9,3035f
Section 3035f. 609.05 (3) of the statutes is amended to read:
609.05 (3) Except as provided in ss. 609.22 (4m), 609.65 and 609.655, a limited service health organization, preferred provider plan or managed care plan may require an enrollee to obtain a referral from the primary provider designated under sub. (2) to another participating provider prior to obtaining health care services from that participating provider.
9,3036c
Section 3036c. 609.10 (title) of the statutes is amended to read:
609.10 (title) Standard plan and point-of-service option plan required.
9,3036d
Section 3036d. 609.10 (1) (a) of the statutes is renumbered 609.10 (1) (am) and amended to read:
609.10 (1) (am) Except as provided in subs. (2) to (4), an employer that offers any of its employes a health maintenance organization or a preferred provider plan that provides comprehensive health care services shall also offer the employes a standard plan, as provided in pars. (b) and (c), that provides at least substantially equivalent coverage of health care expenses and a point-of-service option plan, as provided in pars. (b) and (c).
9,3036e
Section 3036e. 609.10 (1) (ac) of the statutes is created to read:
609.10 (1) (ac) In this section, "point-of-service option plan" means a health maintenance organization or preferred provider plan that permits an enrollee to obtain covered health care services from a provider that is not a participating provider of the health maintenance organization or preferred provider plan under all of the following conditions:
1. The nonparticipating provider holds a license or certificate that authorizes or qualifies the provider to provide the health care services.
2. The health maintenance organization or preferred provider plan is required to pay the nonparticipating provider only the amount that the health maintenance organization or preferred provider plan would pay a participating provider for those health care services.
3. The enrollee is responsible for any additional costs or charges related to the coverage.
9,3036f
Section 3036f. 609.10 (1) (b) of the statutes is amended to read:
609.10 (1) (b) At least once annually, the employer shall provide the employes the opportunity to enroll in the health care plans under par. (a) (am).
9,3036g
Section 3036g. 609.10 (1) (c) of the statutes is amended to read:
609.10 (1) (c) The employer shall provide the employes adequate notice of the opportunity to enroll in the health care plans under par. (a) (am) and shall provide the employes complete and understandable information concerning the differences between among the health maintenance organization or preferred provider plan and
, the standard plan and the point-of-service option plan.
9,3036h
Section 3036h. 609.10 (2) of the statutes is amended to read:
609.10 (2) If, after providing an opportunity to enroll under sub. (1) (b) and the notice and information under sub. (1) (c), fewer than 25 employes indicate that they wish to enroll in
either the standard plan
or the point-of-service option plan under sub. (1) (a)
(am), the employer need not offer
the standard that plan on that occasion.
9,3036i
Section 3036i. 609.10 (3) of the statutes is renumbered 609.10 (3) (intro.) and amended to read:
609.10 (3) (intro.) Subsection (1) does not apply to an employer that employs does any of the following:
(a) Employs fewer than 25 full-time employes.
9,3036j
Section 3036j. 609.10 (3) (b) of the statutes is created to read:
609.10 (3) (b) Offers its employes a health maintenance organization or a preferred provider plan only through an insurer that is a cooperative association organized under ss. 185.981 to 185.985 or only through an insurer that is restricted under s. 609.03 (3).
9,3036k
Section 3036k. 609.10 (6) of the statutes is created to read:
609.10 (6) The commissioner shall promulgate rules necessary for the administration of the requirement to offer point-of-service option plans under sub. (1) (am).
9,3036n
Section 3036n. 609.20 (3) of the statutes is amended to read:
609.20 (3) To define substantially equivalent coverage of health care expenses for purposes of s. 609.10 (1) (a) (am).
9,3036p
Section 3036p. 609.20 (4) of the statutes is amended to read:
609.20 (4) To ensure that employes offered a health maintenance organization or a preferred provider plan that provides comprehensive services under s. 609.10 (1) (a) (am) are given adequate notice of the opportunity to enroll, as well as complete and understandable information under s. 609.10 (1) (c) concerning the differences between among the health maintenance organization or preferred provider plan and, the standard plan and the point-of-service option plan, as defined in s. 609.10 (1) (ac), including differences between among providers available and differences resulting from special limitations or requirements imposed by an institutional provider because of its affiliation with a religious organization.
