Amendment ASA1-AB100

AB100-ASA1,1818,19 (2) (a) Except as specified by the board, the terms of coverage under s. 619.14, including deductible reductions under s. 619.14 (5) (a), do not apply to the coverage offered under this section. Premium reductions under s. 619.165 do not apply to the coverage offered under this section.

AB100-ASA1,1818,23 (b) The schedule of premiums for coverage under this section shall be promulgated by rule by the commissioner. The rates for coverage under this section shall be set such that they differ from the rates for coverage under s. 619.14 by the same percentage as the percentage difference between the following:

AB100-ASA1,1819,3 1. The rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as provided under s. 619.14.

AB100-ASA1,1819,6 2. The rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as the coverage offered under this section.

AB100-ASA1, s. 4860d Section 4860d. 619.146 of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.146, and 149.146 (1) (a) and (b) and (2) (a) and (b) (intro.) and 1., as renumbered, are amended to read:

AB100-ASA1,1819,13 149.146 (1) (a) Beginning on January 1, 1998, in addition to the coverage required under s. 619.14 149.14, the plan shall offer to all eligible persons a choice of coverage, as described in section 2744 (a) (1) (C), P.L. 104-191. Any such choice of coverage shall be major medical expense coverage.

AB100-ASA1,1819,22 (b) An eligible person may elect once each year, at the time and according to procedures established by the board, among the coverages offered under this section and s. 619.14 149.14. If an eligible person elects new coverage, any preexisting condition exclusion imposed under the new coverage is met to the extent that the eligible person has been previously and continuously covered under this subchapter chapter. No preexisting condition exclusion may be imposed on an eligible person who elects new coverage if the person was an eligible individual when first covered under this subchapter chapter and the person remained continuously covered under this subchapter chapter up to the time of electing the new coverage.

AB100-ASA1,1820,2 (2) (a) Except as specified by the board, the terms of coverage under s. 619.14 149.14, including deductible reductions under s. 619.14 149.14 (5) (a), do not apply to the coverage offered under this section. Premium reductions under s. 619.165 149.165 do not apply to the coverage offered under this section.

AB100-ASA1,1820,7 (b) (intro.) The schedule of premiums for coverage under this section shall be promulgated by rule by the commissioner department, as provided in s. 149.143. The rates for coverage under this section shall be set such that they differ from the rates for coverage under s. 619.14 149.14 by the same percentage as the percentage difference between the following:

AB100-ASA1,1820,10 1. The rate that a standard risk would be charged under an individual policy providing substantially the same coverage and deductibles as provided under s. 619.14 149.14.

AB100-ASA1, s. 3433 Section 3433. 619.15 (title) of the statutes is renumbered 149.15 (title).

AB100-ASA1, s. 3434 Section 3434. 619.15 (1) of the statutes is renumbered 149.15 (1) and amended to read:

AB100-ASA1,1821,6 149.15 (1) The plan shall operate subject to the supervision and approval of a have a board of governors consisting of representatives of 2 participating insurers which are nonprofit corporations, representatives of 2 other participating insurers, 3 health care provider representatives, including one representative of the State Medical Society of Wisconsin, one representative of the Wisconsin Health and Hospital Association and one representative of an integrated multidisciplinary health system, and 3 public members, including one representative of small businesses in the state, appointed by the commissioner secretary for staggered 3-year terms. In addition, the commissioner, or a designated representative from the office of the commissioner, and the secretary, or a designated representative from the department, shall be a member members of the board. The public members shall not be professionally affiliated with the practice of medicine, a hospital or an insurer. At least 2 of the public members shall be individuals reasonably expected to qualify for coverage under the plan or the parent or spouse of such an individual. The commissioner secretary or the commissioner's secretary's representative shall be the chairperson of the board. Board members, except the commissioner or the commissioner's representative and the secretary or the secretary's representative, shall be compensated at the rate of $50 per diem plus actual and necessary expenses.

AB100-ASA1, s. 3435 Section 3435. 619.15 (2) of the statutes is renumbered 149.15 (2) and amended to read:

AB100-ASA1,1821,14 149.15 (2) Annually, the board shall make a report to the members of the plan and to the chief clerk of each house of the legislature, for distribution to the appropriate standing committees under s. 13.172 (3), and to the members of the plan summarizing the activities of the plan in the preceding calendar year. The annual report shall define the cost burden imposed by the plan on all policyholders in this state.

