LRB-1376/1
PJK:pgt&jlg:ijs
1999 - 2000 LEGISLATURE
October 27, 1999 - Introduced by Representatives Wasserman, Black, Bock,
Musser and Reynolds, cosponsored by Senators Grobschmidt, Darling and
Risser. Referred to Committee on Health.
AB565,1,6
1An Act to amend 40.51 (8), 40.51 (8m), 60.23 (25), 66.184, 111.91 (2) (n), 120.13
2(2) (g), 149.14 (3) (q), 185.983 (1) (intro.) and 185.983 (1m); and
to create 49.45
3(20m), 149.14 (4) (n), 185.981 (6m), 609.74 and 632.893 of the statutes;
relating
4to: requiring insurance coverage of the diagnosis and treatment of infertility
5and prohibiting collective bargaining by the state with respect to the
6requirement.
Analysis by the Legislative Reference Bureau
With certain limitations, this bill requires health care plans that provide
maternity coverage to provide coverage of any nonexperimental procedure for the
diagnosis or treatment of infertility. Infertility is defined in the bill as the inability
to conceive or produce conception after at least one year of unprotected intercourse
or the inability to carry a pregnancy to live birth. Nonexperimental procedures are
defined in the bill as those that are recognized as safe and effective by the American
Society for Reproductive Medicine or the American College of Obstetricians and
Gynecologists. Copayments and deductibles for the infertility coverage may not be
greater than any copayments or deductibles for the maternity coverage under the
health care plan.
The bill imposes a limitation on the coverage requirement as it applies to three
specified nonexperimental infertility procedures. These three procedures, which are
defined in the bill, must be covered only if certain conditions are met.
The coverage requirement applies to individual health insurance policies and
group health plans, including health maintenance organizations, preferred provider
plans and cooperative sickness care associations; to plans offered by the state to its
employes; and to self-insured plans of counties, cities, towns, villages and school
districts. Excluded from the requirement are medicare supplement and replacement
policies, long-term care insurance policies, limited service health organization
plans, policies issued under the health insurance risk-sharing plan and health care
provided to medical assistance recipients.
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:
AB565, s. 1
1Section
1. 40.51 (8) of the statutes is amended to read:
AB565,2,52
40.51
(8) Every health care coverage plan offered by the state under sub. (6)
3shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.746 (1) to (8) and (10),
4632.747, 632.748, 632.85, 632.853, 632.855, 632.87 (3) to (5),
632.893, 632.895 (5m)
5and (8) to (13) and 632.896.
AB565, s. 2
6Section
2. 40.51 (8m) of the statutes is amended to read:
AB565,2,97
40.51
(8m) Every health care coverage plan offered by the group insurance
8board under sub. (7) shall comply with ss. 632.746 (1) to (8) and (10), 632.747,
9632.748, 632.85, 632.853, 632.855
, 632.893 and 632.895 (11) to (13).
AB565, s. 3
10Section
3. 49.45 (20m) of the statutes is created to read:
AB565,2,1511
49.45
(20m) Exemption from infertility coverage requirements. 12Notwithstanding s. 632.755 (1g) (c), an insurer with which the department contracts
13under sub. (2) (b) 2. for the provision of health care to medical assistance recipients
14is exempt from the infertility coverage requirements of s. 632.893 with respect to
15those recipients, their spouses and dependents.
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.