9,3036r
Section 3036r. 609.22 (4m) of the statutes is created to read:
609.22 (4m) Obstetric and gynecologic services. (a) A managed care plan that provides coverage of obstetric or gynecologic services may not require a female enrollee of the managed care plan to obtain a referral for covered obstetric or gynecologic benefits provided by a participating provider who is a physician licensed under ch. 448 and who specializes in obstetrics and gynecology, regardless of whether the participating provider is the enrollee's primary provider. Notwithstanding sub. (4), the managed care plan may not require the enrollee to obtain a standing referral under the procedure established under sub. (4) (a) for covered obstetric or gynecologic benefits.
(b) A managed care plan under par. (a) may not do any of the following:
1. Penalize or restrict the coverage of a female enrollee on account of her having obtained obstetric or gynecologic services in the manner provided under par. (a).
2. Penalize or restrict the contract of a participating provider on account of his or her having provided obstetric or gynecologic services in the manner provided under par. (a).
(c) A managed care plan under par. (a) shall provide written notice of the requirement under par. (a) in every policy or group certificate issued by the managed care plan
and during each open enrollment period.
610.70 (1) (e) "Medical care institution" means a facility, as defined in s. 647.01 (4), or any hospital, nursing home, community-based residential facility, county home, county infirmary, county hospital, county mental health center, tuberculosis sanatorium, adult family home, assisted living facility, rural medical center, hospice or other place licensed, certified or approved by the department of health and family services under s. 49.70, 49.71, 49.72, 50.02, 50.03, 50.032, 50.033, 50.034, 50.35, 50.52, 50.90, 51.04, 51.08, or 51.09, 58.06, 252.073 or 252.076 or a facility under s. 45.365, 51.05, 51.06 or 252.10 or under ch. 233 or licensed or certified by a county department under s. 50.032 or 50.033.
9,3037c
Section 3037c. 628.095 (1) of the statutes is amended to read:
628.095 (1) Required on applications. An application for a license issued under this subchapter shall contain the applicant's social security number, if the applicant is a natural person unless the applicant does not have a social security number, or the applicant's federal employer identification number, if the applicant is not a natural person.
9,3037d
Section 3037d. 628.095 (2) of the statutes is amended to read:
628.095 (2) Refusal to issue license. The commissioner may not issue a license, including a temporary license, under this subchapter unless the applicant provides his or her social security number, if the applicant is a natural person unless the applicant does not have a social security number, or provides the applicant's federal tax identification number, if the applicant is not a natural person.
9,3037e
Section 3037e. 628.095 (3) of the statutes is amended to read:
628.095 (3) Required when annual fee paid. At the time that the annual fee is paid under s. 601.31 (1) (m), an intermediary who is a natural person shall provide his or her social security number unless the intermediary does not have a social security number, and an intermediary that is not a natural person shall provide its federal employer identification number, if the social security number or federal employer identification number was not provided on the application for the license or previously when the annual fee was paid.
9,3037g
Section 3037g. 628.095 (5) of the statutes is created to read:
628.095 (5) If applicant or intermediary has no social security number. If an applicant who is a natural person does not have a social security number, the applicant shall provide to the commissioner, along with the application for a license and on a form prescribed by the department of workforce development, a statement made or subscribed under oath or affirmation that the applicant does not have a social security number. If an intermediary who is a natural person does not have a social security number, the intermediary shall provide to the commissioner, each time that the annual fee is paid under s. 601.31 (1) (m) and on a form prescribed by the department of workforce development, a statement made or subscribed under oath or affirmation that the applicant does not have a social security number.
9,3037j
Section 3037j. 628.10 (2) (cr) of the statutes is created to read:
628.10 (2) (cr) For providing false information in statement. The commissioner shall revoke the license of an intermediary, including a temporary license under s. 628.09, if the commissioner determines, after a hearing, that the intermediary provided false information in a statement provided under s. 628.095 (5) with the intermediary's application or at the time that the annual fee was paid under s. 601.31 (1) (m).
9,3037k
Section 3037k. 628.10 (2) (d) of the statutes is amended to read:
628.10 (2) (d) For failure to provide social security or number, federal employer identification number or statement. If an intermediary fails to provide a social security number or federal employer identification number as required under s. 628.095 (3) or a statement as required under s. 628.095 (5), the commissioner shall suspend or limit the license of the intermediary, effective the day following the last day on which the annual fee under s. 601.31 (1) (m) may be paid, if the commissioner has given the intermediary reasonable notice of when the fee must be paid to avoid suspension or limitation. If the intermediary provides the social security number or, federal employer identification number or statement within 60 days from the effective date of the suspension, the commissioner shall reinstate the intermediary's license effective as of the date of suspension.
