Amendment SA2-SSA2-AB365

AB365-SSA2-SA2,27 Section 27. 632.746 (5) of the statutes is repealed.

AB365-SSA2-SA2,28 Section 28. 632.746 (8) (a) (intro.) of the statutes is amended to read:

AB365-SSA2-SA2,8,17 632.746 (8) (a) (intro.) A health maintenance organization that offers a group health benefit plan and that does not impose any preexisting condition exclusion under sub. (1) with respect to a particular coverage option may impose an affiliation period for that coverage option, but only if all of the following apply:

AB365-SSA2-SA2,29 Section 29. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to read:

AB365-SSA2-SA2,9,2 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years from the date of issue of the policy may be reduced or denied on the ground that a disease or physical condition existed prior to the effective date of coverage, unless the condition was excluded from coverage by name or specific description by a provision effective on the date of loss. This paragraph does not apply to a group health benefit plan, as defined in s. 632.745 (9), which is subject to s. 632.746 , a disability insurance policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s. 632.85 (1) (c).

AB365-SSA2-SA2,9,8 (ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability commencing after 12 months from the date of issue of under an individual disability insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the ground that a disease or physical condition existed prior to the effective date of coverage, unless the condition was excluded from coverage by name or specific description by a provision effective on the date of the loss.

AB365-SSA2-SA2,9,14 2. Except as provided in subd. 3., an An individual disability insurance policy, as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495 (4) and (5), may not define a preexisting condition more restrictively than a condition, whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within 12 months before the effective date of coverage.

AB365-SSA2-SA2,30 Section 30. 632.76 (2) (ac) 3. of the statutes is repealed.

AB365-SSA2-SA2,31 Section 31. 632.795 (4) (a) of the statutes is amended to read:

AB365-SSA2-SA2,9,25 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the same policy form and for the same premium as it originally offered in the most recent enrollment period, subject only to the medical underwriting used in that enrollment period. Unless otherwise prescribed by rule, the insurer may apply deductibles, preexisting condition limitations, waiting periods , or other limits only to the extent that they would have been applicable had coverage been extended at the time of the most recent enrollment period and with credit for the satisfaction or partial satisfaction of similar provisions under the liquidated insurer's policy or plan. The insurer may exclude coverage of claims that are payable by a solvent insurer under insolvency coverage required by the commissioner or by the insurance regulator of another jurisdiction. Coverage shall be effective on the date that the liquidated insurer's coverage terminates.

AB365-SSA2-SA2,32 Section 32. 632.883 of the statutes is created to read:

AB365-SSA2-SA2,10,8 632.883 Lifetime and annual limits. (1) No group or individual disability insurance policy, as defined in s. 632.895 (1) (a), and no self-insured health plan, as defined in s. 632.745 (24), may impose a lifetime limit on the dollar value of benefits provided under the policy or plan.

AB365-SSA2-SA2,10,11 (2) No group or individual disability insurance policy, as defined in s. 632.895 (1) (a), and no self-insured health plan, as defined in s. 632.745 (24), may impose an annual limit on the dollar value of benefits under the policy or plan.

AB365-SSA2-SA2,33 Section 33. 632.895 (8) (d) of the statutes is amended to read:

AB365-SSA2-SA2,10,19 632.895 (8) (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. Coverage under this subsection may not be subject to any deductibles, copayments, or coinsurance.

AB365-SSA2-SA2,34 Section 34. 632.895 (13m) of the statutes is created to read:

AB365-SSA2-SA2,10,22 632.895 (13m) Preventive services. (a) In this section, “self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB365-SSA2-SA2,10,24 (b) Every disability insurance policy and every self-insured health plan shall provide coverage for all of the following preventive services:

AB365-SSA2-SA2,10,25 1. Mammography in accordance with sub. (8).

AB365-SSA2-SA2,11,2 2. Genetic breast cancer screening and counseling and preventive medication for adult women at high risk for breast cancer.

AB365-SSA2-SA2,11,4 3. Papanicolaou test for cancer screening for women 21 years of age or older with an intact cervix.

AB365-SSA2-SA2,11,6 4. Human papillomavirus testing for women who have attained the age of 30 years but have not attained the age of 66 years.

AB365-SSA2-SA2,11,7 5. Colorectal cancer screening in accordance with sub. (16m).

AB365-SSA2-SA2,11,10 6. Annual tomography for lung cancer screening for adults who have attained the age of 55 years but have not attained the age of 80 years and who have health histories demonstrating a risk for lung cancer.

AB365-SSA2-SA2,11,12 7. Skin cancer screening for individuals who have attained the age of 10 years but have not attained the age of 22 years.

AB365-SSA2-SA2,11,14 8. Counseling for skin cancer prevention for adults who have attained the age of 18 years but have not attained the age of 25 years.

