AB416-SSA1,9,1010 1. Premiums received for health care coverage.
AB416-SSA1,9,1111 2. Subscriber contract charges received for health care coverage.
AB416-SSA1,9,1312 3. Health maintenance organization, limited service health organization or
13preferred provider plan charges received for health care coverage.
AB416-SSA1,9,1514 4. The sum of benefits paid and administrative costs incurred for health care
15coverage under a medical reimbursement plan.
AB416-SSA1,9,1716 (b) This subsection does not apply after 2 years after the effective date of this
17paragraph .... [revisor inserts date].
AB416-SSA1, s. 29 18Section 29 . 619.13 of the statutes is repealed and recreated to read:
AB416-SSA1,9,23 19619.13 Health care surcharges. (1) (a) Except as provided in sub. (2), to
20cover claims paid under the plan and the operating and administrative expenses of
21the plan, every health care provider shall impose and collect on every charge billed
22by the health care provider a surcharge in an amount set by the board under s. 619.15
23(3) (bm) or (4) (c).
AB416-SSA1,9,2524 (am) Each individual or insurer or other 3rd-party payer subject to the
25surcharge under par. (a) shall pay the surcharge to the health care provider.
AB416-SSA1,10,11
1(b) A health care provider may retain up to 15% of the surcharge amounts
2under par. (a) that are collected before July 1, 1997, for its own administrative
3expenses. The board shall establish by rule the amount that a health care provider
4may retain of surcharges collected on and after July 1, 1997, for its administrative
5expenses at a level sufficient to cover the health care provider's administrative
6expenses. The health care provider shall remit the remainder of the surcharge
7amounts collected, after deducting its administrative expenses, to the board on a
8quarterly basis, on or before the last day of the next month following the end of each
9calendar quarter, along with a report that identifies any insurer or other 3rd-party
10payer that has failed to pay a significant surcharge amount billed during that
11calendar quarter.
AB416-SSA1,10,12 12(2) Subsection (1) does not apply to any of the following:
AB416-SSA1,10,1313 (a) Charges billed for services or articles provided to any of the following:
AB416-SSA1,10,1414 1. Medical assistance recipients.
AB416-SSA1,10,1615 2. Persons receiving relief under s. 49.025, 49.027 or 49.029 or under a
16county-funded relief program under s. 59.07 (154).
AB416-SSA1,10,1817 3. Persons with coverage under the plan, including an alternative plan under
18s. 619.145.
AB416-SSA1,10,2019 4. Persons with coverage under part A or part B of Title XVIII of the federal
20social security act, 42 USC 1395 to 1395zz.
AB416-SSA1,10,2221 5. Persons for whom health care benefits are provided under any other federal
22assistance program.
AB416-SSA1,10,2323 (b) Charges payable by worker's compensation insurance.
AB416-SSA1,11,2 24(3) An insurer or other 3rd-party payer that pays a charge for a service or
25article on behalf of the person receiving the service or article shall include a line item

1identifying payment of the surcharge on any documentation of payment provided to
2the health care provider providing the service or article.
AB416-SSA1,11,7 3(4) The surcharge under this section shall be imposed and paid in addition to
4the charge for a service or article, including fees and payments for fees specified in
5existing contracts unless such a contract specifically provides that the fees or
6payments for fees specified in the contract include any surcharge that may be
7imposed in addition to the amount charged for a service or article.
AB416-SSA1,11,14 8(4m) If the person receiving the service or article, rather than an insurer or
9other 3rd-party payer, is paying for the service or article directly and full payment
10is not made in one payment, any instalment payments received by the health care
11provider shall be credited against the balance due on the charge for the service or
12article first and credited against the balance due on the surcharge only after the
13charge for the service or article is paid in full. This subsection does not apply if the
14payer specifies that a payment is intended to cover the surcharge.
AB416-SSA1,11,18 15(5) A health care provider is not liable for the payment of any surcharge amount
16imposed but not collected by the health care provider. A health care provider is
17immune from civil liability for imposing, collecting or attempting to collect a
18surcharge under this section.
AB416-SSA1,11,21 19(6) (a) If the surcharge under this section or its application is held by a court
20to be invalid with respect to any person or group of persons, then the surcharge or
21its application shall be invalid with respect to all persons.
AB416-SSA1,12,222 (b) If the commissioner, after consulting with the attorney general, determines
23that the surcharge or its application is invalid under par. (a) with respect to all
24persons, the commissioner shall certify such determination to the revisor of statutes.
25Upon the certification, the revisor of statutes shall publish notice in the Wisconsin

1administrative register of the determination, the date of the certification and that
2on the date of the certification:
AB416-SSA1,12,33 1. All of the following are effective:
AB416-SSA1,12,44 a. Section 619.10 (3m), 1993 stats., for 2 years.
AB416-SSA1,12,55 b. Section 619.13, 1993 stats., for 2 years.
AB416-SSA1,12,66 c. Section 619.135 (2) and (3), 1993 stats., for 2 years.
AB416-SSA1,12,77 d. Section 619.145 (3) (e) and (4), 1993 stats., for 2 years.
AB416-SSA1,12,88 e. Section 619.15 (3) (c) and (4) (c) and (e), 1993 stats., for 2 years.
AB416-SSA1,12,99 f. Section 619.175, 1993 stats., for 2 years.
AB416-SSA1,12,1010 2. All of the following are not effective:
AB416-SSA1,12,1111 a. Section 619.10 (3m), 1995 stats.
AB416-SSA1,12,1212 b. Section 619.13, 1995 stats.
AB416-SSA1,12,1313 c. Section 619.135 (2) and (3), 1995 stats.
AB416-SSA1,12,1414 d. Section 619.15 (3) (bc), (bm) and (c) and (4) (c), 1995 stats.
AB416-SSA1,12,1515 e. Section 619.175, 1995 stats.
AB416-SSA1,12,16 16(7) This section does not apply after June 30, 2000.
AB416-SSA1, s. 30 17Section 30 . 619.13 of the statutes, as affected by 1995 Wisconsin Act .... (this
18act), is repealed and recreated to read:
AB416-SSA1,12,22 19619.13 Participation of insurers. (1) (a) Every insurer shall participate in
20the cost of administering the plan, except the commissioner may by rule exempt as
21a class those insurers whose share as determined under par. (b) would be so minimal
22as to not exceed the estimated cost of levying the assessment.
AB416-SSA1,13,323 (b) Except as provided by a rule promulgated under s. 619.145 (4), every
24participating insurer shall share in the operating, administrative and subsidy
25expenses of the plan in proportion to the ratio of the insurer's total health care

1coverage revenue for residents of this state during the preceding calendar year to the
2aggregate health care coverage revenue of all participating insurers for residents of
3this state during the preceding calendar year, as determined by the commissioner.
AB416-SSA1,13,94 (c) If assessments and other receipts by the commissioner, board or
5administering carrier exceed payments made to alternative plans in accordance with
6contracts entered into under s. 619.145 (3) and the actual losses and administrative
7expenses of the plan, the excess shall be held at interest and used by the board to
8offset future losses or to reduce plan premiums. In this paragraph, "future losses"
9includes reserves for incurred but not reported claims.
AB416-SSA1,13,1210 (d) 1. Each insurer's proportion of participation under par. (b) shall be
11determined annually by the commissioner based on annual statements and other
12reports filed by the insurer with the commissioner.
AB416-SSA1,13,1813 2. If the commissioner finds that the commissioner's authority to require
14insurers to report under chs. 600 to 646 and 655 is not adequate to permit the
15commissioner or the board to carry out the commissioner's or the board's
16responsibilities under this subchapter, the commissioner may promulgate rules
17requiring insurers to report the information necessary for the commissioner and the
18board to make the determinations required under this subchapter.
AB416-SSA1,13,22 19(2) Any deficit incurred under the plan shall be recouped by assessments
20apportioned under sub. (1) by the board among participating insurers, who may
21recover these amounts in the normal course of their respective businesses without
22time limitation.
AB416-SSA1,13,24 23(3) This section does not apply after 2 years after the effective date of this
24subsection .... [revisor inserts date].
AB416-SSA1, s. 31 25Section 31 . 619.135 (2) of the statutes is amended to read:
AB416-SSA1,14,9
1619.135 (2) If the moneys under s. 20.145 (7) (a) and (g) are insufficient to
2reimburse the plan for premium reductions under s. 619.165 and deductible
3reductions under s. 619.14 (5) (a), or the commissioner determines that the moneys
4under s. 20.145 (7) (a) and (g) will be insufficient to reimburse the plan for premium
5reductions under s. 619.165 and deductible reductions under s. 619.14 (5) (a), the
6commissioner shall, by rule, increase the amount of the assessment under sub. (1)
7(a) or levy an assessment against every insurer, or a combination of both, sufficient
8to reimburse the plan for premium reductions under s. 619.165 and deductible
9reductions under s. 619.14 (5) (a).
AB416-SSA1, s. 32 10Section 32 . 619.135 (2) of the statutes, as affected by 1995 Wisconsin Act ....
11(this act), section 31, is repealed and recreated to read:
AB416-SSA1,14,2012 619.135 (2) If the moneys under s. 20.145 (7) (a) and (g) are insufficient to
13reimburse the plan for premium reductions under s. 619.165 and deductible
14reductions under s. 619.14 (5) (a), or the commissioner determines that the moneys
15under s. 20.145 (7) (a) and (g) will be insufficient to reimburse the plan for premium
16reductions under s. 619.165 and deductible reductions under s. 619.14 (5) (a), the
17commissioner shall, by rule, increase the amount of the assessment under sub. (1)
18(a) or levy an assessment against every insurer, or a combination of both, sufficient
19to reimburse the plan for premium reductions under s. 619.165 and deductible
20reductions under s. 619.14 (5) (a).
AB416-SSA1, s. 33 21Section 33 . 619.135 (2) of the statutes, as affected by 1995 Wisconsin Act ....
22(this act), sections 31 and 32, is repealed and recreated to read:
AB416-SSA1,15,523 619.135 (2) If the moneys under s. 20.145 (7) (a) and (g) are insufficient to
24reimburse the plan for premium reductions under s. 619.165 and deductible
25reductions under s. 619.14 (5) (a), or the commissioner determines that the moneys

1under s. 20.145 (7) (a) and (g) will be insufficient to reimburse the plan for premium
2reductions under s. 619.165 and deductible reductions under s. 619.14 (5) (a), the
3commissioner shall, by rule, increase the amount of the assessment under sub. (1)
4(a) sufficient to reimburse the plan for premium reductions under s. 619.165 and
5deductible reductions under s. 619.14 (5) (a).
AB416-SSA1, s. 34 6Section 34 . 619.135 (3) of the statutes is amended to read:
AB416-SSA1,15,127 619.135 (3) In addition to the assessments assessment under subs. sub. (1) (a)
8and (2), the commissioner may, by rule, establish an assessment to be levied against
9each insurer that issues a notice of rejection under s. 619.12 (1) (a) to a person who
10becomes eligible for and obtains coverage under the plan as a result of receiving the
11notice. Any assessments levied and collected under this subsection shall be credited
12to the appropriation under s. 20.145 (7) (g).
AB416-SSA1, s. 35 13Section 35 . 619.135 (3) of the statutes, as affected by 1995 Wisconsin Act ....
14(this act), section 34, is repealed and recreated to read:
AB416-SSA1,15,2015 619.135 (3) In addition to the assessments under subs. (1) (a) and (2), the
16commissioner may, by rule, establish an assessment to be levied against each insurer
17that issues a notice of rejection under s. 619.12 (1) (a) to a person who becomes
18eligible for and obtains coverage under the plan as a result of receiving the notice.
19Any assessments levied and collected under this subsection shall be credited to the
20appropriation under s. 20.145 (7) (g).
AB416-SSA1, s. 36 21Section 36 . 619.135 (3) of the statutes, as affected by 1995 Wisconsin Act ....
22(this act), sections 33 and 34, is repealed and recreated to read:
AB416-SSA1,16,323 619.135 (3) In addition to the assessment under sub. (1) (a), the commissioner
24may, by rule, establish an assessment to be levied against each insurer that issues
25a notice of rejection under s. 619.12 (1) (a) to a person who becomes eligible for and

1obtains coverage under the plan as a result of receiving the notice. Any assessments
2levied and collected under this subsection shall be credited to the appropriation
3under s. 20.145 (7) (g).
AB416-SSA1, s. 37 4Section 37. 619.14 (5) (a) of the statutes is amended to read:
AB416-SSA1,16,255 619.14 (5) (a) The plan shall offer a deductible in combination with appropriate
6premiums determined under this subchapter for major medical expense coverage
7required under this section. For coverage offered to those persons eligible for
8medicare, the plan shall offer a deductible equal to the deductible charged by part
9A of title XVIII of the federal social security act, as amended. The deductible
10amounts for all other eligible persons shall be dependent upon household income as
11determined under s. 619.165. For eligible persons under s. 619.165 (1) (b) 1., the
12deductible shall be $500. For eligible persons under s. 619.165 (1) (b) 2., the
13deductible shall be $600. For eligible persons under s. 619.165 (1) (b) 3., the
14deductible shall be $700. For eligible persons under s. 619.165 (1) (b) 4., the
15deductible shall be $800. For all other eligible persons who are not eligible for
16medicare, the deductible shall be $1,000. With respect to all eligible persons,
17expenses used to satisfy the deductible during the last 90 days of a calendar year
18shall also be applied to satisfy the deductible for the following calendar year. The
19schedule of premiums shall be promulgated by rule by the commissioner , subject to
20s. 619.15 (3) (f)
. The commissioner shall set rates at 60% of the operating and
21administrative costs of the plan
premiums for eligible persons who have a household
22income, as defined in s. 71.52 (5) and as determined under s. 619.165 (1) (d), at or
23above the threshold amount established under s. 619.15 (3) (g) at a higher rate than
24premiums for eligible persons who have a household income below the threshold
25amount
.
AB416-SSA1, s. 38
1Section 38. 619.14 (5) (d) of the statutes is amended to read:
AB416-SSA1,17,82 619.14 (5) (d) Notwithstanding pars. (a) to (c), the board may establish
3different deductible amounts, a different coinsurance percentage and different
4covered costs and deductible aggregate amounts from those specified in pars. (a) to
5(c) in accordance with cost containment provisions established by the commissioner
6under s. 619.17 (4) (a) and for individuals who enroll in an alternative plan under s.
7619.145 or who are unable to enroll in an alternative plan because of the
8unavailability of such a plan in the individual's geographic area
.
AB416-SSA1, s. 39 9Section 39. 619.145 (1) of the statutes is amended to read:
AB416-SSA1,17,1610 619.145 (1) The Except as provided in sub. (1m), the board may offer to persons
11eligible for coverage under s. 619.12 the opportunity to enroll, on a voluntary basis,
12in an alternative plan that uses managed care and that the commissioner determines
13provides benefits that are substantially equivalent to or greater than the benefits
14provided under the plan. A person who voluntarily enrolls in an alternative plan
15under this section is ineligible for coverage under the plan for 12 months after
16enrolling in the alternative plan.
AB416-SSA1, s. 40 17Section 40. 619.145 (1m) of the statutes is created to read:
AB416-SSA1,17,2218 619.145 (1m) (a) The board shall promulgate rules that implement the use of
19alternative plans that use managed care and capitation or other risk-sharing
20mechanisms and that the commissioner determines provide benefits for persons who
21use the services of providers designated by the alternative plan that are
22substantially equivalent to or greater than the benefits provided under the plan.
AB416-SSA1,17,2523 (b) Beginning on July 1, 1997, the board shall offer to persons eligible for
24coverage under s. 619.12 the opportunity to enroll, and may require such persons to
25enroll, in an alternative plan.
AB416-SSA1,18,7
1(c) Notwithstanding s. 619.14 (5) (a), the board may by rule establish premiums
2for persons who enroll in an alternative plan that are different from premiums for
3persons who do not enroll in an alternative plan to reflect the differences in the cost
4of covered services and articles. A person who is unable to enroll in an alternative
5plan because of the unavailability of such a plan in the person's geographic area,
6however, shall be allowed to pay the same premium rate as persons who do enroll in
7an alternative plan.
AB416-SSA1, s. 41 8Section 41. 619.145 (3) (e) of the statutes is repealed.
AB416-SSA1, s. 42 9Section 42. 619.145 (3) (e) of the statutes is created to read:
AB416-SSA1,18,1310 619.145 (3) (e) Subject to sub. (4), a reduction in the alternative plan's
11assessment under s. 619.13 for operating and administrative, but not subsidy,
12expenses of the plan. This paragraph does not apply after 2 years after the effective
13date of this paragraph .... [revisor inserts date].
AB416-SSA1, s. 43 14Section 43. 619.145 (4) of the statutes is repealed.
AB416-SSA1, s. 44 15Section 44. 619.145 (4) of the statutes is created to read:
AB416-SSA1,18,1916 619.145 (4) A contract under sub. (3) may not provide for a reduction in the
17assessment under s. 619.13 against an alternative plan unless the assessment
18reduction has been adopted by rule under s. 619.15 (4) (e). This subsection does not
19apply after 2 years after the effective date of this subsection .... [revisor inserts date].
AB416-SSA1, s. 45 20Section 45. 619.15 (1) of the statutes is amended to read:
AB416-SSA1,19,821 619.15 (1) The plan shall operate subject to the supervision and approval of a
22board consisting of representatives of 2 participating insurers which are nonprofit
23corporations, 2 other participating insurers
3 insurers and 3 health care providers,
24and 3 public members, appointed by the commissioner for staggered 3-year terms.
25In addition, the commissioner or a designated representative from the office of the

1commissioner shall be a member of the board. The public members shall not be
2professionally affiliated with the practice of medicine, a hospital or an insurer. At
3least 2 of the public members shall be individuals reasonably expected to qualify for
4coverage under the plan or the parent or spouse of such an individual. The
5commissioner or the commissioner's representative shall be the chairperson of the
6board. Board members, except the commissioner or the commissioner's
7representative, shall be compensated at the rate of $50 per diem plus actual and
8necessary expenses.
AB416-SSA1, s. 46 9Section 46. 619.15 (3) (bc) of the statutes is created to read:
AB416-SSA1,19,1310 619.15 (3) (bc) Specify all persons that are required to impose and collect the
11surcharge under s. 619.13 (1) (a). The board shall include every type of provider that
12may provide a covered service or article under s. 619.14 (3). This paragraph does not
13apply after June 30, 2000.
AB416-SSA1, s. 47 14Section 47. 619.15 (3) (bc) of the statutes, as created by 1995 Wisconsin Act
15.... (this act), is repealed.
AB416-SSA1, s. 48 16Section 48. 619.15 (3) (bm) of the statutes is created to read:
AB416-SSA1,19,2317 619.15 (3) (bm) Set the amount of the surcharge under s. 619.13 (1) (a) at a level
18that is sufficient to cover claims paid under the plan, the operating and
19administrative expenses of the plan and the administrative expenses that may be
20retained by health care providers under s. 619.13 (1) (b) at a level sufficient to cover
21a health care provider's administrative expenses. The amount shall be a flat
22encounter fee, and the board may provide for different surcharge amounts for
23different services or articles. This paragraph does not apply after June 30, 2000.
AB416-SSA1, s. 49 24Section 49. 619.15 (3) (bm) of the statutes, as created by 1995 Wisconsin Act
25.... (this act), is repealed.
AB416-SSA1, s. 50
1Section 50. 619.15 (3) (c) of the statutes is amended to read:
AB416-SSA1,20,102 619.15 (3) (c) Collect assessments surcharges from all insurers health care
3providers
to provide for claims paid under the plan and for administrative expenses
4incurred or estimated to be incurred during the period for which the assessment is
5made. The level of payments shall be established by the board. Assessment of the
6insurers shall occur at the end of each calendar year or other fiscal year end
7established by the board. Assessments are due and payable within 30 days of receipt
8by the insurer of the assessment notice
. The board shall ensure that all surcharges
9are deposited in the health insurance risk-sharing plan fund. This paragraph does
10not apply after June 30, 2000
.
AB416-SSA1, s. 51 11Section 51. 619.15 (3) (c) of the statutes, as affected by 1995 Wisconsin Act ....
12(this act), is repealed and recreated to read:
AB416-SSA1,20,2013 619.15 (3) (c) Collect assessments from all insurers to provide for claims paid
14under the plan and for administrative expenses incurred or estimated to be incurred
15during the period for which the assessment is made. The level of payments shall be
16established by the board. Assessment of the insurers shall occur at the end of each
17calendar year or other fiscal year end established by the board. Assessments are due
18and payable within 30 days of receipt by the insurer of the assessment notice. This
19paragraph does not apply after 2 years after the effective date of this paragraph ....
20[revisor inserts date].
AB416-SSA1, s. 52 21Section 52. 619.15 (3) (f) and (g) of the statutes are created to read:
AB416-SSA1,20,2422 619.15 (3) (f) Determine the percentage, but not less than 60%, of the operating
23and administrative costs of the plan at which the commissioner must set premium
24rates under s. 619.14 (5) (a).
AB416-SSA1,21,3
1(g) Establish a threshold amount for the household income, as defined in s.
271.52 (5) and as determined under s. 619.165 (1) (d), of an eligible person for purposes
3of determining premium rates under s. 619.14 (5) (a).
AB416-SSA1, s. 53 4Section 53 . 619.15 (4) (c) of the statutes is repealed and recreated to read:
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