9,3038
Section
3038. 631.20 (1) of the statutes is renumbered 631.20 (1) (a) and amended to read:
631.20 (1) (a) No form subject to s. 631.01 (1), except as exempted under s. 631.01 (2) to (5) or by rule under par. (b), may be used unless it has been filed with and approved by the commissioner and unless the insurer certifies that the form complies with chs. 600 to 655 and rules promulgated under chs. 600 to 655. It is deemed approved if it is not disapproved within 30 days after filing, or within a 30-day extension of that period ordered by the commissioner prior to the expiration of the first 30 days.
9,3039
Section
3039. 631.20 (1) (b) of the statutes is created to read:
631.20 (1) (b) Subject to s. 655.24 (1), the commissioner may by rule exempt certain classes of policy forms from prior filing and approval.
9,3040
Section
3040. 631.20 (3) of the statutes is amended to read:
631.20 (3) Subsequent disapproval. Whenever the commissioner finds, after a hearing, that a form approved or deemed to be approved under sub. (1) (a) would be disapproved under sub. (2) if newly filed, the commissioner may order that on or before a date not less than 30 nor more than 90 days after the order the use of the form shall be discontinued or appropriate changes shall be made.
9,3041
Section
3041. 631.20 (6) (a) of the statutes is amended to read:
631.20 (6) (a) The penalties under s. 601.64 (3) to (5) may not be imposed against an insurer for using a form that does not comply with a statute or rule if the statute or rule was in effect on the date the form was approved or deemed to be approved under sub. (1) (a).
9,3042
Section
3042. 631.20 (6) (b) of the statutes is amended to read:
631.20 (6) (b) Use of a form that does not comply with a statute or rule which takes effect after the date the form was approved or deemed to be approved under sub. (1) (a) is a violation of the statute or rule, and the penalties under s. 601.64 may be imposed against the insurer using the form.
9,3043
Section
3043. 631.36 (1) (a) of the statutes is amended to read:
631.36 (1) (a) General. Except as otherwise provided in this section or in other statutes or by rule under par. (c), this section applies to all contracts of insurance based on forms which are subject to filing and approval under s. 631.20 (1) (a).
9,3043c
Section 3043c. 632.68 (2) (b) (intro.) of the statutes is amended to read:
632.68 (2) (b) (intro.) A person may apply to the commissioner for a viatical settlement provider license on a form prescribed by the commissioner for that purpose. The application form shall require the applicant to provide the applicant's social security number, if the applicant is a natural person unless the applicant does not have a social security number, or the applicant's federal employer identification number, if the applicant is not a natural person. The fee specified in s. 601.31 (1) (mm) shall accompany the application. After any investigation of the applicant that the commissioner determines is sufficient, the commissioner shall issue a viatical settlement provider license to an applicant that satisfies all of the following:
9,3043d
Section 3043d. 632.68 (2) (b) 2. of the statutes is amended to read:
632.68 (2) (b) 2. Provides complete information on the application, including the applicant's social security number, unless the applicant does not have a social security number, or federal employer identification number.
9,3043e
Section 3043e. 632.68 (2) (b) 3m. of the statutes is created to read:
632.68 (2) (b) 3m. If a natural person who does not have a social security number, provides on a form prescribed by the department of workforce development a statement made or subscribed under oath or affirmation that the applicant does not have a social security number.
9,3043f
Section 3043f. 632.68 (2) (e) of the statutes is amended to read:
632.68 (2) (e) Except as provided in sub. (3), a license issued under this subsection shall be renewed annually on the anniversary date upon payment of the fee specified in s. 601.31 (1) (mp) and upon providing the licensee's social security number, unless the licensee does not have a social security number, or federal employer identification number, as applicable, if not previously provided on the application for the license or at a previous renewal of the license. If the licensee is a natural person who does not have a social security number, the license shall be renewed annually on the anniversary date upon payment of the fee specified in s. 601.31 (1) (mp) and upon providing to the commissioner a statement made or subscribed under oath or affirmation, on a form prescribed by the department of workforce development, that the licensee does not have a social security number.
