SB218, s. 53 3Section 53. 635.11 (2m) of the statutes is created to read:
SB218,47,74 635.11 (2m) Information required to be disclosed under this section shall be
5provided in a manner that is understandable to an employer and shall be sufficient
6to reasonably inform an employer of the employer's rights and obligations under the
7health insurance coverage.
SB218, s. 54 8Section 54. 635.11 (3m) of the statutes is created to read:
SB218,47,109 635.11 (3m) An insurer is not required under this section to disclose
10information that is proprietary or trade secret information under applicable law.
SB218, s. 55 11Section 55. 635.13 (title) of the statutes is amended to read:
SB218,47,13 12635.13 (title) Annual certification of compliance for group health
13benefit plans
.
SB218, s. 56 14Section 56. 635.13 (1) of the statutes is amended to read:
SB218,47,2015 635.13 (1) Records. A small employer An insurer that issues group health
16benefit plans
shall maintain at its principal place of business complete and detailed
17records with respect to those group health benefit plans relating to its rating
18methods and practices and its renewal underwriting methods and practices, and
19shall make the records available to the commissioner and the small employer
20insurance board
upon request.
SB218,47,25 21(2) Certification. A small employer An insurer that issues group health
22benefit plans
shall file with the commissioner on or before May 1 annually an
23actuarial opinion by a member of the American academy of actuaries Academy of
24Actuaries
certifying all of the following with respect to those group health benefit
25plans
:
SB218,48,2
1(a) That the small employer insurer is in compliance with the rate provisions
2of s. 635.05 635.09.
SB218,48,43 (b) That the small employer insurer's rating methods are based on generally
4accepted and sound actuarial principles, policies and procedures.
SB218,48,85 (c) That the opinion is based on the actuary's examination of the small employer
6insurer's records and a review of the small employer insurer's actuarial assumptions
7and statistical methods used in setting rates and procedures used in implementing
8rating plans.
SB218, s. 57 9Section 57. 635.15 of the statutes is renumbered 635.10 and amended to read:
SB218,48,17 10635.10 (title) Temporary suspension of rate regulation for individual
11and group health benefit plans
. The commissioner may suspend the operation
12of all or any part of s. 635.05 635.09 with respect to one or more small employers or
13one or more individuals
for one or more rating periods upon the written request of
14a small employer an insurer and a finding by the commissioner that the suspension
15is necessary in light of the financial condition of the small employer insurer or that
16the suspension would enhance the efficiency and fairness of the small employer
17health insurance market.
SB218, s. 58 18Section 58. 635.16 of the statutes is created to read:
SB218,48,23 19635.16 Contract termination and renewability for group health
20benefit plans.
(1) (a) Except as provided in subs. (2) to (4) and notwithstanding
21s. 631.36 (2) to (4m), an insurer that offers a group health benefit plan shall renew
22such coverage or continue such coverage in force at the option of the employer and,
23if applicable, plan sponsor.
SB218,48,2524 (b) At the time of coverage renewal, the insurer may modify a group health
25benefit plan issued in the large group market.
SB218,49,2
1(2) Notwithstanding s. 631.36 (2) to (4m), an insurer may nonrenew or
2discontinue a group health benefit plan, but only if any of the following applies:
SB218,49,43 (a) The plan sponsor has failed to pay premiums or contributions in accordance
4with the terms of the group health benefit plan or in a timely manner.
SB218,49,75 (b) The plan sponsor has performed an act or engaged in a practice that
6constitutes fraud or made an intentional misrepresentation of material fact under
7the terms of the coverage.
SB218,49,108 (c) The plan sponsor has failed to comply with a material plan provision that
9is permitted under law relating to employer contribution or group participation
10rules.
SB218,49,1311 (d) The insurer is ceasing to offer coverage in the market in which the group
12health benefit plan is included in accordance with sub. (3) and any other applicable
13state law.
SB218,49,1714 (e) In the case of a group health benefit plan that the insurer offers through a
15network plan, there is no longer an enrollee under the plan who resides, lives or
16works in the service area of the insurer or in an area in which the insurer is
17authorized to do business.
SB218,49,2218 (f) In the case of a group health benefit plan that is made available only through
19one or more bona fide associations, the employer ceases to be a member of the
20association on which the coverage is based. Coverage may be terminated if this
21paragraph applies only if the coverage is terminated uniformly without regard to any
22health status-related factor of any covered individual.
SB218,50,2 23(3) (a) Notwithstanding s. 631.36 (2) to (4m), an insurer may discontinue
24offering in this state a particular type of group health benefit plan offered in either

1the large group market or the group market other than the large group market, but
2only if all of the following apply:
SB218,50,63 1. The insurer provides notice of the discontinuance to each employer and, if
4applicable, plan sponsor for whom the insurer provides coverage of this type in this
5state, and to the participants and beneficiaries covered under the coverage, at least
690 days before the date on which the coverage will be discontinued.
SB218,50,137 2. The insurer offers to each employer and, if applicable, plan sponsor for whom
8the insurer provides coverage of this type in this state the option to purchase from
9among all of the other group health benefit plans that the insurer offers in the market
10in which is included the type of group health benefit plan that is being discontinued,
11except that in the case of the large group market, the insurer must offer each
12employer and, if applicable, plan sponsor the option to purchase one other group
13health benefit plan that the insurer offers in the large group market.
SB218,50,1814 3. In exercising the option to discontinue coverage of this particular type and
15in offering the option to purchase coverage under subd. 2., the insurer acts uniformly
16without regard to any health status-related factor of any covered participants or
17beneficiaries or any participants or beneficiaries who may become eligible for
18coverage.
SB218,50,2219 (b) Notwithstanding s. 631.36 (2) to (4m), an insurer may discontinue offering
20in this state all group health benefit plans in the large group market or in the group
21market other than the large group market, or in both such group markets, but only
22if all of the following apply:
SB218,51,223 1. The insurer provides notice of the discontinuance to the commissioner and
24to each employer and, if applicable, plan sponsor for whom the insurer provides
25coverage of this type in this state, and to the participants and beneficiaries covered

1under the coverage, at least 180 days before the date on which the coverage will be
2discontinued.
SB218,51,53 2. All group health benefit plans issued or delivered for issuance in this state
4in the affected market or markets are discontinued and coverage under such group
5health benefit plans is not renewed.
SB218,51,86 3. The insurer does not issue or deliver for issuance in this state any group
7health benefit plan in the affected market or markets before 5 years after the day on
8which the last group health benefit plan is discontinued under subd. 2.
SB218,51,10 9(4) This section does not apply to a group health benefit plan offered by the
10state under s. 40.51 (6) or by the group insurance board under s. 40.51 (7).
SB218, s. 59 11Section 59. 635.165 of the statutes is created to read:
SB218,51,17 12635.165 Guaranteed renewability of individual health benefit plans.
13(1) (a) Except as provided in subs. (2) and (3) and notwithstanding s. 631.36 (2) to
14(4m), an insurer that provides individual health benefit plan coverage shall renew
15such coverage or continue such coverage in force at the option of the insured
16individual and, if applicable, the association through which the individual has
17coverage.
SB218,51,2118 (b) At the time of coverage renewal, the insurer may modify the individual
19health benefit plan coverage policy form as long as the modification is consistent with
20state law and effective on a uniform basis among all individuals with coverage under
21that policy form.
SB218,51,24 22(2) Notwithstanding s. 631.36 (2) to (4m), an insurer may nonrenew or
23discontinue the individual health benefit plan coverage of an individual, but only if
24any of the following applies:
SB218,52,3
1(a) The individual or, if applicable, the association through which the
2individual has coverage has failed to pay premiums or contributions in accordance
3with the terms of the health insurance coverage or in a timely manner.
SB218,52,74 (b) The individual or, if applicable, the association through which the
5individual has coverage has performed an act or engaged in a practice that
6constitutes fraud or made an intentional misrepresentation of material fact under
7the terms of the health insurance coverage.
SB218,52,98 (c) The insurer is ceasing to offer individual health benefit plan coverage in
9accordance with sub. (3) and any other applicable state law.
SB218,52,1410 (d) In the case of individual health benefit plan coverage that the insurer offers
11through a network plan, the individual no longer resides, lives or works in the service
12area or in an area in which the insurer is authorized to do business. Coverage may
13be terminated if this paragraph applies only if the coverage is terminated uniformly
14without regard to any health status-related factor of covered individuals.
SB218,52,1915 (e) In the case of individual health benefit plan coverage that the insurer offers
16only through one or more bona fide associations, the individual ceases to be a member
17of the association on which the coverage is based. Coverage may be terminated if this
18paragraph applies only if the coverage is terminated uniformly without regard to any
19health status-related factor of covered individuals.
