JPC:cjs
2023 - 2024 LEGISLATURE
June 30, 2023 - Introduced by Representatives Vining,
Drake, Andraca, Bare,
Billings, Cabrera, Clancy, Conley, Considine, Emerson, Goyke, Haywood,
Hong, J. Anderson, Jacobson, Joers, Moore Omokunde, Myers, Ohnstad,
Palmeri, Ratcliff, Shelton, Sinicki, Snodgrass, Stubbs, Shankland, Baldeh,
Subeck and Riemer, cosponsored by Senators Roys,
L. Johnson, Agard,
Hesselbein, Larson, Pfaff, Carpenter, Spreitzer, Taylor, Smith and Wirch.
Referred to Committee on Health, Aging and Long-Term Care.
AB340,1,3
1An Act to create 632.895 (14m) of the statutes;
relating to: coverage of
2maternity and newborn care under health insurance policies and plans and
3granting rule-making authority.
Analysis by the Legislative Reference Bureau
This bill requires certain health insurance policies, known in the bill as
disability insurance policies, and governmental self-insured health plans to cover
the essential health benefit of maternity and newborn care, as specified by the
commissioner of insurance by rule. The bill specifies a list of requirements that the
commissioner must follow when establishing the maternity and newborn care
benefit, including certain limitations on cost sharing. If the maternity or newborn
care benefit specified by the commissioner is also subject to its own mandated
coverage requirement under current law, the bill requires the disability insurance
policy or self-insured health plan to provide coverage under whichever requirement
provides the insured or plan participant with more comprehensive coverage.
This proposal may contain a health insurance mandate requiring a social and
financial impact report under s. 601.423, stats.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB340,1
4Section 1
. 632.895 (14m) of the statutes is created to read:
AB340,2,3
1632.895
(14m) Maternity and newborn care; essential health benefit. (a)
2In this subsection, “self-insured health plan” has the meaning given in s. 632.85 (1)
3(c).
AB340,2,84
(b) On a date specified by the commissioner, by rule, every disability insurance
5policy, except as provided in par. (g), and every self-insured health plan shall provide
6coverage for the essential health benefit of maternity and newborn care, including
7benefits, items, and services, as determined by the commissioner, by rule, subject to
8par. (c).
AB340,2,109
(c) In determining the scope of maternity and newborn care benefits for which
10coverage is required under par. (b), the commissioner shall do all of the following:
AB340,2,1511
1. Conduct a survey of employer-sponsored coverage to determine maternity
12and newborn care benefits typically covered by employers and ensure that the scope
13of benefits for which coverage is required under this subsection is equal to the scope
14of benefits covered under a typical disability insurance policy offered by an employer
15to its employees.
AB340,2,1716
2. Ensure that the maternity and newborn care benefit is provided with no or
17limited cost-sharing requirements.
AB340,2,2218
3. Require that disability insurance policies and self-insured health plans do
19not, with regards to maternity and newborn care coverage required under par. (b),
20make coverage decisions, determine reimbursement rates, establish incentive
21programs, or design benefits in ways that discriminate against individuals because
22of their disability or expected length of life.
AB340,2,2523
(d) The commissioner shall periodically update, by rule, the maternity and
24newborn care benefits under this subsection to address any gaps in access to
25coverage.
AB340,3,5
1(e) If the maternity or newborn care benefit is also subject to mandated
2coverage elsewhere under this section and the coverage requirements are not
3identical, the disability insurance policy or self-insured health plan shall provide
4coverage under whichever subsection provides the insured or plan participant with
5more comprehensive coverage of the benefit, item, or service.
AB340,3,96
(f) Nothing in this subsection or rules promulgated under this subsection
7prohibits a disability insurance policy or a self-insured health plan from providing
8benefits in excess of the essential health benefit coverage required under this
9subsection.
AB340,3,1110
(g) This subsection does not apply to any disability insurance policy that is
11described in s. 632.745 (11) (b) 1. to 12.
