AB416-ASA2,11,24 19(3) State or municipal self-insured plans. If the state or a county, city, village,
20town or school district provides coverage under a self-insured health plan, it shall
21provide coverage under the self-insured health plan to an eligible employe who
22waived coverage during an enrollment period during which the employe was entitled
23to enroll in the self-insured health plan, regardless of health condition or claims
24experience, if all of the following apply:
AB416-ASA2,12,2
1(a) The eligible employe was covered as a dependent under qualifying coverage
2when he or she waived coverage under the self-insured health plan.
AB416-ASA2,12,73 (b) The eligible employe's coverage under the qualifying coverage has
4terminated or will terminate due to a divorce from the insured under the qualifying
5coverage, the death of the insured under the qualifying coverage, loss of employment
6by the insured under the qualifying coverage or involuntary loss of coverage under
7the qualifying coverage by the insured under the qualifying coverage.
AB416-ASA2,12,108 (c) The eligible employe applies for coverage under the self-insured health plan
9not more than 30 days after termination of his or her coverage under the qualifying
10coverage.
AB416-ASA2, s. 16 11Section 16. 632.749 of the statutes is created to read:
AB416-ASA2,12,17 12632.749 Contract termination and renewability. (1) Midterm
13cancellation.
Notwithstanding s. 631.36 (2) to (4m), a group health benefit plan
14may not be canceled by an insurer before the expiration of the agreed term, and shall
15be renewable to the policyholder and all insureds and dependents eligible under the
16terms of the group health benefit plan at the expiration of the agreed term at the
17option of the policyholder, except for any of the following reasons:
AB416-ASA2,12,1818 (a) Failure to pay a premium when due.
AB416-ASA2,12,2019 (b) Fraud or misrepresentation by the policyholder, or, with respect to coverage
20for an insured individual, fraud or misrepresentation by that insured individual.
AB416-ASA2,12,2121 (c) Substantial breaches of contractual duties, conditions or warranties.
AB416-ASA2,12,2322 (d) The number of individuals covered under the group health benefit plan is
23less than the number required by the group health benefit plan.
AB416-ASA2,12,2524 (e) The employer to which the group health benefit plan is issued is no longer
25actively engaged in a business enterprise.
AB416-ASA2,13,2
1(2) Nonrenewal. Notwithstanding sub. (1), an insurer may elect not to renew
2a group health benefit plan if the insurer complies with all of the following:
AB416-ASA2,13,43 (a) The insurer ceases to renew all other group health benefit plans issued by
4the insurer.
AB416-ASA2,13,75 (b) The insurer provides notice to all affected policyholders and to the
6commissioner in each state in which an affected insured individual resides at least
7one year before termination of coverage.
AB416-ASA2,13,98 (c) The insurer does not issue a group health benefit plan before 5 years after
9the nonrenewal of the group health benefit plans.
AB416-ASA2,13,1310 (d) The insurer does not transfer or otherwise provide coverage to a
11policyholder from the nonrenewed business unless the insurer offers to transfer or
12provide coverage to all affected policyholders from the nonrenewed business without
13regard to claims experience, health condition or duration of coverage.
AB416-ASA2,13,15 14(3) Insurer in liquidation. This section does not apply to a group health benefit
15plan if the insurer that issued the group health benefit plan is in liquidation.
AB416-ASA2,13,18 16(4) Applicability to certain government plans. This section does not apply to
17a group health benefit plan offered by the state under s. 40.51 (6) or by the group
18insurance board under s. 40.51 (7).
AB416-ASA2, s. 17 19Section 17. 632.76 (2) (a) of the statutes is amended to read:
AB416-ASA2,13,2520 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
21from the date of issue of the policy may be reduced or denied on the ground that a
22disease or physical condition existed prior to the effective date of coverage, unless the
23condition was excluded from coverage by name or specific description by a provision
24effective on the date of loss. This paragraph does not apply to a group health benefit
25plan, as defined in s. 632.745 (1) (c), which is subject to s. 632.745 (2).
AB416-ASA2, s. 18
1Section 18. 632.896 (4) of the statutes is amended to read:
AB416-ASA2,14,72 632.896 (4) Preexisting conditions. Notwithstanding s. ss. 632.745 (2) and
3632.76 (2) (a), a disability insurance policy that is subject to sub. (2) and that is in
4effect when a court makes a final order granting adoption or when the child is placed
5for adoption may not exclude or limit coverage of a disease or physical condition of
6the child on the ground that the disease or physical condition existed before coverage
7is required to begin under sub. (3).
AB416-ASA2, s. 19 8Section 19. 635.02 (5m) of the statutes is repealed.
AB416-ASA2, s. 20 9Section 20. 635.07 of the statutes is repealed.
AB416-ASA2, s. 21 10Section 21. 635.17 of the statutes is repealed.
AB416-ASA2, s. 22 11Section 22. 635.26 (1) (a) of the statutes is renumbered 635.26 (1).
AB416-ASA2, s. 23 12Section 23. 635.26 (1) (b) of the statutes is repealed.
AB416-ASA2, s. 24 13Section 24. Initial applicability.
AB416-ASA2,14,14 14(1) This act first applies to all of the following:
AB416-ASA2,14,17 15(a)  Except as provided in paragraphs (b) and (c), group health benefit plans
16that are issued or renewed, and self-insured health plans that are established,
17extended, modified or renewed, on the effective date of this paragraph.
AB416-ASA2,14,20 18(b) Group health benefit plans covering employes who are affected by a
19collective bargaining agreement containing provisions inconsistent with this act
20that are issued or renewed on the earlier of the following:
AB416-ASA2,14,21 211. The day on which the collective bargaining agreement expires.
AB416-ASA2,14,23 222. The day on which the collective bargaining agreement is extended, modified
23or renewed.
AB416-ASA2,15,3
1(c) Self-insured health plans covering employes who are affected by a collective
2bargaining agreement containing provisions inconsistent with this act that are
3established, extended, modified or renewed on the earlier of the following:
AB416-ASA2,15,4 41. The day on which the collective bargaining agreement expires.
AB416-ASA2,15,6 52. The day on which the collective bargaining agreement is extended, modified
6or renewed.
AB416-ASA2, s. 25 7Section 25. Effective date.
AB416-ASA2,15,9 8(1)This act takes effect on the first day of the 12th month beginning after
9publication.
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