SB70,1590,1716 (c) A group health benefit plan other than one described under par. (b) shall
17have a medical loss ratio of at least 85 percent.
SB70,1590,21 18(9) Actuarial values of plan tiers. Any health benefit plan offered on the
19individual or small employer market shall provide a level of coverage that is designed
20to provide benefits that are actuarially equivalent to at least 60 percent of the full
21actuarial value of the benefits provided under the plan.
SB70,3069 22Section 3069 . 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and
23amended to read:
SB70,1591,524 632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health
25benefit plan may, with respect to a participant or beneficiary under the plan, not

1impose a preexisting condition exclusion only if the exclusion relates to a condition,
2whether physical or mental, regardless of the cause of the condition, for which
3medical advice, diagnosis, care or treatment was recommended or received within
4the 6-month period ending on the participant's or beneficiary's enrollment date
5under the plan
on a participant or beneficiary under the plan.
SB70,3070 6Section 3070 . 632.746 (1) (b) of the statutes is repealed.
SB70,3071 7Section 3071 . 632.746 (2) (a) of the statutes is amended to read:
SB70,1591,118 632.746 (2) (a) An insurer offering a group health benefit plan may not treat
9impose a preexisting condition exclusion based on genetic information as a
10preexisting condition under sub. (1) without a diagnosis of a condition related to the
11information
.
SB70,3072 12Section 3072 . 632.746 (2) (c), (d) and (e) of the statutes are repealed.
SB70,3073 13Section 3073 . 632.746 (3) (a) of the statutes is repealed.
SB70,3074 14Section 3074 . 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).
SB70,3075 15Section 3075 . 632.746 (3) (d) 2. and 3. of the statutes are repealed.
SB70,3076 16Section 3076 . 632.746 (5) of the statutes is repealed.
SB70,3077 17Section 3077 . 632.746 (8) (a) (intro.) of the statutes is amended to read:
SB70,1591,2118 632.746 (8) (a) (intro.) A health maintenance organization that offers a group
19health benefit plan and that does not impose any preexisting condition exclusion
20under sub. (1)
with respect to a particular coverage option may impose an affiliation
21period for that coverage option, but only if all of the following apply:
SB70,3078 22Section 3078 . 632.748 (2) of the statutes is amended to read:
SB70,1592,423 632.748 (2) An insurer offering a group health benefit plan may not require any
24individual, as a condition of enrollment or continued enrollment under the plan, to
25pay, on the basis of any health status-related factor with respect to the individual

1or a dependent of the individual, a premium or contribution or a deductible,
2copayment, or coinsurance amount
that is greater than the premium or contribution
3or deductible, copayment, or coinsurance amount respectively for a similarly
4situated individual enrolled under the plan.
SB70,3079 5Section 3079. 632.7495 (4) (b) of the statutes is amended to read:
SB70,1592,66 632.7495 (4) (b) The coverage has a term of not more than 12 3 months.
SB70,3080 7Section 3080. 632.7495 (4) (c) of the statutes is amended to read:
SB70,1592,128 632.7495 (4) (c) The coverage term aggregated with all consecutive periods of
9the insurer's coverage of the insured by individual health benefit plan coverage not
10required to be renewed under this subsection does not exceed 18 6 months. For
11purposes of this paragraph, coverage periods are consecutive if there are no more
12than 63 days between the coverage periods.
SB70,3081 13Section 3081 . 632.7496 of the statutes is created to read:
SB70,1592,16 14632.7496 Coverage requirements for short-term plans. (1) Definition.
15In this section, “short-term, limited duration plan” means an individual health
16benefit plan described in s. 632.7495 (4).
SB70,1592,19 17(2) Guaranteed issue. An insurer that offers a short-term, limited duration
18plan shall accept every individual in this state who applies for coverage regardless
19of whether the individual has a preexisting condition.
SB70,1592,25 20(3) Prohibiting discrimination based on health status. (a) An insurer that
21offers a short-term, limited duration plan may not establish rules for the eligibility
22of any individual to enroll, or for the continued eligibility of any individual to remain
23enrolled, under a short-term, limited duration plan based on any of the following
24health status-related factors with respect to the individual or a dependent of the
25individual:
SB70,1593,1
11. Health status.
SB70,1593,22 2. Medical condition, including both physical and mental illnesses.
SB70,1593,33 3. Claims experience.
SB70,1593,44 4. Receipt of health care.
SB70,1593,55 5. Medical history.
