AB75,1543,1513
632.32
(4) (a) 2m. Excluding a policy written by a town mutual organized under
14ch. 612, uninsured motorist coverage, in limits of at least $100,000 per person and
15$300,000 per accident.
AB75, s. 3162
16Section
3162. 632.32 (4) (a) 3. of the statutes is renumbered 632.32 (4) (c) and
17amended to read:
AB75,1543,2118
632.32
(4) (c)
Insurers Unless an insurer waives the right to subrogation,
19insurers making payment under
the uninsured motorists' coverage any of the
20coverages under this subsection shall, to the extent of the payment, be subrogated
21to the rights of their insureds.
AB75, s. 3163
22Section
3163. 632.32 (4) (b) (title) of the statutes is repealed.
AB75, s. 3164
23Section
3164. 632.32 (4) (b) of the statutes is renumbered 632.32 (4) (a) 3m.
24and amended to read:
AB75,1544,10
1632.32
(4) (a) 3m.
To indemnify for medical payments or chiropractic payments
2or both Medical payments coverage, in the amount of at least
$1,000 $10,000 per
3person
for protection of all persons using the insured motor vehicle from losses
4resulting from bodily injury or death. The named insured may reject the coverage.
5If the named insured rejects the coverage, it need not be provided in a subsequent
6renewal policy issued by the same insurer unless the insured requests it in writing.
7Under the medical or chiropractic payments coverage, the insurer shall be
8subrogated to the rights of its insured to the extent of its payments. Coverage written
9under this
paragraph subdivision may be excess coverage over any other source of
10reimbursement to which the insured person has a legal right.
AB75, s. 3165
11Section
3165. 632.32 (4) (bc) of the statutes is created to read:
AB75,1544,1512
632.32
(4) (bc) Notwithstanding par. (a) 3m., the named insured may reject
13medical payments coverage. If the named insured rejects the coverage, the coverage
14need not be provided in a subsequent renewal policy issued by the same insurer
15unless the insured requests it in writing.
AB75, s. 3166
16Section
3166. 632.32 (4m) of the statutes is repealed.
AB75, s. 3167
17Section
3167. 632.32 (4r) of the statutes is created to read:
AB75,1545,218
632.32
(4r) Required written offers of uninsured motorist and
19underinsured motorist coverages for umbrella or excess liability policies. (a)
20An insurer writing umbrella or excess liability policies that insure with respect to a
21motor vehicle registered or principally garaged in this state against loss resulting
22from liability imposed by law for bodily injury or death suffered by a person arising
23out of the ownership, maintenance, or use of a motor vehicle shall provide written
24offers of uninsured motorist coverage and underinsured motorist coverage, which
25offers shall include a brief description of the coverage offered. An insurer is required
1to provide the offers required under this subsection only one time with respect to any
2policy in the manner provided in par. (b).
AB75,1545,63
(b) 1. Each application for an umbrella or excess liability policy issued on or
4after the effective date of this subdivision .... [LRB inserts date], shall contain a
5written offer of uninsured motorist coverage and a written offer of underinsured
6motorist coverage.
AB75,1545,147
2. For umbrella or excess liability policies that are in effect on the effective date
8of this subdivision .... [LRB inserts date], the insurer shall provide a written offer of
9uninsured motorist coverage to the named insureds under each policy that does not
10include uninsured motorist coverage and a written offer of underinsured motorist
11coverage to the named insureds under each policy that does not include
12underinsured motorist coverage. The insurer shall provide an offer under this
13subdivision in conjunction with the notice of the first renewal of the policy occurring
14after the effective date of this subdivision .... [LRB inserts date].
AB75,1545,1915
(c) An applicant or named insureds may reject one or both of the coverages
16offered, but must do so in writing. If the applicant or named insureds reject either
17of the coverages offered, the insurer is not required to provide the rejected coverage
18under a policy that is renewed to the person by that insurer unless an insured under
19the policy subsequently requests the rejected coverage in writing.
AB75,1546,420
(d) If an umbrella or excess liability policy that was issued on or after the
21effective date of this paragraph .... [LRB inserts date], or an umbrella or excess
22liability policy that was in effect on, but renewed after, the effective date of this
23paragraph .... [LRB inserts date], includes neither uninsured motorist coverage nor
24underinsured motorist coverage, or only one of the coverages, and the insurer did not
25provide a written offer required under par. (b) 1. or 2. with respect to the coverage
1or coverages not included, on the request of the insured the court shall reform the
2policy to include the coverage or coverages not included and for which the insurer did
3not provide a written offer, with the same limits as the liability coverage limits under
4the policy.
AB75,1546,55
(e) This subsection does not apply to a town mutual organized under ch. 612.
AB75, s. 3168
6Section
3168. 632.32 (5) (f) of the statutes is renumbered 632.32 (6) (d) and
7amended to read:
AB75,1546,138
632.32
(6) (d)
A No policy may provide that
, regardless of the number of
9policies involved, vehicles involved, persons covered, claims made, vehicles or
10premiums shown on the policy
, or premiums paid
, the limits for any coverage under
11the policy may not be added to the limits for similar coverage applying to other motor
12vehicles to determine the limit of insurance coverage available for bodily injury or
13death suffered by a person in any one accident.
AB75, s. 3169
14Section
3169. 632.32 (5) (g) of the statutes is renumbered 632.32 (6) (e) and
15amended to read:
AB75,1546,2116
632.32
(6) (e)
A No policy may provide that the maximum amount of uninsured
17motorist coverage or underinsured motorist coverage available for bodily injury or
18death suffered by a person who was not using a motor vehicle at the time of an
19accident is
the highest any single limit of uninsured
motorist coverage or
20underinsured motorist coverage, whichever is applicable, for any motor vehicle with
21respect to which the person is insured.
AB75, s. 3170
22Section
3170. 632.32 (5) (h) of the statutes is renumbered 632.32 (6) (f) and
23amended to read:
AB75,1547,324
632.32
(6) (f)
A No policy may provide that the maximum amount of medical
25payments coverage available for bodily injury or death suffered by a person who was
1not using a motor vehicle at the time of an accident is
the highest any single limit of
2medical payments coverage for any motor vehicle with respect to which the person
3is insured.
AB75, s. 3171
4Section
3171. 632.32 (5) (i) of the statutes is renumbered 632.32 (6) (g), and
5632.32 (6) (g) (intro.), as renumbered, is amended to read:
AB75,1547,96
632.32
(6) (g) (intro.)
A No policy may provide that the limits under the policy
7for uninsured
motorist coverage or underinsured motorist coverage for bodily injury
8or death resulting from any one accident shall be reduced by any of the following that
9apply:
AB75, s. 3172
10Section
3172. 632.32 (5) (j) of the statutes is renumbered 632.32 (6) (h), and
11632.32 (6) (h) (intro.), as renumbered, is amended to read:
AB75,1547,1412
632.32
(6) (h) (intro.)
A No policy may provide that any coverage under the
13policy does not apply to a loss resulting from the use of a motor vehicle that meets
14all of the following conditions:
AB75, s. 3173
15Section
3173. 632.72 (1g) (b) of the statutes is amended to read:
AB75,1547,1916
632.72
(1g) (b) "Medical benefits or assistance" means health care services
17funded by a relief block grant
under ch. 49, as defined in s. 49.001 (5p); medical
18assistance, as defined under s. 49.43 (8); or maternal and child health services under
19s. 253.05.
AB75, s. 3174
20Section
3174. 632.7497 of the statutes is created to read:
AB75,1547,24
21632.7497 Modifications at renewal. (1) In this section, "individual major
22medical or comprehensive health benefit plan" includes coverage under a group
23health benefit plan that is underwritten on an individual basis and issued to
24individuals or families.
AB75,1548,3
1(2) An insurer that issues an individual major medical or comprehensive
2health benefit plan shall, at the time of a coverage renewal, at the request of an
3insured, permit the insured to do either of the following:
AB75,1548,44
(a) Change his or her coverage to any of the following:
AB75,1548,65
1. A different but comparable individual major medical or comprehensive
6health benefit plan currently offered by the insurer.
AB75,1548,87
2. An individual major medical or comprehensive health benefit plan currently
8offered by the insurer with more limited benefits.
AB75,1548,109
3. An individual major medical or comprehensive health benefit plan currently
10offered by the insurer with higher deductibles.
AB75,1548,1311
(b) Modify his or her existing coverage by electing an optional higher
12deductible, if any, under the individual major medical or comprehensive health
13benefit plan.
AB75,1548,17
14(3) (a) The insurer may not impose any new preexisting condition exclusion
15under the new or modified coverage under sub. (2) that did not apply to the insured's
16original coverage and shall allow the insured credit under the new or modified
17coverage for the period of original coverage.
AB75,1548,2018
(b) For the new or modified coverage, the insurer may not rate for health status
19other than on the insured's health status at the time the insured applied for the
20original coverage and as the insured disclosed on the original application.
AB75,1548,23
21(4) (a) Annually, the insurer shall mail to each insured under an individual
22major medical or comprehensive health benefit plan issued by the insurer, a notice
23that includes all of the following information:
AB75,1548,2524
1. That the insured has the right to elect alternative coverage as described in
25sub. (2).
AB75,1549,1
12. A description of the alternatives available to the insured.
AB75,1549,22
3. The procedure for making the election.
AB75,1549,43
(b) The insurer shall mail the notice under par. (a) not more than 3 months nor
4less than 60 days before the renewal date of the insured's plan.
AB75,1549,7
5(5) (a) Nothing in this section requires an insurer to issue alternative coverage
6under sub. (2) if the insured's coverage may be nonrenewed or discontinued under
7s. 632.7495 (2), (3) (b), or (4).
AB75,1549,118
(b) Notwithstanding s. 600.01 (1) (b) 3. and 4., this section applies to a group
9health benefit plan described in s. 600.01 (1) (b) 3. or 4. if that group health benefit
10plan is an individual major medical or comprehensive health benefit plan as defined
11in sub. (1).
AB75, s. 3175
12Section
3175. 632.76 (2) (a) of the statutes is amended to read:
AB75,1549,1813
632.76
(2) (a) No claim for loss incurred or disability commencing after
2 years 1412 months from the date of issue of the policy may be reduced or denied on the ground
15that a disease or physical condition existed prior to the effective date of coverage,
16unless the condition was excluded from coverage by name or specific description by
17a provision effective on the date of loss. This paragraph does not apply to a group
18health benefit plan, as defined in s. 632.745 (9), which is subject to s. 632.746.
AB75, s. 3176
19Section
3176. 632.76 (2) (ac) of the statutes is created to read:
AB75,1549,2420
632.76
(2) (ac) An individual disability insurance policy, as defined in s.
21632.895 (1) (a), may not define a preexisting condition more restrictively than a
22condition, whether physical or mental, regardless of the cause of the condition, for
23which medical advice, diagnosis, care, or treatment was recommended or received
24within 12 months before the effective date of coverage.
AB75, s. 3177
25Section
3177. 632.76 (2) (b) of the statutes is amended to read:
AB75,1550,18
1632.76
(2) (b) Notwithstanding par. (a), no claim for loss incurred or disability
2commencing after 6 months from the date of issue of a medicare supplement policy,
3medicare replacement policy or long-term care insurance policy may be reduced or
4denied on the ground that a disease or physical condition existed prior to the effective
5date of coverage.
A Notwithstanding par. (ac), a medicare supplement policy,
6medicare replacement policy
, or long-term care insurance policy may not define a
7preexisting condition more restrictively than a condition for which medical advice
8was given or treatment was recommended by or received from a physician within 6
9months before the effective date of coverage. Notwithstanding par. (a), if on the basis
10of information contained in an application for insurance a medicare supplement
11policy, medicare replacement policy
, or long-term care insurance policy excludes
12from coverage a condition by name or specific description, the exclusion must
13terminate no later than 6 months after the date of issue of the medicare supplement
14policy, medicare replacement policy
, or long-term care insurance policy. The
15commissioner may by rule exempt from this paragraph certain classes of medicare
16supplement policies, medicare replacement policies
, and long-term care insurance
17policies, if the commissioner finds the exemption is not adverse to the interests of
18policyholders and certificate holders.
AB75, s. 3178
19Section
3178. 632.835 (title) of the statutes is amended to read:
AB75,1550,21
20632.835 (title)
Independent review of adverse and experimental
21treatment coverage denial determinations.
AB75, s. 3179
22Section
3179. 632.835 (1) (ag) of the statutes is created to read:
AB75,1550,2523
632.835
(1) (ag) "Coverage denial determination" means an adverse
24determination, an experimental treatment determination, a preexisting condition
25exclusion denial determination, or the rescission of a policy or certificate.
AB75, s. 3180
1Section
3180. 632.835 (1) (cm) of the statutes is created to read:
AB75,1551,52
632.835
(1) (cm) "Preexisting condition exclusion denial determination" means
3a determination by or on behalf of an insurer that issues a health benefit plan
4denying or terminating treatment or payment for treatment on the basis of a
5preexisting condition exclusion, as defined in s. 632.745 (23).
AB75, s. 3181
6Section
3181. 632.835 (2) (a) of the statutes is amended to read:
AB75,1551,117
632.835
(2) (a) Every insurer that issues a health benefit plan shall establish
8an independent review procedure whereby an insured under the health benefit plan,
9or his or her authorized representative, may request and obtain an independent
10review of
an adverse determination or an experimental treatment a coverage denial 11determination made with respect to the insured.
AB75, s. 3182
12Section
3182. 632.835 (2) (b) of the statutes is amended to read:
AB75,1551,2013
632.835
(2) (b) If
an adverse determination or an experimental treatment a
14coverage denial determination is made, the insurer involved in the determination
15shall provide notice to the insured of the insured's right to obtain the independent
16review required under this section, how to request the review, and the time within
17which the review must be requested. The notice shall include a current listing of
18independent review organizations certified under sub. (4). An independent review
19under this section may be conducted only by an independent review organization
20certified under sub. (4) and selected by the insured.
AB75, s. 3183
21Section
3183. 632.835 (2) (bg) 3. of the statutes is amended to read:
AB75,1552,622
632.835
(2) (bg) 3. For any
adverse determination or experimental treatment 23coverage denial determination for which an explanation of benefits is not provided
24to the insured, the insurer provides a notice that the insured may have a right to an
25independent review after the internal grievance process and that an insured may be
1entitled to expedited, independent review with respect to an urgent matter. The
2notice shall also include a reference to the section of the policy or certificate that
3contains the description of the independent review procedure as required under
4subd. 1. The notice shall provide a toll-free telephone number and website, if
5appropriate, where consumers may obtain additional information regarding
6internal grievance and independent review processes.
AB75, s. 3184
7Section
3184. 632.835 (2) (c) of the statutes is amended to read:
AB75,1552,138
632.835
(2) (c) Except as provided in par. (d), an insured must exhaust the
9internal grievance procedure under s. 632.83 before the insured may request an
10independent review under this section. Except as provided in sub. (9)
(a), an insured
11who uses the internal grievance procedure must request an independent review as
12provided in sub. (3) (a) within 4 months after the insured receives notice of the
13disposition of his or her grievance under s. 632.83 (3) (d).
AB75, s. 3185
14Section
3185. 632.835 (2) (e) of the statutes is created to read:
AB75,1552,1615
632.835
(2) (e) Nothing in this section affects an insured's right to commence
16a civil proceeding relating to a coverage denial determination.
AB75, s. 3186
17Section
3186. 632.835 (3) (a) of the statutes is amended to read:
AB75,1553,518
632.835
(3) (a) To request an independent review, an insured or his or her
19authorized representative shall provide timely written notice of the request for
20independent review, and of the independent review organization selected, to the
21insurer that made or on whose behalf was made the
adverse or experimental
22treatment coverage denial determination. The insurer shall immediately notify the
23commissioner and the independent review organization selected by the insured of
24the request for independent review.
The insured or his or her authorized
25representative must pay a $25 fee to the independent review organization. If the
1insured prevails on the review, in whole or in part, the entire amount paid by the
2insured or his or her authorized representative shall be refunded by the insurer to
3the insured or his or her authorized representative. For each independent review in
4which it is involved, an insurer shall pay a fee to the independent review
5organization.
AB75, s. 3187
6Section
3187. 632.835 (3) (e) of the statutes is amended to read:
AB75,1553,177
632.835
(3) (e) In addition to the information under pars. (b) and (c), the
8independent review organization may accept for consideration any typed or printed,
9verifiable medical or scientific evidence that the independent review organization
10determines is relevant, regardless of whether the evidence has been submitted for
11consideration at any time previously. The insurer and the insured shall submit to
12the other party to the independent review any information submitted to the
13independent review organization under this paragraph and pars. (b) and (c). If, on
14the basis of any additional information, the insurer reconsiders the insured's
15grievance and determines that the treatment that was the subject of the grievance
16should be covered,
or that the policy or certificate that was rescinded should be
17reinstated, the independent review is terminated.
AB75, s. 3188
18Section
3188. 632.835 (3) (f) of the statutes is renumbered 632.835 (3) (f) 1.
