SB362-SSA1, s. 20
13Section
20. 632.89 (2) (a) 1. of the statutes is renumbered 632.89 (2) (a) and
14amended to read:
SB362-SSA1,8,1915
632.89
(2) (a)
Conditions covered. A group
or blanket disability insurance
16policy issued by an insurer health benefit plan and a self-insured health plan shall
17provide coverage of nervous and mental disorders and alcoholism and other drug
18abuse problems if required by
pars. (c) to (dm) and as provided in pars.
(b) (c) to
(e) 19(dm) and subs. (3) to (3f).
SB362-SSA1, s. 23
22Section
23. 632.89 (2) (c) 1. of the statutes is renumbered 632.89 (2) (c) and
23amended to read:
SB362-SSA1,9,324
632.89
(2) (c)
Minimum coverage Coverage of inpatient hospital services. If a
25group
or blanket disability insurance policy issued by an insurer health benefit plan
1or a self-insured health plan provides coverage of any inpatient hospital treatment,
2the
policy plan shall provide coverage for inpatient hospital services for the
3treatment of conditions under par. (a)
1. as provided in subd. 2.
SB362-SSA1, s. 25
5Section
25. 632.89 (2) (d) 1. of the statutes is renumbered 632.89 (2) (d) and
6amended to read:
SB362-SSA1,9,117
632.89
(2) (d)
Minimum coverage Coverage of outpatient services. If a group
or
8blanket disability insurance policy issued by an insurer health benefit plan or a
9self-insured health plan provides coverage of any outpatient treatment, the
policy 10plan shall provide coverage for outpatient services for the treatment of conditions
11under par. (a)
1. as provided in subd. 2.
SB362-SSA1, s. 27
13Section
27. 632.89 (2) (dm) 1. of the statutes is renumbered 632.89 (2) (dm)
14and amended to read:
SB362-SSA1,9,2015
632.89
(2) (dm)
Minimum coverage Coverage of transitional treatment
16arrangements. If a group
or blanket disability insurance policy issued by an insurer 17health benefit plan or a self-insured health plan provides coverage of any inpatient
18hospital treatment or any outpatient treatment, the
policy plan shall provide
19coverage for transitional treatment arrangements for the treatment of conditions
20under par. (a)
1. as provided in subd. 2.
SB362-SSA1, s. 29
22Section
29. 632.89 (2) (e) of the statutes is renumbered 632.89 (5) (b) and
23amended to read:
SB362-SSA1,9,2624
632.89
(5) (b)
Exclusion
Certain health care plans. This
subsection section does
25not apply to a health care plan offered by a limited service health organization, as
1defined in s. 609.01 (3)
, or by a preferred provider plan, as defined in s. 609.01 (4),
2that is not a defined network plan, as defined in s. 609.01 (1b).
SB362-SSA1, s. 30
3Section
30. 632.89 (2m) of the statutes is renumbered 632.89 (4m).
SB362-SSA1,10,195
632.89
(3) Limitations. For a group health benefit plan and a self-insured
6health plan that provide coverage of the treatment of nervous and mental disorders
7and alcoholism and other drug abuse problems, and for an individual health benefit
8plan that provides coverage of the treatment of nervous and mental disorders or
9alcoholism and other drug abuse problems, the exclusions and limitations;
10deductibles; copayments; coinsurance; annual and lifetime payment limitations;
11out-of-pocket limits; out-of-network charges; day, visit, or appointment limits;
12limitations regarding referrals to nonphysician providers and treatment programs;
13and duration or frequency of coverage limits under the plan may be no more
14restrictive for coverage of the treatment of nervous and mental disorders or
15alcoholism and other drug abuse problems than the most common or frequent type
16of treatment limitations applied to substantially all other coverage under the plan.
17The plan shall include in any overall deductible amount or annual or lifetime limit
18or out-of-pocket limit for the plan, expenses incurred for the treatment of nervous
19and mental disorders or alcoholism and other drug abuse problems.
