LRBa1218/1
PJK:bjk:ph
2009 - 2010 LEGISLATURE
ASSEMBLY AMENDMENT 1,
TO 2009 ASSEMBLY BILL 512
December 15, 2009 - Offered by Representative Pasch.
AB512-AA1,1,11
11"
Section 31m. 632.89 (3c) of the statutes is created to read:
AB512-AA1,2,8
1632.89
(3c) Exemption for cost increase. (a) Notwithstanding sub. (3), a
2group health benefit plan or a self-insured health plan that provides coverage of the
3treatment of nervous and mental disorders and alcoholism and other drug abuse
4problems may elect to be exempt from the requirements under sub. (3) during the
5plan year following any plan year in which, as a result of the requirements under sub.
6(3), there is an increase under the plan in the total cost of coverage for the treatment
7of physical conditions and nervous and mental disorders and alcoholism and other
8drug abuse problems by a percentage that exceeds either of the following:
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1. Two percent in the first plan year in which the requirements apply.
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2. One percent in any plan year after the first plan year in which the
11requirements apply.
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(b) A cost increase specified under par. (a) may not be determined until the
13group health benefit plan or self-insured health plan has complied with the
14requirements under sub. (3) for at least the first 6 months of the plan year for which
15the increase is to be determined. The cost increase shall be determined, and certified,
16by a qualified actuary, as defined in s. 623.06 (1c). A copy of the actuary's
17determination, and all underlying documentation that the actuary relied on in
18making the determination, shall be filed with the commissioner and shall be
19available for public inspection.
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(c) A group health benefit plan or a self-insured health plan that qualifies for
21an exemption under par. (a) and elects to be exempt from the requirements under
22sub. (3) during a plan year shall promptly notify the commissioner and all enrollees
23under the plan. The commissioner shall promulgate rules specifying the information
24that must be provided in the notice and the manner in which the notice must be
25given.
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1(d) Regardless of a cost increase as specified in par. (a), a group health benefit
2plan or self-insured health plan may elect to continue to be subject to the
3requirements under sub. (3). If a group health benefit plan or a self-insured health
4plan elects to be exempt from the requirements under sub. (3), during the plan year
5in which it is exempt the group health benefit plan or self-insured health plan shall
6comply with the coverage requirements under s. 632.89 (2) (a) to (dm), 2007 stats.
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632.89
(3f) Exemption for small employers. (a) Notwithstanding sub. (3), an
9employer that provides health care coverage for its employees through a group
10health benefit plan may elect to be exempt from the requirements under sub. (3)
11during a plan year if, on the first day of the plan year, the employer will have fewer
12than 10 eligible employees, as defined in s. 632.745 (5).
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(b) An employer that qualifies for the exemption under par. (a) and elects to be
14exempt from the requirements under sub. (3) during a plan year shall promptly
15notify the commissioner and all enrollees under the employer's group health benefit
16plan. During the plan year in which the employer is exempt from the requirements
17under sub. (3), the group health benefit plan shall comply with the coverage
18requirements under s. 632.89 (2) (a) to (dm), 2007 stats.
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(c) The commissioner shall promulgate rules specifying the information that
20must be provided in the notice under par. (b) and the manner in which the notice must
21be given.".
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23"
Section 36m. 632.89 (5) (c) of the statutes is created to read:
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1632.89
(5) (c)
Coverage of autism treatment. This section does not apply to
2coverage of treatment for autism spectrum disorder, as defined in s. 632.895 (12m)
3(a) 1., to which s. 632.895 (12m) applies.".
