Analysis by the Legislative Reference Bureau
This bill requires the department of employe trust funds (DETF), after
consulting with the departments of commerce and health and family services and the
office of the commissioner of insurance, to design, establish and administer a health
care coverage plan for employers in the private sector. The bill also creates a private
employer health care coverage board (PEHCCB) that is responsible for approving the
health care coverage plan before DETF may implement the plan. The membership
of the PEHCCB consists of the secretary of employe trust funds, the secretary of
health and family services, a member who represents health maintenance
organizations, a member who represents hospitals, a member who represents
insurance agents, a member who represents insurers, two employes who are eligible
to receive health care coverage under the plan and whose employer employs not more
than 50 employes, two members who represent employers that employ not more than
50 employes and who are eligible to offer health care coverage under the plan, a
member who is a physician and two members who represent the public interest.
The key features of the private employer health care coverage plan are as
follows:
1. Any employer in the private sector that employs two or more employes is
eligible to participate in the plan.
2. Any employer that participates in the plan must offer the health care
coverage to all of its permanent employes who have a normal work week of 30 or more
hours and may offer the coverage to any of its other employes.
3. Any employer that participates in the plan must provide health care
coverage under the plan to at least 50% (or a higher percentage specified by the
PEHCCB) of its permanent employes who have a normal work week of 30 or more
hours.
4. Any employer that participates must pay, on behalf of each employe who has
coverage, at least 50% but not more than 100% of the lowest premium that would be
available to the employer for the coverage.
5. Any employer that participates in the plan and that voluntarily terminates
the coverage must wait at least three years before the employer may participate
again.
6. Any insurer that offers the plan must provide coverage under the plan to any
employer that applies for coverage, without regard to the health condition or claims
experience of any individual who would have coverage, as long as the employer pays
the premium and agrees to comply with plan requirements.
7. The health care coverage plan is subject to all provisions of the state
insurance code to the same extent as any other group health benefit plan that is
offered in the private sector.
8. The plan may not be combined with any health care coverage plan offered
by DETF to state employes.
9. The plan may only be sold by licensed insurance agents in this state.
10. DETF is prohibited from selling any health care coverage under the plan
or enrolling any employe under the plan, but DETF may publicize the availability
of the health care coverage plan for employers.
11. DETF is authorized to contract with any person to provide services relating
to the administration of the health care coverage plan.
12. The commission rate for the sale of the plan is set by the PEHCCB.
13. DETF is required to charge employers who participate in the plan a fee to
cover the costs of designing, establishing and administering the plan.
14. The plan is sunset on January 1, 2007.
Under the bill, the PEHCCB is required to report annually to the governor and
the legislature on the operation of the plan. In addition, no later than January 1,
2005, the PEHCCB must submit a report to the governor and the legislature that
offers recommendations as to whether DETF should continue to administer the plan,
whether a different state agency should administer the plan or whether the plan
should be administered by a private nonprofit organization. If the PEHCCB
recommends that a different state agency administer the health care coverage plan
or that the health care coverage plan be administered by a private nonprofit
organization, the PEHCCB must submit proposed legislation relating to the
recommendation at the time the PEHCCB submits its report.
For further information see the state 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:
AB63, s. 1
1Section
1. 13.94 (1) (p) of the statutes is created to read:
AB63,3,52
13.94
(1) (p) No later than January 1, 2005, prepare a program evaluation audit
3of the private employer health care coverage plan established under subch. X of ch.
440. The legislative audit bureau shall file a copy of the audit report under this
5paragraph with the distributees specified in par. (b).
AB63, s. 2
6Section
2. 13.94 (1) (p) of the statutes, as created by 1999 Wisconsin Act ....
7(this act), is repealed.
AB63, s. 3
8Section
3. 15.07 (1) (b) 21. of the statutes is created to read:
AB63,3,99
15.07
(1) (b) 21. Private employer health care coverage board.
AB63, s. 4
10Section
4. 15.07 (1) (b) 21. of the statutes, as created by 1999 Wisconsin Act
11.... (this act), is repealed.
AB63, s. 5
12Section
5. 15.165 (5) of the statutes is created to read:
AB63,3,1713
15.165
(5) Private employer health care coverage board. (a) There is created
14in the department of employe trust funds a private employer health care coverage
15board consisting of the secretary of employe trust funds or his or her designee, the
16secretary of health and family services or his or her designee and the following
17members appointed for 3-year terms:
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11. One member who represents health maintenance organizations.
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2. One member who represents hospitals.
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3. One member who represents insurance agents, as defined in s. 628.02 (4).
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4. Two members who are employes eligible to receive health care coverage
5under subch. X of ch. 40 and whose employer employs not more than 50 employes.
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5. One member who represents insurers.
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6. Two members who are, or who represent, employers that employ not more
8than 50 employes and who are eligible to offer health care coverage under subch. X
9of ch. 40.
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7. One member who is a physician, as defined in s. 448.01 (5).
