AB68: Bill Text

AB68,2983 Section 2983. 632.895 (16m) (b) of the statutes is amended to read:

AB68,1576,2 632.895 (16m) (b) The coverage required under this subsection may be subject to any limitations, or exclusions , or cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan. The coverage required under this subsection may not be subject to any deductibles, copayments, or coinsurance.

AB68,2984 Section 2984. 632.895 (17) (b) 2. of the statutes is amended to read:

AB68,1576,8 632.895 (17) (b) 2. Outpatient consultations, examinations, procedures, and medical services that are necessary to prescribe, administer, maintain, or remove a contraceptive, if covered for any other drug benefits under the policy or plan sterilization procedures, and patient education and counseling for all females with reproductive capacity.

AB68,2985 Section 2985. 632.895 (17) (c) of the statutes is amended to read:

AB68,1576,24 632.895 (17) (c) Coverage under par. (b) may be subject only to the exclusions, and limitations, or cost-sharing provisions that apply generally to the coverage of outpatient health care services, preventive treatments and services, or prescription drugs and devices that is provided under the policy or self-insured health plan. A disability insurance policy or self-insured health plan may not apply a deductible or impose a copayment or coinsurance to at least one of each type of contraceptive method approved by the federal food and drug administration for which coverage is required under this subsection. The disability insurance policy or self-insured health plan may apply reasonable medical management to a method of contraception to limit coverage under this subsection that is provided without being subject to a deductible, copayment, or coinsurance to prescription drugs without a brand name. The disability insurance policy or self-insured health plan may apply a deductible or impose a copayment or coinsurance for coverage of a contraceptive that is prescribed for a medical need if the services for the medical need would otherwise be subject to a deductible, copayment, or coinsurance.

AB68,2986 Section 2986. 632.897 (11) (a) of the statutes is amended to read:

AB68,1577,9 632.897 (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.

AB68,2987 Section 2987 . Chapter 633 (title) of the statutes is amended to read:

AB68,1577,14 CHAPTER 633 EMPLOYEE BENEFIT PLAN ADMINISTRATORS AND, PRINCIPALS , and Pharmacy benefit managers

AB68,2988 Section 2988 . 633.01 (1) (intro.) and (c) of the statutes are amended to read:

AB68,1577,19 633.01 (1) (intro.) “Administrator" means a person who directly or indirectly solicits or collects premiums or charges or otherwise effects coverage or adjusts or settles claims for a an employee benefit plan, but does not include the following persons if they perform these acts under the circumstances specified for each:

AB68,1577,22 (c) A creditor on behalf of its debtor, if to obtain payment, reimbursement or other method of satisfaction from a an employee benefit plan for any part of a debt owed to the creditor by the debtor.

AB68,2989 Section 2989 . 633.01 (2r) of the statutes is created to read:

AB68,1577,24 633.01 (2r) “Enrollee” has the meaning given in s. 632.861 (1) (b).

AB68,2990 Section 2990 . 633.01 (3) of the statutes is amended to read:

AB68,1578,2 633.01 (3) “Insured employee" means an employee who is a resident of this state and who is covered under a an employee benefit plan.

AB68,2991 Section 2991 . 633.01 (4) of the statutes is renumbered 633.01 (2g) and amended to read:

AB68,1578,10 633.01 (2g) “Plan Employee benefit plan" means an insured or wholly or partially self-insured employee benefit plan which by means of direct payment, reimbursement or other arrangement provides to one or more employees who are residents of this state benefits or services that include, but are not limited to, benefits for medical, surgical or hospital care, benefits in the event of sickness, accident, disability or death, or benefits in the event of unemployment or retirement.

AB68,2992 Section 2992 . 633.01 (4g) of the statutes is created to read:

AB68,1578,13 633.01 (4g) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).

AB68,2993 Section 2993 . 633.01 (4r) of the statutes is created to read:

AB68,1578,16 633.01 (4r) “Prescription drug benefit” has the meaning given in s. 632.865 (1) (e).

AB68,2994 Section 2994 . 633.01 (5) of the statutes is amended to read:

AB68,1578,19 633.01 (5) “Principal" means a person, including an insurer, that uses the services of an administrator to provide a an employee benefit plan.

