AB100-ASA1-AA8,473,13 131374. Page 1827, line 20: delete "$2,000 $7,000" and substitute "$2,000".
AB100-ASA1-AA8,473,14 141375. Page 1827, line 22: delete "$1,800 $6,300" and substitute "$1,800".
AB100-ASA1-AA8,473,15 151376. Page 1828, line 2: delete "$3,000 $7,000" and substitute "$3,000".
AB100-ASA1-AA8,473,16 161377. Page 1828, line 5: delete "$2,700 $6,300" and substitute "$2,700".
AB100-ASA1-AA8,473,17 171378. Page 1828, line 7: delete lines 7 to 24 and substitute:
AB100-ASA1-AA8,474,2 18"632.895 (11) Treatment for the correction of temporomandibular
19disorders.
(a) Every disability insurance policy, and every self-insured health plan
20of the state or a county, city, village, town or school district, that provides coverage
21of any diagnostic or surgical procedure involving a bone, joint, muscle or tissue shall
22provide coverage for diagnostic procedures and medically necessary surgical or
23nonsurgical treatment for the correction of temporomandibular disorders, including

1medically necessary surgery for the correction of functional deformities of the
2maxilla or mandible, if all of the following apply:
AB100-ASA1-AA8,474,43 1. The condition is caused by congenital, developmental or acquired deformity,
4disease or injury.
AB100-ASA1-AA8,474,75 2. Under the accepted standards of the profession of the health care provider
6rendering the service, the procedure or device is reasonable and appropriate for the
7diagnosis or treatment of the condition.
AB100-ASA1-AA8,474,98 3. The purpose of the procedure or device is to control or eliminate infection,
9pain, disease or dysfunction.
AB100-ASA1-AA8,474,1110 (b) 1. The coverage required under this subsection for nonsurgical treatment
11includes coverage for prescribed intraoral splint therapy devices.
AB100-ASA1-AA8,474,1312 2. The coverage required under this subsection does not include coverage for
13cosmetic or elective orthodontic care, periodontic care or general dental care.
AB100-ASA1-AA8,474,1614 (c) The coverage required under this subsection may be subject to any
15limitations, exclusions or cost-sharing provisions that apply generally under the
16disability insurance policy or self-insured health plan.".
AB100-ASA1-AA8,474,17 171379. Page 1829, line 1: delete lines 1 to 5 and substitute:
AB100-ASA1-AA8,474,20 18"632.895 (12) Hospital and ambulatory surgery center charges and
19anesthetics for dental care.
(a) In this subsection, "ambulatory surgery center"
20has the meaning given in s. 49.45 (6r) (a) 1.
AB100-ASA1-AA8,475,221 (b) Every disability insurance policy, and every self-insured health plan of the
22state or a county, city, village, town or school district, shall cover hospital or
23ambulatory surgery center charges incurred, and anesthetics provided, in

1conjunction with dental care that is provided to a covered individual in a hospital or
2ambulatory surgery center, if any of the following applies:".
AB100-ASA1-AA8,475,3 31380. Page 1829, line 11: substitute "(c)" for "(b)".
AB100-ASA1-AA8,475,4 41381. Page 1829, line 11: delete "par. (a)" and substitute "this subsection".
AB100-ASA1-AA8,475,5 51382. Page 1829, line 13: after that line insert:
AB100-ASA1-AA8,475,7 6" Section 4931m. 632.896 (4) of the statutes, as affected by 1995 Wisconsin Act
7289
, is amended to read:
AB100-ASA1-AA8,475,138 632.896 (4) Preexisting conditions. Notwithstanding ss. 632.745 (2) 632.746
9and 632.76 (2) (a), a disability insurance policy that is subject to sub. (2) and that is
10in effect when a court makes a final order granting adoption or when the child is
11placed for adoption may not exclude or limit coverage of a disease or physical
12condition of the child on the ground that the disease or physical condition existed
13before coverage is required to begin under sub. (3).".
AB100-ASA1-AA8,475,14 141383. Page 1829, line 13: after that line insert:
AB100-ASA1-AA8,475,15 15" Section 4930v. 632.895 (13) of the statutes is created to read:
AB100-ASA1-AA8,475,1916 632.895 (13) Breast reconstruction. (a) Every disability insurance policy,
17and every self-insured health plan of the state or a county, city, village, town or school
18district, that provides coverage of the surgical procedure known as a mastectomy
19shall provide coverage of breast reconstruction incident to a mastectomy.
