Amendment SA3-AB64

AB64-SA3,13,18 (2) Prohibition. For the purpose of setting rates or premiums for coverage under a group or individual disability insurance policy or a self-insured health plan and for the purpose of setting any deductibles, copayments, or coinsurance under a group or individual disability insurance policy or a self-insured health plan, the policy or plan may not consider whether an individual, including a dependent, who would be covered under the plan has a preexisting condition.

AB64-SA3,2219j Section 2219j. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and amended to read:

AB64-SA3,14,2 632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health benefit plan may, with respect to a participant or beneficiary under the plan, not impose a preexisting condition exclusion only if the exclusion relates to 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 the 6-month period ending on the participant's or beneficiary's enrollment date under the plan on a participant or beneficiary under the plan.

AB64-SA3,2219n Section 2219n. 632.746 (1) (b) of the statutes is repealed.

AB64-SA3,2219p Section 2219p. 632.746 (2) (a) of the statutes is amended to read:

AB64-SA3,14,7 632.746 (2) (a) An insurer offering a group health benefit plan may not treat genetic information as a preexisting condition under sub. (1) without a diagnosis of a condition related to the information.

AB64-SA3,2219r Section 2219r. 632.746 (2) (c), (d) and (e) of the statutes are repealed.

AB64-SA3,2219t Section 2219t. 632.746 (3) (a) of the statutes is repealed.

AB64-SA3,2219v Section 2219v. 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).

AB64-SA3,2219x Section 2219x. 632.746 (3) (d) 2. and 3. of the statutes are repealed.

AB64-SA3,2219z Section 2219z. 632.746 (5) of the statutes is repealed.

AB64-SA3,2220b Section 2220b. 632.746 (8) (a) (intro.) of the statutes is amended to read:

AB64-SA3,14,17 632.746 (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:

AB64-SA3,2220d Section 2220d. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to read:

AB64-SA3,15,2 632.76 (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).

AB64-SA3,15,8 (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.

AB64-SA3,15,14 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.

AB64-SA3,2220f Section 2220f. 632.76 (2) (ac) 3. of the statutes is repealed.

AB64-SA3,2 Section 2. 632.795 (4) (a) of the statutes is amended to read:

AB64-SA3,16,3 632.795 (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.

AB64-SA3,2220h Section 2220h. 632.897 (11) (a) of the statutes is amended to read:

AB64-SA3,16,13 632.897 (11) (a) Notwithstanding subs. (2) to (10), the commissioner may promulgate rules establishing standards requiring insurers to provide continuation of coverage for any individual covered at any time under a group policy who is a terminated insured or an eligible individual under any federal program that provides for a federal premium subsidy for individuals covered under continuation of coverage under a group policy, including rules governing election or extension of election periods, notice, rates, premiums, premium payment, application of preexisting condition exclusions, election of alternative coverage, and status as an eligible individual, as defined in s. 149.10 (2t), 2011 stats.”.

AB64-SA3,16,14 22. Page 1015, line 10: after that line insert:

AB64-SA3,16,20 “(5r) Extension of prescription drug assistance for elderly. The department of health services shall request from the federal secretary of health and human services any waiver of federal medicaid laws necessary to permit the department of health services to continue administering the program under section 49.688 of the statutes for 4 years from the date the waiver under this subsection is granted. The department shall implement any waiver received under this subsection.”.

AB64-SA3,16,21 23. Page 1016, line 20: after that line insert:

AB64-SA3,17,3 “(7g) Increasing Medical Assistance reimbursement rates. The department of health services shall increase the reimbursement rates 12 percent under the Medical Assistance program for dates of service on and after January 1, 2017, for noninstitutional providers who are not personal care services providers, hospitals, nursing homes, or providers of services for which reimbursement is made on a basis other than a maximum fee schedule.”.

AB64-SA3,17,4 24. Page 1065, line 18: after that line insert:

AB64-SA3,17,5 “(1e) Preexisting conditions.

AB64-SA3,17,12 (a) For policies and plans containing inconsistent provisions, the treatment of sections 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.847, 625.12 (1) (a) and (e) and (2), 625.15 (1), 628.34 (3) (a), 632.728, 632.746 (1) (a) and (b), (2) (a), (c), (d), and (e), (3) (a) and (d) 1., 2. and 3., (5), and (8) (a) (intro.), 632.76 (2) (a) and (ac) 1., 2., and 3., 632.795 (4) (a), and 632.897 (11) (a) of the statutes first applies to policy or plan years beginning on January 1 of the year following the year in which this paragraph takes effect, except as provided in paragraph (b).

AB64-SA3,17,21 (b) For policies or plans that are affected by a collective bargaining agreement containing inconsistent provisions, the treatment of sections 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.847, 625.12 (1) (a) and (e) and (2), 625.15 (1), 628.34 (3) (a), 632.728, 632.746 (1) (a) and (b), (2) (a), (c), (d), and (e), (3) (a) and (d) 1., 2. and 3., (5), and (8) (a) (intro.), 632.76 (2) (a) and (ac) 1., 2., and 3., 632.795 (4) (a), and 632.897 (11) (a) of the statutes first applies to policy or plan years beginning on the effective date of this paragraph or on the day on which the collective bargaining agreement is newly established, extended, modified, or renewed, whichever is later.”.

AB64-SA3,17,22 25. Page 1067, line 3: after that line insert:

AB64-SA3,17,24 “(3x) Levy limit exception. The treatment of section 66.0602 (3) (e) 10. of the statutes first applies to a levy that is imposed in December 2017.”.

AB64-SA3,18,1 26. Page 1071, line 13: after that line insert:

AB64-SA3,18,4 “(13w) Additional household and care expenses tax credit. The treatment of sections 71.07 (8m) and 71.10 (4) (cs) of the statutes first applies to taxable years beginning on January 1, 2018.”.

AB64-SA3,18,5 27. Page 1080, line 17: after that line insert:

AB64-SA3,18,8 “(7g) Medicaid expansion. The treatment of sections 49.45 (23) (a) and 49.471 (1) (cr), (4) (a) 4. b., and (4g) of the statutes take effect on January 1, 2018, or on the day after publication, whichever is later.”.

AB64-SA3,18,9 28. Page 1080, line 24: after that line insert:

AB64-SA3,18,15 “(2e) Preexisting conditions. This act 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.847, 625.12 (1) (a) and (e) and (2), 625.15 (1), 628.34 (3) (a), 632.728, 632.746 (1) (a) and (b), (2) (a), (c), (d), and (e), (3) (a) and (d) 1., 2. and 3., (5), and (8) (a) (intro.), 632.76 (2) (a) and (ac) 1., 2., and 3., 632.795 (4) (a), and 632.897 (11) (a) of the statutes and Section 9324 (1e) take effect on the first day of the 4th month beginning after publication.”.

AB64-SA3,18,16 (End)