SB698: Bill Text

SB698,13,16 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits not provided under the Wisconsin Health Care Plan under ch. 634 under its home rule power, or if a town provides health care benefits not provided under the Wisconsin Health Care Plan under ch. 634, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.895 (9) to (14), 632.896, and 767.25 (4m) (d).

SB698, s. 27 Section 27. 66.0137 (4m) (b) of the statutes is amended to read:

SB698,13,21 66.0137 (4m) (b) A political subdivision and one or more other political subdivisions, that together have at least 100 employees, may jointly provide health care benefits not provided under the Wisconsin Health Care Plan under ch. 634 to their officers and employees on a self insured self-insured basis.

SB698, s. 28 Section 28. 66.0137 (5) of the statutes is amended to read:

SB698,14,7 66.0137 (5) Hospital, accident, and life insurance. The Subject to s. 634.40, the state or a local governmental unit may provide for the payment of premiums for hospital, surgical and other health and accident insurance and life insurance for employees and officers and their spouses and dependent children. A local governmental unit may also provide for the payment of premiums for hospital and surgical care for its retired employees. In addition, a local governmental unit may, by ordinance or resolution, elect to offer to all of its employees a health care coverage plan through a program offered by the group insurance board under ch. 40. A local governmental unit that elects to participate under s. 40.51 (7) is subject to the applicable sections of ch. 40 instead of this subsection.

SB698, s. 29 Section 29. 109.075 (9) of the statutes is created to read:

SB698,14,11 109.075 (9) This section does not apply to an employer that ceases providing health care benefits to its employees because the employees are covered under the Wisconsin Health Care Plan under ch. 634.

SB698, s. 30 Section 30. 111.70 (1) (dm) of the statutes is amended to read:

SB698,15,2 111.70 (1) (dm) "Economic issue" means salaries, overtime pay, sick leave, payments in lieu of sick leave usage, vacations, clothing allowances in excess of the actual cost of clothing, length-of-service credit, continuing education credit, shift premium pay, longevity pay, extra duty pay, performance bonuses, health insurance coverage of benefits not provided under the Wisconsin Health Care Plan under ch. 634, life insurance, dental insurance, disability insurance, vision insurance, long-term care insurance, worker's compensation and unemployment insurance, social security benefits, vacation pay, holiday pay, lead worker pay, temporary assignment pay, retirement contributions, supplemental retirement benefits, severance or other separation pay, hazardous duty pay, certification or license payment, limitations on layoffs that create a new or increased financial liability on the employer and contracting or subcontracting of work that would otherwise be performed by municipal employees in the collective bargaining unit with which there is a labor dispute.

SB698, s. 31 Section 31. 111.91 (2) (pm) of the statutes is created to read:

SB698,15,5 111.91 (2) (pm) Health care coverage of employees under the Wisconsin Health Care Plan under ch. 634.

SB698, s. 32 Section 32. 120.12 (24) of the statutes is amended to read:

SB698,15,11 120.12 (24) Health care benefits. Prior to the selection for school district professional employees, as defined in s. 111.70 (1) (ne), of any provider of group health care benefits provider for school district professional employees, as defined in s. 111.70 (1) (ne) not provided under the Wisconsin Health Care Plan under ch. 634, solicit sealed bids for the provision of such benefits.

SB698, s. 33 Section 33. 120.13 (2) (b) of the statutes is amended to read:

SB698,15,18 120.13 (2) (b) Provide health care benefits not provided under the Wisconsin Health Care Plan under ch. 634 on a self-insured basis to the employees of the school district if the school district has at least 100 employees. In addition, any 2 or more school districts which together have at least 100 employees may jointly provide health care benefits not provided under the Wisconsin Health Care Plan under ch. 634 on a self-insured basis to employees of the school districts.

SB698, s. 34 Section 34. 120.13 (2) (g) of the statutes, as affected by 2005 Wisconsin Act 194, is amended to read:

SB698,15,24 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.895 (9) to (14), 632.896, and 767.25 (4m) (d).