AB68,2995 Section 2995 . 633.01 (6) of the statutes is created to read:

AB68,1578,21 633.01 (6) “Self-insured health plan" has the meaning given in s. 632.85 (1) (c).

AB68,2996 Section 2996 . 633.04 (intro.) of the statutes is amended to read:

AB68,1579,2 633.04 Written agreement required. (intro.) An administrator may not administer a an employee benefit plan in the absence of a written agreement between the administrator and a principal. The administrator and principal shall each retain a copy of the written agreement for the duration of the agreement and for 5 years thereafter. The written agreement shall contain the following terms:

AB68,2997 Section 2997 . 633.05 of the statutes is amended to read:

AB68,1579,10 633.05 Payment to administrator. If a principal is an insurer, payment to the administrator of a premium or charge by or on behalf of an insured employee is payment to the insurer, but payment of a return premium or claim by the insurer to the administrator is not payment to an insured employee until the payment is received by the insured employee. This section does not limit any right of the insurer against the administrator for failure to make payments to the insurer or an insured employee.

AB68,2998 Section 2998 . 633.06 of the statutes is amended to read:

AB68,1579,16 633.06 Examination and inspection of books and records. (1) The commissioner may examine, audit or accept an audit of the books and records of an administrator or pharmacy benefit manager as provided for examination of licensees under s. 601.43 (1), (3), (4) and (5), to be conducted as provided in s. 601.44, and with costs to be paid as provided in s. 601.45.

AB68,1579,20 (2) A principal that uses an administrator may inspect the books and records of the administrator, subject to any restrictions set forth in ss. 146.81 to 146.835 and in the written agreement required under s. 633.04, for the purpose of enabling the principal to fulfill its contractual obligations to insureds insured employees.

AB68,2999 Section 2999 . 633.07 of the statutes is amended to read:

AB68,1579,24 633.07 Approval of advertising. An administrator may not use any advertising for a an employee benefit plan underwritten by an insurer unless the insurer approves the advertising in advance.

AB68,3000 Section 3000 . 633.09 (4) (b) 2. and 3. of the statutes are amended to read:

AB68,1580,2 633.09 (4) (b) 2. To a an employee benefit plan policyholder for payment to a principal, the funds belonging to the principal.

AB68,1580,3 3. To an insured employee, the funds belonging to the insured employee.

AB68,3001 Section 3001 . 633.11 of the statutes is amended to read:

AB68,1580,10 633.11 Claim adjustment compensation. If an administrator adjusts or settles claims under a an employee benefit plan, the commission, fees or charges that the principal pays the administrator may not be based on the employee benefit plan's loss experience. This section does not prohibit compensation based on the number or amount of premiums or charges collected, or the number or amount of claims paid or processed by the administrator.

AB68,3002 Section 3002 . 633.12 (1) (intro.), (b) and (c) of the statutes are amended to read:

AB68,1580,17 633.12 (1) (intro.) An administrator shall prepare sufficient copies of a written notice approved in advance by the principal for distribution to all insureds insured employees of the principal and either shall distribute the copies to the insureds insured employees or shall provide the copies to the principal for distribution to the insureds insured employees. The written notice shall contain all of the following:

AB68,1580,19 (b) An explanation of the respective rights and responsibilities of the administrator, the principal and the insureds insured employees.

AB68,1580,21 (c) A statement of the extent to which the employee benefit plan is insured or self-insured, and an explanation of the terms “insured" and “self-insured".

AB68,3003 Section 3003 . 633.13 (1) and (3) of the statutes are amended to read:

AB68,1581,2 633.13 (1) General. Except as provided in sub. (2), a person may not perform, offer to perform or advertise any service as an administrator or a pharmacy benefit manager unless the person has obtained a license under s. 633.14. A pharmacy benefit manager that also performs services as an administrator need only obtain an administrator license under s. 633.14.

AB68,1581,7 (3) Responsibilities of principal. A principal may not use the services of an administrator unless the administrator furnishes proof of licensure under s. 633.14 or exemption under sub. (2). An insurer or a self-insured health plan may not use the services of a pharmacy benefit manager unless the pharmacy benefit manager furnishes proof of licensure under s. 633.14.

AB68,3004 Section 3004 . 633.14 (2) (intro.) and (c) 1. and 3. and (3) of the statutes are amended to read:

AB68,1581,12 633.14 (2) (intro.) The commissioner shall issue a license to act as an administrator or pharmacy benefit manager to a corporation, limited liability company or partnership that does all of the following:

AB68,1581,16 (c) 1. That the corporation, limited liability company or partnership intends in good faith to act as an administrator or pharmacy benefit manager through individuals designated under subd. 3. in compliance with applicable laws of this state and rules and orders of the commissioner.

AB68,1581,21 3. That for each employee benefit plan or prescription drug benefit to be administered, the corporation, limited liability company or partnership has designated or will designate an individual in the corporation, limited liability company or partnership to directly administer the employee benefit plan or prescription drug benefit.

AB68,1581,25 (3) The commissioner shall promulgate rules establishing the specifications that a bond supplied by an administrator or pharmacy benefit manager under sub. (1) (b) or (2) (b) must satisfy to guarantee faithful performance of the administrator or pharmacy benefit manager.

AB68,3005 Section 3005. 633.15 (1) (a), (1m), and (2) (a) 1., 2. and 3. and (b) 1. of the statutes are amended to read:

AB68,1582,5 633.15 (1) (a) Payment. An administrator or pharmacy benefit manager shall pay the annual renewal fee under s. 601.31 (1) (w) for each annual renewal of a license by the date specified by a schedule established under par. (b).

AB68,1582,17 (1m) Social security number, federal employer identification number or statement. At an annual renewal, an administrator or pharmacy benefit manager shall provide his or her social security number, if the administrator is an individual unless he or she does not have a social security number, or its federal employer identification number, if the administrator or pharmacy benefit manager is a corporation, limited liability company or partnership, if the social security number or federal employer identification number was not previously provided on the application for the license or at a previous renewal of the license. If an administrator who is an individual does not have a social security number, the individual shall provide to the commissioner, at each annual renewal and on a form prescribed by the department of children and families, a statement made or subscribed under oath or affirmation that the administrator does not have a social security number.

AB68,1582,25 (2) (a) 1. If an administrator or pharmacy benefit manager fails to pay the annual renewal fee as provided under sub. (1) or fails to provide a social security number, federal employer identification number or statement made or subscribed under oath or affirmation as required under sub. (1m), the commissioner shall suspend the administrator's or pharmacy benefit manager's license effective the day following the last day when the annual renewal fee may be paid, if the commissioner has given the administrator or pharmacy benefit manager reasonable notice of when the fee must be paid to avoid suspension.

AB68,1583,6 2. If, within 60 days from the effective date of suspension under subd. 1., an administrator or pharmacy benefit manager pays the annual renewal fee or provides the social security number, federal employer identification number or statement made or subscribed under oath or affirmation, or both if the suspension was based upon a failure to do both, the commissioner shall reinstate the administrator's or pharmacy benefit manager's license effective as of the date of suspension.

AB68,1583,11 3. If payment is not made or the social security number, federal employer identification number or statement made or subscribed under oath or affirmation is not provided within 60 days from the effective date of suspension under subd. 1., the commissioner shall revoke the administrator's or pharmacy benefit manager's license.

AB68,1583,14 (b) 1. Except as provided in pars. (c) to (e), the commissioner may revoke, suspend or limit the license of an administrator or pharmacy benefit manager after a hearing if the commissioner makes any of the following findings:

AB68,1583,16 a. That the administrator or pharmacy benefit manager is unqualified to perform the responsibilities of an administrator or pharmacy benefit manager.

AB68,1583,18 b. That the administrator or pharmacy benefit manager has repeatedly or knowingly violated an applicable law, rule or order of the commissioner.

AB68,1583,23 c. That If the licensee is an administrator, that the administrator's methods or practices in administering a an employee benefit plan endanger the interests of insureds insured employees or the public, or that the financial resources of the administrator are inadequate to safeguard the interests of insureds insured employees or the public.

AB68,3006 Section 3006 . 633.15 (2) (b) 1. d. of the statutes is created to read:

AB68,1584,5 633.15 (2) (b) 1. d. If the licensee is a pharmacy benefit manager, that the pharmacy benefit manager's methods or practices in administering a prescription drug benefit endanger the interests of enrollees or the public, or that the financial resources of the pharmacy benefit manager are inadequate to safeguard the interests of enrollees or the public.