AB63,4,1111
8. Two members who represent the public interest.
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(b) The secretary of employe trust funds or his or her designee and the secretary
13of health and family services or his or her designee shall be nonvoting members.
AB63, s. 6
14Section
6. 15.165 (5) of the statutes, as created by 1999 Wisconsin Act .... (this
15act), is repealed.
AB63, s. 7
16Section
7. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
17the following amounts for the purposes indicated:
-
See PDF for table ![PDF](https://docs.legis.wisconsin.gov/assets/image/file_acrobat.gif)
AB63, s. 8
18Section
8. 20.515 (2) (title) of the statutes is created to read:
AB63,4,1919
20.515
(2) (title)
Private employer health care coverage plan.
AB63, s. 9
1Section
9. 20.515 (2) (title) of the statutes, as created by 1999 Wisconsin Act
2.... (this act), is repealed.
AB63, s. 10
3Section
10. 20.515 (2) (a) of the statutes is created to read:
AB63,5,74
20.515
(2) (a)
Private employer health care coverage plan; start-up costs. The
5amounts in the schedule for the start-up costs for designing, establishing and
6administering the private employer health care coverage plan under subch. X of ch.
740.
AB63, s. 11
8Section
11. 20.515 (2) (a) of the statutes, as created by 1999 Wisconsin Act ....
9(this act), is repealed.
AB63, s. 12
10Section
12. 20.515 (2) (g) of the statutes is created to read:
AB63,5,1411
20.515
(2) (g)
Private employer health care coverage plan. All moneys received
12under subch. X of ch. 40 from employers who elect to participate in the private
13employer health care coverage plan under subch. X of ch. 40, for the costs of
14designing, establishing and administering the plan.
AB63, s. 13
15Section
13. 20.515 (2) (g) of the statutes, as created by 1999 Wisconsin Act ....
16(this act), is repealed.
AB63, s. 14
17Section
14
. 40.02 (26) (intro.) of the statutes is amended to read:
AB63,5,2518
40.02
(26) (intro.) "Employe" means any person who receives earnings as
19payment for personal services rendered for the benefit of any employer including
20officers of the employer
, except as provided in subch. X. An employe is deemed to
21have separated from the service of an employer at the end of the day on which the
22employe last performed services for the employer, or, if later, the day on which the
23employe-employer relationship is terminated because of the expiration or
24termination of leave without pay, sick leave, vacation or other leave of absence. A
25person shall not be considered an employe if a person:
AB63, s. 15
1Section
15
. 40.02 (26) (intro.) of the statutes, as affected by 1999 Wisconsin
2Act .... (this act), is amended to read:
AB63,6,103
40.02
(26) (intro.) "Employe" means any person who receives earnings as
4payment for personal services rendered for the benefit of any employer including
5officers of the employer
, except as provided in subch. X. An employe is deemed to
6have separated from the service of an employer at the end of the day on which the
7employe last performed services for the employer, or, if later, the day on which the
8employe-employer relationship is terminated because of the expiration or
9termination of leave without pay, sick leave, vacation or other leave of absence. A
10person shall not be considered an employe if a person:
AB63, s. 16
11Section
16
. 40.02 (28) of the statutes is amended to read:
AB63,6,2012
40.02
(28) "Employer" means the state, including each state agency, any
13county, city, village, town, school district, other governmental unit or
14instrumentality of 2 or more units of government now existing or hereafter created
15within the state
and, any federated public library system established under s. 43.19
16whose territory lies within a single county with a population of 500,000 or more
and
17a local exposition district created under subch. II of ch. 229, except as provided under
18ss. 40.51 (7) and 40.61 (3)
, or a local exposition district created under subch. II of ch.
19229 and subch. X. Each employer shall be a separate legal jurisdiction for OASDHI
20purposes.
AB63, s. 17
21Section
17
. 40.02 (28) of the statutes, as affected by 1999 Wisconsin Act ....
22(this act), is amended to read:
AB63,7,523
40.02
(28) "Employer" means the state, including each state agency, any
24county, city, village, town, school district, other governmental unit or
25instrumentality of 2 or more units of government now existing or hereafter created
1within the state, any federated public library system established under s. 43.19
2whose territory lies within a single county with a population of 500,000 or more and
3a local exposition district created under subch. II of ch. 229, except as provided under
4ss. 40.51 (7) and 40.61 (3)
and subch. X. Each employer shall be a separate legal
5jurisdiction for OASDHI purposes.
AB63, s. 18
6Section
18. Subchapter X of chapter 40 [precedes 40.98] of the statutes is
7created to read:
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Subchapter X
10
Private employer health
11
Care coverage
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1240.98 Health care coverage. (1) In this subchapter:
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(ar) "Board" means the private employer health care coverage board.
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(b) "Dependent" means a spouse, an unmarried child under the age of 19 years,
15an unmarried child who is a full-time student under the age of 21 years and who is
16financially dependent upon the parent, or an unmarried child of any age who is
17medically certified as disabled and who is dependent upon the parent.
