SB466: Bill Text

SB466, s. 55 Section 55. 632.895 (4) (c) of the statutes is amended to read:

SB466,19,20 632.895 (4) (c) Coverage under this subsection may not be subject to exclusions or limitations, including deductibles and coinsurance factors, which are not generally applicable to other conditions covered under the policy or plan.

SB466, s. 56 Section 56. 632.895 (5) (a), (b), (c) and (d) of the statutes are amended to read:

SB466,19,24 632.895 (5) (a) Every disability insurance policy and every self-insured health plan under sub. (1) (g) 2. and 3. shall provide coverage for a newly born child of the insured from the moment of birth.

SB466,20,6 (b) Coverage for newly born children required under this subsection shall consider congenital defects and birth abnormalities as an injury or sickness under the policy or self-insured health plan under sub. (1) (g) 2. and 3. and shall cover functional repair or restoration of any body part when necessary to achieve normal body functioning, but shall not cover cosmetic surgery performed only to improve appearance.

SB466,20,14 (c) If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or self-insured health plan under sub. (1) (g) 2. and 3. may require that notification of the birth of a child and payment of the required premium or fees shall be furnished to the insurer within 60 days after the date of birth. The insurer may refuse to continue coverage beyond the 60-day period if such notification is not received, unless within one year after the birth of the child the insured makes all past-due payments and in addition pays interest on such payments at the rate of 5 1/2% per year.

SB466,20,18 (d) If payment of a specific premium or subscription fee is not required to provide coverage for a child, the policy, self-insured health plan under sub. (1) (g) 2. and 3., or contract may request notification of the birth of a child but may not deny or refuse to continue coverage if such notification is not furnished.

SB466, s. 57 Section 57. 632.895 (5m) of the statutes is amended to read:

SB466,20,23 632.895 (5m) Coverage of grandchildren. Every disability insurance policy issued or renewed on or after May 7, 1986, and every self-insured health plan under sub. (1) (g) 2. and 3. that provides coverage for any child of the insured shall provide the same coverage for all children of that child until that child is 18 years of age.

SB466, s. 58 Section 58. 632.895 (6) and (7) of the statutes are amended to read:

SB466,21,12 632.895 (6) Equipment and supplies for treatment of diabetes. Every disability insurance policy and every self-insured health plan under sub. (1) (g) 2. and 3. which provides coverage of expenses incurred for treatment of diabetes shall provide coverage for expenses incurred by the installation and use of an insulin infusion pump, coverage for all other equipment and supplies, including insulin or any other prescription medication, used in the treatment of diabetes, and coverage of diabetic self-management education programs. Coverage required under this subsection shall be subject to the same exclusions, limitations, deductibles, and coinsurance provisions of the policy or self-insured health plan as other covered expenses, except that insulin infusion pump coverage may be limited to the purchase of one pump per year and the insurer may require the insured to use a pump for 30 days before purchase.

SB466,21,18 (7) Maternity coverage. Every group disability insurance policy which and every self-insured health plan under sub. (1) (g) 2. and 3. that provides maternity coverage shall provide maternity coverage for all persons covered under the policy. Coverage required under this subsection may not be subject to exclusions or limitations which are not applied to other maternity coverage under the policy or self-insured health plan.

SB466, s. 59 Section 59. 632.895 (8) (b) 1. (intro.) and 2., (c), (d) and (e) (intro.) of the statutes are amended to read:

SB466,21,25 632.895 (8) (b) 1. (intro.) Except as provided in subd. 2. and par. (f), every disability insurance policy and every self-insured health plan under sub. (1) (g) 2. and 3. that provides coverage for a woman age 45 to 49 shall provide coverage for that woman of 2 examinations by low-dose mammography performed when the woman is age 45 to 49, if all of the following are satisfied:

SB466,22,5 2. A disability insurance policy or self-insured health plan under sub. (1) (g) 2. and 3. need not provide coverage under subd. 1. to the extent that the woman had obtained one or more examinations by low-dose mammography while between the ages of 45 and 49 and before obtaining coverage under the disability insurance policy or self-insured health plan.

SB466,22,11 (c) Except as provided in par. (f), every disability insurance policy and every self-insured health plan under sub. (1) (g) 2. and 3. that provides coverage for a woman age 50 or older shall provide coverage for that woman of an annual examination by low-dose mammography to screen for the presence of breast cancer, if the examination is performed at the direction of a licensed physician or a nurse practitioner or if par. (e) applies.

