SB416: Bill Text

For further information see the state and local 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:

SB416, s. 1 Section 1. 632.89 (2) (a) 2. of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB416,2,6 632.89 (2) (a) 2. Except as provided in pars. (b) to (e), coverage of conditions under subd. 1. by a policy or certificate may not be subject to exclusions or limitations, including deductibles, that are not generally applicable to other conditions covered under the policy or certificate.

SB416, s. 2 Section 2. 632.89 (2) (c) of the statutes, as affected by 1997 Wisconsin Act 27, is repealed and recreated to read:

SB416,2,13 632.89 (2) (c) Minimum coverage of inpatient hospital services. 1. If a group or blanket disability insurance policy issued by an insurer provides coverage of any inpatient hospital treatment, the policy shall provide coverage for inpatient hospital services for the treatment of conditions under par. (a) 1. as provided in subds. 2. and 3.

SB416,2,15 2. Except as provided in subd. 3. and par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than the lesser of the following:

SB416,3,1 a. The expenses of the first 30 days as an inpatient in a hospital.

SB416,3,5 b. The first $7,000 minus a copayment of up to 10% for inpatient hospital services or, if the coverage is provided by a health maintenance organization, as defined in s. 609.01 (2), the first $6,300 or the equivalent benefits measured in services rendered.

SB416,3,9 3. Except as provided in par. (b), if a certificate issued under a policy under subd. 1. has high deductibles, high copayments or other high cost-sharing provisions and is linked to a medical savings account, the certificate shall provide coverage in every policy year for not less than the lesser of the following:

SB416,3,10 a. The expenses of 30 days as an inpatient in a hospital.

SB416,3,14 b. Seven thousand dollars minus a copayment of up to 10% for inpatient hospital services or, if the coverage is provided by a health maintenance organization, as defined in s. 609.01 (2), $6,300 or the equivalent benefits measured in services rendered.

SB416, s. 3 Section 3. 632.89 (2) (d) of the statutes, as affected by 1997 Wisconsin Act 27, is repealed and recreated to read:

SB416,3,20 632.89 (2) (d) Minimum coverage of outpatient services. 1. If a group or blanket disability insurance policy issued by an insurer provides coverage of any outpatient treatment, the policy shall provide coverage for outpatient services for the treatment of conditions under par. (a) 1. as provided in subds. 2. and 3.

SB416,3,25 2. Except as provided in subd. 3. and par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than the first $2,000 minus a copayment of up to 10% for outpatient services or, if the coverage is provided by a health maintenance organization, as defined in s. 609.01 (2), the first $1,800 or the equivalent benefits measured in services rendered.

SB416,4,7 3. Except as provided in par. (b), if a certificate issued under a policy under subd. 1. has high deductibles, high copayments or other high cost-sharing provisions and is linked to a medical savings account, the certificate shall provide coverage in every policy year for not less than $2,000 minus a copayment of up to 10% for outpatient services or, if the coverage is provided by a health maintenance organization, as defined in s. 609.01 (2), $1,800 or the equivalent benefits measured in services rendered.

SB416, s. 4 Section 4. 632.89 (2) (dm) of the statutes, as affected by 1997 Wisconsin Act 27, is repealed and recreated to read:

SB416,4,14 632.89 (2) (dm) Minimum coverage of transitional treatment arrangements. 1. If a group or blanket disability insurance policy issued by an insurer provides coverage of any inpatient hospital treatment or any outpatient treatment, the policy shall provide coverage for transitional treatment arrangements for the treatment of conditions under par. (a) 1. as provided in subds. 2. and 3.

SB416,4,19 2. Except as provided in subd. 3. and par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than the first $3,000 minus a copayment of up to 10% for transitional treatment arrangements or, if the coverage is provided by a health maintenance organization, as defined in s. 609.01 (2), the first $2,700 or the equivalent benefits measured in services rendered.

SB416,5,2 3. Except as provided in par. (b), if a certificate issued under a policy under subd. 1. has high deductibles, high copayments or other high cost-sharing provisions and is linked to a medical savings account, the certificate shall provide coverage in every policy year for not less than $3,000 minus a copayment of up to 10% for transitional treatment arrangements or, if the coverage is provided by a health maintenance organization, as defined in s. 609.01 (2), $2,700 or the equivalent benefits measured in services rendered.

SB416, s. 5 Section 5 . Initial applicability.

SB416,5,4 (1) This act first applies to all of the following:

SB416,5,6 (a) Except as provided in paragraph (b), group or blanket disability insurance policies that are issued or renewed on the effective date of this paragraph.

SB416,5,9 (b) Group or blanket disability insurance policies covering employes who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are issued or renewed on the earlier of the following:

SB416,5,10 1The day on which the collective bargaining agreement expires.

SB416,5,12 2The day on which the collective bargaining agreement is extended, modified or renewed.

SB416, s. 6 Section 6. Effective date.

SB416,5,15 (1) This act takes effect on March 1, 1998, or on the day after publication, whichever is later.

SB416,5,16 (End)