AB365-SSA2-SA2,11,16 9. Abdominal aortic aneurysm screening for men who have attained the age of 65 years but have not attained the age of 75 years and who have ever smoked.

AB365-SSA2-SA2,11,19 10. Hypertension screening for adults and blood pressure testing for adults, for children under the age of 3 years who are at high risk for hypertension, and for children 3 years of age or older.

AB365-SSA2-SA2,11,22 11. Lipid disorder screening for minors 2 years of age or older, high risk women 20 years of age or older, men age 20 years of age or older at high risk for lipid disorders, and all men 35 years of age or older.

AB365-SSA2-SA2,11,25 12. Aspirin therapy for cardiovascular health for adults who have attained the age of 55 years but have not attained the age of 80 years and for men who have attained the age of 45 years but have not attained the age of 55 years.

AB365-SSA2-SA2,12,2 13. Behavioral counseling for cardiovascular health for adults who are overweight or obese and who have risk factors for cardiovascular disease.

AB365-SSA2-SA2,12,3 14. Type II diabetes screening for adults with elevated blood pressure.

AB365-SSA2-SA2,12,5 15. Depression screening for minors 11 years of age or older and for adults when follow-up supports are available.

AB365-SSA2-SA2,12,7 16. Hepatitis B screening for minors at high risk for infection and adults at high risk for infection.

AB365-SSA2-SA2,12,9 17. Hepatitis C screening for adults at high risk for infection and one time hepatitis C screening for adults born in 1945 to 1965.

AB365-SSA2-SA2,12,13 18. Obesity screening and management for all minors and adults with a body mass index indicating obesity, counseling and behavioral interventions for obese minors who are 6 years of age or older, and referral for intervention for obesity for adults with a body mass index of 30 kilograms per square meter or higher.

AB365-SSA2-SA2,12,15 19. Osteoporosis screening for all women 65 years of age or older and for women at high risk for osteoporosis under the age of 65 years.

AB365-SSA2-SA2,12,16 20. Immunizations in accordance with sub. (14).

AB365-SSA2-SA2,12,19 21. Anemia screening for individuals 6 months of age or older and iron supplements for individuals at high risk for anemia and who have attained the age of 6 months but have not attained the age of 12 months.

AB365-SSA2-SA2,12,21 22. Fluoride varnish for prevention of tooth decay for minors at the age of eruption of their primary teeth.

AB365-SSA2-SA2,12,23 23. Fluoride supplements for prevention of tooth decay for minors 6 months of age or older who do not have fluoride in their water source.

AB365-SSA2-SA2,12,24 24. Gonorrhea prophylaxis treatment for newborns.

AB365-SSA2-SA2,12,25 25. Health history and physical exams for prenatal visits and for minors.

AB365-SSA2-SA2,13,2 26. Length and weight measurements for newborns and height and weight measurements for minors.

AB365-SSA2-SA2,13,4 27. Head circumference and weight for length measurements for newborns and minors who have not attained the age of 3 years.

AB365-SSA2-SA2,13,5 28. Body mass index for minors 2 years of age or older.

AB365-SSA2-SA2,13,7 29. Blood pressure measurements for minors 3 years of age or older and a blood pressure risk assessment at birth.

AB365-SSA2-SA2,13,9 30. Risk assessment and referral for oral health issues for minors who have attained the age of 6 months but have not attained the age of 7 years.

AB365-SSA2-SA2,13,11 31. Blood screening for newborns and minors who have not attained age 2 months.

AB365-SSA2-SA2,13,12 32. Screening for critical congenital health defect for newborns.

AB365-SSA2-SA2,13,13 33. Lead screenings in accordance with sub. (10).

AB365-SSA2-SA2,13,15 34. Metabolic and hemoglobin screening and screening for phenylketonuria, sickle cell anemia, and congenital hypothyroidism for minors including newborns.

AB365-SSA2-SA2,13,17 35. Tuberculin skin test based on risk assessment for minors one month of age or older.

AB365-SSA2-SA2,13,19 36. Tobacco counseling and cessation interventions for individuals who are 5 years of age or older.

AB365-SSA2-SA2,13,21 37. Vision and hearing screening and assessment for minors including newborns.

AB365-SSA2-SA2,13,23 38. Sexually transmitted infection and human immunodeficiency virus counseling for sexually active minors.

AB365-SSA2-SA2,14,3 39. Risk assessment for sexually transmitted infection for minors who are 10 years of age or older and screening for sexually transmitted infection for minors who are 16 years of age or older.

AB365-SSA2-SA2,14,4 40. Alcohol misuse screening and counseling for minors 11 years of age or older.

AB365-SSA2-SA2,14,6 41. Autism screening for minors who have attained the age of 18 months but have not attained the age of 25 months.

