AB565, s. 4
16Section
4. 60.23 (25) of the statutes is amended to read:
AB565,3,5
160.23
(25) Self-insured health plans. Provide health care benefits to its
2officers and employes on a self-insured basis if the self-insured plan complies with
3ss. 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85,
4632.853, 632.855, 632.87 (4) and (5),
632.893, 632.895 (9) and (11) to (13) and
5632.896.
AB565, s. 5
6Section
5. 66.184 of the statutes is amended to read:
AB565,3,13
766.184 Self-insured health plans. If a city, including a 1st class city, or a
8village provides health care benefits under its home rule power, or if a town provides
9health care benefits, to its officers and employes on a self-insured basis, the
10self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
11632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4) and (5),
12632.893, 632.895 (9) to (13), 632.896, 767.25 (4m) (d), 767.51 (3m) (d) and 767.62 (4)
13(b) 4.
AB565, s. 6
14Section
6. 111.91 (2) (n) of the statutes is amended to read:
AB565,3,1615
111.91
(2) (n) The provision to employes of the health insurance coverage
16required under
s. ss. 632.893 and 632.895 (11) to (13).
AB565, s. 7
17Section
7. 120.13 (2) (g) of the statutes is amended to read:
AB565,3,2118
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
1949.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
20632.85, 632.853, 632.855, 632.87 (4) and (5),
632.893, 632.895 (9) to (13), 632.896,
21767.25 (4m) (d), 767.51 (3m) (d) and 767.62 (4) (b) 4.
AB565, s. 8
22Section
8. 149.14 (3) (q) of the statutes is amended to read:
AB565,3,2423
149.14
(3) (q) Any other health insurance coverage, only to the extent required
24under subch. VI of ch. 632
and not excluded under sub. (4).
AB565, s. 9
25Section
9. 149.14 (4) (n) of the statutes is created to read:
AB565,4,2
1149.14
(4) (n) Any charge for performing a procedure for the diagnosis or
2treatment of infertility.
AB565, s. 10
3Section
10. 185.981 (6m) of the statutes is created to read:
AB565,4,54
185.981
(6m) A sickness care plan that is operated by a cooperative association
5and that provides maternity coverage is subject to s. 632.893.
AB565, s. 11
6Section
11. 185.983 (1) (intro.) of the statutes is amended to read:
AB565,4,127
185.983
(1) (intro.) Every such voluntary nonprofit sickness care plan shall be
8exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
9601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72
10(2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853, 632.855, 632.87
11(2m), (3), (4) and (5),
632.893, 632.895 (5) and (9) to (13), 632.896 and 632.897 (10)
12and chs. 609, 630, 635, 645 and 646, but the sponsoring association shall:
AB565, s. 12
13Section
12. 185.983 (1m) of the statutes is amended to read:
AB565,4,2014
185.983
(1m) In addition to ss. 601.04, 601.31, 632.79 and 632.895 (5), the
15commissioner of insurance may by rule subject a medicare supplement policy as
16defined in s. 600.03 (28r), a medicare replacement policy as defined in s. 600.03 (28p)
17or a long-term care insurance policy as defined in s. 600.03 (28g) sold by a voluntary
18nonprofit sickness care plan to other provisions of chs. 600 to 646, except the
19commissioner may not subject a medicare supplement policy, a medicare
20replacement policy or a long-term care insurance policy to s.
632.893 or 632.895 (8).
AB565, s. 13
21Section
13. 609.74 of the statutes is created to read:
AB565,4,23
22609.74 Infertility coverage. Except as provided in s. 49.45 (20m), managed
23care plans and preferred provider plans are subject to s. 632.893.
AB565, s. 14
24Section
14. 632.893 of the statutes is created to read:
AB565,5,2
1632.893 Required coverage of diagnosis and treatment of infertility. 2(1) Definitions. In this section:
AB565,5,33
(a) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
AB565,5,64
(b) "Gamete intrafallopian tube transfer" means a procedure in which a
5mixture containing both egg and sperm is directly transferred to the fallopian tube,
6where fertilization occurs.
AB565,5,97
(c) "Infertility" means the inability to conceive or produce conception after
8engaging in unprotected sexual intercourse over a period of at least one year, or the
9inability to carry a pregnancy to live birth.
AB565,5,1210
(d) "In vitro fertilization" means a procedure in which an egg and sperm are
11combined in a laboratory dish, where fertilization occurs, and the fertilized and
12dividing egg is transferred to the uterus or cryopreserved for future use.
AB565,5,1513
(e) "Nonexperimental procedure" means a clinical procedure that is recognized
14as safe and effective by the American Society for Reproductive Medicine or the
15American College of Obstetricians and Gynecologists.
AB565,5,1916
(f) "Zygote intrafallopian tube transfer" means a procedure in which an egg and
17sperm are combined in a laboratory dish, where fertilization occurs, and the
18fertilized egg is transferred to the fallopian tube at the pronuclear stage before cell
19division takes place.
AB565,5,24
20(2) Required coverage. Except as provided in subs. (3) and (5) and s. 49.45
21(20m), every disability insurance policy, and every self-insured health plan of the
22state or a county, city, village, town or school district, that provides maternity
23coverage shall provide coverage of any nonexperimental procedure for the diagnosis
24and treatment of infertility.
AB565,6,3
1(3) Conditional requirements for certain procedures. The coverage
2requirement under sub. (2) applies to in vitro fertilization, gamete intrafallopian
3tube transfer or zygote intrafallopian tube transfer only if all of the following apply:
AB565,6,64
(a) The covered individual has tried other less costly and medically appropriate
5nonexperimental procedures for the treatment of infertility and has been unable to
6carry a pregnancy to live birth.
AB565,6,87
(b) The covered individual has undergone fewer than 4 completed oocyte
8retrievals at any time in connection with any infertility procedure or procedures.
AB565,6,119
(c) The covered individual has undergone fewer than 2 completed oocyte
10retrievals at any time in connection with any infertility procedure or procedures after
11a live birth following a completed oocyte retrieval.
AB565,6,1512
(d) The procedure is performed at a medical facility that conforms to the
13standards and guidelines of the American Association of Tissue Banks and of either
14the American Society for Reproductive Medicine or the American College of
15Obstetricians and Gynecologists.
AB565,6,18
16(4) Copayments and deductibles. The coverage required under this section
17may not be subject to copayments or deductibles that are greater than any
18copayments or deductibles that apply to maternity coverage under the policy or plan.
AB565,6,19
19(5) Exclusion. This section does not apply to any of the following:
AB565,6,2120
(a) A medicare replacement policy, a medicare supplement policy or a
21long-term care insurance policy.
AB565,6,2222
(b) A limited service health organization, as defined in s. 609.01 (3).
AB565,6,2423
(c) The mandatory health insurance risk-sharing plan under ch. 149,
24regardless of whether coverage is provided unser s. 149.14 or 149.146.
AB565,7,1
1(1) This act first applies to all of the following:
AB565,7,42
(a) Except as provided in paragraphs (b) and (c
), disability insurance policies
3that are issued or renewed, and self-insured health plans that are established,
4extended, modified or renewed, on the effective date of this paragraph.
AB565,7,75
(b) Disability insurance policies covering employes who are affected by a
6collective bargaining agreement containing provisions inconsistent with this act
7that are issued or renewed on the earlier of the following:
AB565,7,8
81. The day on which the collective bargaining agreement expires.
AB565,7,10
92. The day on which the collective bargaining agreement is extended, modified
10or renewed.
AB565,7,1311
(c) Self-insured health plans covering employes who are affected by a collective
12bargaining agreement containing provisions inconsistent with this act that are
13established, extended, modified or renewed on the earlier of the following:
AB565,7,14
141. The day on which the collective bargaining agreement expires.
AB565,7,16
152. The day on which the collective bargaining agreement is extended, modified
16or renewed.
AB565,7,1918
(1)
This act takes effect on the first day of the 6th month beginning after
19publication.