Amendment ASA1-AB100

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AB100-ASA1, s. 4873c Section 4873c. 619.15 (4) (c) of the statutes is repealed.

AB100-ASA1, s. 3443 Section 3443. 619.15 (4) (d) of the statutes is repealed.

AB100-ASA1, s. 3444 Section 3444. 619.15 (4) (e) of the statutes is repealed.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

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

AB100-ASA1,1828,17 632.89 (2) (c) 2. b. The first $7,000 Seven thousand dollars minus a copayment of up to 10% for inpatient hospital services or, if the coverage is provided by a health maintenance organization, as defined in s. 609.01 (2), the first $6,300 or the equivalent benefits measured in services rendered.

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

AB100-ASA1,1828,23 632.89 (2) (d) 2. Except as provided in par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than the first $2,000 $7,000 minus a copayment of up to 10% for outpatient services or, if the coverage is provided by a health maintenance organization, as defined in s. 609.01 (2), the first $1,800 $6,300 or the equivalent benefits measured in services rendered.

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

AB100-ASA1,1829,5 632.89 (2) (dm) 2. Except as provided in par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than the first $3,000 $7,000 minus a copayment of up to 10% for transitional treatment arrangements or, if the coverage is provided by a health maintenance organization, as defined in s. 609.01 (2), the first $2,700 $6,300 or the equivalent benefits measured in services rendered.

AB100-ASA1, s. 4930t Section 4930t. 632.895 (11) of the statutes is created to read:

AB100-ASA1,1829,14 632.895 (11) Procedures involving a bone, joint, muscle or tissue and intraoral splint therapy devices. (a) Every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, that provides coverage of any diagnostic or surgical procedure involving a bone, joint, muscle or tissue shall provide coverage for diagnostic and surgical procedures involving a bone, joint, muscle or tissue of the face, neck, head or skeletal structure, and for prescribed intraoral splint therapy devices, for the treatment of a condition, if all of the following apply:

AB100-ASA1,1829,16 1. The condition is caused by congenital, developmental or acquired deformity, disease or injury.

AB100-ASA1,1829,19 2. Under the accepted standards of the profession of the health care provider rendering the service, the procedure or device is reasonable and appropriate for the diagnosis or treatment of the condition.

AB100-ASA1,1829,21 3. The purpose of the procedure or device is to control or eliminate infection, pain, disease or facial disfigurement or to restore functional swallowing or chewing.

AB100-ASA1,1829,24 (b) The coverage required under this subsection may be subject to any limitations, exclusions or cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan.

AB100-ASA1, s. 4930u Section 4930u. 632.895 (12) of the statutes is created to read:

AB100-ASA1,1830,5 632.895 (12) Hospital services and anesthetics for dental care. (a) Every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, shall cover hospital services and anesthetics that are provided in conjunction with dental care that is provided to a covered individual in a hospital, if any of the following applies:

AB100-ASA1,1830,6 1. The individual is a child under the age of 5.

AB100-ASA1,1830,8 2. The individual has a chronic disability that meets all of the conditions under s. 230.04 (9r) (a) 2. a., b. and c.

AB100-ASA1,1830,10 3. The individual has a medical condition that requires hospitalization or general anesthesia for dental care.

AB100-ASA1,1830,13 (b) The coverage required under par. (a) may be subject to any limitations, exclusions or cost-sharing provisions that apply generally under the disability insurance policy or self-insured plan.

AB100-ASA1, s. 3474 Section 3474. 632.897 (10) (am) 2. of the statutes is amended to read:

AB100-ASA1,1830,19 632.897 (10) (am) 2. Provide family coverage under the group policy or individual policy for the individual's child, if eligible for coverage, upon application by the individual, the child's other parent, the department of health and family services workforce development or the county designee child support agency under s. 59.53 (5).

AB100-ASA1, s. 4932m Section 4932m. 632.898 (1), (2), (3), (4), (5) and (6) of the statutes are repealed.