SB218,52,2120 (f) The individual is eligible for medicare and the commissioner by rule permits
21coverage to be terminated.
SB218,52,24 22(3) (a) Notwithstanding s. 631.36 (2) to (4m), an insurer may discontinue
23offering in this state a particular type of individual health benefit plan coverage, but
24only if all of the following apply:
SB218,53,4
11. The insurer provides notice of the discontinuance to each individual for
2whom the insurer provides coverage of this type in this state and, if applicable, to the
3association through which the individual has coverage at least 90 days before the
4date on which the coverage will be discontinued.
SB218,53,85 2. The insurer offers to each individual for whom the insurer provides coverage
6of this type in this state and, if applicable, to the association through which the
7individual has coverage the option to purchase any other type of individual health
8insurance coverage that the insurer offers for individuals.
SB218,53,129 3. In electing to discontinue coverage of this particular type and in offering the
10option to purchase coverage under subd. 2., the insurer acts uniformly without
11regard to any health status-related factor of enrolled individuals or individuals who
12may become eligible for the type of coverage described under subd. 2.
SB218,53,1513 (b) Notwithstanding s. 631.36 (2) to (4m), an insurer may discontinue offering
14individual health benefit plan coverage in this state, but only if all of the following
15apply:
SB218,53,2016 1. The insurer provides notice of the discontinuance to the commissioner and
17to each individual for whom the insurer provides individual health benefit plan
18coverage in this state and, if applicable, to the association through which the
19individual has coverage at least 90 days before the date on which the coverage will
20be discontinued.
SB218,53,2221 2. All individual health benefit plan coverage issued or delivered for issuance
22in this state is discontinued and coverage under such coverage is not renewed.
SB218,53,2523 3. The insurer does not issue or deliver for issuance in this state any individual
24health benefit plan coverage before 5 years after the day on which the last individual
25health benefit plan coverage is discontinued under subd. 2.
SB218, s. 60
1Section 60. 635.18 (title) of the statutes is amended to read:
SB218,54,3 2635.18 (title) Fair marketing standards for group and individual health
3benefit plans
.
SB218, s. 61 4Section 61. 635.18 (1) of the statutes is renumbered 635.18 (1) (intro.) and
5amended to read:
SB218,54,156 635.18 (1) (intro.) Every small employer insurer that provides coverage under
7a health benefit plan
shall actively market such health benefit plan coverage,
8including basic health benefit plans, to small employers in the state. If a small
9employer insurer denies coverage to a small employer under a health benefit plan
10that is not a basic health benefit plan on the basis of the health status or claims
11experience of the small employer or its eligible employes or their dependents, the
12small employer insurer shall offer the small employer the opportunity to purchase
13a basic health benefit plan
. In addition to other marketing limitations that the
14commissioner may authorize by rule, an insurer may limit its marketing under this
15subsection to any of the following:
SB218, s. 62 16Section 62. 635.18 (1) (a) and (b) of the statutes are created to read:
SB218,54,1717 635.18 (1) (a) Health benefit plans for employer groups of all sizes.
SB218,54,1818 (b) Health benefit plans for individuals.
SB218, s. 63 19Section 63. 635.18 (2) of the statutes is amended to read:
SB218,54,2120 635.18 (2) (a) Except as provided in par. (b), a small employer an insurer or an
21intermediary may not, directly or indirectly, do any of the following:
SB218,54,2522 1. Discourage a small an employer or an individual from applying, or direct a
23small
an employer or an individual not to apply, for coverage with the small employer
24insurer because of the health status condition, claims experience, industry,
25occupation or geographic location area of the small employer or individual.
SB218,55,3
12. Encourage or direct a small an employer or an individual to seek coverage
2from another insurer because of the health status condition, claims experience,
3industry, occupation or geographic location area of the small employer or individual.
SB218,55,74 (b) Paragraph (a) does not prohibit a small employer an insurer or an
5intermediary from providing a small an employer or an individual with information
6about an established geographic service area or a restricted network provision of the
7small employer insurer.
SB218, s. 64 8Section 64. 635.18 (3) (a) of the statutes is amended to read:
SB218,55,149 635.18 (3) (a) Except as provided in par. (b), a small employer an insurer may
10not, directly or indirectly, enter into any contract, agreement or arrangement with
11an intermediary that provides for or results in compensation to an the intermediary
12for the sale of a health benefit plan that varies according to the health status
13condition, claims experience, industry, occupation or geographic location area of the
14small employer or, eligible employes, insured individual or dependents.