SB70,1593,66 6. Genetic information.
SB70,1593,87 7. Evidence of insurability, including conditions arising out of acts of domestic
8violence.
SB70,1593,99 8. Disability.
SB70,1593,1710 (b) An insurer that offers a short-term, limited duration plan may not require
11any individual, as a condition of enrollment or continued enrollment under the
12short-term, limited duration plan, to pay, on the basis of any health status-related
13factor described under par. (a) with respect to the individual or a dependent of the
14individual, a premium or contribution or a deductible, copayment, or coinsurance
15amount that is greater than the premium or contribution or deductible, copayment,
16or coinsurance amount respectively for a similarly situated individual enrolled
17under the short-term, limited duration plan.
SB70,1593,20 18(4) Premium rate variation. An insurer that offers a short-term, limited
19duration plan may vary premium rates for a specific short-term, limited duration
20plan based only on the following considerations:
SB70,1593,2221 (a) Whether the short-term, limited duration plan covers an individual or a
22family.
SB70,1593,2323 (b) Rating area in the state, as established by the commissioner.
SB70,1594,3
1(c) Age, except that the rate may not vary by more than 3 to 1 for adults over
2the age groups and the age bands shall be consistent with recommendations of the
3National Association of Insurance Commissioners.
SB70,1594,44 (d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
SB70,1594,6 5(5) Annual and lifetime limits. A short-term, limited duration plan may not
6establish any of the following:
SB70,1594,87 (a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent
8of an enrollee under the short-term, limited duration plan.
SB70,1594,119 (b) Limits on the dollar value of benefits for an enrollee or a dependent of an
10enrollee under the short-term, limited duration plan for a term of coverage or for the
11aggregate duration of the short-term, limited duration plan.
SB70,3082 12Section 3082 . 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to
13read:
SB70,1594,2114 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
15from the date of issue of the policy may be reduced or denied on the ground that a
16disease or physical condition existed prior to the effective date of coverage, unless the
17condition was excluded from coverage by name or specific description by a provision
18effective on the date of loss. This paragraph does not apply to a group health benefit
19plan, as defined in s. 632.745 (9), which is subject to s. 632.746 , a disability insurance
20policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s.
21632.85 (1) (c)
.
SB70,1595,222 (ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability
23commencing after 12 months from the date of issue of under an individual disability
24insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the
25ground 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
.
SB70,1595,93 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
.
SB70,3083 10Section 3083. 632.76 (2) (ac) 3. (intro.) of the statutes is amended to read:
SB70,1595,1311 632.76 (2) (ac) 3. (intro.) Except as the commissioner provides by rule under
12s. 632.7495 (5), all of the following apply to an individual disability insurance policy
13that is a short-term policy, limited duration plan subject to s. 632.7495 (4) and (5):
SB70,3084 14Section 3084. 632.76 (2) (ac) 3. b. of the statutes is amended to read:
SB70,1595,2015 632.76 (2) (ac) 3. b. The policy shall reduce the length of time during which a
16may not impose any preexisting condition exclusion may be imposed by the
17aggregate of the insured's consecutive periods of coverage under the insurer's
18individual disability insurance policies that are short-term policies subject to s.
19632.7495 (4) and (5). For purposes of this subd. 3. b., coverage periods are consecutive
20if there are no more than 63 days between the coverage periods
.
SB70,3085 21Section 3085 . 632.795 (4) (a) of the statutes is amended to read:
SB70,1596,822 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the
23same policy form and for the same premium as it originally offered in the most recent
24enrollment period, subject only to the medical underwriting used in that enrollment
25period. Unless otherwise prescribed by rule, the insurer may apply deductibles,

1preexisting condition limitations, waiting periods, or other limits only to the extent
2that they would have been applicable had coverage been extended at the time of the
3most recent enrollment period and with credit for the satisfaction or partial
4satisfaction of similar provisions under the liquidated insurer's policy or plan. The
5insurer may exclude coverage of claims that are payable by a solvent insurer under
6insolvency coverage required by the commissioner or by the insurance regulator of
7another jurisdiction. Coverage shall be effective on the date that the liquidated
8insurer's coverage terminates.
SB70,3086 9Section 3086. 632.862 of the statutes is created to read:
SB70,1596,11 10632.862 Application of prescription drug payments. (1) Definitions. In
11this section:
SB70,1596,1212 (a) “Brand name” has the meaning given in s. 450.12 (1) (a).
SB70,1596,1313 (b) “Brand name drug” means any of the following:
SB70,1596,1514 1. A prescription drug that contains a brand name and that has no generic
15equivalent.
SB70,1596,2016 2. A prescription drug that contains a brand name and has a generic equivalent
17but for which the enrollee has received prior authorization from the insurer offering
18the disability insurance policy or self-insured health plan or authorization from a
19physician to obtain the prescription drug under the disability insurance policy or
20self-insured health plan.
SB70,1596,2121 (c) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
SB70,1596,2222 (d) “Prescription drug” has the meaning given in s. 450.01 (20).
SB70,1596,2423 (e) “Self-insured health plan” means a self-insured health plan of the state or
24a county, city, village, town, or school district.
SB70,1597,6
1(2) Application of discounts. A disability insurance policy that offers a
2prescription drug benefit or a self-insured health plan shall apply to any calculation
3of an out-of-pocket maximum amount and to any deductible of the disability
4insurance policy or self-insured health plan for an enrollee the amount that any
5discount provided by the manufacturer of a brand name drug reduces the cost
6sharing amount charged to the enrollee for that brand name drug.
SB70,3087 7Section 3087. 632.863 of the statutes is created to read:
SB70,1597,8 8632.863 Pharmaceutical representatives. (1) Definitions. In this section:
SB70,1597,119 (a) “Health care professional” means a physician or other health care
10practitioner who is licensed to provide health care services or to prescribe
11pharmaceutical or biologic products.
SB70,1597,1312 (b) “Pharmaceutical” means a medication that may legally be dispensed only
13with a valid prescription from a health care professional.
SB70,1597,1614 (c) “Pharmaceutical representative” means an individual who markets or
15promotes pharmaceuticals to health care professionals on behalf of a pharmaceutical
16manufacturer for compensation.
SB70,1597,23 17(2) Licensure. Beginning on the first day of the 12th month beginning after
18the effective date of this subsection .... [LRB inserts date], no individual may act as
19a pharmaceutical representative in this state without being licensed by the
20commissioner as a pharmaceutical representative under this section. In order to
21obtain a license, the individual shall apply to the commissioner in the form and
22manner prescribed by the commissioner. The term of a license issued under this
23subsection is one year and is renewable.
SB70,1598,3
1(3) Display of license. A pharmaceutical representative licensed under sub.
2(2) shall display the pharmaceutical representative's license during each visit with
3a health care professional.
SB70,1598,6 4(4) Enforcement. (a) Any individual who violates this section shall be fined
5not less than $1,000 nor more than $3,000 for each offense. Each day of continued
6violation constitutes a separate offense.
SB70,1598,107 (b) The commissioner may suspend or revoke the license of a pharmaceutical
8representative who violates this section. A suspended or revoked license may not be
9reinstated until the pharmaceutical representative remedies all violations related
10to the suspension or revocation and pays all assessed penalties and fees.
SB70,1598,13 11(5) Rules. The commissioner shall promulgate rules to implement this section,
12including rules that require pharmaceutical representatives to complete continuing
13educational coursework as a condition of licensure.
SB70,3088 14Section 3088. 632.864 of the statutes is created to read:
SB70,1598,16 15632.864 Pharmacy services administrative organizations. (1)
16Definitions. In this section:
SB70,1598,1717 (a) “Administrative service” means any of the following:
SB70,1598,1818 1. Assisting with claims.
SB70,1598,1919 2. Assisting with audits.
SB70,1598,2020 3. Providing centralized payment.
SB70,1598,2121 4. Performing certification in a specialized care program.
SB70,1598,2222 5. Providing compliance support.
SB70,1598,2323 6. Setting flat fees for generic drugs.
SB70,1598,2424 7. Assisting with store layout.
SB70,1598,2525 8. Managing inventory.
SB70,1599,1
19. Providing marketing support.
SB70,1599,22 10. Providing management and analysis of payment and drug dispensing data.
SB70,1599,33 11. Providing resources for retail cash cards.
SB70,1599,64 (b) “Independent pharmacy" means a pharmacy operating in this state that is
5licensed under s. 450.06 or 450.065 and is under common ownership with no more
6than 2 other pharmacies.
SB70,1599,77 (c) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
SB70,1599,98 (d) “Pharmacy services administrative organization” means an entity
9operating in this state that does all of the following:
SB70,1599,1110 1. Contracts with an independent pharmacy to conduct business on the
11independent pharmacy's behalf with a 3rd-party payer.
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