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.
SB70-AA3,44,1
143. Psychosocial and behavioral assessment for minors including newborns.
SB70-AA3,44,32 44. Alcohol misuse screening and counseling for pregnant adults and a risk
3assessment for all adults.
SB70-AA3,44,54 45. Fall prevention and counseling and preventive medication for fall
5prevention for community-dwelling adults 65 years of age or older.
SB70-AA3,44,66 46. Screening and counseling for intimate partner violence for adult women.
SB70-AA3,44,97 47. Well-woman visits for women who have attained the age of 18 years but
8have not attained the age of 65 years and well-woman visits for recommended
9preventive services, preconception care, and prenatal care.
SB70-AA3,44,1110 48. Counseling on, consultations with a trained provider on, and equipment
11rental for breastfeeding for pregnant and lactating women.
SB70-AA3,44,1212 49. Folic acid supplement for adult women with reproductive capacity.
SB70-AA3,44,1313 50. Iron deficiency anemia screening for pregnant and lactating women.
SB70-AA3,44,1514 51. Preeclampsia preventive medicine for pregnant adult women at high risk
15for preeclampsia.
SB70-AA3,44,1716 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high
17risk for miscarriage, preeclampsia, or clotting disorders.
SB70-AA3,44,1818 53. Screenings for hepatitis B and bacteriuria for pregnant women.
SB70-AA3,44,2019 54. Screening for gonorrhea for pregnant and sexually active females 24 years
20of age or younger and females older than 24 years of age who are at risk for infection.
SB70-AA3,44,2321 55. Screening for chlamydia for pregnant and sexually active females 24 years
22of age and younger and females older than 24 years of age who are at risk for
23infection.
SB70-AA3,44,2524 56. Screening for syphilis for pregnant women and adults who are at high risk
25for infection.
SB70-AA3,45,3
157. Human immunodeficiency virus screening for adults who have attained the
2age of 15 years but have not attained the age of 66 years and individuals at high risk
3of infection who are younger than 15 years of age or older than 65 years of age.
SB70-AA3,45,44 58. All contraceptives and services in accordance with sub. (17).
SB70-AA3,45,65 59. Any services not already specified under this paragraph having an A or B
6rating in current recommendations from the U.S. preventive services task force.
SB70-AA3,45,97 60. Any preventive services not already specified under this paragraph that are
8recommended by the federal health resources and services administration's Bright
9Futures project.
SB70-AA3,45,1210 61. Any immunizations, not already specified under sub. (14), that are
11recommended and determined to be for routine use by the federal advisory
12committee on immunization practices.
SB70-AA3,45,1513 (c) Subject to par. (d), no disability insurance policy and no self-insured health
14plan may subject the coverage of any of the preventive services under par. (b) to any
15deductibles, copayments, or coinsurance under the policy or plan.
SB70-AA3,45,1916 (d) 1. If an office visit and a preventive service specified under par. (b) are billed
17separately by the health care provider, the disability insurance policy or self-insured
18health plan may apply deductibles to and impose copayments or coinsurance on the
19office visit but not on the preventive service.
SB70-AA3,45,2220 2. If the primary reason for an office visit is not to obtain a preventive service,
21the disability insurance policy or self-insured health plan may apply deductibles to
22and impose copayments or coinsurance on the office visit.
SB70-AA3,46,723 3. Except as otherwise provided in this subdivision, if a preventive service
24specified under par. (b) is provided by a health care provider that is outside the
25disability insurance policy's or self-insured health plan's network of providers, the

1policy or plan may apply deductibles to and impose copayments or coinsurance on the
2office visit and the preventive service. If a preventive service specified under par. (b)
3is provided by a health care provider that is outside the disability insurance policy's
4or self-insured health plan's network of providers because there is no available
5health care provider in the policy's or plan's network of providers that provides the
6preventive service, the policy or plan may not apply deductibles to or impose
7copayments or coinsurance on the preventive service.
SB70-AA3,46,128 4. If multiple well-woman visits described under par. (b) 47. are required to
9fulfill all necessary preventive services and are in accordance with clinical
10recommendations, the disability insurance policy or self-insured health plan may
11not apply a deductible to or impose a copayment or coinsurance on any of those
12well-woman visits.
SB70-AA3,26 13Section 26. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:
SB70-AA3,46,1414 632.895 (14) (a) 1. i. Hepatitis A and B.
SB70-AA3,46,1515 j. Varicella and herpes zoster.
SB70-AA3,27 16Section 27. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:
SB70-AA3,46,1717 632.895 (14) (a) 1. k. Human papillomavirus.
SB70-AA3,46,1818 L. Meningococcal meningitis.
SB70-AA3,46,1919 m. Pneumococcal pneumonia.