AB100-ASA1, s. 3436 Section 3436. 619.15 (3) (intro.) of the statutes is renumbered 149.15 (3) (intro.) and amended to read:

AB100-ASA1,1821,17 149.15 (3) (intro.) The board shall do all of the following:

AB100-ASA1, s. 3437 Section 3437. 619.15 (3) (a) of the statutes is renumbered 149.15 (3) (a).

AB100-ASA1, s. 3438 Section 3438. 619.15 (3) (b) of the statutes is repealed.

AB100-ASA1, s. 4867c Section 4867c. 619.15 (3) (c) of the statutes is renumbered 149.15 (3) (c) and amended to read:

AB100-ASA1,1822,3 149.15 (3) (c) Collect assessments from all insurers to provide for claims paid under the plan and for administrative expenses incurred or estimated to be incurred during the period for which the assessment is made. The level of payments shall be established by the board as provided under s. 149.143. Assessment of the insurers shall occur at the end of each calendar year or other fiscal year end established by the board. Assessments are due and payable within 30 days of receipt by the insurer of the assessment notice.

AB100-ASA1, s. 3439 Section 3439. 619.15 (3) (d) of the statutes is renumbered 149.15 (3) (d).

AB100-ASA1, s. 4869c Section 4869c. 619.15 (3) (e) of the statutes is renumbered 149.15 (3) (e) and amended to read:

AB100-ASA1,1822,12 149.15 (3) (e) Establish for payment of covered expenses, a payment rate that is 10% less than the charges approved by the administering carrier plan administrator for reimbursement of covered expenses under s. 619.14 149.14 (3). A provider of a covered service or article may not bill an eligible person who receives the service or article for any amount by which the charge is reduced under this paragraph.

AB100-ASA1, s. 4869d Section 4869d. 619.15 (3) (f) of the statutes is created to read:

AB100-ASA1,1822,15 619.15 (3) (f) In consultation with the office and the department of health and family services, establish a choice of coverage under s. 619.146.

AB100-ASA1, s. 4869f Section 4869f. 619.15 (3) (f) of the statutes, as created by 1997 Wisconsin Act .... (this act), is renumbered 149.15 (3) (f) and amended to read:

AB100-ASA1,1822,20 149.15 (3) (f) In consultation with the office of the commissioner of insurance and the department of health and family services, establish a choice of coverage under s. 619.146 149.146.

AB100-ASA1, s. 3440 Section 3440. 619.15 (4) (intro.) of the statutes is renumbered 149.15 (4) (intro.) and amended to read:

AB100-ASA1,1822,23 149.15 (4) (intro.) The board may do any of the following:

AB100-ASA1, s. 3441 Section 3441. 619.15 (4) (a) of the statutes is renumbered 149.15 (4) (a).

AB100-ASA1, s. 3442 Section 3442. 619.15 (4) (b) of the statutes is renumbered 149.15 (4) (b).

AB100-ASA1, s. 4873c Section 4873c. 619.15 (4) (c) of the statutes is repealed.

AB100-ASA1, s. 3443 Section 3443. 619.15 (4) (d) of the statutes is repealed.

AB100-ASA1, s. 3444 Section 3444. 619.15 (4) (e) of the statutes is repealed.

AB100-ASA1, s. 3445 Section 3445. 619.15 (5) of the statutes is renumbered 149.15 (5) and amended to read:

AB100-ASA1,1823,7 149.15 (5) The commissioner department may, by rule, establish additional powers and duties of the board.

AB100-ASA1, s. 3446 Section 3446. 619.15 (6) of the statutes is renumbered 149.15 (6) and amended to read:

AB100-ASA1,1823,11 149.15 (6) If any provision of this subchapter chapter conflicts with s. 625.11 or 625.12, this subchapter chapter prevails.

AB100-ASA1, s. 3447 Section 3447. 619.15 (7) of the statutes is renumbered 149.15 (7).

AB100-ASA1, s. 3448 Section 3448. 619.16 (title) of the statutes is repealed.

AB100-ASA1, s. 3449 Section 3449. 619.16 (1) of the statutes is repealed.

AB100-ASA1, s. 3450 Section 3450. 619.16 (2) of the statutes is repealed.

AB100-ASA1, s. 3451 Section 3451. 619.16 (3) (a) of the statutes is renumbered 149.16 (3) (a) and amended to read:

AB100-ASA1,1823,19 149.16 (3) (a) The administering carrier plan administrator shall perform all eligibility and administrative claims payment functions relating to the plan.

AB100-ASA1, s. 3452 Section 3452. 619.16 (3) (b) of the statutes is renumbered 149.16 (3) (b) and amended to read:

AB100-ASA1,1823,24 149.16 (3) (b) The administering carrier plan administrator shall establish a premium billing procedure for collection of premiums from insured persons. Billings shall be made on a periodic basis as determined by the board department.

AB100-ASA1, s. 4884c Section 4884c. 619.16 (3) (c) of the statutes is renumbered 149.16 (3) (c), and 149.16 (3) (c) (intro.), as renumbered, is amended to read:

AB100-ASA1,1824,5 149.16 (3) (c) (intro.) The administering carrier plan administrator shall perform all necessary functions to assure timely payment of benefits to covered persons under the plan, including:

AB100-ASA1, s. 3453 Section 3453. 619.16 (3) (d) of the statutes is repealed.

AB100-ASA1, s. 3454 Section 3454. 619.16 (3) (e) of the statutes is renumbered 149.16 (3) (e) and amended to read:

AB100-ASA1,1824,16 149.16 (3) (e) The administering carrier plan administrator, under the direction of the department, shall pay claims expenses from the premium payments received from or on behalf of covered persons under the plan. If the administering carrier's plan administrator's payments for claims expenses exceed the portion of premiums allocated by the board for payment of claims expenses premium payments, the board shall forward to the department, and the department shall provide to the carrier plan administrator, additional funds for payment of claims expenses.

AB100-ASA1, s. 3455 Section 3455. 619.16 (3) (em) of the statutes is repealed.

AB100-ASA1, s. 3456 Section 3456. 619.16 (3) (f) of the statutes is repealed.

AB100-ASA1, s. 3457 Section 3457. 619.165 (title) of the statutes is renumbered 149.165 (title).

AB100-ASA1, s. 3458 Section 3458. 619.165 (1) (a) of the statutes is renumbered 149.165 (1) and amended to read:

AB100-ASA1,1824,25 149.165 (1) The board Except as provided in s. 149.146 (2) (a), the department shall reduce the premiums established by the commissioner under s. 619.11 149.11 in conformity with ss. 619.14 (5) 149.143 and 619.17 149.17, for the eligible persons and in the manner set forth in pars. (b) to (d) subs. (2) and (3).

AB100-ASA1, s. 3459 Section 3459. 619.165 (1) (b) of the statutes is renumbered 149.165 (2), and 149.165 (2) (intro.), as renumbered, is amended to read:

AB100-ASA1,1825,7 149.165 (2) (intro.) If the household income, as defined in s. 71.52 (5) and as determined under par. (d) sub. (3), of an eligible person is equal to or greater than the first amount and less than the 2nd amount listed in any of the following, the board department shall reduce the premium for the eligible person, as established by the commissioner, to the rate shown after the amounts:

AB100-ASA1, s. 3460 Section 3460. 619.165 (1) (d) of the statutes is renumbered 149.165 (3) and amended to read:

AB100-ASA1,1825,11 149.165 (3) The board department shall establish and implement the method for determining the household income of an eligible person under par. (b) sub. (2).

AB100-ASA1, s. 3461 Section 3461. 619.165 (2) of the statutes is repealed.

AB100-ASA1, s. 3462 Section 3462. 619.165 (3) of the statutes is renumbered 149.165 (4) and amended to read:

AB100-ASA1,1825,18 149.165 (4) The commissioner shall forward to the board moneys received under s. 20.145 (7) (a) and (g) in an amount sufficient to department shall reimburse the plan for premium reductions under sub. (1) (2) and deductible reductions under s. 619.14 149.14 (5) (a) with moneys from the appropriation under s. 20.435 (5) (ah).

AB100-ASA1, s. 3463 Section 3463. 619.167 of the statutes is repealed.

AB100-ASA1, s. 3464 Section 3464. 619.17 (intro.) of the statutes is renumbered 149.17 (intro.).

AB100-ASA1, s. 3465 Section 3465. 619.17 (1) of the statutes is renumbered 149.17 (1) and amended to read:

AB100-ASA1,1825,24 149.17 (1) Subject to s. 619.14 (5) (a) ss. 149.143 and 149.146 (2) (b), a rating plan calculated in accordance with generally accepted actuarial principles.

AB100-ASA1, s. 3466 Section 3466. 619.17 (2) of the statutes is renumbered 149.17 (2) and amended to read:

AB100-ASA1,1826,4 149.17 (2) A schedule of premiums, deductibles and coinsurance payments which complies with all requirements of this subchapter chapter.

AB100-ASA1, s. 3467 Section 3467. 619.17 (3) of the statutes is renumbered 149.17 (3).

AB100-ASA1, s. 3468 Section 3468. 619.17 (4) (a) of the statutes is renumbered 149.17 (4) and amended to read:

AB100-ASA1,1826,9 149.17 (4) Cost containment provisions established by the commissioner department by rule, including managed care requirements.

AB100-ASA1, s. 3469 Section 3469. 619.175 of the statutes is renumbered 149.175 and amended to read:

AB100-ASA1,1826,16 149.175 Waiver or exemption from provisions prohibited. Except as provided in s. 619.13 (1) (a) 149.13 (1), the commissioner department may not waive, or authorize the board to waive, any of the requirements of this subchapter chapter or exempt, or authorize the board to exempt, an individual or a class of individuals from any of the requirements of this subchapter chapter.

AB100-ASA1, s. 3470 Section 3470. 619.18 of the statutes is renumbered 149.18 and amended to read:

AB100-ASA1,1826,21 149.18 Chapters 600 to 645 applicable. Except as otherwise provided in this subchapter chapter, the plan shall comply and be administered in compliance with chs. 600 to 645.

AB100-ASA1, s. 3471 Section 3471. 631.36 (7) (a) 2. of the statutes is amended to read:

AB100-ASA1,1827,2 631.36 (7) (a) 2. Unless the notice contains adequate instructions to the policyholder for applying for insurance through a risk-sharing plan under subch. I of ch. 619, if a risk-sharing plan exists under subch. I of ch. 619 for the kind of coverage being canceled or nonrenewed, except as provided in par. (b).

AB100-ASA1, s. 3472 Section 3472. 632.745 (1) (d) of the statutes, as created by 1995 Wisconsin Act 289, is amended to read:

AB100-ASA1,1827,13 632.745 (1) (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. 619 149 or other insurance exempted by rule of the commissioner.

AB100-ASA1, s. 4929c Section 4929c. 632.745 (1) (f) 2. of the statutes, as created by 1995 Wisconsin Act 453, is amended to read:

AB100-ASA1,1827,22 632.745 (1) (f) 2. Notwithstanding subd. 1. b. and c., "qualifying coverage" does not include a high cost-share health plan, as defined in s. 632.898 (1) (c), 1995 stats., that is linked to a medical savings account, as described in s. 632.898, 1995 stats., if the employer that provides the individual's new coverage offers its eligible employes a choice of health benefit plan options that includes a high cost-share health plan, as defined in s. 632.898 (1) (c), 1995 stats., and the individual's new coverage is not a high cost-share health plan.

AB100-ASA1, s. 3473 Section 3473. 632.785 (1) (intro.) of the statutes is amended to read:

AB100-ASA1,1828,5 632.785 (1) (intro.) If an insurer issues one or more of the following or takes any other action based wholly or partially on medical underwriting considerations which is likely to render any person eligible under s. 619.12 149.12 for coverage under subch. II of ch. 619 149, the insurer shall notify all persons affected of the existence of the mandatory health insurance risk-sharing plan under subch. II of ch. 619 149, as well as the eligibility requirements and method of applying for coverage under the plan:

AB100-ASA1, s. 4930d Section 4930d. 632.89 (2) (a) 2. of the statutes is amended to read:

AB100-ASA1,1828,10 632.89 (2) (a) 2. Except as provided in pars. (b) to (e), coverage of conditions under subd. 1. by a policy may not be subject to exclusions or limitations, including deductibles, that are not generally applicable to other conditions covered under the policy.

AB100-ASA1, s. 4930f Section 4930f. 632.89 (2) (c) 2. a. of the statutes is amended to read:

AB100-ASA1,1828,12 632.89 (2) (c) 2. a. The expenses of the first 30 days as an inpatient in a hospital.