 82. 609.94 (1) (b) of the statutes is amended to read:

AB927,29,22 609.94 (1) (b) Each selected participating provider of the health maintenance organization insurer, at the time that the provider becomes a selected participating provider.

AB927, s. 83 Section 83. 645.69 (1) of the statutes is amended to read:

AB927,30,3 645.69 (1) A claim against a health maintenance organization insurer or an insurer described in s. 609.91 (1m) for health care costs, as defined in s. 609.01 (1j), for which an enrolled participant enrollee, as defined in s. 609.01 (1d), policyholder or insured of the health maintenance organization insurer or other insurer is not liable under ss. 609.91 to 609.935.

AB927, s. 84 Section 84. 645.69 (2) of the statutes is amended to read:

AB927,30,7 645.69 (2) A claim for health care costs, as defined in s. 609.01 (1j), for which an enrolled participant enrollee, as defined in s. 609.01 (1d), or policyholder of a health maintenance organization is not liable for any reason.

AB927, s. 85 Section 85. 646.31 (1) (d) 8. of the statutes is amended to read:

AB927,30,11 646.31 (1) (d) 8. Made for health care costs, as defined in s. 609.01 (1j), for which an enrolled participant enrollee, as defined in s. 609.01 (1d), or policyholder of a health maintenance organization insurer is not liable under ss. 609.91 to 609.935.

AB927, s. 86 Section 86. 646.31 (1) (d) 9. of the statutes is amended to read:

AB927,30,15 646.31 (1) (d) 9. Made for health care costs, as defined in s. 609.01 (1j), for which an enrolled participant enrollee, as defined in s. 609.01 (1d), or policyholder of a health maintenance organization is not liable for any reason.

AB927, s. 87 Section 87 . Initial applicability.

AB927,30,20 (1) If a contract that is in effect on January 1, 1999, that is affected by this act and that was not issued or renewed after the effective date of this subsection contains terms or provisions that are inconsistent with the requirements under this act, this act first applies to that contract upon renewal.

AB927,30,25 (2) If a contract that is in effect on January 1, 1999, that is affected by this act and that is affected by a collective bargaining agreement that was not extended, modified or renewed after the effective date of this subsection contains terms or provisions that are inconsistent with this act, this act first applies to that contract on the earlier of the following:

AB927,31,1 (a) The day on which the collective bargaining agreement expires.

AB927,31,3 (b) The day on which the collective bargaining agreement is extended, modified or renewed.

AB927, s. 88 Section 88. Effective dates. This act takes effect on January 1, 1999, or on the day after publication, whichever is later, except as follows:

AB927,31,6 (1) Section 87 of this act takes effect on the day after publication.

AB927,31,7 (End)