SB59,2073
18Section
2073. 625.12 (1) (e) of the statutes is amended to read:
SB59,1022,2019
625.12
(1) (e) Subject to
s.
ss. 632.365
and 632.728, all other relevant factors,
20including the judgment of technical personnel.
SB59,2074
21Section
2074. 625.12 (2) of the statutes is amended to read:
SB59,1023,522
625.12
(2) Classification. Risks Except as provided in s. 632.728, risks may
23be classified in any reasonable way for the establishment of rates and minimum
24premiums, except that no classifications may be based on race, color, creed or
25national origin, and classifications in automobile insurance may not be based on
1physical condition or developmental disability as defined in s. 51.01 (5). Subject to
2s. ss. 632.365
and 632.728, rates thus produced may be modified for individual risks
3in accordance with rating plans or schedules that establish reasonable standards for
4measuring probable variations in hazards, expenses, or both. Rates may also be
5modified for individual risks under s. 625.13 (2).
SB59,2075
6Section
2075. 625.15 (1) of the statutes is amended to read:
SB59,1023,147
625.15
(1) Rate making. An Except as provided in s. 632.728, an insurer may
8itself establish rates and supplementary rate information for one or more market
9segments based on the factors in s. 625.12 and, if the rates are for motor vehicle
10liability insurance, subject to s. 632.365, or the insurer may use rates and
11supplementary rate information prepared by a rate service organization, with
12average expense factors determined by the rate service organization or with such
13modification for its own expense and loss experience as the credibility of that
14experience allows.
SB59,2076
15Section
2076. 628.34 (3) (a) of the statutes is amended to read:
SB59,1023,2216
628.34
(3) (a) No insurer may unfairly discriminate among policyholders by
17charging different premiums or by offering different terms of coverage except on the
18basis of classifications related to the nature and the degree of the risk covered or the
19expenses involved, subject to ss. 632.365,
632.728, 632.746 and 632.748. Rates are
20not unfairly discriminatory if they are averaged broadly among persons insured
21under a group, blanket or franchise policy, and terms are not unfairly discriminatory
22merely because they are more favorable than in a similar individual policy.
SB59,2077
23Section 2077
. 632.35 of the statutes is amended to read:
SB59,1024,3
24632.35 Prohibited rejection, cancellation and nonrenewal. No insurer
25may cancel or refuse to issue or renew an automobile insurance policy wholly or
1partially because of one or more of the following characteristics of any person: age,
2sex, residence, race, color, creed, religion, national origin, ancestry, marital status
or, 3occupation
, or status as a holder or nonholder of a license under s. 343.03 (3m).
SB59,2078
4Section
2078. 632.697 of the statutes is amended to read:
SB59,1024,13
5632.697 Benefits subject to department's right to recover. Death
6benefits payable under a life insurance policy or an annuity are subject to the right
7of the department of health services to recover under s. 46.27 (7g)
, 2017 stats.,
849.496, 49.682, or 49.849 an amount equal to the medical assistance that is
9recoverable under s. 49.496 (3) (a), an amount equal to aid under s. 49.68, 49.683,
1049.685, or 49.785 that is recoverable under s. 49.682 (2) (a) or (am), or an amount
11equal to long-term community support services under s. 46.27
, 2017 stats., that is
12recoverable under s. 46.27 (7g) (c) 1.
, 2017 stats., and that was paid on behalf of the
13deceased policyholder or annuitant.
SB59,2079
14Section
2079. 632.728 of the statutes is created to read:
SB59,1024,16
15632.728 Coverage of persons with preexisting conditions; guaranteed
16issue; benefit limits. (1) Definitions. In this section:
SB59,1024,1717
(a) “Health benefit plan” has the meaning given in s. 632.745 (11).
SB59,1024,1818
(b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
SB59,1024,24
19(2) Guaranteed issue. (a) Every individual health benefit plan shall accept
20every individual in this state who, and every group health benefit plan shall accept
21every employer in this state that, applies for coverage, regardless of sexual
22orientation, gender identity, or whether or not any employee or individual has a
23preexisting condition. A health benefit plan may restrict enrollment in coverage
24described in this paragraph to open or special enrollment periods.
SB59,1025,3
1(b) The commissioner shall establish a statewide open enrollment period of no
2shorter than 30 days for every individual health benefit plan to allow individuals,
3including individuals who do not have coverage, to enroll in coverage.
SB59,1025,8
4(3) Prohibiting discrimination based on health status. (a) An individual
5health benefit plan or a self-insured health plan may not establish rules for the
6eligibility of any individual to enroll, or for the continued eligibility of any individual
7to remain enrolled, under the plan based on any of the following health
8status-related factors in relation to the individual or a dependent of the individual:
SB59,1025,99
1. Health status.
SB59,1025,1010
2. Medical condition, including both physical and mental illnesses.
SB59,1025,1111
3. Claims experience.
SB59,1025,1212
4. Receipt of health care.
SB59,1025,1313
5. Medical history.
SB59,1025,1414
6. Genetic information.
SB59,1025,1615
7. Evidence of insurability, including conditions arising out of acts of domestic
16violence.
SB59,1025,1717
8. Disability.
SB59,1025,2418
(b) An insurer offering an individual health benefit plan or a self-insured
19health plan may not require any individual, as a condition of enrollment or continued
20enrollment under the plan, to pay, on the basis of any health status-related factor
21under par. (a) with respect to the individual or a dependent of the individual, a
22premium or contribution or a deductible, copayment, or coinsurance amount that is
23greater than the premium or contribution or deductible, copayment, or coinsurance
24amount respectively for a similarly situated individual enrolled under the plan.
SB59,1026,4
1(c) Nothing in this subsection prevents an insurer offering an individual health
2benefit plan or a self-insured health plan from establishing premium discounts or
3rebates or modifying otherwise applicable cost sharing in return for adherence to
4programs of health promotion and disease prevention.
SB59,1026,7
5(4) Premium rate variation. A health benefit plan offered on the individual or
6small employer market or a self-insured health plan may vary premium rates for a
7specific plan based only on the following considerations:
SB59,1026,88
(a) Whether the policy or plan covers an individual or a family.
SB59,1026,99
(b) Rating area in the state, as established by the commissioner.
SB59,1026,1210
(c) Age, except that the rate may not vary by more than 3 to 1 for adults over
11the age groups and the age bands shall be consistent with recommendations of the
12National Association of Insurance Commissioners.
SB59,1026,1313
(d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
SB59,1026,15
14(5) Annual and lifetime limits. An individual or group health benefit plan or
15a self-insured health plan may not establish any of the following:
SB59,1026,1716
(a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent
17of an enrollee under the plan.
SB59,1026,1918
(b) Annual limits on the dollar value of benefits for an enrollee or a dependent
19of an enrollee under the plan.
SB59,1027,2
20(6) Short-term plans. This section and s. 632.76 apply to every short-term,
21limited-duration health insurance policy. In this subsection, “short-term,
22limited-duration health insurance policy” means health coverage that is provided
23under a contract with an insurer, has an expiration date specified in the contract that
24is less than 12 months after the original effective date of the contract, and, taking
25into account renewals or extensions, has a duration of no longer than 36 months in
1total. “Short-term, limited-duration health insurance policy” includes any
2short-term policy subject to s. 632.7495 (4).
SB59,2080
3Section
2080. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and
4amended to read:
SB59,1027,115
632.746
(1) Subject to subs. (2) and (3), an An insurer that offers a group health
6benefit plan may
, with respect to a participant or beneficiary under the plan, not 7impose a preexisting condition exclusion
only if the exclusion relates to a condition,
8whether physical or mental, regardless of the cause of the condition, for which
9medical advice, diagnosis, care or treatment was recommended or received within
10the 6-month period ending on the participant's or beneficiary's enrollment date
11under the plan on a participant or beneficiary under the plan.
SB59,2081
12Section
2081. 632.746 (1) (b) of the statutes is repealed.
SB59,2082
13Section
2082. 632.746 (2) (a) of the statutes is amended to read:
SB59,1027,1714
632.746
(2) (a) An insurer offering a group health benefit plan may not
treat 15impose a preexisting condition exclusion based on genetic information
as a
16preexisting condition under sub. (1) without a diagnosis of a condition related to the
17information.
SB59,2083
18Section
2083. 632.746 (2) (c), (d) and (e) of the statutes are repealed.
SB59,2084
19Section
2084. 632.746 (3) (a) of the statutes is repealed.
SB59,2085
20Section 2085
. 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).
SB59,2086
21Section 2086
. 632.746 (3) (d) 2. and 3. of the statutes are repealed.
SB59,2087
22Section 2087
. 632.746 (5) of the statutes is repealed.
SB59,2088
23Section
2088. 632.746 (8) (a) (intro.) of the statutes is amended to read:
SB59,1028,224
632.746
(8) (a) (intro.) A health maintenance organization that offers a group
25health benefit plan
and that does not impose any preexisting condition exclusion
1under sub. (1) with respect to a particular coverage option may impose an affiliation
2period for that coverage option, but only if all of the following apply:
SB59,2089
3Section 2089
. 632.748 (2) of the statutes is amended to read:
SB59,1028,104
632.748
(2) An insurer offering a group health benefit plan may not require any
5individual, as a condition of enrollment or continued enrollment under the plan, to
6pay, on the basis of any health status-related factor with respect to the individual
7or a dependent of the individual, a premium or contribution
or a deductible,
8copayment, or coinsurance amount that is greater than the premium or contribution
9or deductible, copayment, or coinsurance amount respectively for a similarly
10situated individual enrolled under the plan.
SB59,2090
11Section
2090. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to
12read:
SB59,1028,2013
632.76
(2) (a) No claim for loss incurred or disability commencing after 2 years
14from the date of issue of the policy may be reduced or denied on the ground that a
15disease or physical condition existed prior to the effective date of coverage, unless the
16condition was excluded from coverage by name or specific description by a provision
17effective on the date of loss. This paragraph does not apply to a group health benefit
18plan, as defined in s. 632.745 (9), which is subject to s. 632.746
, a disability insurance
19policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s.
20632.85 (1) (c).
SB59,1029,221
(ac) 1.
Notwithstanding par. (a), no No claim or loss incurred or disability
22commencing
after 12 months from the date of issue of
under an individual disability
23insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the
24ground that a disease or physical condition existed prior to the effective date of
1coverage
, unless the condition was excluded from coverage by name or specific
2description by a provision effective on the date of the loss.
SB59,1029,93
2.
Except as provided in subd. 3., an An individual disability insurance policy,
4as defined in s. 632.895 (1) (a),
other than a short-term policy subject to s. 632.7495
5(4) and (5), may not define a preexisting condition more restrictively than a condition
6that was present before the date of enrollment for the coverage, whether physical or
7mental, regardless of the cause of the condition,
for which and regardless of whether 8medical advice, diagnosis, care, or treatment was recommended or received
within
912 months before the effective date of coverage.
SB59,2091
10Section
2091. 632.76 (2) (ac) 3. of the statutes is repealed.
SB59,2092
11Section
2092. 632.795 (4) (a) of the statutes is amended to read:
SB59,1029,2312
632.795
(4) (a) An insurer subject to sub. (2) shall provide coverage under the
13same policy form and for the same premium as it originally offered in the most recent
14enrollment period, subject only to the medical underwriting used in that enrollment
15period. Unless otherwise prescribed by rule, the insurer may apply deductibles,
16preexisting condition limitations, waiting periods
, or other limits only to the extent
17that they would have been applicable had coverage been extended at the time of the
18most recent enrollment period and with credit for the satisfaction or partial
19satisfaction of similar provisions under the liquidated insurer's policy or plan. The
20insurer may exclude coverage of claims that are payable by a solvent insurer under
21insolvency coverage required by the commissioner or by the insurance regulator of
22another jurisdiction. Coverage shall be effective on the date that the liquidated
23insurer's coverage terminates.
SB59,2093
24Section
2093. 632.796 of the statutes is created to read:
SB59,1030,2
1632.796 Drug cost report.
(1) Definition. In this section, “disability
2insurance policy” has the meaning given in s. 632.895 (1) (a).
SB59,1030,8
3(2) Report required. Annually, at the time the insurer files its rate request
4with the commissioner, each insurer that offers a disability insurance policy that
5covers prescription drugs shall submit to the commissioner a report that identifies
6the 25 prescription drugs that are the highest cost to the insurer and the 25
7prescription drugs that have the highest cost increases over the 12 months before the
8submission of the report.
SB59,2094
9Section
2094. 632.865 (3) of the statutes is created to read:
SB59,1030,1210
632.865
(3) Registration required. (a) No person may perform any activities
11of a pharmacy benefit manager in this state without first registering with the
12commissioner under this subsection.
SB59,1030,1513
(b) The commissioner shall establish a registration procedure for pharmacy
14benefit managers. The commissioner may promulgate any rules necessary to
15implement the registration procedure under this paragraph.
SB59,2095
16Section
2095. 632.866 of the statutes is created to read:
SB59,1030,17
17632.866 Prescription drug cost reporting. (1) Definitions. In this section:
SB59,1030,1918
(a) “Brand-name drug” means a prescription drug approved under
21 USC 355 19(b) or
42 USC 262.
SB59,1030,2120
(b) “Covered hospital” means an entity described in
42 USC 256b (a) (4) (L) to
21(N) that participates in the federal drug-pricing program under
42 USC 256b.
SB59,1030,2222
(c) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
SB59,1030,2323
(d) “Generic drug” means a prescription drug approved under
21 USC 355 (j).
SB59,1031,3
1(e) “Manufacturer” has the meaning given in s. 450.01 (12). “Manufacturer”
2does not include an entity that is engaged only in the dispensing, as defined in s.
3450.01 (7), of a brand-name drug or a generic drug.
SB59,1031,74
(f) “Manufacturer-sponsored assistance program” means a program offered by
5a manufacturer or an intermediary under contract with a manufacturer through
6which a brand-name drug or a generic drug is provided to a patient at no charge or
7at a discount.
SB59,1031,118
(g) “Margin” means, for a covered hospital, the difference between the net cost
9of a brand-name drug or generic drug covered under the federal drug-pricing
10program under
42 USC 256b and the net payment by the covered hospital for that
11brand-name drug or generic drug.
SB59,1031,1312
(h) “Net payment” means the amount paid for a brand-name drug or generic
13drug after all discounts and rebates have been applied.
SB59,1031,1414
(i) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
SB59,1031,1815
(j) “Wholesale acquisition cost” means the most recently reported
16manufacturer list or catalog price for a brand-name drug or a generic drug available
17to wholesalers or direct purchasers in the United States, before application of
18discounts, rebates, or reductions in price.
SB59,1031,24
19(2) Price increase or introduction notice; justification report. (a) A
20manufacturer shall notify the commissioner if it is increasing the wholesale
21acquisition cost of a brand-name drug on the market in this state by more than 10
22percent or by more than $10,000 during any 12-month period or if it intends to
23introduce to market in this state a brand-name drug that has an annual wholesale
24acquisition cost of $30,000 or more.
SB59,1032,4
1(b) A manufacturer shall notify the commissioner if it is increasing the
2wholesale acquisition cost of a generic drug by more than 25 percent or by more than
3$300 during any 12-month period or if it intends to introduce to market a generic
4drug that has an annual wholesale acquisition cost of $3,000 or more.
SB59,1032,105
(c) The manufacturer shall provide the notice under par. (a) or (b) in writing
6at least 30 days before the planned effective date of the cost increase or drug
7introduction with a justification that includes all documents and research related to
8the manufacturer's selection of the cost increase or introduction price and a
9description of life cycle management, market competition and context, and
10estimated value or cost-effectiveness of the product.
SB59,1032,14
11(3) Net prices paid by pharmacy benefit managers. By March 1 annually, the
12manufacturer shall report to the commissioner the value of price concessions,
13expressed as a percentage of the wholesale acquisition cost, provided to each
14pharmacy benefit manager for each drug sold in this state.
SB59,1032,19
15(4) Rebates and price concessions. By March 1 annually, each pharmacy
16benefit manager shall report to the commissioner the amount received from
17manufacturers as drug rebates and the value of price concessions, expressed as a
18percentage of the wholesale acquisition cost, provided by manufacturers for each
19drug.
SB59,1032,24
20(5) Hospital margin spending. By March 1 annually, each covered hospital
21operating in this state shall report to the commissioner the per unit margin for each
22drug covered under the federal drug pricing program under
42 USC 256b dispensed
23in the previous year multiplied by the number of units dispensed at that margin and
24how the margin revenue was used.
SB59,1033,4
1(6) Manufacturer-sponsored assistance programs. By March 1 annually,
2each manufacturer shall provide the commissioner with a description of each
3manufacturer-sponsored patient assistance program in effect during the previous
4year that includes all of the following:
SB59,1033,55
(a) The terms of the programs.
SB59,1033,66
(b) The number of prescriptions provided to state residents under the program.
SB59,1033,87
(c) The total market value of assistance provided to residents of this state under
8the program.
SB59,1033,13
9(7) Certification and penalties for noncompliance. Each manufacturer and
10covered hospital that is required to report under this section shall certify each report
11as accurate under the penalty of perjury. A manufacturer or covered hospital that
12fails to submit a report required under this section is subject to a forfeiture of no more
13than $10,000 each day the report is overdue.
SB59,1033,17
14(8) Hearing and public reporting. (a) The commissioner shall publicly post
15manufacturer price justification documents and covered hospital documentation of
16how each hospital spends the margin revenue. The commissioner shall keep any
17trade secret or proprietary information confidential.