SB218, s. 65 15Section 65. 635.18 (3) (b) of the statutes is amended to read:
SB218,55,1916 635.18 (3) (b) Payment of compensation on the basis of percentage of premium
17is not a violation of par. (a) if the percentage does not vary based on the health status
18condition, claims experience, industry, occupation or geographic area of the small
19employer or, eligible employes, insured individual or dependents.
SB218, s. 66 20Section 66. 635.18 (3) (c) of the statutes is repealed.
SB218, s. 67 21Section 67. 635.18 (4) of the statutes is amended to read:
SB218,56,222 635.18 (4) A small employer An insurer may not terminate, fail to renew or
23limit its contract or agreement of representation with an intermediary for any reason
24related to the health status condition, claims experience, occupation or geographic

1location area of the small employers or, eligible employes , insured individuals or
2their dependents placed by the intermediary with the small employer insurer.
SB218, s. 68 3Section 68. 635.18 (5) of the statutes is amended to read:
SB218,56,74 635.18 (5) A small employer An insurer or an intermediary may not induce or
5otherwise encourage a small an employer to separate or otherwise exclude an
6employe from health coverage or benefits provided in connection with the employe's
7employment.
SB218, s. 69 8Section 69. 635.18 (6) of the statutes is amended to read:
SB218,56,119 635.18 (6) Denial by a small employer an insurer of an application for coverage
10from a small employer under a health benefit plan shall be in writing and shall state
11the reason or reasons for the denial.
SB218, s. 70 12Section 70. 635.18 (7) of the statutes is amended to read:
SB218,56,1713 635.18 (7) A 3rd-party administrator that enters into a contract, agreement
14or other arrangement with a small employer an insurer to provide administrative,
15marketing or other services related to the offering of health benefit plans to small
16employers or individuals in this state is subject to this subchapter chapter as if it
17were a small employer an insurer.
SB218, s. 71 18Section 71. 635.18 (8) of the statutes is amended to read:
SB218,56,2219 635.18 (8) The commissioner may by rule establish additional standards to
20provide for the fair marketing and broad availability of health benefit plans to small
21employers and individuals in this state, including requirements designed to prevent
22evasion of the purposes of this chapter
.
SB218, s. 72 23Section 72. Subchapter II of chapter 635 [precedes 635.20] of the statutes, as
24affected by 1995 Wisconsin Act 289, is repealed.
SB218, s. 73 25Section 73 . Nonstatutory provisions.
SB218,57,6
1(1) Risk adjustment committee. The commissioner of insurance shall appoint
2a committee on risk adjustment under section 15.04 (1) (c) of the statutes, consisting
3of 5 to 8 members, to advise the commissioner on, and to assist the commissioner in
4developing rules for, the group risk adjustment mechanism under section 635.06 (4)
5of the statutes, as created by this act. The commissioner shall appoint at least 5
6representatives of insurers to be members of the committee.
SB218,57,147 (2) Risk adjustment mechanism emergency rule-making authority. Using the
8procedure under section 227.24 of the statutes, the commissioner of insurance may
9promulgate rules under section 635.06 (4) (e) of the statutes, as created by this act,
10for the period before the effective date of the permanent rules promulgated under
11section 635.06 (4) (e) of the statutes, as created by this act, but not to exceed the
12period authorized under section 227.24 (1) (c) and (2) of the statutes.
13Notwithstanding section 227.24 (1) and (3) of the statutes, the commissioner is not
14required to make a finding of emergency.
SB218,57,1515 (3) Evaluation of market reforms.
SB218,57,2016 (a) The commissioner of insurance shall evaluate the effectiveness of the health
17insurance market reforms under chapter 635 of the statutes, as affected by this act,
18and under the federal Health Insurance Portability and Accountability Act of 1996,
19P.L. 104-191, including the effectiveness of the reforms with respect to all of the
20following:
SB218,57,22 211. Accessibility of health insurance coverage, including such accessibility for
22persons who reside in rural areas of the state.
SB218,57,23 232. Availability of health insurance coverage for uninsured persons.
SB218,57,24 243. Affordability of health insurance coverage.
SB218,58,4
1(b) The commissioner shall submit a report of the results of the evaluation and
2any recommendations to the legislature in the manner provided under section
313.172 (2) of the statutes no later than the first day of the 24th month beginning after
4publication.
SB218, s. 74 5Section 74 . Initial applicability.
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