SB70: Bill Text

The bill does not eliminate any of the other requirements that exist in current law related to coverage of dependents.

For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SB70, s. 1 Section 1. 40.51 (8) of the statutes is amended to read:

SB70,2,5 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8) and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to (5) (6), 632.885, 632.895 (5m) and (8) to (15), and 632.896.

SB70, s. 2 Section 2. 40.51 (8m) of the statutes is amended to read:

SB70,2,9 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.885, and 632.895 (11) to (15).

SB70, s. 3 Section 3. 66.0137 (4) of the statutes is amended to read:

SB70,3,6 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4), and (5), and (6), 632.885, 632.895 (9) to (15), 632.896, and 767.25 (4m) (d) 767.513 (4).

SB70, s. 4 Section 4. 111.91 (2) (t) of the statutes is created to read:

SB70,3,8 111.91 (2) (t) The requirements related to dependent coverage under s. 632.885.

SB70, s. 5 Section 5. 120.13 (2) (g) of the statutes is amended to read:

SB70,3,13 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4) and, (5), and (6), 632.885, 632.895 (9) to (15), 632.896, and 767.25 (4m) (d) 767.513 (4).

SB70, s. 6 Section 6. 185.981 (4t) of the statutes is amended to read:

SB70,3,18 185.981 (4t) A sickness care plan operated by a cooperative association is subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85, 632.853, 632.855, 632.87 (2m), (3), (4), and (5), and (6), 632.885, 632.895 (10) to (15), and 632.897 (10) and chs. 149 and 155.

SB70, s. 7 Section 7. 185.983 (1) (intro.) of the statutes is amended to read:

SB70,4,2 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93, 631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853, 632.855, 632.87 (2m), (3), (4), and (5), and (6), 632.885, 632.895 (5) and (9) to (15), 632.896, and 632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring association shall:

SB70, s. 8 Section 8. 609.74 of the statutes is created to read:

SB70,4,5 609.74 Coverage of dependents. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.885.

SB70, s. 9 Section 9. 632.885 of the statutes is created to read:

SB70,4,7 632.885 Coverage of dependents. (1) Definitions. In this section:

SB70,4,8 (a) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).

SB70,4,9 (b) "Insured" includes an enrollee.

SB70,4,10 (c) "Self-insured health plan" has the meaning given in s. 632.745 (24).

SB70,4,15 (2) Requirement to offer dependent coverage. (a) Subject to ss. 632.88 and 632.895 (5), every insurer that issues a disability insurance policy, and every self-insured health plan, shall offer and, if so requested by an applicant or an insured, provide coverage for an adult child of the applicant or insured as a dependent of the applicant or insured if the child satisfies all of the following criteria:

SB70,4,16 1. The child is over 17 but less than 27 years of age.

SB70,4,17 2. The child is not married.

SB70,4,21 3. The child is not eligible for coverage under a group health benefit plan, as defined in s. 632.745 (9), that is offered by the child's employer and for which the amount of the child's premium contribution is no greater than the premium amount for his or her coverage as a dependent under this section.

SB70,4,23 (b) Notwithstanding par. (a) 1., the coverage requirement under this section applies to an adult child who satisfies all of the following criteria:

SB70,4,24 1. The child is a full-time student, regardless of age.

SB70,4,25 2. The child satisfies the criteria under par. (a) 2. and 3.

SB70,5,3 3. The child was called to federal active duty in the national guard or in a reserve component of the U.S. armed forces while the child was attending, on a full-time basis, an institution of higher education.

SB70,5,5 4. The child was under the age of 27 years when called to federal active duty under subd. 3.

SB70,5,9 (3) Premium determination. An insurer or self-insured health plan shall determine the premium for coverage of a dependent who is over 18 years of age on the same basis as the premium is determined for coverage of a dependent who is 18 years of age or younger.

SB70,5,13 (4) Documentation of criteria satisfaction. An insurer or self-insured health plan may require that an applicant or insured seeking coverage of a dependent child provide written documentation, initially and annually thereafter, that the dependent child satisfies the criteria for coverage under this section.

SB70, s. 10 Section 10. 632.895 (15) (a) of the statutes is amended to read:

SB70,5,20 632.895 (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.

SB70, s. 11 Section 11. 632.895 (15) (c) 5. of the statutes is amended to read:

SB70,5,25 632.895 (15) (c) 5. The Except for a person who has coverage as a dependent under s. 632.885 (2) (b), the person reaches the age at which coverage as a dependent who is a full-time student would otherwise end under the terms and conditions of the policy or plan.

SB70, s. 12 Section 12. Initial applicability.

SB70,6,2 (1) This act first applies to all of the following:

SB70,6,6 (a) Except as provided in paragraphs (b) and (c ), disability insurance policies that are issued or renewed, and governmental or school district self-insured health plans that are established, extended, modified, or renewed, on the effective date of this paragraph.

SB70,6,9 (b) Disability insurance policies covering employees who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are issued or renewed on the earlier of the following:

SB70,6,10 1. The day on which the collective bargaining agreement expires.

SB70,6,12 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

SB70,6,16 (c) Governmental or school district self-insured 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:

SB70,6,17 1. The day on which the collective bargaining agreement expires.

SB70,6,19 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

SB70, s. 13 Section 13. Effective date.

SB70,6,22 (1) This act takes effect on the first day of the 7th month beginning after publication.

SB70,6,23 (End)