SB698, s. 35 Section 35. 149.12 (2) (e) of the statutes is repealed and recreated to read:

SB698,16,3 149.12 (2) (e) No person who is covered under the Wisconsin Health Care Plan under s. 634.10 (2) (a) is eligible for coverage under the plan established under this chapter.

SB698, s. 36 Section 36. 227.01 (13) (nm) of the statutes is created to read:

SB698,16,6 227.01 (13) (nm) Relates to determining coverage under s. 634.10 (4) or setting premiums or assessments under s. 634.25.

SB698, s. 37 Section 37. 254.11 (13) of the statutes is amended to read:

SB698,16,15 254.11 (13) "Third-party payer" means a disability insurance policy that is required to provide coverage for a blood lead test under s. 632.895 (10) (a); a health maintenance organization or preferred provider plan under ch. 609; a health care coverage plan offered by the state under s. 40.51 (6); a self-insured health plan offered by a city or village under s. 66.0137 (4), a political subdivision under s. 66.0137 (4m), a town under s. 60.23 (25), a county under s. 59.52 (11) (c), or a school district under s. 120.13 (2) (b); or a sickness care plan operated by a cooperative association under s. 185.981.

SB698, s. 38 Section 38. 609.10 of the statutes is repealed.

SB698, s. 39 Section 39. 609.20 (1m) (c) of the statutes is repealed.

SB698, s. 40 Section 40. 609.20 (1m) (d) of the statutes is repealed.

SB698, s. 41 Section 41. 628.36 (4) (a) (intro.) of the statutes is amended to read:

SB698,16,23 628.36 (4) (a) (intro.) The commissioner shall provide information and assistance to the department of employee trust funds, employers and their employees, providers of health care services, and members of the public, as provided in par. (b), for the following purposes:

SB698, s. 42 Section 42. 628.36 (4) (b) 1. of the statutes is repealed.

SB698, s. 43 Section 43. 628.36 (4) (b) 2. of the statutes is repealed.

SB698, s. 44 Section 44. 628.36 (4) (b) 3. of the statutes is repealed.

SB698, s. 45 Section 45. 632.87 (5) of the statutes is amended to read:

SB698,17,10 632.87 (5) No insurer or self-insured school district, city or village may, under a policy, plan, or contract covering gynecological services or procedures, exclude or refuse to provide coverage for Papanicolaou tests, pelvic examinations , or associated laboratory fees when the test or examination is performed by a licensed nurse practitioner, as defined in s. 632.895 (8) (a) 3., within the scope of the nurse practitioner's professional license, if the policy, plan, or contract includes coverage for Papanicolaou tests, pelvic examinations, or associated laboratory fees when the test or examination is performed by a physician.

SB698, s. 46 Section 46. 632.895 (8) (f) 4. of the statutes is created to read:

SB698,17,13 632.895 (8) (f) 4. A disability insurance policy providing only health care benefits not provided under the Wisconsin Health Care Plan under ch. 634.

SB698, s. 47 Section 47. 632.895 (9) (d) 4. of the statutes is created to read:

SB698,17,16 632.895 (9) (d) 4. A disability insurance policy providing only health care benefits not provided under the Wisconsin Health Care Plan under ch. 634.

SB698, s. 48 Section 48. 632.895 (10) (a) of the statutes is amended to read:

SB698,17,25 632.895 (10) (a) Except as provided in par. (b), every disability insurance policy and every health care benefits plan provided on a self-insured basis by a county board under s. 59.52 (11), by a city or village under s. 66.0137 (4), by a political subdivision under s. 66.0137 (4m), by a town under s. 60.23 (25), or by a school district under s. 120.13 (2) shall provide coverage for blood lead tests for children under 6 years of age, which shall be conducted in accordance with any recommended lead screening methods and intervals contained in any rules promulgated by the department of health and family services under s. 254.158.

SB698, s. 49 Section 49. 632.895 (10) (b) 6. of the statutes is created to read:

SB698,18,3 632.895 (10) (b) 6. A disability insurance policy providing only health care benefits not provided under the Wisconsin Health Care Plan under ch. 634.

SB698, s. 50 Section 50. 632.895 (11) (a) (intro.) of the statutes is amended to read:

SB698,18,10 632.895 (11) (a) (intro.) Except as provided in par. (e), every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, that provides coverage of any diagnostic or surgical procedure involving a bone, joint, muscle, or tissue shall provide coverage for diagnostic procedures and medically necessary surgical or nonsurgical treatment for the correction of temporomandibular disorders if all of the following apply:

SB698, s. 51 Section 51. 632.895 (11) (c) 1. of the statutes is amended to read:

SB698,18,14 632.895 (11) (c) 1. The coverage required under this subsection may be subject to any limitations, exclusions, or cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan.

SB698, s. 52 Section 52. 632.895 (11) (d) of the statutes is amended to read:

SB698,18,19 632.895 (11) (d) Notwithstanding par. (c) 1., an insurer or a self-insured health plan of the state or a county, city, village, town or school district may require that an insured obtain prior authorization for any medically necessary surgical or nonsurgical treatment for the correction of temporomandibular disorders.

SB698, s. 53 Section 53. 632.895 (11) (e) 3. of the statutes is created to read:

SB698,18,22 632.895 (11) (e) 3. A disability insurance policy providing only health care benefits not provided under the Wisconsin Health Care Plan under ch. 634.

SB698, s. 54 Section 54. 632.895 (14) (b) of the statutes is amended to read:

SB698,19,3 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, town, village or school district, that provides coverage for a dependent of the insured shall provide coverage of appropriate and necessary immunizations, from birth to the age of 6 years, for a dependent who is a child of the insured.

SB698, s. 55 Section 55. 632.895 (14) (d) 7. of the statutes is created to read:

SB698,19,6 632.895 (14) (d) 7. A disability insurance policy providing only health care benefits not provided under the Wisconsin Health Care Plan under ch. 634.

SB698, s. 56 Section 56. Chapter 634 of the statutes is created to read:

SB698,19,8 Chapter 634

SB698,19,9 Wisconsin Health Care Plan

SB698,19,10 634.01 Definitions. In this chapter:

SB698,19,11 (1) "Board" means the Wisconsin health care plan board.

SB698,19,12 (2) "Dependent" means any of the following:

SB698,19,13 (a) A spouse.

SB698,19,16 (b) An unmarried child under the age of 19 years, including a stepchild of the current marriage if the stepchild is dependent on the stepparent for support and maintenance.

SB698,19,19 (c) An unmarried child over the age of 18 years and under the age of 21 years, including a stepchild of the current marriage, if the child or stepchild is a full-time student and is financially dependent on the parent or stepparent.

SB698,19,22 (d) An unmarried child of any age, including a stepchild of the current marriage, if the child or stepchild is medically certified as disabled and is dependent on the parent or stepparent.

SB698,19,23 (3) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).

SB698,19,24 (4) "Distributor" has the meaning given in s. 450.01 (9).

SB698,20,4 (5) "Employee" means an individual who is employed in this state by an employer, regardless of whether the individual is a resident. "Employee" does not include a self-employed individual, regardless of whether the self-employed individual has other employees.

SB698,20,9 (6) "Employer" means any person engaged in any activity, enterprise, or business employing one or more individuals within this state. "Employer" includes the state and its political subdivisions and charitable, nonprofit, or tax-exempt organizations or institutions. "Employer" does not include a self-employed individual who has no other employees.

SB698,20,10 (7) "Manufacturer" has the meaning given in s. 450.01 (12).

SB698,20,12 (8) "Medicare" means coverage under part A, part B, or Part D of Title XVIII of the federal Social Security Act, 42 USC 1395 et seq., as amended.

SB698,20,13 (9) "Plan" means the Wisconsin Health Care Plan.

SB698,20,14 (10) "Prescription drug" has the meaning given in s. 450.01 (20).