SB466,22,17 (d) Coverage is required under this subsection despite whether the woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c) and (e), coverage under this subsection may only be subject to exclusions and limitations, including deductibles, copayments and restrictions on excessive charges, that are applied to other radiological examinations covered under the disability insurance policy or self-insured health plan under sub. (1) (g) 2. and 3.

SB466,22,22 (e) (intro.) A disability insurance policy or self-insured health plan under sub. (1) (g) 2. and 3. shall cover an examination by low-dose mammography that is not performed at the direction of a licensed physician or a nurse practitioner but that is otherwise required to be covered under par. (b) or (c), if all of the following are satisfied:

SB466, s. 60 Section 60. 632.895 (9) (b) (intro.) of the statutes is amended to read:

SB466,23,2 632.895 (9) (b) (intro.) Except as provided in par. (d), every disability insurance policy that is issued or renewed on or after April 28, 1990, and every self-insured health plan under sub. (1) (g) 2. and 3. that provides coverage of prescription medication shall provide coverage for each drug that satisfies all of the following:

SB466, s. 61 Section 61. 632.895 (9) (c) of the statutes is amended to read:

SB466,23,7 632.895 (9) (c) Coverage of a drug under par. (b) may be subject to any copayments and deductibles that the disability insurance policy or self-insured health plan under sub. (1) (g) 2. and 3. applies generally to other prescription medication covered by the disability insurance policy or self-insured health plan.

SB466, s. 62 Section 62. 632.895 (10) (a) of the statutes is amended to read:

SB466,23,17 632.895 (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) self-insured health plan under sub. (1) (g) 2. and 3. 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 services under s. 254.158.

SB466, s. 63 Section 63. 632.895 (11) (a) (intro.) and (d) of the statutes are amended to read:

SB466,23,24 632.895 (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:

SB466,24,4 (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.

SB466, s. 64 Section 64. 632.895 (12) (b) (intro.) of the statutes is amended to read:

SB466,24,11 632.895 (12) (b) (intro.) Except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, shall cover hospital or ambulatory surgery center charges incurred, and anesthetics provided, in conjunction with dental care that is provided to a covered individual in a hospital or ambulatory surgery center, if any of the following applies:

SB466, s. 65 Section 65. 632.895 (12) (c) of the statutes is amended to read:

SB466,24,15 632.895 (12) (c) 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.

SB466, s. 66 Section 66. 632.895 (13) (a) of the statutes is amended to read:

SB466,24,20 632.895 (13) (a) 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 the surgical procedure known as a mastectomy shall provide coverage of breast reconstruction of the affected tissue incident to a mastectomy.

SB466, s. 67 Section 67. 632.895 (14) (b) of the statutes is amended to read:

SB466,25,2 632.895 (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.

SB466, s. 68 Section 68. 632.895 (15) (a) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB466,25,10 632.895 (15) (a) Subject to pars. (b) and (c), 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 person as a dependent of the insured because the person is a full-time student, including the coverage under s. 632.885 (2) (b), shall continue to provide dependent coverage for the person if, due to a medically necessary leave of absence, he or she ceases to be a full-time student.

SB466, s. 69 Section 69. 632.895 (16) (a) 4. of the statutes, as created by 2009 Wisconsin Act 14, is repealed.

SB466, s. 70 Section 70. 632.895 (16) (c) 2. of the statutes, as created by 2009 Wisconsin Act 14, is amended to read:

SB466,25,17 632.895 (16) (c) 2. A disability insurance policy, or a self-insured health plan of the state or a county, city, town, village, or school district, that provides only limited-scope dental or vision benefits.

SB466, s. 71 Section 71. 632.895 (17) (b) (intro.) of the statutes, as created by 2009 Wisconsin Act 28, is amended to read:

SB466,25,24 632.895 (17) (b) (intro.) Every disability insurance policy, and every self-insured health plan of the state or of a county, city, town, village, or school district, that provides coverage of outpatient health care services, preventive treatments and services, or prescription drugs and devices shall provide coverage for all of the following:

SB466, s. 72 Section 72. 632.895 (17) (d) 2. of the statutes, as created by 2009 Wisconsin Act 28, is amended to read:

SB466,26,5 632.895 (17) (d) 2. A disability insurance policy, or a self-insured health plan of the state or a county, city, town, village, or school district, that provides only limited-scope dental or vision benefits.

