SB466, s. 55 17Section 55. 632.895 (4) (c) of the statutes is amended to read:
SB466,19,2018 632.895 (4) (c) Coverage under this subsection may not be subject to exclusions
19or limitations, including deductibles and coinsurance factors, which are not
20generally applicable to other conditions covered under the policy or plan.
SB466, s. 56 21Section 56. 632.895 (5) (a), (b), (c) and (d) of the statutes are amended to read:
SB466,19,2422 632.895 (5) (a) Every disability insurance policy and every self-insured health
23plan under sub. (1) (g) 2. and 3.
shall provide coverage for a newly born child of the
24insured from the moment of birth.
SB466,20,6
1(b) Coverage for newly born children required under this subsection shall
2consider congenital defects and birth abnormalities as an injury or sickness under
3the policy or self-insured health plan under sub. (1) (g) 2. and 3. and shall cover
4functional repair or restoration of any body part when necessary to achieve normal
5body functioning, but shall not cover cosmetic surgery performed only to improve
6appearance.
SB466,20,147 (c) If payment of a specific premium or subscription fee is required to provide
8coverage for a child, the policy or self-insured health plan under sub. (1) (g) 2. and
93.
may require that notification of the birth of a child and payment of the required
10premium or fees shall be furnished to the insurer within 60 days after the date of
11birth. The insurer may refuse to continue coverage beyond the 60-day period if such
12notification is not received, unless within one year after the birth of the child the
13insured makes all past-due payments and in addition pays interest on such
14payments at the rate of 5 1/2% per year.
SB466,20,1815 (d) If payment of a specific premium or subscription fee is not required to
16provide coverage for a child, the policy, self-insured health plan under sub. (1) (g) 2.
17and 3.,
or contract may request notification of the birth of a child but may not deny
18or refuse to continue coverage if such notification is not furnished.
SB466, s. 57 19Section 57. 632.895 (5m) of the statutes is amended to read:
SB466,20,2320 632.895 (5m) Coverage of grandchildren. Every disability insurance policy
21issued or renewed on or after May 7, 1986, and every self-insured health plan under
22sub. (1) (g) 2. and 3.
that provides coverage for any child of the insured shall provide
23the same coverage for all children of that child until that child is 18 years of age.
SB466, s. 58 24Section 58. 632.895 (6) and (7) of the statutes are amended to read:
SB466,21,12
1632.895 (6) Equipment and supplies for treatment of diabetes. Every
2disability insurance policy and every self-insured health plan under sub. (1) (g) 2.
3and 3.
which provides coverage of expenses incurred for treatment of diabetes shall
4provide coverage for expenses incurred by the installation and use of an insulin
5infusion pump, coverage for all other equipment and supplies, including insulin or
6any other prescription medication, used in the treatment of diabetes, and coverage
7of diabetic self-management education programs. Coverage required under this
8subsection shall be subject to the same exclusions, limitations, deductibles, and
9coinsurance provisions of the policy or self-insured health plan as other covered
10expenses, except that insulin infusion pump coverage may be limited to the purchase
11of one pump per year and the insurer may require the insured to use a pump for 30
12days before purchase.
SB466,21,18 13(7) Maternity coverage. Every group disability insurance policy which and
14every self-insured health plan under sub. (1) (g) 2. and 3. that
provides maternity
15coverage shall provide maternity coverage for all persons covered under the policy.
16Coverage required under this subsection may not be subject to exclusions or
17limitations which are not applied to other maternity coverage under the policy or
18self-insured health plan
.
SB466, s. 59 19Section 59. 632.895 (8) (b) 1. (intro.) and 2., (c), (d) and (e) (intro.) of the
20statutes are amended to read:
SB466,21,2521 632.895 (8) (b) 1. (intro.) Except as provided in subd. 2. and par. (f), every
22disability insurance policy and every self-insured health plan under sub. (1) (g) 2.
23and 3.
that provides coverage for a woman age 45 to 49 shall provide coverage for that
24woman of 2 examinations by low-dose mammography performed when the woman
25is age 45 to 49, if all of the following are satisfied:
SB466,22,5
12. A disability insurance policy or self-insured health plan under sub. (1) (g)
22. and 3.
need not provide coverage under subd. 1. to the extent that the woman had
3obtained one or more examinations by low-dose mammography while between the
4ages of 45 and 49 and before obtaining coverage under the disability insurance policy
5or self-insured health plan.
SB466,22,116 (c) Except as provided in par. (f), every disability insurance policy and every
7self-insured health plan under sub. (1) (g) 2. and 3.
that provides coverage for a
8woman age 50 or older shall provide coverage for that woman of an annual
9examination by low-dose mammography to screen for the presence of breast cancer,
10if the examination is performed at the direction of a licensed physician or a nurse
11practitioner or if par. (e) applies.
SB466,22,1712 (d) Coverage is required under this subsection despite whether the woman
13shows any symptoms of breast cancer. Except as provided in pars. (b), (c) and (e),
14coverage under this subsection may only be subject to exclusions and limitations,
15including deductibles, copayments and restrictions on excessive charges, that are
16applied to other radiological examinations covered under the disability insurance
17policy or self-insured health plan under sub. (1) (g) 2. and 3.
SB466,22,2218 (e) (intro.) A disability insurance policy or self-insured health plan under sub.
19(1) (g) 2. and 3.
shall cover an examination by low-dose mammography that is not
20performed at the direction of a licensed physician or a nurse practitioner but that is
21otherwise required to be covered under par. (b) or (c), if all of the following are
22satisfied:
SB466, s. 60 23Section 60. 632.895 (9) (b) (intro.) of the statutes is amended to read:
SB466,23,224 632.895 (9) (b) (intro.) Except as provided in par. (d), every disability insurance
25policy that is issued or renewed on or after April 28, 1990, and every self-insured

1health plan under sub. (1) (g) 2. and 3.
that provides coverage of prescription
2medication shall provide coverage for each drug that satisfies all of the following:
SB466, s. 61 3Section 61. 632.895 (9) (c) of the statutes is amended to read:
SB466,23,74 632.895 (9) (c) Coverage of a drug under par. (b) may be subject to any
5copayments and deductibles that the disability insurance policy or self-insured
6health plan under sub. (1) (g) 2. and 3.
applies generally to other prescription
7medication covered by the disability insurance policy or self-insured health plan.
SB466, s. 62 8Section 62. 632.895 (10) (a) of the statutes is amended to read:
SB466,23,179 632.895 (10) (a) Except as provided in par. (b), every disability insurance policy
10and every health care benefits plan provided on a self-insured basis by a county
11board under s. 59.52 (11), by a city or village under s. 66.0137 (4), by a political
12subdivision under s. 66.0137 (4m), by a town under s. 60.23 (25), or by a school district
13under s. 120.13 (2)
self-insured health plan under sub. (1) (g) 2. and 3. shall provide
14coverage for blood lead tests for children under 6 years of age, which shall be
15conducted in accordance with any recommended lead screening methods and
16intervals contained in any rules promulgated by the department of health services
17under s. 254.158.
SB466, s. 63 18Section 63. 632.895 (11) (a) (intro.) and (d) of the statutes are amended to read:
SB466,23,2419 632.895 (11) (a) (intro.) Except as provided in par. (e), every disability
20insurance policy, and every self-insured health plan of the state or a county, city,
21village, town or school district
, that provides coverage of any diagnostic or surgical
22procedure involving a bone, joint, muscle or tissue shall provide coverage for
23diagnostic procedures and medically necessary surgical or nonsurgical treatment for
24the correction of temporomandibular disorders if all of the following apply:
SB466,24,4
1(d) Notwithstanding par. (c) 1., an insurer or a self-insured health plan of the
2state or a county, city, village, town or school district
may require that an insured
3obtain prior authorization for any medically necessary surgical or nonsurgical
4treatment for the correction of temporomandibular disorders.
