Amendment ASA2-AB416

LRBs0126/1

PJK:kmg:km

1995 - 1996 LEGISLATURE

ASSEMBLY SUBSTITUTE AMENDMENT 2, To 1995 ASSEMBLY BILL 416

July 11, 1995 - Offered by Committee on Health.

AB416-ASA2,1,9 An Act to repeal 635.02 (5m), 635.07, 635.17 and 635.26 (1) (b); to renumber 635.26 (1) (a); to amend 40.51 (8), 60.23 (25), 66.184, 111.70 (1) (a), 120.13 (2) (g), 185.981 (4t), 185.983 (1) (intro.), 600.01 (2) (b), 628.34 (3) (a), 628.34 (3) (b), 632.76 (2) (a) and 632.896 (4); and to create 40.51 (8m), 111.70 (4) (m), 111.91 (2) (k), 632.745, 632.747 and 632.749 of the statutes; relating to: group health insurance market reform, including preexisting condition exclusions and limitations, guaranteed acceptance, portability and contract termination and renewability; collective bargaining of certain health care coverage requirements; and granting rule-making authority.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB416-ASA2, s. 1 Section 1. 40.51 (8) of the statutes is amended to read:

AB416-ASA2,1,13 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.745 (1) to (3) and (5), 632.747, 632.87 (3) to (5), 632.895 (5m) and (8) to (10) and 632.896.

AB416-ASA2, s. 2 Section 2. 40.51 (8m) of the statutes is created to read:

AB416-ASA2,2,2 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 632.745 (1) to (3) and (5) and 632.747.

AB416-ASA2, s. 3 Section 3. 60.23 (25) of the statutes is amended to read:

AB416-ASA2,2,7 60.23 (25) Self-insured health plans. Provide health care benefits to its officers and employes on a self-insured basis if the self-insured plan complies with ss. 631.89, 631.90, 631.93 (2), 632.745 (2), (3) and (5) (a) 2. and (b) 2., 632.747 (3), 632.87 (4) and (5), 632.895 (9) and 632.896.

AB416-ASA2, s. 4 Section 4. 66.184 of the statutes is amended to read:

AB416-ASA2,2,14 66.184 Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employes on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.745 (2), (3) and (5) (a) 2. and (b) 2., 632.747 (3), 632.87 (4) and (5), 632.895 (9) and (10), 632.896, 767.25 (4m) (d) and 767.51 (3m) (d).

AB416-ASA2, s. 5 Section 5. 111.70 (1) (a) of the statutes is amended to read:

AB416-ASA2,3,11 111.70 (1) (a) "Collective bargaining" means the performance of the mutual obligation of a municipal employer, through its officers and agents, and the representatives of its employes, to meet and confer at reasonable times, in good faith, with the intention of reaching an agreement, or to resolve questions arising under such an agreement, with respect to wages, hours and conditions of employment, and with respect to a requirement of the municipal employer for a municipal employe to perform law enforcement and fire fighting services under s. 61.66, except as provided in sub. (4) (m) and s. 40.81 (3) and except that a municipal employer shall not meet and confer with respect to any proposal to diminish or abridge the rights guaranteed to municipal employes under ch. 164. The duty to bargain, however, does not compel either party to agree to a proposal or require the making of a concession. Collective bargaining includes the reduction of any agreement reached to a written and signed document. The employer shall not be required to bargain on subjects reserved to management and direction of the governmental unit except insofar as the manner of exercise of such functions affects the wages, hours and conditions of employment of the employes. In creating this subchapter the legislature recognizes that the public employer must exercise its powers and responsibilities to act for the government and good order of the municipality, its commercial benefit and the health, safety and welfare of the public to assure orderly operations and functions within its jurisdiction, subject to those rights secured to public employes by the constitutions of this state and of the United States and by this subchapter.

AB416-ASA2, s. 6 Section 6. 111.70 (4) (m) of the statutes is created to read:

AB416-ASA2,3,16 111.70 (4) (m) Health benefit plan requirements. 1. Except as provided in subd. 2., the municipal employer is prohibited from bargaining collectively with respect to compliance with the health benefit plan requirements under ss. 632.745, 632.747 and 632.749.

AB416-ASA2,3,21 2. If a municipal employer offers its employes a health care coverage plan through a program offered by the group insurance board under s. 40.51 (7), the municipal employer is prohibited from bargaining collectively with respect to compliance with the health benefit plan requirements under ss. 632.745 (1) to (3) and (5) and 632.747 with respect to the health care coverage plan.

AB416-ASA2, s. 7 Section 7. 111.91 (2) (k) of the statutes is created to read:

AB416-ASA2,3,24 111.91 (2) (k) Compliance with the health benefit plan requirements under ss. 632.745 (1) to (3) and (5) and 632.747.

AB416-ASA2, s. 8 Section 8. 120.13 (2) (g) of the statutes is amended to read:

AB416-ASA2,4,4 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.745 (2), (3) and (5) (a) 2. and (b) 2., 632.747 (3), 632.87 (4) and (5), 632.895 (9) and (10), 632.896, 767.25 (4m) (d) and 767.51 (3m) (d).

AB416-ASA2, s. 9 Section 9. 185.981 (4t) of the statutes is amended to read:

AB416-ASA2,4,8 185.981 (4t) A sickness care plan operated by a cooperative association is subject to ss. 252.14, 631.89, 632.72 (2), 632.745, 632.747, 632.749, 632.87 (2m), (3), (4) and (5), 632.895 (10) and 632.897 (10) and ch. 155.

AB416-ASA2, s. 10 Section 10. 185.983 (1) (intro.) of the statutes is amended to read:

AB416-ASA2,4,15 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72 (2), 632.745, 632.747, 632.749, 632.775, 632.79, 632.795, 632.87 (2m), (3), (4) and (5), 632.895 (5), (9) and (10), 632.896 and 632.897 (10), subch. II of ch. 619 and chs. 609, 630, 635, 645 and 646, but the sponsoring association shall:

AB416-ASA2, s. 11 Section 11. 600.01 (2) (b) of the statutes is amended to read:

AB416-ASA2,4,18 600.01 (2) (b) Group or blanket insurance described in sub. (1) (b) 3. and 4. is not exempt from s. 632.745, 632.747 or 632.749 or ch. 633 or 635.

AB416-ASA2, s. 12 Section 12. 628.34 (3) (a) of the statutes is amended to read:

AB416-ASA2,5,2 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by charging different premiums or by offering different terms of coverage except on the basis of classifications related to the nature and the degree of the risk covered or the expenses involved, subject to s. ss. 632.365 and 632.745. Rates are not unfairly discriminatory if they are averaged broadly among persons insured under a group, blanket or franchise policy, and terms are not unfairly discriminatory merely because they are more favorable than in a similar individual policy.

AB416-ASA2, s. 13 Section 13. 628.34 (3) (b) of the statutes is amended to read:

AB416-ASA2,5,9 628.34 (3) (b) No insurer may refuse to insure or refuse to continue to insure, or limit the amount, extent or kind of coverage available to an individual, or charge an individual a different rate for the same coverage because of a mental or physical disability except when the refusal, limitation or rate differential is based on either sound actuarial principles supported by reliable data or actual or reasonably anticipated experience, subject to ss. 632.745, 632.747, 632.749, 635.09 and 635.26.

AB416-ASA2, s. 14 Section 14. 632.745 of the statutes is created to read:

AB416-ASA2,5,13 632.745 Coverage requirements for group health benefit plans. (1) Group health insurance market reform; definitions. In this section and ss. 632.747 and 632.749:

AB416-ASA2,5,20 (a) 1. Except as provided in subd. 2., "eligible employe" means an employe who works on a permanent basis and has a normal work week of 30 or more hours. The term includes a sole proprietor, a business owner, including the owner of a farm business, a partner of a partnership and a member of a limited liability company if the sole proprietor, business owner, partner or member is included as an employe under a health benefit plan of an employer, but the term does not include an employe who works on a temporary or substitute basis.

AB416-ASA2,5,23 2. For purposes of a group health benefit plan, or a self-insured health plan, that is offered by the state under s. 40.51 (6) or by the group insurance board under s. 40.51 (7), "eligible employe" has the meaning given in s. 40.02 (25).

AB416-ASA2,5,24 (b) "Employer" means any of the following:

AB416-ASA2,6,3 1. An individual, firm, corporation, partnership, limited liability company or association that is actively engaged in a business enterprise in this state, including a farm business.

AB416-ASA2,6,4 2. A municipality, as defined in s. 16.70 (8).

AB416-ASA2,6,5 3. The state.

AB416-ASA2,6,9 (c) "Group health benefit plan" means a health benefit plan that is issued by an insurer to an employer on behalf of a group consisting of eligible employes of the employer. The term includes individual health benefit plans covering eligible employes when 3 or more are sold to an employer.

AB416-ASA2,6,18 (d) "Health benefit plan" means any hospital or medical policy or certificate. "Health benefit plan" does not include accident-only, credit accident or health, dental, vision, medicare supplement, medicare replacement, long-term care, disability income or short-term insurance, coverage issued as a supplement to liability insurance, worker's compensation or similar insurance, automobile medical payment insurance, individual conversion policies, specified disease policies, hospital indemnity policies, as defined in s. 632.895 (1) (c), policies or certificates issued under the health insurance risk-sharing plan or an alternative plan under subch. II of ch. 619 or other insurance exempted by rule of the commissioner.

AB416-ASA2,6,25 (e) "Insurer" means an insurer that is authorized to do business in this state, in one or more lines of insurance that includes health insurance, and that offers group health benefit plans covering eligible employes of one or more employers in this state. The term includes a health maintenance organization, as defined in s. 609.01 (2), a preferred provider plan, as defined in s. 609.01 (4), an insurer operating as a cooperative association organized under ss. 185.981 to 185.985 and a limited service health organization, as defined in s. 609.01 (3).

AB416-ASA2,7,2 (f) "Qualifying coverage" means benefits or coverage provided under any of the following:

AB416-ASA2,7,3 1. Medicare or medicaid.

AB416-ASA2,7,6 2. A group health benefit plan or an employer-based health benefit arrangement that provides benefits similar to or exceeding benefits provided under a basic health benefit plan under subch. II of ch. 635.

AB416-ASA2,7,9 3. An individual health benefit plan that provides benefits similar to or exceeding benefits provided under a basic health benefit plan under subch. II of ch. 635, if the individual health benefit plan has been in effect for at least one year.

AB416-ASA2,7,11 (g) "Self-insured health plan" means a self-insured health plan of the state or a county, city, village, town or school district.

AB416-ASA2,7,17 (2) Preexisting conditions. A group health benefit plan, or a self-insured health plan, may not deny, exclude or limit benefits for a covered individual for losses incurred more than 12 months after the effective date of the individual's coverage due to a preexisting condition. A group health benefit plan, or a self-insured health plan, may not define a preexisting condition more restrictively than any of the following: