SB206, s. 50 3Section 50. 632.76 (2) (ac) 3. of the statutes, as affected by 2011 Wisconsin Act
4.... (this act), is repealed.
SB206, s. 51 5Section 51. 632.76 (2) (ac) 4. of the statutes is created to read:
SB206,20,126 632.76 (2) (ac) 4. No individual disability insurance policy, as defined in s.
7632.895 (1) (a), or self-insured health plan, as defined in 632.745 (24), may reduce
8or deny a claim for loss by a participant or beneficiary under the policy or plan who
9is under the age of 19 on the ground that a disease or physical condition existed prior
10to the effective date of coverage. This subdivision does not apply to a grandfathered
11health plan, as defined in s. 632.758 (1), that provides individual health insurance
12coverage.
SB206, s. 52 13Section 52. 632.76 (2) (ac) 4. of the statutes, as affected by 2011 Wisconsin Act
14.... (this act), is repealed.
SB206, s. 53 15Section 53. 632.76 (2) (b) of the statutes is amended to read:
SB206,21,816 632.76 (2) (b) Notwithstanding par. (a), no claim for loss incurred or disability
17commencing after 6 months from the date of issue of a medicare supplement policy,
18medicare replacement policy or long-term care insurance policy may be reduced or
19denied on the ground that a disease or physical condition existed prior to the effective
20date of coverage. Notwithstanding par. (ac) 2., a A medicare supplement policy,
21medicare replacement policy, or long-term care insurance policy may not define a
22preexisting condition more restrictively than a condition for which medical advice
23was given or treatment was recommended by or received from a physician within 6
24months before the effective date of coverage. Notwithstanding par. (a), if on the basis
25of information contained in an application for insurance a medicare supplement

1policy, medicare replacement policy, or long-term care insurance policy excludes
2from coverage a condition by name or specific description, the exclusion must
3terminate no later than 6 months after the date of issue of the medicare supplement
4policy, medicare replacement policy, or long-term care insurance policy. The
5commissioner may by rule exempt from this paragraph certain classes of medicare
6supplement policies, medicare replacement policies, and long-term care insurance
7policies, if the commissioner finds the exemption is not adverse to the interests of
8policyholders and certificate holders.
SB206, s. 54 9Section 54. 632.795 (4) (a) of the statutes is amended to read:
SB206,21,2110 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the
11same policy form and for the same premium as it originally offered in the most recent
12enrollment period, subject only to the medical underwriting used in that enrollment
13period. Unless otherwise prescribed by rule, the insurer may apply deductibles,
14preexisting condition limitations, waiting periods , or other limits only to the extent
15that they would have been applicable had coverage been extended at the time of the
16most recent enrollment period and with credit for the satisfaction or partial
17satisfaction of similar provisions under the liquidated insurer's policy or plan. The
18insurer may exclude coverage of claims that are payable by a solvent insurer under
19insolvency coverage required by the commissioner or by the insurance regulator of
20another jurisdiction. Coverage shall be effective on the date that the liquidated
21insurer's coverage terminates.
SB206, s. 55 22Section 55. 632.85 (2) of the statutes is amended to read:
SB206,22,323 632.85 (2) If a health care plan or a self-insured health plan provides coverage
24of any emergency medical services, the health care plan or self-insured health plan
25shall provide coverage of emergency medical services that are provided in a hospital

1emergency facility, regardless whether that facility is a participating provider with
2respect to the plan,
and that are needed to evaluate or stabilize, as defined in section
31867 of the federal Social Security Act, an emergency medical condition.
SB206, s. 56 4Section 56. 632.85 (4) of the statutes is created to read:
SB206,22,105 632.85 (4) A health care plan or self-insured health plan that is required to
6provide the coverage under sub. (2) shall impose the same cost-sharing
7requirements on coverage for emergency medical services provided by a
8nonparticipating provider as it imposes for services provided by a participating
9provider. This subsection does not apply to a grandfathered health plan, as defined
10in s. 632.758 (1).
SB206, s. 57 11Section 57. 632.865 of the statutes is created to read:
SB206,22,18 12632.865 Choice of primary care provider. A group or individual health
13benefit plan, as defined in s. 632.745 (11), that requires or provides for the
14designation by any individual or beneficiary covered under the plan of a
15participating primary care provider shall allow each individual or beneficiary to
16designate any participating primary care provider who is available to accept that
17individual or beneficiary. This section does not apply to a grandfathered health plan,
18as defined in s. 632.758 (1).