SB466, s. 64 5Section 64. 632.895 (12) (b) (intro.) of the statutes is amended to read:
SB466,24,116 632.895 (12) (b) (intro.) Except as provided in par. (d), every disability
7insurance policy, and every self-insured health plan of the state or a county, city,
8village, town or school district,
shall cover hospital or ambulatory surgery center
9charges incurred, and anesthetics provided, in conjunction with dental care that is
10provided to a covered individual in a hospital or ambulatory surgery center, if any
11of the following applies:
SB466, s. 65 12Section 65. 632.895 (12) (c) of the statutes is amended to read:
SB466,24,1513 632.895 (12) (c) The coverage required under this subsection may be subject
14to any limitations, exclusions or cost-sharing provisions that apply generally under
15the disability insurance policy or self-insured health plan.
SB466, s. 66 16Section 66. 632.895 (13) (a) of the statutes is amended to read:
SB466,24,2017 632.895 (13) (a) Every disability insurance policy, and every self-insured
18health plan of the state or a county, city, village, town or school district, that provides
19coverage of the surgical procedure known as a mastectomy shall provide coverage of
20breast reconstruction of the affected tissue incident to a mastectomy.
SB466, s. 67 21Section 67. 632.895 (14) (b) of the statutes is amended to read:
SB466,25,222 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy,
23and every self-insured health plan of the state or a county, city, town, village or school
24district
, that provides coverage for a dependent of the insured shall provide coverage

1of appropriate and necessary immunizations, from birth to the age of 6 years, for a
2dependent who is a child of the insured.
SB466, s. 68 3Section 68. 632.895 (15) (a) of the statutes, as affected by 2009 Wisconsin Act
428
, is amended to read:
SB466,25,105 632.895 (15) (a) Subject to pars. (b) and (c), every disability insurance policy,
6and every self-insured health plan of the state or a county, city, town, village, or
7school district,
that provides coverage for a person as a dependent of the insured
8because the person is a full-time student, including the coverage under s. 632.885
9(2) (b), shall continue to provide dependent coverage for the person if, due to a
10medically necessary leave of absence, he or she ceases to be a full-time student.
SB466, s. 69 11Section 69. 632.895 (16) (a) 4. of the statutes, as created by 2009 Wisconsin
12Act 14
, is repealed.
SB466, s. 70 13Section 70. 632.895 (16) (c) 2. of the statutes, as created by 2009 Wisconsin
14Act 14
, is amended to read:
SB466,25,1715 632.895 (16) (c) 2. A disability insurance policy, or a self-insured health plan
16of the state or a county, city, town, village, or school district, that provides only
17limited-scope dental or vision benefits.
SB466, s. 71 18Section 71. 632.895 (17) (b) (intro.) of the statutes, as created by 2009
19Wisconsin Act 28
, is amended to read:
SB466,25,2420 632.895 (17) (b) (intro.) Every disability insurance policy, and every
21self-insured health plan of the state or of a county, city, town, village, or school
22district,
that provides coverage of outpatient health care services, preventive
23treatments and services, or prescription drugs and devices shall provide coverage for
24all of the following:
SB466, s. 72
1Section 72. 632.895 (17) (d) 2. of the statutes, as created by 2009 Wisconsin
2Act 28
, is amended to read:
SB466,26,53 632.895 (17) (d) 2. A disability insurance policy, or a self-insured health plan
4of the state or a county, city, town, village, or school district, that provides only
5limited-scope dental or vision benefits.
SB466, s. 73 6Section 73. 632.896 (1) (bg) of the statutes is created to read:
SB466,26,87 632.896 (1) (bg) "Insured" includes a person who participates in a self-insured
8health plan.
SB466, s. 74 9Section 74. 632.896 (1) (bk) of the statutes is created to read:
SB466,26,1210 632.896 (1) (bk) "Insurer" includes a city, town, village, county, or school district
11that provides a self-insured health plan, with respect to the self-insured health
12plan.
SB466, s. 75 13Section 75. 632.896 (1) (d) of the statutes is created to read:
SB466,26,1514 632.896 (1) (d) "Self-insured health plan" has the meaning given in s. 632.85
15(1) (c) 2. and 3.
SB466, s. 76 16Section 76. 632.896 (2) of the statutes is amended to read:
SB466,26,2317 632.896 (2) Adopted or placed for adoption. Every disability insurance policy
18that is issued or renewed on or after March 1, 1991, and every self-insured health
19plan,
that provides coverage for dependent children of the insured, as defined in the
20disability insurance policy or self-insured health plan, shall cover adopted children
21of the insured and children placed for adoption with the insured, on the same terms
22and conditions, including exclusions, limitations, deductibles and copayments, as
23other dependent children, except as provided in subs. (3) to (6).
SB466, s. 77 24Section 77. 632.896 (3) (a) 2. of the statutes is amended to read:
SB466,27,3
1632.896 (3) (a) 2. Subdivision 1. does not require coverage to begin before
2coverage is available under the disability insurance policy or self-insured health
3plan
for other dependent children.
SB466, s. 78 4Section 78. 632.896 (4) of the statutes is amended to read:
SB466,27,105 632.896 (4) Preexisting conditions. Notwithstanding ss. 632.746 and 632.76
6(2) (a), a disability insurance policy or self-insured health plan, that is subject to sub.
7(2) and that is in effect when a court makes a final order granting adoption or when
8the child is placed for adoption may not exclude or limit coverage of a disease or
9physical condition of the child on the ground that the disease or physical condition
10existed before coverage is required to begin under sub. (3).
SB466, s. 79 11Section 79. 632.896 (6) of the statutes is amended to read:
SB466,27,2112 632.896 (6) Notice to insurer. The disability insurance policy or self-insured
13health plan
may require the insured to notify the insurer that a child is adopted or
14placed for adoption and to pay the insurer any premium or fees required to provide
15coverage for the child, within 60 days after coverage is required to begin under sub.
16(3). If the insured fails to give notice or make payment within 60 days as required
17by the disability insurance policy or self-insured health plan in accordance with this
18subsection, the disability insurance policy or self-insured health plan shall treat the
19adopted child or child placed for adoption no less favorably than it treats other
20dependents, other than newborn children, who seek coverage at a time other than
21when the dependent was first eligible to apply for coverage.
SB466, s. 80 22Section 80. 635.02 (3k) of the statutes is amended to read:
SB466,27,2423 635.02 (3k) "Group health benefit plan" has the meaning given in s. 632.745
24(9) (a) and (b).
SB466, s. 81 25Section 81. 645.02 (8) of the statutes is created to read:
SB466,28,2
1645.02 (8) A city, town, village, county, or school district that provides a
2self-insured health plan, with respect to the self-insured health plan.
SB466, s. 82 3Section 82. 646.01 (1) (a) 3. of the statutes is created to read:
SB466,28,54 646.01 (1) (a) 3. A city, town, village, county, or school district that provides a
5self-insured health plan, with respect to the self-insured health plan.
SB466, s. 83 6Section 83. 646.01 (1) (b) 9. of the statutes is amended to read:
SB466,28,117 646.01 (1) (b) 9. Any Except for a self-insured health plan of a city, town,
8village, county, or school district, any
self-funded, self-insured, or partially or wholly
9uninsured plan of an employer or other person to provide life insurance, annuity, or
10disability benefits to its employees or members to the extent that the plan is
11self-funded, self-insured, or uninsured.
SB466, s. 84 12Section 84. 646.03 (2q) of the statutes is created to read:
SB466,28,1513 646.03 (2q) "Insurer" includes a city, village, town, county, or school district
14that provides a self-insured health plan, with respect to the self-insured health
15plan.
SB466, s. 85 16Section 85. Initial applicability.
SB466,28,1717 (1) This act first applies to the following:
SB466,28,2018 (a) Except as provided in paragraph (b), self-insured governmental health
19plans provided by that are established, extended, modified, or renewed on the
20effective date of this paragraph.
SB466,28,2421 (b) Self-insured governmental health plans covering employees who are
22affected by a collective bargaining agreement containing provisions inconsistent
23with this act that are established, extended, modified, or renewed on the earlier of
24the following:
SB466,28,25 251. The day on which the collective bargaining agreement expires.
SB466,29,2
12. The day on which the collective bargaining agreement is extended, modified,
2or renewed.
SB466, s. 86 3Section 86. Effective date.
SB466,29,54 (1) This act takes effect on the first day of the 7th month beginning after
5publication.
SB466,29,66 (End)
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