SB466, s. 73 Section 73. 632.896 (1) (bg) of the statutes is created to read:

SB466,26,8 632.896 (1) (bg) "Insured" includes a person who participates in a self-insured health plan.

SB466, s. 74 Section 74. 632.896 (1) (bk) of the statutes is created to read:

SB466,26,12 632.896 (1) (bk) "Insurer" includes a city, town, village, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan.

SB466, s. 75 Section 75. 632.896 (1) (d) of the statutes is created to read:

SB466,26,15 632.896 (1) (d) "Self-insured health plan" has the meaning given in s. 632.85 (1) (c) 2. and 3.

SB466, s. 76 Section 76. 632.896 (2) of the statutes is amended to read:

SB466,26,23 632.896 (2) Adopted or placed for adoption. Every disability insurance policy that is issued or renewed on or after March 1, 1991, and every self-insured health plan, that provides coverage for dependent children of the insured, as defined in the disability insurance policy or self-insured health plan, shall cover adopted children of the insured and children placed for adoption with the insured, on the same terms and conditions, including exclusions, limitations, deductibles and copayments, as other dependent children, except as provided in subs. (3) to (6).

SB466, s. 77 Section 77. 632.896 (3) (a) 2. of the statutes is amended to read:

SB466,27,3 632.896 (3) (a) 2. Subdivision 1. does not require coverage to begin before coverage is available under the disability insurance policy or self-insured health plan for other dependent children.

SB466, s. 78 Section 78. 632.896 (4) of the statutes is amended to read:

SB466,27,10 632.896 (4) Preexisting conditions. Notwithstanding ss. 632.746 and 632.76 (2) (a), a disability insurance policy or self-insured health plan, that is subject to sub. (2) and that is in effect when a court makes a final order granting adoption or when the child is placed for adoption may not exclude or limit coverage of a disease or physical condition of the child on the ground that the disease or physical condition existed before coverage is required to begin under sub. (3).

SB466, s. 79 Section 79. 632.896 (6) of the statutes is amended to read:

SB466,27,21 632.896 (6) Notice to insurer. The disability insurance policy or self-insured health plan may require the insured to notify the insurer that a child is adopted or placed for adoption and to pay the insurer any premium or fees required to provide coverage for the child, within 60 days after coverage is required to begin under sub. (3). If the insured fails to give notice or make payment within 60 days as required by the disability insurance policy or self-insured health plan in accordance with this subsection, the disability insurance policy or self-insured health plan shall treat the adopted child or child placed for adoption no less favorably than it treats other dependents, other than newborn children, who seek coverage at a time other than when the dependent was first eligible to apply for coverage.

SB466, s. 80 Section 80. 635.02 (3k) of the statutes is amended to read:

SB466,27,24 635.02 (3k) "Group health benefit plan" has the meaning given in s. 632.745 (9) (a) and (b).

SB466, s. 81 Section 81. 645.02 (8) of the statutes is created to read:

SB466,28,2 645.02 (8) A city, town, village, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan.

SB466, s. 82 Section 82. 646.01 (1) (a) 3. of the statutes is created to read:

SB466,28,5 646.01 (1) (a) 3. A city, town, village, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan.

SB466, s. 83 Section 83. 646.01 (1) (b) 9. of the statutes is amended to read:

SB466,28,11 646.01 (1) (b) 9. Any Except for a self-insured health plan of a city, town, village, county, or school district, any self-funded, self-insured, or partially or wholly uninsured plan of an employer or other person to provide life insurance, annuity, or disability benefits to its employees or members to the extent that the plan is self-funded, self-insured, or uninsured.

SB466, s. 84 Section 84. 646.03 (2q) of the statutes is created to read:

SB466,28,15 646.03 (2q) "Insurer" includes a city, village, town, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan.

SB466, s. 85 Section 85. Initial applicability.

SB466,28,17 (1) This act first applies to the following:

SB466,28,20 (a) Except as provided in paragraph (b), self-insured governmental health plans provided by that are established, extended, modified, or renewed on the effective date of this paragraph.

SB466,28,24 (b) Self-insured governmental health plans covering employees who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are established, extended, modified, or renewed on the earlier of the following:

SB466,28,25 1. The day on which the collective bargaining agreement expires.

SB466,29,2 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

SB466, s. 86 Section 86. Effective date.

SB466,29,5 (1) This act takes effect on the first day of the 7th month beginning after publication.

SB466,29,6 (End)