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(c) "Employe" means any person who receives earnings as payment for personal
19services rendered for the benefit of any employer including officers of the employer.
20An employe is considered to have separated from the service of an employer at the
21end of the day on which the employe last performed services for the employer, or, if
22later, the day on which the employe-employer relationship is terminated because of
23the expiration or termination of leave without pay, sick leave, vacation or other leave
24of absence. A person shall not be considered an employe if any of the following
25applies:
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11. The person is employed under a contract involving the furnishing of more
2than personal services.
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2. The person is customarily engaged in an independently established trade,
4business or profession providing the same type of services to more than one employer
5and the person's services to an employer are not compensated for on a payroll of that
6employer.
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3. The person is a patient or inmate of a hospital, home or institution and
8performs services in the hospital, home or institution.
AB63,8,119
(d) "Employer" means any person doing business or operating an organization
10in this state and employing at least 2 employes. "Employer" does not include an
11employer as defined in s. 40.02 (28).
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(e) "Health care coverage plan" means the health care coverage plan
13established under sub. (2) (a).
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(f) "Insurer" has the meaning given in s. 600.03 (27).
AB63,9,2
15(2) (a) The department shall design, establish and administer an actuarially
16sound health care coverage plan for employers that provides coverage beginning not
17later than January 1, 2002. In designing the health care coverage plan, the
18department shall consult with the departments of commerce and health and family
19services and the office of the commissioner of insurance. In establishing the health
20care coverage plan, the department shall solicit and accept bids and enter into
21contracts with insurers who are to provide health care coverage under the health
22care coverage plan. The health care coverage plan is subject to the provisions of chs.
23600 to 646 that apply to group health benefit plans, as defined in s. 632.745 (9), to
24the same extent as any other group health benefit plan, as defined in s. 632.745 (9).
1Before the health care coverage plan may be implemented, the board must approve
2the plan.
AB63,9,43
(am) The health care coverage plan established under par. (a) may not be
4combined with any health care coverage plan under subch. IV.
AB63,9,85
(b) The health care coverage plan shall require that all insurance rates under
6the plan be published annually in a single publication that is made available to
7employers and employes. The rates shall be listed by county and by any other factor
8that the department considers appropriate.
AB63,9,109
(c) The health care coverage plan shall have an enrollment period that is
10established by the board.
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(d) The department shall charge employers who participate in the health care
12coverage plan a fee to cover the department's cost in designing, establishing and
13administering the health care coverage plan. All moneys received under this
14paragraph shall be credited to the appropriation account under s. 20.515 (2) (g).
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(e) The department may not sell any health care coverage plan to an employer
16or enroll any employe in the health care coverage plan, but the department may
17publicize the availability of the health care coverage plan for employers.
AB63,9,1918
(f) The department may enter into a contract with any person to provide
19services relating to the administration of the health care coverage plan.
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20(3) Any employer who participates in the health care coverage plan shall do all
21of the following:
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(a) Offer health care coverage under the plan to all of its permanent employes
23who have a normal work week of 30 or more hours and may offer health care coverage
24under the plan to any of its other employes.
AB63,10,5
1(b) Provide health care coverage under the plan to at least 50% of its permanent
2employes who have a normal work week of 30 or more hours and who do not otherwise
3receive health care coverage as a dependent under any other plan that is not offered
4by the employer or a percentage of such employes specified by the board, whichever
5percentage is greater.
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(c) Pay for each employe at least 50% but not more than 100% of the lowest
7premium rate that would be available to the employer for that employe's coverage
8under the health care coverage plan.
AB63,10,109
(d) Make premium payments for the health care coverage of its employes in the
10manner specified by the board.
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11(4) Any employer that provides health care coverage for its employes under the
12plan and that voluntarily terminates coverage under the plan is not eligible to
13participate in the plan for at least 3 years from the date that coverage is terminated.
AB63,10,18
14(5) Any insurer that offers the health care coverage plan shall provide coverage
15under the plan to any employer that applies for coverage, and to all of the employer's
16employes who elect coverage under the health care coverage plan, without regard to
17the health condition or claims experience of any individual who would be covered
18under the health care coverage plan if all of the following apply:
AB63,10,2019
(a) The employer agrees to pay the premium required for coverage under the
20health care coverage plan.
AB63,10,2321
(b) The employer agrees to comply with all provisions of the health care
22coverage plan that apply generally to a policyholder or an insured without regard to
23health condition or claims experience.
AB63,10,25
24(6) (a) The health care coverage plan may only be sold by insurance agents
25licensed under ch. 628.
AB63,11,4
1(b) An insurance agent may not sell any health care coverage under the health
2care coverage plan on behalf of an insurer unless he or she is employed by the insurer
3or has a contract with the insurer to sell the health care coverage on behalf of the
4insurer.