SB288, s. 6
5Section
6. 632.855 (2) (intro.) of the statutes is amended to read:
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632.855
(2) Disclosure of limitations. (intro.)
A Subject to s. 632.87 (6), a 7health care plan or a self-insured health plan that limits coverage of experimental
8treatment shall define the limitation and disclose the limits in any agreement, policy
9or certificate of coverage. This disclosure shall include the following information:
SB288, s. 7
10Section
7. 632.855 (3) of the statutes is renumbered 632.855 (3) (am).
SB288, s. 8
11Section
8. 632.855 (3) (bm) of the statutes is created to read:
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632.855
(3) (bm) A health care plan or a self-insured health plan may not deny
13coverage under par. (am) of an experimental treatment, procedure, drug, or device
14for an insured if the denial violates s. 632.87 (6).
SB288, s. 9
15Section
9. 632.87 (1) of the statutes is amended to read:
SB288,3,2016
632.87
(1) No insurer may refuse to provide or pay for benefits for health care
17services provided by a licensed health care professional on the ground that the
18services were not rendered by a physician as defined in s. 990.01 (28), unless the
19contract clearly excludes services by such practitioners, but no contract or plan may
20exclude services in violation of sub. (2), (2m), (3), (4)
or, (5)
, or (6).
SB288, s. 10
21Section
10. 632.87 (6) of the statutes is created to read:
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632.87
(6) No policy, plan, or contract may exclude coverage for any health care
23service, item, or drug for the treatment of cancer that is administered in a clinical
24trial if the policy, plan, or contract would have covered the health care service, item,
1or drug had it not been administered in a clinical trial and if the clinical trial satisfies
2all of the following:
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(a) The clinical trial does one of the following:
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1. Tests how to administer a health care service, item, or drug for the treatment
5of cancer.
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2. Tests responses to a health care service, item, or drug for the treatment of
7cancer.
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3. Compares the effectiveness of health care services, items, or drugs for the
9treatment of cancer with that of other health care services, items, or drugs for the
10treatment of cancer.
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4. Studies new uses of health care services, items, or drugs for the treatment
12of cancer.
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(b) The clinical trial is approved by one of the following:
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1. A National Institute of Health, or one of its cooperative groups or centers,
15under the federal department of health and human services.
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2. The federal food and drug administration.
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3. The federal department of defense.
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4. The federal department of veterans affairs.
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5. An institutional review board of an institution that is approved by the office
20for human research protections of the federal department of health and human
21services.
SB288,4,2323
(1) This act first applies to all of the following:
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1(a) Except as provided in paragraphs (b) and (c), disability insurance policies
2that are issued or renewed, and self-insured health plans that are established,
3extended, modified, or renewed, on the effective date of this paragraph.
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(b) Disability insurance policies covering employees who are affected by a
5collective bargaining agreement containing provisions inconsistent with this act
6that are issued or renewed on the earlier of the following:
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71. The day on which the collective bargaining agreement expires.
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82. The day on which the collective bargaining agreement is extended, modified,
9or renewed.
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(c) Self-insured health plans covering employees who are affected by a
11collective bargaining agreement containing provisions inconsistent with this act
12that are established, extended, modified, or renewed on the earlier of the following:
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131. The day on which the collective bargaining agreement expires.
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142. The day on which the collective bargaining agreement is extended, modified,
15or renewed.
SB288,5,1817
(1)
This act takes effect on the first day of the 7th month beginning after
18publication.