SB206, s. 58 19Section 58. 632.87 (5m) of the statutes is created to read:
SB206,22,2320 632.87 (5m) (a) 1. Except as provided in subd. 2. and par. (d), no health care
21plan, as defined in s. 628.36 (2) (a) 1., that provides coverage for hospital lengths of
22stay in connection with childbirth for a mother or a newborn child may do any of the
23following:
SB206,23,3
1a. Restrict benefits under the plan for any hospital length of stay in connection
2with childbirth for the mother or newborn child, following a normal vaginal delivery,
3to less than 48 hours.
SB206,23,64 b. Restrict benefits under the plan for any hospital length of stay in connection
5with childbirth for the mother or newborn child, following a cesarean section, to less
6than 96 hours.
SB206,23,87 c. Require that a provider obtain authorization from the plan for prescribing
8any length of stay required under subd. 1. a. or b.
SB206,23,129 2. Subdivision 1. does not apply to a health care plan in any case in which the
10decision to discharge the mother or her newborn child before the minimum length
11of stay described under subd. 1. a. or b. is made by an attending provider in
12consultation with the mother.
SB206,23,1413 (b) No health care plan, as defined in s. 628.36 (2) (a) 1., may do any of the
14following:
SB206,23,1715 1. Deny to the mother or her newborn child eligibility, or continued eligibility,
16to enroll in or renew coverage under the plan solely for the purpose of avoiding the
17requirements of this subsection.
SB206,23,1918 2. Provide monetary payments or rebates to mothers to encourage mothers to
19accept less than the minimum protections available under this subsection.
SB206,23,2220 3. Penalize a provider or reduce or limit the reimbursement of a provider
21because the provider provided care to an individual in accordance with this
22subsection.
SB206,23,2523 4. Subject to par. (c), restrict benefits for any portion of a hospital length of stay
24under subd. 1. a. or b. in a manner that is less favorable than the benefits provided
25for any preceding portion of the stay.
SB206,24,5
1(c) A health care plan may impose cost-sharing requirements in relation to
2benefits for hospital lengths of stay in connection with childbirth for a mother or
3newborn child, except that those cost-sharing requirements for any portion of a
4hospital length of stay may not be greater than the cost-sharing requirements for
5any preceding portion of the stay.
SB206,24,76 (d) This subsection does not apply to a grandfathered health plan, as defined
7in s. 632.758 (1).
SB206, s. 59 8Section 59. 632.883 of the statutes is created to read:
SB206,24,13 9632.883 Lifetime and annual limits. (1) No insurer may impose a lifetime
10limit on the dollar value of benefits under a group or individual health care plan, as
11defined in s. 628.36 (2) (a) 1., and no self-insured health plan, as defined in s. 632.745
12(24), may impose a lifetime limit on the dollar value of benefits under the
13self-insured health plan.
SB206,24,20 14(2) For plan years beginning before January 1, 2014, an insurer under a group
15or individual health care plan, as defined in s. 628.36 (2) (a) 1., and a self-insured
16health plan, as defined in s. 632.745 (24), may impose only a restricted annual limit
17on the dollar value of benefits, as restricted annual limit is defined by the secretary
18of the federal department of health and human services under 42 USC 300gg-11 (a).
19This subsection does not apply to a grandfathered health plan, as defined in s.
20632.758 (1), that provides individual health insurance coverage.
SB206, s. 60 21Section 60 . 632.883 (2) of the statutes, as created by 2011 Wisconsin Act ....
22(this act), is amended to read:
SB206,25,523 632.883 (2) For plan years beginning before January 1, 2014, an No insurer
24under a group or individual health care plan, as defined in s. 628.36 (2) (a) 1., and
25 a no self-insured health plan, as defined in s. 632.745 (24), may impose only a

1restricted
an annual limit on the dollar value of benefits, as restricted annual limit
2is defined by the secretary of the federal department of health and human services
3under 42 USC 300gg-11 (a)
. This subsection does not apply to a grandfathered
4health plan, as defined in s. 632.758 (1), that provides individual health insurance
5coverage.
SB206, s. 61 6Section 61. 632.895 (13) (a) of the statutes is renumbered 632.895 (13) (a)
7(intro.) and amended to read:
SB206,25,128 632.895 (13) (a) (intro.) Every disability insurance policy, and every
9self-insured health plan of the state or a county, city, village, town or school district,
10that provides coverage of the surgical procedure known as a mastectomy shall
11provide coverage of all of the following in a manner determined in consultation with
12the attending physician and the patient:
SB206,25,14 131. All stages of breast reconstruction of the affected tissue incident to a
14mastectomy.