9,3043g
Section 3043g. 632.68 (3) (b) 3. of the statutes is created to read:
632.68 (3) (b) 3. The commissioner shall revoke a viatical settlement provider license if the commissioner determines, after a hearing, that the licensee provided false information in a statement provided under sub. (2) (b) 3m. or (e).
9,3043h
Section 3043h. 632.68 (4) (b) of the statutes is amended to read:
632.68 (4) (b) A person may apply to the commissioner for a viatical settlement broker license on a form prescribed by the commissioner for that purpose. The application form shall require the applicant to provide the applicant's social security number, if the applicant is a natural person unless the applicant does not have a social security number, or the applicant's federal employer identification number, if the applicant is not a natural person. The fee specified in s. 601.31 (1) (mr) shall accompany the application. The commissioner may not issue a license under this subsection unless the applicant provides his or her social security number, unless the applicant does not have a social security number, or its federal employer identification number, whichever is applicable. If the applicant is a natural person who does not have a social security number, the commissioner may not issue a license under this subsection unless the applicant provides, on a form prescribed by the department of workforce development, a statement made or subscribed under oath or affirmation that the applicant does not have a social security number.
9,3043i
Section 3043i. 632.68 (4) (c) of the statutes is amended to read:
632.68 (4) (c) Except as provided in sub. (5), a license issued under this subsection shall be renewed annually on the anniversary date upon payment of the fee specified in s. 601.31 (1) (ms) and upon providing the licensee's social security number, unless the licensee does not have a social security number, or federal employer identification number, as applicable, if not previously provided on the application for the license or at a previous renewal of the license. If the licensee is a natural person who does not have a social security number, the license shall be renewed annually, except as provided in sub. (5), on the anniversary date upon payment of the fee specified in s. 601.31 (1) (ms) and upon providing to the commissioner a statement made or subscribed under oath or affirmation, on a form prescribed by the department of workforce development, that the licensee does not have a social security number.
9,3043j
Section 3043j. 632.68 (5) (b) 3. of the statutes is created to read:
632.68 (5) (b) 3. The commissioner shall revoke a viatical settlement broker license if the commissioner determines, after a hearing, that the licensee provided false information in a statement submitted under sub. (4) (b) or (c).
9,3044
Section
3044. 632.745 (6) (a) 2m. of the statutes is created to read:
632.745 (6) (a) 2m. A family care district under s. 46.2895.
9,3044b
Section 3044b. 632.89 (2) (a) 2. of the statutes is amended to read:
632.89 (2) (a) 2. Except as provided in pars. (b) to (e), coverage of conditions under subd. 1. by a policy may be subject to exclusions or limitations, including deductibles and copayments, that are generally applicable to other conditions covered under the policy.
9,3044c
Section 3044c. 632.89 (2) (b) 1. of the statutes is amended to read:
632.89 (2) (b) 1. Except as provided in subd. 2., if a group or blanket disability insurance policy issued by an insurer provides coverage of inpatient hospital treatment or outpatient treatment or both, the policy shall provide coverage in every policy year as provided in pars. (c) to (dm), as appropriate, except that the total coverage under the policy for a policy year need not exceed $7,000 or, if the coverage is provided by a health maintenance organization, as defined in s. 609.01 (2), the equivalent benefits measured in services rendered.
9,3044e
Section 3044e. 632.89 (2) (c) 2. b. of the statutes is amended to read:
632.89 (2) (c) 2. b. Seven thousand dollars minus
a copayment of up to 10% any applicable cost sharing at the level charged under the policy 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 or, if the policy does not use cost sharing, $6,300 in equivalent benefits measured in services rendered.
9,3044ht
Section 3044ht. 632.89 (2) (d) 2. of the statutes is amended to read:
632.89 (2) (d) 2. Except as provided in par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than $2,000 minus a copayment of up to 10% any applicable cost sharing at the level charged under the policy 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 or, if the policy does not use cost sharing, $1,800 in equivalent benefits measured in services rendered.
9,3044i
Section 3044i. 632.89 (2) (dm) 2. of the statutes is amended to read:
632.89 (2) (dm) 2. Except as provided in par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than $3,000 minus a copayment of up to 10% any applicable cost sharing at the level charged under the policy 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 or, if the policy does not use cost sharing, $2,700 in equivalent benefits measured in services rendered.
9,3044j
Section 3044j. 632.896 (1) (c) 1. of the statutes is amended to read:
