SB70-AA3,35,88 3. Claims experience.
SB70-AA3,35,99 4. Receipt of health care.
SB70-AA3,35,1010 5. Medical history.
SB70-AA3,35,1111 6. Genetic information.
SB70-AA3,35,1312 7. Evidence of insurability, including conditions arising out of acts of domestic
13violence.
SB70-AA3,35,1414 8. Disability.
SB70-AA3,35,2115 (b) An insurer offering an individual health benefit plan or a self-insured
16health plan may not require any individual, as a condition of enrollment or continued
17enrollment under the plan, to pay, on the basis of any health status-related factor
18under par. (a) with respect to the individual or a dependent of the individual, a
19premium or contribution or a deductible, copayment, or coinsurance amount that is
20greater than the premium or contribution or deductible, copayment, or coinsurance
21amount respectively for a similarly situated individual enrolled under the plan.
SB70-AA3,35,2522 (c) Nothing in this subsection prevents an insurer offering an individual health
23benefit plan or a self-insured health plan from establishing premium discounts or
24rebates or modifying otherwise applicable cost sharing in return for adherence to
25programs of health promotion and disease prevention.
SB70-AA3,36,3
1(4) Premium rate variation. A health benefit plan offered on the individual or
2small employer market or a self-insured health plan may vary premium rates for a
3specific plan based only on the following considerations:
SB70-AA3,36,44 (a) Whether the policy or plan covers an individual or a family.
SB70-AA3,36,55 (b) Rating area in the state, as established by the commissioner.
SB70-AA3,36,86 (c) Age, except that the rate may not vary by more than 3 to 1 for adults over
7the age groups and the age bands shall be consistent with recommendations of the
8National Association of Insurance Commissioners.
SB70-AA3,36,99 (d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
SB70-AA3,36,14 10(5) Statewide risk pool. An insurer offering a health benefit plan may not
11segregate enrollees into risk pools other than a single statewide risk pool for the
12individual market and a single statewide risk pool for the small employer market or
13a single statewide risk pool that combines the individual and small employer
14markets.
SB70-AA3,36,16 15(6) Annual and lifetime limits. An individual or group health benefit plan or
16a self-insured health plan may not establish any of the following:
SB70-AA3,36,1817 (a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent
18of an enrollee under the plan.
SB70-AA3,36,2019 (b) Annual limits on the dollar value of benefits for an enrollee or a dependent
20of an enrollee under the plan.
SB70-AA3,36,24 21(7) Cost sharing maximum. A health benefit plan offered on the individual or
22small employer market may not require an enrollee under the plan to pay more in
23cost sharing than the maximum amount calculated under 42 USC 18022 (c),
24including the annual indexing of the limits.
SB70-AA3,37,3
1(8) Medical loss ratio. (a) In this subsection, “medical loss ratio” means the
2proportion, expressed as a percentage, of premium revenues spent by a health
3benefit plan on clinical services and quality improvement.
SB70-AA3,37,54 (b) A health benefit plan on the individual or small employer market shall have
5a medical loss ratio of at least 80 percent.
SB70-AA3,37,76 (c) A group health benefit plan other than one described under par. (b) shall
7have a medical loss ratio of at least 85 percent.
SB70-AA3,37,11 8(9) Actuarial values of plan tiers. Any health benefit plan offered on the
9individual or small employer market shall provide a level of coverage that is designed
10to provide benefits that are actuarially equivalent to at least 60 percent of the full
11actuarial value of the benefits provided under the plan.
SB70-AA3,12 12Section 12. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and
13amended to read:
SB70-AA3,37,2014 632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health
15benefit plan may, with respect to a participant or beneficiary under the plan, not
16impose a preexisting condition exclusion only if the exclusion relates to a condition,
17whether physical or mental, regardless of the cause of the condition, for which
18medical advice, diagnosis, care or treatment was recommended or received within
19the 6-month period ending on the participant's or beneficiary's enrollment date
20under the plan
on a participant or beneficiary under the plan.
SB70-AA3,13 21Section 13. 632.746 (1) (b) of the statutes is repealed.
SB70-AA3,14 22Section 14. 632.746 (2) (a) of the statutes is amended to read:
SB70-AA3,38,223 632.746 (2) (a) An insurer offering a group health benefit plan may not treat
24impose a preexisting condition exclusion based on genetic information as a

1preexisting condition under sub. (1) without a diagnosis of a condition related to the
2information
.
SB70-AA3,15 3Section 15. 632.746 (2) (c), (d) and (e) of the statutes are repealed.
SB70-AA3,16 4Section 16. 632.746 (3) (a) of the statutes is repealed.
SB70-AA3,17 5Section 17. 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).
SB70-AA3,18 6Section 18. 632.746 (3) (d) 2. and 3. of the statutes are repealed.
SB70-AA3,19 7Section 19. 632.746 (5) of the statutes is repealed.
SB70-AA3,20 8Section 20. 632.746 (8) (a) (intro.) of the statutes is amended to read:
SB70-AA3,38,129 632.746 (8) (a) (intro.) A health maintenance organization that offers a group
10health benefit plan and that does not impose any preexisting condition exclusion
11under sub. (1)
with respect to a particular coverage option may impose an affiliation
12period for that coverage option, but only if all of the following apply:
SB70-AA3,21 13Section 21. 632.748 (2) of the statutes is amended to read:
SB70-AA3,38,2014 632.748 (2) An insurer offering a group health benefit plan may not require any
15individual, as a condition of enrollment or continued enrollment under the plan, to
16pay, on the basis of any health status-related factor with respect to the individual
17or a dependent of the individual, a premium or contribution or a deductible,
18copayment, or coinsurance amount
that is greater than the premium or contribution
19or deductible, copayment, or coinsurance amount respectively for a similarly
20situated individual enrolled under the plan.
SB70-AA3,22 21Section 22. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to read:
SB70-AA3,39,422 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
23from the date of issue of the policy may be reduced or denied on the ground that a
24disease or physical condition existed prior to the effective date of coverage, unless the
25condition was excluded from coverage by name or specific description by a provision

1effective on the date of loss. This paragraph does not apply to a group health benefit
2plan, as defined in s. 632.745 (9), which is subject to s. 632.746 , a disability insurance
3policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s.
4632.85 (1) (c)
.
SB70-AA3,39,105 (ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability
6commencing after 12 months from the date of issue of under an individual disability
7insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the
8ground that a disease or physical condition existed prior to the effective date of
9coverage, unless the condition was excluded from coverage by name or specific
10description by a provision effective on the date of the loss
.
SB70-AA3,39,1711 2. Except as provided in subd. 3., an An individual disability insurance policy,
12as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495
13(4) and (5), may not define a preexisting condition more restrictively than a condition
14that was present before the date of enrollment for the coverage, whether physical or
15mental, regardless of the cause of the condition, for which and regardless of whether
16medical advice, diagnosis, care, or treatment was recommended or received within
1712 months before the effective date of coverage
.
SB70-AA3,23 18Section 23. 632.795 (4) (a) of the statutes is amended to read:
SB70-AA3,40,519 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the
20same policy form and for the same premium as it originally offered in the most recent
21enrollment period, subject only to the medical underwriting used in that enrollment
22period. Unless otherwise prescribed by rule, the insurer may apply deductibles,
23preexisting condition limitations, waiting periods , or other limits only to the extent
24that they would have been applicable had coverage been extended at the time of the
25most recent enrollment period and with credit for the satisfaction or partial

1satisfaction of similar provisions under the liquidated insurer's policy or plan. The
2insurer may exclude coverage of claims that are payable by a solvent insurer under
3insolvency coverage required by the commissioner or by the insurance regulator of
4another jurisdiction. Coverage shall be effective on the date that the liquidated
5insurer's coverage terminates.
SB70-AA3,24 6Section 24. 632.895 (8) (d) of the statutes is amended to read:
SB70-AA3,40,137 632.895 (8) (d) Coverage is required under this subsection despite whether the
8woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c), and
9(e), coverage under this subsection may only be subject to exclusions and limitations,
10including deductibles, copayments and restrictions on excessive charges, that are
11applied to other radiological examinations covered under the disability insurance
12policy. Coverage under this subsection may not be subject to any deductibles,
13copayments, or coinsurance.
SB70-AA3,25 14Section 25. 632.895 (13m) of the statutes is created to read:
SB70-AA3,40,1615 632.895 (13m) Preventive services. (a) In this section, “self-insured health
16plan” has the meaning given in s. 632.85 (1) (c).
SB70-AA3,40,1917 (b) Every disability insurance policy, except any disability insurance policy that
18is described in s. 632.745 (11) (b) 1. to 12., and every self-insured health plan shall
19provide coverage for all of the following preventive services:
SB70-AA3,40,2020 1. Mammography in accordance with sub. (8).
SB70-AA3,40,2221 2. Genetic breast cancer screening and counseling and preventive medication
22for adult women at high risk for breast cancer.
SB70-AA3,40,2423 3. Papanicolaou test for cancer screening for women 21 years of age or older
24with an intact cervix.
SB70-AA3,41,2
14. Human papillomavirus testing for women who have attained the age of 30
2years but have not attained the age of 66 years.
SB70-AA3,41,33 5. Colorectal cancer screening in accordance with sub. (16m).
SB70-AA3,41,64 6. Annual tomography for lung cancer screening for adults who have attained
5the age of 55 years but have not attained the age of 80 years and who have health
6histories demonstrating a risk for lung cancer.
SB70-AA3,41,87 7. Skin cancer screening for individuals who have attained the age of 10 years
8but have not attained the age of 22 years.
SB70-AA3,41,109 8. Counseling for skin cancer prevention for adults who have attained the age
10of 18 years but have not attained the age of 25 years.
SB70-AA3,41,1211 9. Abdominal aortic aneurysm screening for men who have attained the age of
1265 years but have not attained the age of 75 years and who have ever smoked.
SB70-AA3,41,1513 10. Hypertension screening for adults and blood pressure testing for adults, for
14children under the age of 3 years who are at high risk for hypertension, and for
15children 3 years of age or older.
SB70-AA3,41,1716 11. Lipid disorder screening for minors 2 years of age or older, adults 20 years
17of age or older at high risk for lipid disorders, and all men 35 years of age or older.
SB70-AA3,41,2018 12. Aspirin therapy for cardiovascular health for adults who have attained the
19age of 55 years but have not attained the age of 80 years and for men who have
20attained the age of 45 years but have not attained the age of 55 years.
SB70-AA3,41,2221 13. Behavioral counseling for cardiovascular health for adults who are
22overweight or obese and who have risk factors for cardiovascular disease.
SB70-AA3,41,2323 14. Type II diabetes screening for adults with elevated blood pressure.
SB70-AA3,41,2524 15. Depression screening for minors 11 years of age or older and for adults when
25follow-up supports are available.
SB70-AA3,42,2
116. Hepatitis B screening for minors at high risk for infection and adults at high
2risk for infection.
SB70-AA3,42,43 17. Hepatitis C screening for adults at high risk for infection and onetime
4hepatitis C screening for adults born in any year from 1945 to 1965.
SB70-AA3,42,85 18. Obesity screening and management for all minors and adults with a body
6mass index indicating obesity, counseling and behavioral interventions for obese
7minors who are 6 years of age or older, and referral for intervention for obesity for
8adults with a body mass index of 30 kilograms per square meter or higher.
SB70-AA3,42,109 19. Osteoporosis screening for all women 65 years of age or older and for women
10at high risk for osteoporosis under the age of 65 years.
SB70-AA3,42,1111 20. Immunizations in accordance with sub. (14).
SB70-AA3,42,1412 21. Anemia screening for individuals 6 months of age or older and iron
13supplements for individuals at high risk for anemia and who have attained the age
14of 6 months but have not attained the age of 12 months.
SB70-AA3,42,1615 22. Fluoride varnish for prevention of tooth decay for minors at the age of
16eruption of their primary teeth.
SB70-AA3,42,1817 23. Fluoride supplements for prevention of tooth decay for minors 6 months of
18age or older who do not have fluoride in their water source.
SB70-AA3,42,1919 24. Gonorrhea prophylaxis treatment for newborns.
SB70-AA3,42,2020 25. Health history and physical exams for prenatal visits and for minors.
SB70-AA3,42,2221 26. Length and weight measurements for newborns and height and weight
22measurements for minors.
SB70-AA3,42,2423 27. Head circumference and weight-for-length measurements for newborns
24and minors who have not attained the age of 3 years.
SB70-AA3,42,2525 28. Body mass index for minors 2 years of age or older.
SB70-AA3,43,2
129. Blood pressure measurements for minors 3 years of age or older and a blood
2pressure risk assessment at birth.
SB70-AA3,43,43 30. Risk assessment and referral for oral health issues for minors who have
4attained the age of 6 months but have not attained the age of 7 years.
SB70-AA3,43,65 31. Blood screening for newborns and minors who have not attained the age of
62 months.
SB70-AA3,43,77 32. Screening for critical congenital health defects for newborns.
SB70-AA3,43,88 33. Lead screenings in accordance with sub. (10).
SB70-AA3,43,109 34. Metabolic and hemoglobin screening and screening for phenylketonuria,
10sickle cell anemia, and congenital hypothyroidism for minors including newborns.
SB70-AA3,43,1211 35. Tuberculin skin test based on risk assessment for minors one month of age
12or older.
SB70-AA3,43,1413 36. Tobacco counseling and cessation interventions for individuals who are 5
14years of age or older.
SB70-AA3,43,1615 37. Vision and hearing screening and assessment for minors including
16newborns.
SB70-AA3,43,1817 38. Sexually transmitted infection and human immunodeficiency virus
18counseling for sexually active minors.
SB70-AA3,43,2119 39. Risk assessment for sexually transmitted infection for minors who are 10
20years of age or older and screening for sexually transmitted infection for minors who
21are 16 years of age or older.
SB70-AA3,43,2222 40. Alcohol misuse screening and counseling for minors 11 years of age or older.
SB70-AA3,43,2423 41. Autism screening for minors who have attained the age of 18 months but
24have not attained the age of 25 months.
SB70-AA3,43,2525 42. Developmental screening and surveillance for minors including newborns.
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