LRB-2596/1
PJK:jlg:jf
1999 - 2000 LEGISLATURE
April 28, 1999 - Introduced by Senators Grobschmidt, Clausing, Moen,
Rosenzweig, Burke, Darling, Wirch, Robson, Plache and Risser,
cosponsored by Representatives
Huebsch, Carpenter, Sinicki, Ryba, Bock,
Staskunas, Musser, Gronemus, Hahn, Boyle, Black, Young, Pocan, Miller,
Plale and Wasserman. Referred to Committee on Insurance, Tourism,
Transportation and Corrections.
SB136,1,4
1An Act to amend 40.51 (8), 40.51 (8m), 60.23 (25), 66.184, 111.91 (2) (n), 120.13
2(2) (g), 185.981 (4t) and 185.983 (1) (intro.); and
to create 609.88 and 632.895
3(14) of the statutes;
relating to: requiring insurance coverage of certain
4immunizations for children.
Analysis by the Legislative Reference Bureau
This bill requires every health insurance policy (called "disability insurance
policy" in the statutes), including managed care plans, health care plans offered by
the state, and every self-insured health plan of the state or a county, city, town,
village or school district, to provide coverage of appropriate and necessary
immunizations, specified in the bill, from birth to age two, for a dependent child of
the insured if the policy or plan covers a dependent of the insured. (Under current
law, health insurance policies are required to cover a newly born child of the insured,
even if the policy did not provide coverage for dependents at the time of the birth.)
Generally, coverage of the specified immunizations may not be subject to any
deductibles, coinsurance or copayments under the policy or plan. Specifically
excluded from this coverage requirement are health insurance policies that cover
only hospital and surgical charges or only certain specified diseases, health care
plans offered by limited service health organizations or by preferred provider plans
that are not managed care plans, medicare replacement or supplement policies and
long-term care insurance policies.
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:
SB136, s. 1
1Section
1. 40.51 (8) of the statutes is amended to read:
SB136,2,52
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), 632.895 (5m) and (8) to
5(13) (14) and 632.896.
SB136, s. 2
6Section
2. 40.51 (8m) of the statutes is amended to read:
SB136,2,97
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 and 632.895 (11) to
(13) (14).
SB136, s. 3
10Section
3. 60.23 (25) of the statutes is amended to read:
SB136,2,1411
60.23
(25) Self-insured health plans. Provide health care benefits to its
12officers and employes on a self-insured basis if the self-insured plan complies with
13ss. 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85,
14632.853, 632.855, 632.87 (4) and (5), 632.895 (9) and (11) to
(13) (14) and 632.896.
SB136, s. 4
15Section
4. 66.184 of the statutes is amended to read:
SB136,3,2
1666.184 Self-insured health plans. If a city, including a 1st class city, or a
17village provides health care benefits under its home rule power, or if a town provides
18health care benefits, to its officers and employes on a self-insured basis, the
19self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
20632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4) and (5),
1632.895 (9) to
(13) (14), 632.896, 767.25 (4m) (d), 767.51 (3m) (d) and 767.62 (4) (b)
24.
SB136, s. 5
3Section
5. 111.91 (2) (n) of the statutes is amended to read:
SB136,3,54
111.91
(2) (n) The provision to employes of the health insurance coverage
5required under s. 632.895 (11) to
(13) (14).
SB136, s. 6
6Section
6. 120.13 (2) (g) of the statutes is amended to read:
SB136,3,107
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
849.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
9632.85, 632.853, 632.855, 632.87 (4) and (5), 632.895 (9) to
(13) (14), 632.896, 767.25
10(4m) (d), 767.51 (3m) (d) and 767.62 (4) (b) 4.
SB136, s. 7
11Section
7. 185.981 (4t) of the statutes is amended to read:
SB136,3,1512
185.981
(4t) A sickness care plan operated by a cooperative association is
13subject to ss. 252.14, 631.89, 632.72 (2), 632.745 to 632.749, 632.85, 632.853, 632.855,
14632.87 (2m), (3), (4) and (5), 632.895 (10) to
(13)
(14) and 632.897 (10) and chs. 149
15and 155.
SB136, s. 8
16Section
8. 185.983 (1) (intro.) of the statutes is amended to read:
SB136,3,2217
185.983
(1) (intro.) Every such voluntary nonprofit sickness care plan shall be
18exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
19601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72
20(2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853, 632.855, 632.87
21(2m), (3), (4) and (5), 632.895 (5) and (9) to
(13)
(14), 632.896 and 632.897 (10) and
22chs. 609, 630, 635, 645 and 646, but the sponsoring association shall:
SB136, s. 9
23Section
9. 609.88 of the statutes is created to read:
SB136,3,25
24609.88 Coverage of immunizations. Managed care plans are subject to s.
25632.895 (14).
SB136, s. 10
1Section
10. 632.895 (14) of the statutes is created to read:
SB136,4,22
632.895
(14) Coverage of immunizations. (a) In this subsection:
SB136,4,53
1. "Appropriate and necessary immunizations" means the administration of
4vaccine that meets the standards approved by the U.S. public health service for such
5biological products against at least all of the following:
SB136,4,66
a. Diphtheria.
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h. Hemophilus influenza B.
SB136,4,1414
i. Hepatitis B.
SB136,4,1815
2. "Dependent" means a spouse, an unmarried child under the age of 19 years,
16an unmarried child who is a full-time student under the age of 21 years and who is
17financially dependent upon the parent, or an unmarried child of any age who is
18medically certified as disabled and who is dependent upon the parent.
SB136,4,2319
(b) Except as provided in par. (d), every disability insurance policy, and every
20self-insured health plan of the state or a county, city, town, village or school district,
21that provides coverage for a dependent of the insured shall provide coverage of
22appropriate and necessary immunizations, from birth to the age of 2 years, for a
23dependent who is a child of the insured.
SB136,5,324
(c) The coverage required under par. (b) may not be subject to any deductibles,
25copayments or coinsurance under the policy or plan. This paragraph applies to a
1managed care plan, as defined in s. 609.01 (3c), only with respect to appropriate and
2necessary immunizations provided by providers participating, as defined in s. 609.01
3(3m), in the plan.
SB136,5,44
(d) This subsection does not apply to any of the following:
SB136,5,55
1. A disability insurance policy that covers only certain specified diseases.
SB136,5,66
2. A disability insurance policy that covers only hospital and surgical charges.
SB136,5,97
3. A health care plan offered by a limited service health organization, as defined
8in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not
9a managed care plan, as defined in s. 609.01 (3c).
SB136,5,1010
4. A long-term care insurance policy, as defined in s. 600.03 (28g).
SB136,5,1111
5. A medicare replacement policy, as defined in s. 600.03 (28p).
SB136,5,1212
6. A medicare supplement policy, as defined in s. 600.03 (28r).
SB136,5,1414
(1) This act first applies to first applies to all of the following: