613.03 (4) Mandatory health insurance risk-sharing plan. Service insurance corporations organized or operating under this chapter are subject to ch. 149.
27,4810
Section 4810
. 614.05 (1) of the statutes is amended to read:
614.05 (1) Chapters 611
and 619. No section of ch. 611 or subch. I of ch. 619 applies to fraternals unless it is specifically made applicable by this chapter.
27,4811
Section 4811
. Subchapter I of chapter 619 [precedes 619.001] of the statutes is renumbered chapter 619 [precedes 619.001].
27,4812
Section 4812
. Subchapter I (title) of chapter 619 [precedes 619.01] of the statutes is repealed.
27,4813
Section 4813
. Subchapter II (title) of chapter 619 [precedes 619.10] of the statutes is repealed.
27,4814
Section 4814
. 619.10 (intro.) of the statutes is renumbered 149.10 (intro.) and amended to read:
149.10 Definitions. (intro.) In this subchapter chapter:
27,4815
Section 4815
. 619.10 (1) of the statutes is repealed.
27,4816
Section 4816
. 619.10 (1m) of the statutes is repealed.
27,4817
Section 4817
. 619.10 (2) of the statutes is renumbered 149.10 (2) and amended to read:
149.10 (2) “Board" means the board of governors established under s. 619.15 149.15.
27,4817b
Section 4817b. 619.10 (2c) of the statutes is created to read:
619.10 (2c) “Church plan" has the meaning given in section 3 (33) of the federal Employee Retirement Income Security Act of 1974.
27,4817bm
Section 4817bm. 619.10 (2c) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (2c).
27,4817c
Section 4817c. 619.10 (2j) of the statutes is created to read:
619.10 (2j) (a) Except as provided in par. (b), “creditable coverage" means coverage under any of the following:
1. A group health plan.
2. Health insurance.
3. Part A or part B of title XVIII of the federal Social Security Act.
4. Title XIX of the federal Social Security Act, except for coverage consisting solely of benefits under section 1928 of that act.
5. Chapter 55 of title 10 of the United States Code.
6. A medical care program of the federal Indian health service or of an American Indian tribal organization.
7. A state health benefits risk pool.
8. A health plan offered under chapter 89 of title 5 of the United States Code.
9. A public health plan.
10. A health coverage plan under section 5 (e) of the federal Peace Corps Act, 22 USC 2504 (e).
(b) “Creditable coverage" does not include coverage consisting solely of coverage of excepted benefits, as defined in section 2791 (c) of P.L. 104-191.
27,4817cm
Section 4817cm. 619.10 (2j) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (2j).
27,4817m
Section 4817m. 619.10 (2t) of the statutes is created to read:
619.10 (2t) “Eligible individual" means an individual for whom all of the following apply:
(a) The aggregate of the individual's periods of creditable coverage is 18 months or more.
(b) The individual's most recent period of creditable coverage was under a group health plan, governmental plan, federal governmental plan or church plan, or under any health insurance offered in connection with any of those plans.
(c) The individual does not have creditable coverage and is not eligible for coverage under a group health plan, part A or part B of title XVIII of the federal Social Security Act or a state plan under title XIX of the federal Social Security Act or any successor program.
(d) The individual's most recent period of creditable coverage was not terminated for any reason related to fraud or intentional misrepresentation of material fact or a failure to pay premiums.
(e) If the individual was offered the option of continuation coverage under a federal continuation provision or similar state program, the individual elected the continuation coverage.
(f) The individual has exhausted any continuation coverage under par. (e).
27,4817mm
Section 4817mm. 619.10 (2t) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (2t).
27,4818
Section 4818
. 619.10 (3) of the statutes is renumbered 149.10 (3) and amended to read:
149.10 (3) “Eligible person" means a resident of this state who qualifies under s. 619.12 149.12 whether or not the person is legally responsible for the payment of medical expenses incurred on the person's behalf.
27,4818c
Section 4818c. 619.10 (3c) of the statutes is created to read:
619.10 (3c) “Federal continuation provision" means any of the following:
(a) Section 4980B of the Internal Revenue Code of 1986, except for section 4980B (f) (1) of that code insofar as it relates to pediatric vaccines.
(b) Part 6 of subtitle B of title I of the federal Employee Retirement Income Security Act of 1974, except for section 609 of that act.
(c) Title XXII of P.L. 104-191.
27,4818cm
Section 4818cm. 619.10 (3c) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (3c).
27,4818d
Section 4818d. 619.10 (3d) of the statutes is created to read:
619.10 (3d) “Federal governmental plan" means a benefit program established or maintained for its employes by the government of the United States or by any agency or instrumentality of the government of the United States.
27,4818dm
Section 4818dm. 619.10 (3d) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (3d).
27,4818g
Section 4818g. 619.10 (3g) of the statutes is created to read:
619.10 (3g) “Governmental plan" has the meaning given under section 3 (32) of the federal Employee Retirement Income Security Act of 1974.
27,4818gm
Section 4818gm. 619.10 (3g) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (3g).
27,4818j
Section 4818j. 619.10 (3j) of the statutes is created to read:
619.10 (3j) “Group health plan" means any of the following:
(a) An employe welfare plan, as defined in section 3 (1) of the federal Employee Retirement Security Act of 1974, to the extent that the employe welfare plan provides medical care, including items and services paid for as medical care, to employes or to their dependents, as defined under the terms of the employe welfare plan, directly or through insurance, reimbursement or otherwise.
(b) Any program that would not otherwise be an employe welfare benefit plan and that is established or maintained by a partnership, to the extent that the program provides medical care, including items and services paid for as medical care, to present or former partners of the partnership or to their dependents, as defined under the terms of the program, directly or through insurance, reimbursement or otherwise.
27,4818jm
Section 4818jm. 619.10 (3j) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.10 (3j).
27,4819
Section 4819
. 619.10 (3m) and (4) of the statutes are renumbered 149.10 (3m) and (4).
27,4820
Section 4820
. 619.10 (4m) of the statutes is renumbered 149.10 (4m).
27,4821
Section 4821
. 619.10 (5) of the statutes is renumbered 149.10 (5) and amended to read:
149.10 (5) “Insurer" means any person or association of persons, including a health maintenance organization, limited service health organization or preferred provider plan offering or insuring health services on a prepaid basis, including, but not limited to, policies of health insurance issued by a currently licensed insurer, as defined in s. 600.03 (27), nonprofit hospital or medical service plans under ch. 613, cooperative medical service plans under s. 185.981, or other entity whose primary function is to provide diagnostic, therapeutic or preventive services to a defined population in return for a premium paid on a periodic basis. “Insurer" includes any person providing health services coverage for individuals on a self-insurance basis without the intervention of other entities, as well as any person providing health insurance coverage under a medical reimbursement plan to persons. “Insurer" does not include a plan under ch. 613 which offers only dental care.
27,4822
Section 4822
. 619.10 (6) and (7) of the statutes are renumbered 149.10 (6) and (7).
27,4823
Section 4823
. 619.10 (8) of the statutes is renumbered 149.10 (8) and amended to read:
149.10 (8) “Plan" means the health care insurance plan established and administered under this
subchapter chapter.
27,4824
Section 4824
. 619.10 (9) of the statutes is renumbered 149.10 (9) and amended to read:
149.10 (9) “Resident" means a person who has been legally domiciled in this state for a period of at least 30 days or, with respect to an eligible individual, an individual who resides in this state. For purposes of this subchapter chapter, legal domicile is established by living in this state and obtaining a Wisconsin motor vehicle operator's license, registering to vote in Wisconsin or filing a Wisconsin income tax return. A child is legally domiciled in this state if the child lives in this state and if at least one of the child's parents or the child's guardian is legally domiciled in this state. A person with a developmental disability or another disability which prevents the person from obtaining a Wisconsin motor vehicle operator's license, registering to vote in Wisconsin, or filing a Wisconsin income tax return, is legally domiciled in this state by living in this state for 30 days.
27,4825
Section 4825
. 619.11 of the statutes is renumbered 149.11 and amended to read:
149.11 (title) Establishment Operation of plan. The commissioner department shall promulgate rules establishing for the operation of a plan of health insurance coverage for an eligible person which satisfies the requirements of this chapter.
27,4825c
Section 4825c. 619.115 of the statutes is created to read:
619.115 Rules relating to creditable coverage. The commissioner shall promulgate rules that specify how creditable coverage is to be aggregated for purposes of s. 619.10 (2t) (a) and that determine the creditable coverage to which s. 619.10 (2t) (b) and (d) applies. The rules shall comply with section 2701 (c) of P.L. 104-191.
27,4825f
Section 4825f. 619.115 of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.115 and amended to read:
149.115 Rules relating to creditable coverage. The commissioner, in consultation with the department, shall promulgate rules that specify how creditable coverage is to be aggregated for purposes of s. 619.10 149.10 (2t) (a) and that determine the creditable coverage to which s. 619.10 149.10 (2t) (b) and (d) applies. The rules shall comply with section 2701 (c) of P.L. 104-191.
27,4826
Section 4826
. 619.12 (title) of the statutes is renumbered 149.12 (title).
27,4827
Section 4827
. 619.12 (1) of the statutes is renumbered 149.12 (1), and 149.12 (1) (intro.), as renumbered, is amended to read:
149.12 (1) (intro.) Except as provided in subs. (1m) and (2), the board or administering carrier plan administrator shall certify as eligible a person who is covered by medicare because he or she is disabled under 42 USC 423, a person who submits evidence that he or she has tested positive for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV, a person who is an eligible individual, and any person who receives and submits any of the following based wholly or partially on medical underwriting considerations within 9 months prior to making application for coverage by the plan:
27,4828
Section 4828
. 619.12 (1m) (intro) and (a) of the statutes are consolidated, renumbered 149.12 (1m) and amended to read:
149.12 (1m) The board or administering carrier plan administrator may not certify a person as eligible under circumstances requiring notice under sub. (1) (a) to (d) if the required notices were issued by one of the following: (a) An an insurance intermediary who is not acting as an administrator, as defined in s. 633.01.
27,4829
Section 4829
. 619.12 (1m) (b) of the statutes is repealed.
27,4830b
Section 4830b. 619.12 (2) (b) of the statutes is renumbered 149.12 (2) (b) and amended to read:
149.12 (2) (b) 1. Except as provided in subd. 2., no person who is covered under the plan and who voluntarily terminates the coverage under the plan, is again eligible for coverage unless 12 months have elapsed since the person's latest voluntary termination of coverage under the plan.
2. Subdivision 1. does not apply to any person who is an eligible individual or to any person who terminates coverage under the plan because he or she is receiving, or is eligible to receive, medical assistance benefits.
27,4830c
Section 4830c. 619.12 (2) (c) of the statutes is renumbered 149.12 (2) (c) and amended to read:
149.12 (2) (c) No person on whose behalf the plan has paid out $500,000 $1,000,000 or more is eligible for coverage under the plan.
27,4830d
Section 4830d. 619.12 (2) (d) of the statutes is renumbered 149.12 (2) (d) and amended to read:
149.12 (2) (d) No Except for a person who is an eligible individual, no person who is 65 years of age or older is eligible for coverage under the plan.
27,4830ec
Section 4830ec. 619.12 (2) (e) of the statutes, as affected by 1997 Wisconsin Act .... (this act), is renumbered 149.12 (2) (e) and amended to read:
149.12 (2) (e) No person who is eligible for
health care benefits creditable coverage, other than those benefits specified in s. 632.745 (11) (b) 1. to 12., that are is provided by an employer on a self-insured basis or through health insurance is eligible for coverage under the plan.
27,4830em
Section 4830em. 619.12 (2) (e) 1. of the statutes is renumbered 619.12 (2) (e) and amended to read:
619.12 (2) (e) Except as provided in subd. 2., no No person who is eligible for health care benefits, other than those benefits specified in s. 632.745 (11) (b) 1. to 12., that are provided by an employer on a self-insured basis or through health insurance is eligible for coverage under the plan.