SB362-SSA1,11,521
632.89
(3c) Exemption for cost increase. (a) Notwithstanding sub. (3), an
22employer that provides health care coverage for its employees through a group
23health benefit plan or a self-insured health plan that provides coverage of the
24treatment of nervous and mental disorders and alcoholism and other drug abuse
25problems may elect for the employer's plan to be exempt from the requirements
1under sub. (3) during the plan year following any plan year in which, as a result of
2the requirements under sub. (3), there is an increase under the plan in the employer's
3total cost of coverage for the treatment of physical conditions and nervous and
4mental disorders and alcoholism and other drug abuse problems by a percentage that
5exceeds either of the following:
SB362-SSA1,11,66
1. Two percent in the first plan year in which the requirements apply.
SB362-SSA1,11,87
2. One percent in any plan year after the first plan year in which the
8requirements apply.
SB362-SSA1,11,179
(b) A cost increase specified under par. (a) may not be determined until the
10employer's group health benefit plan or self-insured health plan has complied with
11the requirements under sub. (3) for at least the first 6 months of the plan year for
12which the increase is to be determined. The cost increase shall be determined, and
13certified, by a qualified actuary, as defined in s. 623.06 (1c). A copy of the actuary's
14determination, and all underlying documentation that the actuary relied on in
15making the determination, shall be filed with and, in accordance with rules
16promulgated by the commissioner, retained by the insurer issuing the group health
17benefit plan or by the self-insured health plan.
SB362-SSA1,11,2118
(c) A group health benefit plan or a self-insured health plan that qualifies for
19an exemption under par. (a) and for which the employer providing coverage under
20the plan has elected for the plan to be exempt from the requirements under sub. (3)
21during a plan year shall promptly notify all enrollees under the plan.
SB362-SSA1,12,222
(d) Regardless of a cost increase as specified in par. (a), an employer may elect
23for the employer's plan to continue to be subject to the requirements under sub. (3).
24If an employer elects for the employer's plan to be exempt from the requirements
25under sub. (3), during the plan year in which it is exempt the group health benefit
1plan or self-insured health plan shall comply with the coverage requirements under
2s. 632.89 (2) (a) to (dm), 2007 stats.
SB362-SSA1,12,104
632.89
(3f) Exemption for small employers. (a) Notwithstanding sub. (3), an
5employer that provides health care coverage for its employees through a group
6health benefit plan that provides coverage of the treatment of nervous and mental
7disorders and alcoholism and other drug abuse problems may elect for the employer's
8plan to be exempt from the requirements under sub. (3) during a plan year if, on the
9first day of the plan year, the employer will have fewer than 10 eligible employees,
10as defined in s. 632.745 (5).
SB362-SSA1,12,1711
(b) A group health benefit plan that qualifies for an exemption under par. (a)
12and for which the employer providing coverage under the plan has elected for the
13plan to be exempt from the requirements under sub. (3) during a plan year shall
14promptly notify all enrollees under the employer's plan. During the plan year in
15which it is exempt from the requirements under sub. (3), the group health benefit
16plan shall comply with the coverage requirements under s. 632.89 (2) (a) to (dm),
172007 stats.
SB362-SSA1,13,1020
632.89
(3p) Availability of plan information. A group health benefit plan and
21a self-insured health plan that provide coverage of the treatment of nervous and
22mental disorders and alcoholism and other drug abuse problems, and an individual
23health benefit plan that provides coverage of the treatment of nervous and mental
24disorders or alcoholism and other drug abuse problems, shall, upon request, make
25available to any current or potential insured, participant, beneficiary, or contracting
1provider the criteria for determining medical necessity under the plan with respect
2to that coverage. If a group health benefit plan or a self-insured health plan that
3provides coverage of the treatment of nervous and mental disorders and alcoholism
4and other drug abuse problems denies any particular insured, participant, or
5beneficiary coverage for services for that treatment, or if an individual health benefit
6plan that provides coverage of the treatment of nervous and mental disorders or
7alcoholism and other drug abuse problems denies any particular insured coverage
8for services for that treatment, the plan shall, upon request, make the reason for the
9denial available to the insured, participant, or beneficiary, in addition to complying
10with s. 632.857, if applicable.
SB362-SSA1, s. 36
11Section
36. 632.89 (4) (title) of the statutes is repealed and recreated to read:
SB362-SSA1,13,1212
632.89
(4) (title)
Rules.
SB362-SSA1, s. 37
13Section
37. 632.89 (4) of the statutes is renumbered 632.89 (4) (a).
SB362-SSA1,13,2215
632.89
(4) (b) 1. The commissioner shall promulgate rules for the
16administration of this section, including rules that specify the information that must
17be provided in the notices under subs. (3c) (c) and (3f) (b) and the manner in which
18the notices must be given, that specify who is responsible for the actuarial study and
19determination under sub. (3c) (b), and that specify retention requirements for the
20determination and underlying documentation. In promulgating the rules, the
21commissioner shall follow, as a minimum standard, any relevant federal regulations
22or guidelines that are in effect.
SB362-SSA1,14,523
2. Using the procedure under s. 227.24, the commissioner may promulgate the
24rules under subd. 1. for the period before the effective date of any permanent rules
25promulgated under subd. 1., but not to exceed the period authorized under s. 227.24
1(1) (c) and (2). Notwithstanding s. 227.24 (1) (a), (2) (b), and (3), the commissioner
2is not required to provide evidence that promulgating a rule under this subdivision
3as an emergency rule is necessary for the preservation of the public peace, health,
4safety, or welfare and is not required to make a finding of emergency for a rule
5promulgated under this subdivision.
SB362-SSA1, s. 39
6Section
39. 632.89 (5) (title) of the statutes is repealed and recreated to read:
SB362-SSA1,14,77
632.89
(5) (title)
Exclusions.
SB362-SSA1, s. 40
8Section
40. 632.89 (5) of the statutes is renumbered 632.89 (5) (a).
SB362-SSA1, s. 41
9Section
41. 632.89 (5) (a) (title) of the statutes is created to read:
SB362-SSA1,14,1010
632.89
(5) (a) (title)
Medicare.
SB362-SSA1,14,1412
632.89
(5) (c)
Coverage of autism treatment. This section does not apply to
13coverage of treatment for autism spectrum disorder, as defined in s. 632.895 (12m)
14(a) 1., to which s. 632.895 (12m) applies.
SB362-SSA1,14,1818
(1) This act first applies to all of the following:
SB362-SSA1,14,2119
(a) Except as provided in paragraphs (b) and (c
), health benefit plans that are
20issued or renewed, and governmental self-insured health plans that are established,
21extended, modified, or renewed, on the effective date of this paragraph.
SB362-SSA1,14,2422
(b) Health benefit plans covering employees who are affected by a collective
23bargaining agreement containing provisions inconsistent with this act that are
24issued or renewed on the earlier of the following:
SB362-SSA1,14,25
251. The day on which the collective bargaining agreement expires.
SB362-SSA1,15,2
12. The day on which the collective bargaining agreement is extended, modified,
2or renewed.
SB362-SSA1,15,63
(c) Governmental self-insured health plans covering employees who are
4affected by a collective bargaining agreement containing provisions inconsistent
5with this act that are established, extended, modified, or renewed on the earlier of
6the following:
SB362-SSA1,15,7
71. The day on which the collective bargaining agreement expires.
SB362-SSA1,15,9
82. The day on which the collective bargaining agreement is extended, modified,
9or renewed.
SB362-SSA1,15,1211
(1) This act takes effect on the first day of the 7th month beginning after
12publication.