SB70-AA3,46,2020 n. Influenza.
SB70-AA3,46,2121 o. Rotavirus.
SB70-AA3,28 22Section 28. 632.895 (14) (b) of the statutes is amended to read:
SB70-AA3,47,323 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy,
24and every self-insured health plan of the state or a county, city, town, village, or
25school district, that provides coverage for a dependent of the insured shall provide

1coverage of appropriate and necessary immunizations, from birth to the age of 6
2years,
for an insured or plan participant, including a dependent who is a child of the
3insured or plan participant.
SB70-AA3,29 4Section 29. 632.895 (14) (c) of the statutes is amended to read:
SB70-AA3,47,95 632.895 (14) (c) The coverage required under par. (b) may not be subject to any
6deductibles, copayments, or coinsurance under the policy or plan. This paragraph
7applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to
8appropriate and necessary immunizations provided by providers participating, as
9defined in s. 609.01 (3m), in the plan.
SB70-AA3,30 10Section 30. 632.895 (14) (d) 3. of the statutes is amended to read:
SB70-AA3,47,1311 632.895 (14) (d) 3. A health care plan offered by a limited service health
12organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined
13in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b)
.
SB70-AA3,31 14Section 31. 632.895 (14m) of the statutes is created to read:
SB70-AA3,47,1615 632.895 (14m) Essential health benefits. (a) In this subsection,
16“self-insured health plan” has the meaning given in s. 632.85 (1) (c).
SB70-AA3,47,2017 (b) On a date specified by the commissioner, by rule, every disability insurance
18policy, except as provided in par. (g), and every self-insured health plan shall provide
19coverage for essential health benefits as determined by the commissioner, by rule,
20subject to par. (c).
SB70-AA3,47,2221 (c) In determining the essential health benefits for which coverage is required
22under par. (b), the commissioner shall do all of the following:
SB70-AA3,47,2423 1. Include benefits, items, and services in, at least, all of the following
24categories:
SB70-AA3,47,2525 a. Ambulatory patient services.
SB70-AA3,48,1
1b. Emergency services.
SB70-AA3,48,22 c. Hospitalization.
SB70-AA3,48,33 d. Maternity and newborn care.
SB70-AA3,48,54 e. Mental health and substance use disorder services, including behavioral
5health treatment.
SB70-AA3,48,66 f. Prescription drugs.
SB70-AA3,48,77 g. Rehabilitative and habilitative services and devices.
SB70-AA3,48,88 h. Laboratory services.
SB70-AA3,48,99 i. Preventive and wellness services and chronic disease management.
SB70-AA3,48,1010 j. Pediatric services, including oral and vision care.
SB70-AA3,48,1511 2. Conduct a survey of employer-sponsored coverage to determine benefits
12typically covered by employers and ensure that the scope of essential health benefits
13for which coverage is required under this subsection is equal to the scope of benefits
14covered under a typical disability insurance policy offered by an employer to its
15employees.
SB70-AA3,48,1716 3. Ensure that essential health benefits reflect a balance among the categories
17described in subd. 1. such that benefits are not unduly weighted toward one category.
SB70-AA3,48,1918 4. Ensure that essential health benefit coverage is provided with no or limited
19cost-sharing requirements.
SB70-AA3,48,2320 5. Require that disability insurance policies and self-insured health plans do
21not make coverage decisions, determine reimbursement rates, establish incentive
22programs, or design benefits in ways that discriminate against individuals because
23of their age, disability, or expected length of life.
SB70-AA3,49,3
16. Establish essential health benefits in a way that takes into account the
2health care needs of diverse segments of the population, including women, children,
3persons with disabilities, and other groups.
SB70-AA3,49,74 7. Ensure that essential health benefits established under this subsection are
5not subject to a coverage denial based on an insured's or plan participant's age,
6expected length of life, present or predicted disability, degree of dependency on
7medical care, or quality of life.
SB70-AA3,49,148 8. Require that disability insurance policies and self-insured health plans
9cover emergency department services that are essential health benefits without
10imposing any requirement to obtain prior authorization for those services and
11without limiting coverage for services provided by an emergency services provider
12that is not in the provider network of a policy or plan in a way that is more restrictive
13than requirements or limitations that apply to emergency services provided by a
14provider that is in the provider network of the policy or plan.
SB70-AA3,49,1915 9. Require a disability insurance policy or self-insured health plan to apply to
16emergency department services that are essential health benefits provided by an
17emergency department provider that is not in the provider network of the policy or
18plan the same copayment amount or coinsurance rate that applies if those services
19are provided by a provider that is in the provider network of the policy or plan.
SB70-AA3,49,2120 (d) The commissioner shall periodically update, by rule, the essential health
21benefits under this subsection to address any gaps in access to coverage.
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