SB206, s. 62 15Section 62. 632.895 (13) (a) 2. of the statutes is created to read:
SB206,25,1716 632.895 (13) (a) 2. Surgery and reconstruction of the other breast than the one
17on which the mastectomy was performed to produce a symmetrical appearance.
SB206, s. 63 18Section 63. 632.895 (13) (a) 3. of the statutes is created to read:
SB206,25,2019 632.895 (13) (a) 3. Prostheses and physical complications of mastectomy,
20including lymphademas.
SB206, s. 64 21Section 64. 632.895 (13) (c) of the statutes is created to read:
SB206,25,2422 632.895 (13) (c) The disability insurance policy and self-insured health plan
23shall provide written notice of the available coverage under par. (a) upon enrollment
24in the policy or plan and annually thereafter.
SB206, s. 65 25Section 65. 632.895 (13m) of the statutes is created to read:
SB206,26,2
1632.895 (13m) Preventive care copayments prohibited. (a) In this subsection,
2"preventive care service" means any service described under 42 USC 300gg-13 (a).
SB206,26,63 (b) Except as provided in par. (d), every group health plan, every insurer
4providing a disability insurance policy, and every self-insured health plan of the
5state or a county, city, town, village, or school district, shall provide coverage for all
6preventive care services.
SB206,26,87 (c) No insurer or plan described under par. (b) may subject the coverage of a
8preventive care service to a copayment or coinsurance.
SB206,26,109 (d) This subsection does not apply to a grandfathered health plan, as defined
10in s. 632.758 (1).
SB206, s. 66 11Section 66. 632.895 (15) (a) of the statutes is renumbered 632.895 (15) (a)
12(intro.) and amended to read:
SB206,26,1913 632.895 (15) (a) (intro.) Subject to pars. (b) and (c), every disability insurance
14policy, and every self-insured health plan of the state or a county, city, town, village,
15or school district, that provides coverage for a person as a dependent of the insured
16because the person is a full-time student, including the coverage under s. 632.885
17(2) (b), shall continue to provide dependent coverage for the person if, due to a
18medically necessary leave of absence, he or she ceases to be a full-time student., if
19the leave of absence meets all of the following criteria:
SB206, s. 67 20Section 67. 632.895 (15) (a) 1., 2. and 3. of the statutes are created to read:
SB206,26,2221 632.895 (15) (a) 1. The leave of absence commences while the person is
22suffering from a serious illness or injury.
SB206,26,2323 2. The leave of absence is medically necessary.
SB206,26,2524 3. The leave of absence causes the person to lose student status for purposes
25of coverage under the terms of the plan or coverage.
SB206, s. 68
1Section 68. 632.895 (15) (b) of the statutes is amended to read:
SB206,27,82 632.895 (15) (b) A policy or plan is not required to continue coverage under par.
3(a) unless the person submits documentation and written certification of the medical
4necessity of
by a treating physician that states the person is suffering from a serious
5illness or injury and that
the leave of absence from the person's attending physician
6is medically necessary. The date on which the person ceases to be a full-time student
7due to the medically necessary leave of absence shall be the date on which the
8coverage continuation under par. (a) begins.
SB206, s. 69 9Section 69. 632.895 (15) (c) 1. to 4. of the statutes are repealed.
SB206, s. 70 10Section 70. 632.895 (15) (c) 5. of the statutes is amended to read:
SB206,27,1411 632.895 (15) (c) 5. Except for a person who has coverage as a dependent under
12s. 632.885 (2) (b), the person reaches the age at which coverage as a dependent who
13is a full-time student
would otherwise end under the terms and conditions of the
14policy or plan.
SB206, s. 71 15Section 71. 632.895 (15) (c) 6. of the statutes is repealed.
SB206, s. 72 16Section 72. 632.895 (15) (d) of the statutes is created to read:
SB206,27,2317 632.895 (15) (d) Every disability insurance policy and every self-insured
18health plan that provides coverage under par. (a) shall include with any notice
19regarding a requirement for certification of student status for coverage under the
20plan or coverage a description of the terms of this subsection for continued coverage
21during a medically necessary leave of absence. The policy or plan shall provide the
22description in language that is understandable to the typical insured or plan
23participant.
SB206, s. 73 24Section 73. 632.895 (15) (e) of the statutes is created to read:
SB206,28,4
1632.895 (15) (e) A person whose benefits are continued under par. (a) is entitled
2to the same benefits as if, during the medically necessary leave of absence, the person
3continued to be covered under the policy or plan as a full-time student who is not on
4a leave of absence.
SB206, s. 74 5Section 74. 632.897 (11) (a) of the statutes is amended to read:
SB206,28,146 632.897 (11) (a) Notwithstanding subs. (2) to (10), the commissioner may
7promulgate rules establishing standards requiring insurers to provide continuation
8of coverage for any individual covered at any time under a group policy who is a
9terminated insured or an eligible individual under any federal program that
10provides for a federal premium subsidy for individuals covered under continuation
11of coverage under a group policy, including rules governing election or extension of
12election periods, notice, rates, premiums, premium payment, application of
13preexisting condition exclusions,
election of alternative coverage, and status as an
14eligible individual, as defined in s. 149.10 (2t).
SB206, s. 75 15Section 75. 635.02 (2) of the statutes is amended to read:
SB206,28,2116 635.02 (2) "Case characteristics" means the demographic, actuarially based
17characteristics ages, geographic locations, and tobacco usage of the employees of a
18small employer, and the employer, if covered, such as age, sex, and geographic
19location,
used by a small employer insurer to determine premium rates for a small
20employer. "Case characteristics" does not include loss or claim history, health status,
21occupation, duration of coverage, or other factors related to claim experience.
SB206, s. 76 22Section 76 . Initial applicability.
SB206,29,723 (1) The treatment of sections 40.51 (8) (by Section 1 ) and (8m) (by Section 3 ),
2466.0137 (4) (by Section 5 ), 120.13 (2) (g) (by Section 7 ), 185.983 (1) (intro.) (by
25Section 9), 632.758, 632.85 (2), and 632.895 (15) (b), (c) 5., (d), and (e) of the statutes,

1the renumbering and amendment of section 632.895 (13) (a) and (15) (a) of the
2statutes, and the creation of sections 609.845, 632.723, 632.746 (2) (dm), 632.753,
3632.76 (2) (ac) 4., 632.85 (4), 632.865, 632.87 (5m), 632.883, and 632.895 (13) (a) 2.
4and 3. and (c), (13m), and (15) (a) 1., 2., and 3., (d), and (e) of the statutes first apply
5to policies or plans that are newly issued or renewed, or self-insured governmental
6or school district health plans that are established, extended, modified, or renewed,
7on the effective date of this subsection.
SB206,29,178 (2) The treatment of sections 40.51 (8) (by Section 2) and (8m) (by Section 4),
966.0137 (4) (by Section 6 ), 120.13 (2) (g) (by Section 8 ), 185.983 (1) (intro.) (by
10Section 10), 609.845 (by Section 13 ), 625.12 (1) (a) and (e) and (2), 625.15 (1), 628.34
11(3) (a), 632.746 (8) (a) (intro.) and (10) (a) 1., 632.795 (4) (a), 632.883 (2) (by Section
1260), 632.897 (11) (a), and 635.02 (2) of the statutes, the renumbering of section
13632.7497 (3) (a) of the statutes, the renumbering and amendment of sections 632.746
14(1) (a) and 632.76 (2) (ac) 1. of the statutes, and the creation of sections 632.728 and
15632.7493 of the statutes first apply to policies or plans that are newly issued or
16renewed, or self-insured governmental or school district health plans that are
17established, extended, modified, or renewed, on the effective date of this subsection.
SB206, s. 77 18Section 77 . Effective dates. This act takes effect on the day after publication,
19except as follows:
SB206,30,520 (1) The treatment of sections 40.51 (8) (by Section 2 ) and (8m) (by Section 4 ),
2166.0137 (4) (by Section 6 ), 120.13 (2) (g) (by Section 8 ), 185.983 (1) (intro.) (by
22Section 10), 609.845 (by Section 13 ), 625.12 (1) (a) and (e) and (2), 625.15 (1), 628.34
23(3) (a), 632.746 (5) (a), (8) (a) (intro.), and (10) (a) 1., 632.76 (2) (b), 632.795 (4) (a),
24632.883 (2) (by Section 60 ), 632.897 (11) (a), and 635.02 (2) of the statutes, the repeal
25of sections 631.95 (3) (a), 632.746 (1) (b), (2) (a), (b), and (dm), (3) (a) and (d) 2. and

13., and (10) (a) 4., 632.7497 (3) (b), and 632.76 (2) (ac) 2., 3., and 4. of the statutes,
2the renumbering of sections 632.746 (3) (d) 1. and 632.7497 (3) (a) of the statutes, the
3renumbering and amendment of sections 632.746 (1) (a) and 632.76 (2) (ac) 1. of the
4statutes, and the creation of sections 632.728 and 632.7493 of the statutes, and
5Section 76 (2) of this act take effect on January 1, 2014.
SB206,30,66 (End)
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