19and amended to read:
AB75,1554,220
632.835
(3) (f) 1. If the independent review is not terminated under par. (e), the
21independent review organization shall, within 30 business days after the expiration
22of all time limits that apply in the matter, make a decision on the basis of the
23documents and information submitted under this subsection. The decision shall be
24in writing, signed on behalf of the independent review organization and served by
25personal delivery or by mailing a copy to the insured or his or her authorized
1representative and to the insurer.
A
Except as provided in subd. 2., a decision of an
2independent review organization is binding on the insured and the insurer.
AB75, s. 3189
3Section
3189. 632.835 (3) (f) 2. of the statutes is created to read:
AB75,1554,64
632.835
(3) (f) 2. A decision of an independent review organization regarding
5a preexisting condition exclusion denial determination or a rescission is not binding
6on the insured.
AB75, s. 3190
7Section
3190. 632.835 (3m) (a) of the statutes is amended to read:
AB75,1554,118
632.835
(3m) (a) A decision of an independent review organization regarding
9an adverse determination
or a preexisting condition exclusion denial determination 10must be consistent with the terms of the health benefit plan under which the adverse
11determination
or preexisting condition exclusion denial determination was made.
AB75, s. 3191
12Section
3191. 632.835 (6m) (a) of the statutes is amended to read:
AB75,1554,1613
632.835
(6m) (a)
Be Unless the review relates to a rescission, be a health care
14provider who is expert in treating the medical condition that is the subject of the
15review and who is knowledgeable about the treatment that is the subject of the
16review through current, actual clinical experience.
AB75, s. 3192
17Section
3192. 632.835 (7) (b) of the statutes is amended to read:
AB75,1554,2218
632.835
(7) (b) A health benefit plan that is the subject of an independent
19review and the insurer that issued the health benefit plan shall not be liable to any
20person for damages attributable to the insurer's or plan's actions taken in compliance
21with any decision
regarding an adverse determination or an experimental treatment
22determination rendered by a certified independent review organization.
AB75, s. 3193
23Section
3193. 632.835 (8) of the statutes is renumbered 632.835 (8) (a) and
24amended to read:
AB75,1555,9
1632.835
(8) (a)
Adverse and experimental treatment determinations. The
2commissioner shall make a determination that at least one independent review
3organization has been certified under sub. (4) that is able to effectively provide the
4independent reviews required under this section
for adverse determinations and
5experimental treatment determinations and shall publish a notice in the Wisconsin
6Administrative Register that states a date that is 2 months after the commissioner
7makes that determination. The date stated in the notice shall be the date on which
8the independent review procedure under this section begins operating
with respect
9to adverse determinations and experimental treatment determinations.
AB75, s. 3194
10Section
3194. 632.835 (8) (b) of the statutes is created to read:
AB75,1555,1911
632.835
(8) (b)
Preexisting condition exclusion denials and rescissions. The
12commissioner shall make a determination that at least one independent review
13organization has been certified under sub. (4) that is able to effectively provide the
14independent reviews required under this section for preexisting condition exclusion
15denial determinations and rescissions and shall publish a notice in the Wisconsin
16Administrative Register that states a date that is 2 months after the commissioner
17makes that determination. The date stated in the notice shall be the date on which
18the independent review procedure under this section begins operating with respect
19to preexisting condition exclusion denial determinations and rescissions.
AB75, s. 3195
20Section
3195. 632.835 (9) of the statutes is renumbered 632.835 (9) (a) and
21amended to read:
AB75,1556,522
632.835
(9) (a)
Adverse and experimental treatment determinations. The
23independent review required under this section
with respect to an adverse
24determination or an experimental treatment determination shall be available to an
25insured who receives notice of the disposition of his or her grievance under s. 632.83
1(3) (d) on or after December 1, 2000. Notwithstanding sub. (2) (c), an insured who
2receives notice of the disposition of his or her grievance under s. 632.83 (3) (d) on or
3after December 1, 2000, but before June 15, 2002,
with respect to an adverse
4determination or an experimental treatment determination must request an
5independent review no later than 4 months after June 15, 2002.
AB75, s. 3196
6Section
3196. 632.835 (9) (b) of the statutes is created to read:
AB75,1556,127
632.835
(9) (b)
Preexisting condition exclusion denials and rescissions. The
8independent review required under this section with respect to a preexisting
9condition exclusion denial determination or a rescission shall be available to an
10insured who receives notice of the disposition of his or her grievance under s. 632.83
11(3) (d) on or after the date stated in the notice published in the Wisconsin
12Administrative Register by the commissioner under sub. (8) (b).