AB68,3007 Section 3007 . 633.15 (2) (b) 2. of the statutes is amended to read:

AB68,1584,10 633.15 (2) (b) 2. A person whose license has been revoked under subd. 1. may apply for a new license under s. 633.14 only after the expiration of 5 years from the date of the order revoking the administrator's or pharmacy benefit manager's license, unless the order specifies a lesser period.

AB68,3008 Section 3008 . 633.15 (2) (f) of the statutes is created to read:

AB68,1584,15 633.15 (2) (f) The commissioner, after ordering a suspension or revocation under this subsection, may allow a pharmacy benefit manager to continue to provide services for the purpose of providing continuity of care in prescription drug benefits to existing enrollees.

AB68,3009 Section 3009 . 633.16 of the statutes is amended to read:

AB68,1584,19 633.16 Regulation. Nothing in this chapter gives the commissioner the authority to impose requirements on a an employee benefit plan that is exempt from state law under 29 USC 1144 (b).

AB68,3010 Section 3010 . 700.19 (2) of the statutes is amended to read:

AB68,1585,3 700.19 (2) Husband and wife Spouses. If persons named as owners in a document of title, transferees in an instrument of transfer, or buyers in a bill of sale are described in the document, instrument, or bill of sale as husband and wife married to each other, or are in fact husband and wife married to each other, they are joint tenants, unless the intent to create a tenancy in common is expressed in the document, instrument, or bill of sale. This subsection applies to property acquired before January 1, 1986, and, if ch. 766 does not apply when the property is acquired, to property acquired on or after January 1, 1986.

AB68,3011 Section 3011. 704.07 (2) (bm) 1. of the statutes is repealed.

AB68,3012 Section 3012. 704.07 (2) (bm) 3. of the statutes is amended to read:

AB68,1585,7 704.07 (2) (bm) 3. The violation presents a significant threat to the prospective tenant's health or safety.

AB68,3013 Section 3013. 704.17 (3m) of the statutes is repealed.

AB68,3014 Section 3014. 704.17 (5) (a) of the statutes is renumbered 704.17 (5) and amended to read:

AB68,1585,13 704.17 (5) Contrary provision in the lease. Except as provided in par. (b), provisions Provisions in the lease or rental agreement for termination contrary to this section are invalid except in leases for more than one year.

AB68,3015 Section 3015. 704.17 (5) (b) of the statutes is repealed.

AB68,3016 Section 3016. 704.19 (2) (b) 2. of the statutes is amended to read:

AB68,1585,20 704.19 (2) (b) 2. Notwithstanding subd. 1., nothing in this section prevents termination of a tenancy before the end of a rental period because of an imminent threat of serious physical harm, as provided in s. 704.16, or for criminal activity or drug-related criminal activity, nonpayment of rent, or breach of any other condition of the tenancy, as provided in s. 704.17.

AB68,3017 Section 3017 . 705.01 (4) of the statutes is amended to read:

AB68,1586,2 705.01 (4) “Joint account" means an account, other than a marital account, payable on request to one or more of 2 or more parties whether or not mention is made of any right of survivorship. “Joint account" also means any account established with the right of survivorship on or after January 1, 1986, by 2 parties who claim to be husband and wife married to each other, which is payable on request to either or both of the parties.

AB68,3018 Section 3018 . 705.01 (4m) of the statutes is amended to read:

AB68,1586,9 705.01 (4m) “Marital account" means an account established without the right of survivorship on or after January 1, 1986, by 2 parties who claim to be husband and wife married to each other, which is payable on request to either or both of the parties and which is designated as a marital account. An account established by those parties with the right of survivorship under s. 766.58 (3) (f) or 766.60 is a joint account.

AB68,3019 Section 3019 . 706.09 (1) (e) of the statutes is amended to read:

AB68,1586,17 706.09 (1) (e) Marital interests. Homestead of the spouse of any transferor of an interest in real estate, if the recorded conveyance purporting to transfer the homestead states that the person executing it is single, unmarried , or widowed a surviving spouse or fails to indicate the marital status of the transferor, and if the conveyance has, in either case, appeared of record for 5 years. This paragraph does not apply to the interest of a married person who is described of record as a holder in joint tenancy or of marital property with that transferor.

AB68,3020 Section 3020. 753.06 (4) (a) of the statutes is amended to read: