AB922,6,1711
185.983
(1) (intro.) Every such voluntary nonprofit sickness care plan shall be
12exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
13601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93,
14631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853,
15632.855, 632.87 (2m), (3), (4),
and (5),
and (6), 632.89, 632.895 (5) and (9) to (15),
16632.896, and 632.897 (10) and chs. 609, 630, 635, 645
, and 646, but the sponsoring
17association shall:
AB922, s. 12
18Section
12. 301.12 (8) (d) of the statutes is amended to read:
AB922,6,2319
301.12
(8) (d) After due regard to the case and to a spouse and minor children
20who are lawfully dependent on the property for support, compromise or waive any
21portion of any claim of the state or county for which a person specified under sub. (2)
22is liable, but not any claim payable by an insurer under s. 632.89 (2) or
(2m) (4m) or
23by any other 3rd party.
AB922, s. 13
24Section
13. 301.12 (14) (a) of the statutes is amended to read:
AB922,7,11
1301.12
(14) (a) Except as provided in pars. (b) and (c), liability of a person
2specified in sub. (2) or s. 301.03 (18) for care and maintenance of persons under 17
3years of age in residential, nonmedical facilities such as group homes, foster homes,
4treatment foster homes, child caring institutions
, and juvenile correctional
5institutions is determined in accordance with the cost-based fee established under
6s. 301.03 (18). The department shall bill the liable person up to any amount of
7liability not paid by an insurer under s. 632.89 (2) or
(2m) (4m) or by other 3rd-party
8benefits, subject to rules which include formulas governing ability to pay
9promulgated by the department under s. 301.03 (18). Any liability of the resident not
10payable by any other person terminates when the resident reaches age 17, unless the
11liable person has prevented payment by any act or omission.
AB922, s. 14
12Section
14. 609.86 of the statutes is created to read:
AB922,7,14
13609.86 Coverage of alcoholism and other diseases. Defined network
14plans are subject to s. 632.89.
AB922, s. 15
15Section
15. 632.89 (title) of the statutes is amended to read:
AB922,7,17
16632.89 (title)
Required coverage of Coverage of mental disorders,
17alcoholism, and other diseases.
AB922, s. 16
18Section
16. 632.89 (1) (b) of the statutes is repealed and recreated to read:
AB922,7,1919
632.89
(1) (b) "Health benefit plan" has the meaning given in s. 632.745 (11).
AB922, s. 17
20Section
17. 632.89 (1) (em) of the statutes is repealed.
AB922, s. 18
21Section
18. 632.89 (1) (er) of the statutes is created to read:
AB922,7,2322
632.89
(1) (er) "Self-insured health plan" has the meaning given in s. 632.745
23(24).
AB922, s. 19
24Section
19. 632.89 (2) (title) of the statutes is amended to read:
AB922,7,2525
632.89
(2) (title)
Required coverage
for group plans.
AB922, s. 20
1Section
20. 632.89 (2) (a) 1. of the statutes is renumbered 632.89 (2) (a) and
2amended to read:
AB922,8,73
632.89
(2) (a)
Conditions covered. A group
or blanket disability insurance
4policy issued by an insurer health benefit plan and a self-insured health plan shall
5provide coverage of nervous and mental disorders and alcoholism and other drug
6abuse problems if required by
pars. (c) to (dm) and as provided in pars.
(b) (c) to
(e) 7(dm) and subs. (2p) and (3).
AB922, s. 21
8Section
21. 632.89 (2) (a) 2. of the statutes is repealed.
AB922, s. 22
9Section
22. 632.89 (2) (b) of the statutes is repealed.
AB922, s. 23
10Section
23. 632.89 (2) (c) 1. of the statutes is renumbered 632.89 (2) (c) and
11amended to read:
AB922,8,1612
632.89
(2) (c)
Minimum coverage Coverage of inpatient hospital services. If a
13group
or blanket disability insurance policy issued by an insurer health benefit plan
14or a self-insured health plan provides coverage of any inpatient hospital treatment,
15the
policy plan shall provide coverage for inpatient hospital services for the
16treatment of conditions under par. (a)
1. as provided in subd. 2.
AB922, s. 24
17Section
24. 632.89 (2) (c) 2. of the statutes is repealed.
AB922, s. 25
18Section
25. 632.89 (2) (d) 1. of the statutes is renumbered 632.89 (2) (d) and
19amended to read:
AB922,8,2420
632.89
(2) (d)
Minimum coverage Coverage of outpatient services. If a group
or
21blanket disability insurance policy issued by an insurer health benefit plan or a
22self-insured health plan provides coverage of any outpatient treatment, the
policy 23plan shall provide coverage for outpatient services for the treatment of conditions
24under par. (a)
1. as provided in subd. 2.
AB922, s. 26
25Section
26. 632.89 (2) (d) 2. of the statutes is repealed.
AB922, s. 27
1Section
27. 632.89 (2) (dm) 1. of the statutes is renumbered 632.89 (2) (dm)
2and amended to read:
AB922,9,83
632.89
(2) (dm)
Minimum coverage Coverage of transitional treatment
4arrangements. If a group
or blanket disability insurance policy issued by an insurer 5health benefit plan or a self-insured health plan provides coverage of any inpatient
6hospital treatment or any outpatient treatment, the
policy plan shall provide
7coverage for transitional treatment arrangements for the treatment of conditions
8under par. (a)
1. as provided in subd. 2.
AB922, s. 28
9Section
28. 632.89 (2) (dm) 2. of the statutes is repealed.
AB922, s. 29
10Section
29. 632.89 (2) (e) of the statutes is renumbered 632.89 (5) (b) and
11amended to read:
AB922,9,1512
632.89
(5) (b)
Exclusion
Certain health care plans. This
subsection section does
13not apply to a health care plan offered by a limited service health organization, as
14defined in s. 609.01 (3)
, or by a preferred provider plan, as defined in s. 609.01 (4),
15that is not a defined network plan, as defined in s. 609.01 (1b).
AB922, s. 30
16Section
30. 632.89 (2m) of the statutes is renumbered 632.89 (4m).
AB922, s. 31
17Section
31. 632.89 (2p) of the statutes is created to read:
AB922,9,2218
632.89
(2p) Additional required coverage of screenings. If a group health
19benefit plan, individual health benefit plan, or self-insured health plan that
20provides coverage for the treatment of nervous and mental disorders and alcoholism
21and other drug abuse problems would provide coverage of at least one annual
22physical examination, the plan shall provide coverage of all of the following:
AB922,9,2523
(a) For an individual who has coverage under the plan, at least one annual
24screening for nervous and mental disorders and alcoholism and other drug abuse
25problems to determine the individual's need for treatment.
AB922,10,5
1(b) For a female individual who has coverage under the plan, with respect to
2any pregnancy at least one screening during the pregnancy for prepartum
3depression and at least one screening within 6 months after a live birth, stillbirth,
4or miscarriage for postpartum depression to determine the individual's need for
5treatment.
AB922, s. 32
6Section
32. 632.89 (3) of the statutes is created to read:
AB922,10,117
632.89
(3) Equal coverage requirement. (a)
Group plans. A group health
8benefit plan or a self-insured health plan that provides coverage for the treatment
9of nervous and mental disorders and alcoholism and other drug abuse problems shall
10provide the same coverage for that treatment that it provides for the treatment of
11physical conditions.
AB922,10,1512
(b)
Individual plans. If an individual health benefit plan provides coverage for
13the treatment of nervous or mental disorders or alcoholism or other drug abuse
14problems, the individual health benefit plan shall provide the same coverage for that
15treatment that it provides for the treatment of physical conditions.
AB922,10,2016
(c)
All coverage components. The requirements under this subsection apply to
17all coverage-related components, including rates; exclusions and limitations;
18deductibles; copayments; coinsurance; annual and lifetime payment limits;
19out-of-pocket limits; out-of-network charges; day, visit, or appointment limits;
20duration or frequency of coverage; and medical necessity definitions.
AB922, s. 33
21Section
33. 632.89 (3m) of the statutes is repealed.
AB922, s. 34
22Section
34. 632.89 (5) (title) of the statutes is amended to read:
AB922,10,2323
632.89
(5) (title)
Medicare exclusion Exclusions.
AB922, s. 35
24Section
35. 632.89 (5) of the statutes is renumbered 632.89 (5) (a).
AB922, s. 36
25Section
36. 632.89 (5) (a) (title) of the statutes is created to read:
AB922,11,1
1632.89
(5) (a) (title)
Medicare.
AB922, s. 37
2Section
37. 632.89 (5m) of the statutes is created to read:
AB922,11,63
632.89
(5m) Special applicability. Notwithstanding s. 600.01 (1) (b) 3., this
4section applies to any group health benefit plan that would otherwise be exempt
5under s. 600.01 (1) (b) 3. if at least 150 of the certificate holders or insureds are
6residents of this state.
AB922, s. 38
7Section
38. 632.89 (6) of the statutes is repealed.
AB922, s. 39
8Section
39. 632.89 (7) of the statutes is repealed.
AB922,11,1010
(1) This act first applies to all of the following:
AB922,11,1311
(a) Except as provided in paragraphs (b) and (c
), health benefit plans that are
12issued or renewed, and self-insured governmental health plans that are established,
13extended, modified, or renewed, on the effective date of this paragraph.
AB922,11,1614
(b) Health benefit plans covering employees who are affected by a collective
15bargaining agreement containing provisions inconsistent with this act that are
16issued or renewed on the earlier of the following:
AB922,11,17
171. The day on which the collective bargaining agreement expires.
AB922,11,19
182. The day on which the collective bargaining agreement is extended, modified,
19or renewed.
AB922,11,2320
(c) Self-insured governmental health plans covering employees who are
21affected by a collective bargaining agreement containing provisions inconsistent
22with this act that are established, extended, modified, or renewed on the earlier of
23the following:
AB922,11,24
241. The day on which the collective bargaining agreement expires.
AB922,12,2
12. The day on which the collective bargaining agreement is extended, modified,
2or renewed.
AB922,12,54
(1)
This act takes effect on the first day of the 7th month beginning after
5publication.