SB698,20,16 (11) "Resident" means an individual who maintains his or her place of permanent abode in this state.

SB698,20,23 634.10 Plan features. (1) Creation. (a) The board shall develop a health care coverage plan, to be known as the Wisconsin Health Care Plan. Coverage under the plan shall begin on the first day of the 13th month beginning after the effective date of this paragraph .... [revisor inserts date]. The plan shall be considered to be a group or blanket disability insurance policy and is subject to the provisions of chs. 600 to 646 that apply to group or blanket disability insurance policies to the same extent as any other group or blanket disability insurance policy.

SB698,20,25 (2) Covered individuals. (a) Except as provided in par. (c), all of the following shall be covered under the plan:

SB698,21,1 1. An employee.

SB698,21,3 2. An individual who is not employed but who, within the preceding 2 months, was employed in this state by an employer.

SB698,21,5 3. A dependent of an individual specified in subd. 1. or 2., regardless of the dependent's residency.

SB698,21,9 (b) Subject to par. (c), any resident not specified in par. (a) who is under 65 years of age may purchase coverage under the plan, for himself or herself and his or her dependents who are under 65 years of age, at a cost determined by the board under s. 634.25 (1) (a) 2.

SB698,21,11 (c) An individual who is eligible for Medicare is not eligible for coverage under the plan.

SB698,21,14 (3) Care coordinator. Each individual covered under the plan shall select a primary care physician, as defined in s. 609.01 (4m), to coordinate the individual's health care.

SB698,21,22 (4) Benefits and exclusions. (a) Except as provided in par. (b), the plan shall cover all reasonable medical services and prescription drugs necessary to maintain health, enable diagnosis, or provide treatment or rehabilitation for an injury, condition, disability, or disease, including mental health services and alcohol or other drug abuse treatment to the same extent as the plan covers treatment for physical conditions. The plan shall cover wellness programs and chronic disease management, and shall include quality control standards generally accepted in the medical field.

SB698,21,25 (b) The plan shall not cover dental or vision care, long-term care, or reconstructive or cosmetic surgery, unless the care or surgery is determined to be medically necessary under criteria promulgated as rules by the board.

SB698,22,5 (c) Covered expenses under the plan shall not include any charge for care for injury or disease for which benefits are payable without regard to fault under coverage statutorily required to be contained in any motor vehicle or other liability insurance policy or equivalent self-insurance, or for which benefits are payable under a worker's compensation or similar law.

SB698,22,9 634.15 Prescription drug purchasing arrangement. (1) Agreements for discounts. The board shall negotiate, or contract with a 3rd party to negotiate, with prescription drug manufacturers and distributors to reach agreements for discounts in the prices of prescription drugs for individuals covered under the plan.

SB698,22,14 (2) Joining with other states. The board may join the prescription drug purchasing arrangement under the plan with similar arrangements or programs in other states to form a multistate purchasing group to negotiate, or contract with a 3rd party to negotiate, with prescription drug manufacturers and distributors for reduced prescription drug prices.

SB698,22,19 (3) Application to other health-related programs. The board may seek to extend the application of the agreements for discounted prescription drug prices negotiated under sub. (1) or (2) to other health care programs under which residents are covered, such as Medical Assistance, the Badger Care health care program, and Worker's Compensation.

SB698,22,22 634.25 Financing. (1) Cost-sharing requirements. (a) 1. Subject to pars. (b) to (e), the board shall determine the deductibles, copayments, coinsurance, and any other cost sharing that individuals with coverage under the plan must pay.

SB698,23,2 2. The board shall determine the premium amounts that must be paid by individuals who purchase coverage under the plan under s. 634.10 (2) (b). The premium amounts shall reflect the actual cost of coverage for those individuals. Any individual who purchases coverage under s. 634.10 (2) (b) and who fails to pay a premium when due loses coverage.

SB698,23,4 (b) Except as provided in par. (d), during the first year of the plan's operation all of the following apply: