HEALTH INSURANCE RISK-SHARING PLANS
HEALTH INSURANCE RISK-SHARING
Administration of plan.
Rules relating to creditable coverage.
Participation of insurers.
Provider payment rates.
Payment of plan costs.
Reductions in premiums for low-income eligible persons.
HEALTH INSURANCE RISK-SHARING
Creation and organization of authority.
Duties of authority.
Powers of authority.
Contracting for professional services.
In this chapter, unless the context requires otherwise:
"Authority" means the Health Insurance Risk-Sharing Plan Authority.
"Board" means the board of directors of the authority.
"Church plan" has the meaning given in section 3 (33) of the federal Employee Retirement Income Security Act of 1974.
"Commissioner" means the commissioner of insurance.
Except as provided in par. (b)
, "creditable coverage" means coverage under any of the following:
Part A, part B, or part D of title XVIII of the federal Social Security Act.
Title XIX of the federal Social Security Act, except for coverage consisting solely of benefits under section 1928 of that act.
A medical care program of the federal Indian health service or of an American Indian tribal organization.
A health plan offered under chapter 89
of title 5 of the United States Code.
"Creditable coverage" does not include coverage consisting solely of coverage of excepted benefits, as defined in section 2791 (c) of P.L. 104-191
"Eligible individual" means an individual for whom all of the following apply:
The aggregate of the individual's periods of creditable coverage is 18 months or more.
The individual's most recent period of creditable coverage was under a group health plan, governmental plan, federal governmental plan or church plan, or under any health insurance offered in connection with any of those plans.
The individual does not have creditable coverage and is not eligible for coverage under a group health plan, part A, part B, or part D of title XVIII of the federal Social Security Act or a state plan under title XIX of the federal Social Security Act or any successor program.
The individual's most recent period of creditable coverage was not terminated for any reason related to fraud or intentional misrepresentation of material fact or a failure to pay premiums.
If the individual was offered the option of continuation coverage under a federal continuation provision or similar state program, including under 2009 Wisconsin Act 11, section 9126 (2)
, the individual elected the continuation coverage.
The individual has exhausted any continuation coverage under par. (e)
"Eligible person" means a resident who qualifies under s. 149.12
whether or not the person is legally responsible for the payment of medical expenses incurred on the person's behalf.
"Federal continuation provision" means any of the following:
of the Internal Revenue Code of 1986, except for section 4980B (f) (1) of that code insofar as it relates to pediatric vaccines.
Part 6 of subtitle B of title I of the federal Employee Retirement Income Security Act of 1974, except for section 609 of that act.