AB100-ASA1, s. 3437 18Section 3437. 619.15 (3) (a) of the statutes is renumbered 149.15 (3) (a).
AB100-ASA1, s. 3438 19Section 3438. 619.15 (3) (b) of the statutes is repealed.
AB100-ASA1, s. 4867c 20Section 4867c. 619.15 (3) (c) of the statutes is renumbered 149.15 (3) (c) and
21amended to read:
AB100-ASA1,1822,322 149.15 (3) (c) Collect assessments from all insurers to provide for claims paid
23under the plan and for administrative expenses incurred or estimated to be incurred
24during the period for which the assessment is made. The level of payments shall be
25established by the board as provided under s. 149.143. Assessment of the insurers

1shall occur at the end of each calendar year or other fiscal year end established by
2the board. Assessments are due and payable within 30 days of receipt by the insurer
3of the assessment notice.
AB100-ASA1, s. 3439 4Section 3439. 619.15 (3) (d) of the statutes is renumbered 149.15 (3) (d).
AB100-ASA1, s. 4869c 5Section 4869c. 619.15 (3) (e) of the statutes is renumbered 149.15 (3) (e) and
6amended to read:
AB100-ASA1,1822,127 149.15 (3) (e) Establish for payment of covered expenses, a payment rate that
8is 10% less than the charges approved by the administering carrier plan
9administrator
for reimbursement of covered expenses under s. 619.14 149.14 (3). A
10provider of a covered service or article may not bill an eligible person who receives
11the service or article for any amount by which the charge is reduced under this
12paragraph.
AB100-ASA1, s. 4869d 13Section 4869d. 619.15 (3) (f) of the statutes is created to read:
AB100-ASA1,1822,1514 619.15 (3) (f) In consultation with the office and the department of health and
15family services, establish a choice of coverage under s. 619.146.
AB100-ASA1, s. 4869f 16Section 4869f. 619.15 (3) (f) of the statutes, as created by 1997 Wisconsin Act
17.... (this act), is renumbered 149.15 (3) (f) and amended to read:
AB100-ASA1,1822,2018 149.15 (3) (f) In consultation with the office of the commissioner of insurance
19and the department of health and family services, establish a choice of coverage
20under s. 619.146 149.146.
AB100-ASA1, s. 3440 21Section 3440. 619.15 (4) (intro.) of the statutes is renumbered 149.15 (4)
22(intro.) and amended to read:
AB100-ASA1,1822,2323 149.15 (4) (intro.) The board may do any of the following:
AB100-ASA1, s. 3441 24Section 3441. 619.15 (4) (a) of the statutes is renumbered 149.15 (4) (a).
AB100-ASA1, s. 3442 25Section 3442. 619.15 (4) (b) of the statutes is renumbered 149.15 (4) (b).
AB100-ASA1, s. 4873c
1Section 4873c. 619.15 (4) (c) of the statutes is repealed.
AB100-ASA1, s. 3443 2Section 3443. 619.15 (4) (d) of the statutes is repealed.
AB100-ASA1, s. 3444 3Section 3444. 619.15 (4) (e) of the statutes is repealed.
AB100-ASA1, s. 3445 4Section 3445. 619.15 (5) of the statutes is renumbered 149.15 (5) and amended
5to read:
AB100-ASA1,1823,76 149.15 (5) The commissioner department may, by rule, establish additional
7powers and duties of the board.
AB100-ASA1, s. 3446 8Section 3446. 619.15 (6) of the statutes is renumbered 149.15 (6) and amended
9to read:
AB100-ASA1,1823,1110 149.15 (6) If any provision of this subchapter chapter conflicts with s. 625.11
11or 625.12, this subchapter chapter prevails.
AB100-ASA1, s. 3447 12Section 3447. 619.15 (7) of the statutes is renumbered 149.15 (7).
AB100-ASA1, s. 3448 13Section 3448. 619.16 (title) of the statutes is repealed.
AB100-ASA1, s. 3449 14Section 3449. 619.16 (1) of the statutes is repealed.
AB100-ASA1, s. 3450 15Section 3450. 619.16 (2) of the statutes is repealed.
AB100-ASA1, s. 3451 16Section 3451. 619.16 (3) (a) of the statutes is renumbered 149.16 (3) (a) and
17amended to read:
AB100-ASA1,1823,1918 149.16 (3) (a) The administering carrier plan administrator shall perform all
19eligibility and administrative claims payment functions relating to the plan.
AB100-ASA1, s. 3452 20Section 3452. 619.16 (3) (b) of the statutes is renumbered 149.16 (3) (b) and
21amended to read:
AB100-ASA1,1823,2422 149.16 (3) (b) The administering carrier plan administrator shall establish a
23premium billing procedure for collection of premiums from insured persons. Billings
24shall be made on a periodic basis as determined by the board department.
AB100-ASA1, s. 4884c
1Section 4884c. 619.16 (3) (c) of the statutes is renumbered 149.16 (3) (c), and
2149.16 (3) (c) (intro.), as renumbered, is amended to read:
AB100-ASA1,1824,53 149.16 (3) (c) (intro.) The administering carrier plan administrator shall
4perform all necessary functions to assure timely payment of benefits to covered
5persons under the plan, including:
AB100-ASA1, s. 3453 6Section 3453. 619.16 (3) (d) of the statutes is repealed.
AB100-ASA1, s. 3454 7Section 3454. 619.16 (3) (e) of the statutes is renumbered 149.16 (3) (e) and
8amended to read:
AB100-ASA1,1824,169 149.16 (3) (e) The administering carrier plan administrator, under the
10direction of the department,
shall pay claims expenses from the premium payments
11received from or on behalf of covered persons under the plan. If the administering
12carrier's
plan administrator's payments for claims expenses exceed the portion of
13premiums allocated by the board for payment of claims expenses
premium
14payments
, the board shall forward to the department, and the department shall
15provide to the carrier plan administrator, additional funds for payment of claims
16expenses.
AB100-ASA1, s. 3455 17Section 3455. 619.16 (3) (em) of the statutes is repealed.
AB100-ASA1, s. 3456 18Section 3456. 619.16 (3) (f) of the statutes is repealed.
AB100-ASA1, s. 3457 19Section 3457. 619.165 (title) of the statutes is renumbered 149.165 (title).
AB100-ASA1, s. 3458 20Section 3458. 619.165 (1) (a) of the statutes is renumbered 149.165 (1) and
21amended to read:
AB100-ASA1,1824,2522 149.165 (1) The board Except as provided in s. 149.146 (2) (a), the department
23shall reduce the premiums established by the commissioner under s. 619.11 149.11
24in conformity with ss. 619.14 (5) 149.143 and 619.17 149.17, for the eligible persons
25and in the manner set forth in pars. (b) to (d) subs. (2) and (3).
AB100-ASA1, s. 3459
1Section 3459. 619.165 (1) (b) of the statutes is renumbered 149.165 (2), and
2149.165 (2) (intro.), as renumbered, is amended to read:
AB100-ASA1,1825,73 149.165 (2) (intro.) If the household income, as defined in s. 71.52 (5) and as
4determined under par. (d) sub. (3), of an eligible person is equal to or greater than
5the first amount and less than the 2nd amount listed in any of the following, the
6board department shall reduce the premium for the eligible person, as established
7by the commissioner,
to the rate shown after the amounts:
AB100-ASA1, s. 3460 8Section 3460. 619.165 (1) (d) of the statutes is renumbered 149.165 (3) and
9amended to read:
AB100-ASA1,1825,1110 149.165 (3) The board department shall establish and implement the method
11for determining the household income of an eligible person under par. (b) sub. (2).
AB100-ASA1, s. 3461 12Section 3461. 619.165 (2) of the statutes is repealed.
AB100-ASA1, s. 3462 13Section 3462. 619.165 (3) of the statutes is renumbered 149.165 (4) and
14amended to read:
AB100-ASA1,1825,1815 149.165 (4) The commissioner shall forward to the board moneys received
16under s. 20.145 (7) (a) and (g) in an amount sufficient to
department shall reimburse
17the plan for premium reductions under sub. (1) (2) and deductible reductions under
18s. 619.14 149.14 (5) (a) with moneys from the appropriation under s. 20.435 (5) (ah).
AB100-ASA1, s. 3463 19Section 3463. 619.167 of the statutes is repealed.
AB100-ASA1, s. 3464 20Section 3464. 619.17 (intro.) of the statutes is renumbered 149.17 (intro.).
AB100-ASA1, s. 3465 21Section 3465. 619.17 (1) of the statutes is renumbered 149.17 (1) and amended
22to read:
AB100-ASA1,1825,2423 149.17 (1) Subject to s. 619.14 (5) (a) ss. 149.143 and 149.146 (2) (b), a rating
24plan calculated in accordance with generally accepted actuarial principles.
AB100-ASA1, s. 3466
1Section 3466. 619.17 (2) of the statutes is renumbered 149.17 (2) and amended
2to read:
AB100-ASA1,1826,43 149.17 (2) A schedule of premiums, deductibles and coinsurance payments
4which complies with all requirements of this subchapter chapter.
AB100-ASA1, s. 3467 5Section 3467. 619.17 (3) of the statutes is renumbered 149.17 (3).
AB100-ASA1, s. 3468 6Section 3468. 619.17 (4) (a) of the statutes is renumbered 149.17 (4) and
7amended to read:
AB100-ASA1,1826,98 149.17 (4) Cost containment provisions established by the commissioner
9department by rule, including managed care requirements.
AB100-ASA1, s. 3469 10Section 3469. 619.175 of the statutes is renumbered 149.175 and amended to
11read:
AB100-ASA1,1826,16 12149.175 Waiver or exemption from provisions prohibited. Except as
13provided in s. 619.13 (1) (a) 149.13 (1), the commissioner department may not waive,
14or authorize the board to waive, any of the requirements of this subchapter chapter
15or exempt, or authorize the board to exempt, an individual or a class of individuals
16from any of the requirements of this subchapter chapter.
AB100-ASA1, s. 3470 17Section 3470. 619.18 of the statutes is renumbered 149.18 and amended to
18read:
AB100-ASA1,1826,21 19149.18 Chapters 600 to 645 applicable. Except as otherwise provided in this
20subchapter chapter, the plan shall comply and be administered in compliance with
21chs. 600 to 645.
AB100-ASA1, s. 3471 22Section 3471. 631.36 (7) (a) 2. of the statutes is amended to read:
AB100-ASA1,1827,223 631.36 (7) (a) 2. Unless the notice contains adequate instructions to the
24policyholder for applying for insurance through a risk-sharing plan under subch. I

1of
ch. 619, if a risk-sharing plan exists under subch. I of ch. 619 for the kind of
2coverage being canceled or nonrenewed, except as provided in par. (b).
AB100-ASA1, s. 3472 3Section 3472. 632.745 (1) (d) of the statutes, as created by 1995 Wisconsin Act
4289
, is amended to read:
AB100-ASA1,1827,135 632.745 (1) (d) "Health benefit plan" means any hospital or medical policy or
6certificate. "Health benefit plan" does not include accident-only, credit accident or
7health, dental, vision, medicare supplement, medicare replacement, long-term care,
8disability income or short-term insurance, coverage issued as a supplement to
9liability insurance, worker's compensation or similar insurance, automobile medical
10payment insurance, individual conversion policies, specified disease policies,
11hospital indemnity policies, as defined in s. 632.895 (1) (c), policies or certificates
12issued under the health insurance risk-sharing plan or an alternative plan under
13subch. II of ch. 619 149 or other insurance exempted by rule of the commissioner.
AB100-ASA1, s. 4929c 14Section 4929c. 632.745 (1) (f) 2. of the statutes, as created by 1995 Wisconsin
15Act 453
, is amended to read:
AB100-ASA1,1827,2216 632.745 (1) (f) 2. Notwithstanding subd. 1. b. and c., "qualifying coverage" does
17not include a high cost-share health plan, as defined in s. 632.898 (1) (c), 1995 stats.,
18that is linked to a medical savings account, as described in s. 632.898, 1995 stats.,
19if the employer that provides the individual's new coverage offers its eligible
20employes a choice of health benefit plan options that includes a high cost-share
21health plan, as defined in s. 632.898 (1) (c), 1995 stats., and the individual's new
22coverage is not a high cost-share health plan.
AB100-ASA1, s. 3473 23Section 3473. 632.785 (1) (intro.) of the statutes is amended to read:
AB100-ASA1,1828,524 632.785 (1) (intro.) If an insurer issues one or more of the following or takes any
25other action based wholly or partially on medical underwriting considerations which

1is likely to render any person eligible under s. 619.12 149.12 for coverage under
2subch. II of ch. 619 149, the insurer shall notify all persons affected of the existence
3of the mandatory health insurance risk-sharing plan under subch. II of ch. 619 149,
4as well as the eligibility requirements and method of applying for coverage under the
5plan:
AB100-ASA1, s. 4930d 6Section 4930d. 632.89 (2) (a) 2. of the statutes is amended to read:
AB100-ASA1,1828,107 632.89 (2) (a) 2. Except as provided in pars. (b) to (e), coverage of conditions
8under subd. 1. by a policy may not be subject to exclusions or limitations, including
9deductibles,
that are not generally applicable to other conditions covered under the
10policy.
AB100-ASA1, s. 4930f 11Section 4930f. 632.89 (2) (c) 2. a. of the statutes is amended to read:
AB100-ASA1,1828,1212 632.89 (2) (c) 2. a. The expenses of the first 30 days as an inpatient in a hospital.
AB100-ASA1, s. 4930h 13Section 4930h. 632.89 (2) (c) 2. b. of the statutes is amended to read:
AB100-ASA1,1828,1714 632.89 (2) (c) 2. b. The first $7,000 Seven thousand dollars minus a copayment
15of up to 10% for inpatient hospital services or, if the coverage is provided by a health
16maintenance organization, as defined in s. 609.01 (2), the first $6,300 or the
17equivalent benefits measured in services rendered.
AB100-ASA1, s. 4930pm 18Section 4930pm. 632.89 (2) (d) 2. of the statutes is amended to read:
AB100-ASA1,1828,2319 632.89 (2) (d) 2. Except as provided in par. (b), a policy under subd. 1. shall
20provide coverage in every policy year for not less than the first $2,000 $7,000 minus
21a copayment of up to 10% for outpatient services or, if the coverage is provided by a
22health maintenance organization, as defined in s. 609.01 (2), the first $1,800 $6,300
23or the equivalent benefits measured in services rendered.
AB100-ASA1, s. 4930rm 24Section 4930rm. 632.89 (2) (dm) 2. of the statutes is amended to read:
AB100-ASA1,1829,5
1632.89 (2) (dm) 2. Except as provided in par. (b), a policy under subd. 1. shall
2provide coverage in every policy year for not less than the first $3,000 $7,000 minus
3a copayment of up to 10% for transitional treatment arrangements or, if the coverage
4is provided by a health maintenance organization, as defined in s. 609.01 (2), the first
5$2,700
$6,300 or the equivalent benefits measured in services rendered.
AB100-ASA1, s. 4930t 6Section 4930t. 632.895 (11) of the statutes is created to read:
AB100-ASA1,1829,147 632.895 (11) Procedures involving a bone, joint, muscle or tissue and
8intraoral splint therapy devices.
(a) Every disability insurance policy, and every
9self-insured health plan of the state or a county, city, village, town or school district,
10that provides coverage of any diagnostic or surgical procedure involving a bone, joint,
11muscle or tissue shall provide coverage for diagnostic and surgical procedures
12involving a bone, joint, muscle or tissue of the face, neck, head or skeletal structure,
13and for prescribed intraoral splint therapy devices, for the treatment of a condition,
14if all of the following apply:
AB100-ASA1,1829,1615 1. The condition is caused by congenital, developmental or acquired deformity,
16disease or injury.
AB100-ASA1,1829,1917 2. Under the accepted standards of the profession of the health care provider
18rendering the service, the procedure or device is reasonable and appropriate for the
19diagnosis or treatment of the condition.
AB100-ASA1,1829,2120 3. The purpose of the procedure or device is to control or eliminate infection,
21pain, disease or facial disfigurement or to restore functional swallowing or chewing.
AB100-ASA1,1829,2422 (b) The coverage required under this subsection may be subject to any
23limitations, exclusions or cost-sharing provisions that apply generally under the
24disability insurance policy or self-insured health plan.
AB100-ASA1, s. 4930u 25Section 4930u. 632.895 (12) of the statutes is created to read:
AB100-ASA1,1830,5
1632.895 (12) Hospital services and anesthetics for dental care. (a) Every
2disability insurance policy, and every self-insured health plan of the state or a
3county, city, village, town or school district, shall cover hospital services and
4anesthetics that are provided in conjunction with dental care that is provided to a
5covered individual in a hospital, if any of the following applies:
AB100-ASA1,1830,66 1. The individual is a child under the age of 5.
AB100-ASA1,1830,87 2. The individual has a chronic disability that meets all of the conditions under
8s. 230.04 (9r) (a) 2. a., b. and c.
AB100-ASA1,1830,109 3. The individual has a medical condition that requires hospitalization or
10general anesthesia for dental care.
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