AB365-SSA2-SA2,14,7 42. Developmental screening and surveillance for minors including newborns.

AB365-SSA2-SA2,14,8 43. Psychosocial and behavioral assessment for minors including newborns.

AB365-SSA2-SA2,14,10 44. Alcohol misuse screening and counseling for pregnant adults and a risk assessment for all adults.

AB365-SSA2-SA2,14,12 45. Fall prevention and counseling and preventive medication for fall prevention for community-dwelling adults 65 years of age or older.

AB365-SSA2-SA2,14,13 46. Screening and counseling for intimate partner violence for adult women.

AB365-SSA2-SA2,14,16 47. Well-woman visits for women who have attained the age of 18 years but have not attained the age of 65 years and well-woman visits for recommended preventive services, preconception care, and prenatal care.

AB365-SSA2-SA2,14,18 48. Counseling on, consultations with a trained provider on, and equipment rental for breastfeeding for pregnant and lactating women.

AB365-SSA2-SA2,14,19 49. Folic acid supplement for adult women with reproductive capacity.

AB365-SSA2-SA2,14,20 50. Iron deficiency anemia screening for pregnant and lactating women.

AB365-SSA2-SA2,14,22 51. Preeclampsia preventive medicine for pregnant adult women at high risk for preeclampsia.

AB365-SSA2-SA2,14,24 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high risk for miscarriage, preeclampsia, or clotting disorders.

AB365-SSA2-SA2,14,25 53. Screenings for hepatitis B and bacteriuria for pregnant women.

AB365-SSA2-SA2,15,2 54. Screening for gonorrhea for pregnant and sexually active females 24 years of age or younger and females older than 24 years of age who are at risk for infection.

AB365-SSA2-SA2,15,5 55. Screening for chlamydia for pregnant and sexually active females 24 years of age and younger and females older than 24 years of age who are at risk for infection.

AB365-SSA2-SA2,15,7 56. Screening for syphilis for pregnant women and adults who are at high risk for infection.

AB365-SSA2-SA2,15,10 57. Human immunodeficiency virus screening for adults who have attained the age of 15 years but have not attained the age of 66 years and individuals at high risk of infection who are younger than 15 years of age or older than 65 years of age.

AB365-SSA2-SA2,15,11 58. All contraceptives and services in accordance with sub. (17).

AB365-SSA2-SA2,15,13 59. Any services not already specified under this paragraph having an A or B rating in current recommendations from the U.S. Preventive Services Task Force.

AB365-SSA2-SA2,15,16 60. Any preventive services not already specified under this paragraph that are recommended by the federal health resources and services administration's Bright Futures project.

AB365-SSA2-SA2,15,19 61. Any immunizations, not already specified under sub. (14), that are recommended and determined to be for routine use by the Advisory Committee on Immunization Practices.

AB365-SSA2-SA2,15,22 (c) Subject to par. (d), no disability insurance policy and no self-insured health plan may subject the coverage of any of the preventive services under par. (b) to any deductibles, copayments, or coinsurance under the policy or plan.

AB365-SSA2-SA2,16,2 (d) 1. If an office visit and a preventive service specified under par. (b) are billed separately by the health care provider, the disability insurance policy or self-insured health plan may apply deductibles to and impose copayments or coinsurance on the office visit but not on the preventive service.

AB365-SSA2-SA2,16,5 2. If the primary reason for an office visit is not to obtain a preventive service, the disability insurance policy or self-insured health plan may apply deductibles to and impose copayments or coinsurance on the office visit.

AB365-SSA2-SA2,16,14 3. If a preventive service specified under par. (b) is provided by a health care provider that is outside the disability insurance policy's or self-insured health plan's network of providers, the policy or plan may apply deductibles to and impose copayments or coinsurance on the office visit and the preventive service. If a preventive service specified under par. (b) is provided by a health care provider that is outside the disability insurance policy's or self-insured health plan's network of providers because there is no available health care provider in the policy's or plan's network of providers that provides the preventive service, the policy or plan may not apply deductibles to or impose copayments or coinsurance on preventive service.

AB365-SSA2-SA2,16,19 4. If multiple well-woman visits described under par. (b) 47. are required to fulfill all necessary preventive services and are in accordance with clinical recommendations, the disability insurance policy or self-insured health plan may not apply a deductible or impose a copayment or coinsurance to any of those well-woman visits.

AB365-SSA2-SA2,35 Section 35. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:

AB365-SSA2-SA2,16,21 632.895 (14) (a) 1. i. Hepatitis A and B.

AB365-SSA2-SA2,16,22 j. Varicella and herpes zoster.

AB365-SSA2-SA2,36 Section 36. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:

AB365-SSA2-SA2,16,24 632.895 (14) (a) 1. k. Human papillomavirus.