AB100-ASA1-AA8,475,2220 (b) The coverage required under par. (a) may be subject to any limitations,
21exclusions or cost-sharing provisions that apply generally under the disability
22insurance policy or self-insured health plan.".
AB100-ASA1-AA8,475,24 231384. Page 1829, line 20: delete the material beginning with that line and
24ending with page 1830, line 13, and substitute:
AB100-ASA1-AA8,476,1
1" Section 4932b. 632.898 of the statutes is repealed.
AB100-ASA1-AA8, s. 4932d 2Section 4932d. Subchapter I (title) of chapter 635 [precedes 635.01] of the
3statutes is repealed.
AB100-ASA1-AA8, s. 4932f 4Section 4932f. 635.01 of the statutes is amended to read:
AB100-ASA1-AA8,476,11 5635.01 Scope. This subchapter chapter applies to all group health insurance
6plans, policies or certificates, written on risks or operations in this state, providing
7coverage for employes of a small employer, or employes of a small employer and the
8employer, and to individual health insurance policies, written on risks or operations
9in this state, providing coverage for employes of a small employer, or employes of a
10small employer and the employer when 3 or more are sold to or through a small
11employer.
AB100-ASA1-AA8, s. 4932h 12Section 4932h. 635.02 (intro.) of the statutes is amended to read:
AB100-ASA1-AA8,476,13 13635.02 Definitions. (intro.) In this subchapter chapter:
AB100-ASA1-AA8, s. 4932j 14Section 4932j. 635.02 (1c) of the statutes is repealed.
AB100-ASA1-AA8, s. 4932L 15Section 4932L. 635.02 (1p) of the statutes is created to read:
AB100-ASA1-AA8,476,1616 635.02 (1p) "Bona fide association" has the meaning given in s. 632.745 (3).
AB100-ASA1-AA8, s. 4932p 17Section 4932p. 635.02 (3c) of the statutes is repealed.
AB100-ASA1-AA8, s. 4932q 18Section 4932q. 635.02 (3f) of the statutes is repealed.
AB100-ASA1-AA8, s. 4932r 19Section 4932r. 635.02 (3g) of the statutes is created to read:
AB100-ASA1-AA8,476,2020 635.02 (3g) "Employer" has the meaning given in s. 632.745 (6).
AB100-ASA1-AA8, s. 4932s 21Section 4932s. 635.02 (3k) of the statutes is created to read:
AB100-ASA1-AA8,476,2322 635.02 (3k) "Group health benefit plan" has the meaning given in s. 632.745
23(9).
AB100-ASA1-AA8, s. 4932t 24Section 4932t. 635.02 (3m) of the statutes is repealed and recreated to read:
AB100-ASA1-AA8,476,2525 635.02 (3m) "Health benefit plan" has the meaning given in s. 632.745 (11).
AB100-ASA1-AA8, s. 4932u
1Section 4932u. 635.02 (4t) of the statutes is created to read:
AB100-ASA1-AA8,477,22 635.02 (4t) "Network plan" has the meaning given in s. 632.745 (19).
AB100-ASA1-AA8, s. 4932v 3Section 4932v. 635.02 (7) of the statutes is repealed and recreated to read:
AB100-ASA1-AA8,477,104 635.02 (7) "Small employer" means, with respect to a calendar year and a plan
5year, an employer that employed an average of at least 2 but not more than 50
6employes on business days during the preceding calendar year, or that is reasonably
7expected to employ an average of at least 2 but not more than 50 employes on
8business days during the current calendar year if the employer was not in existence
9during the preceding calendar year, and that employs at least 2 employes on the first
10day of the plan year.
AB100-ASA1-AA8, s. 4932w 11Section 4932w. 635.02 (9) of the statutes is created to read:
AB100-ASA1-AA8,477,1212 635.02 (9) "Small group market" has the meaning given in s. 632.745 (26).
AB100-ASA1-AA8, s. 4932x 13Section 4932x. 635.09 of the statutes is repealed.
AB100-ASA1-AA8, s. 4932y 14Section 4932y. 635.11 of the statutes is renumbered 635.11 (1m), and 635.11
15(1m) (intro.), as renumbered, is amended to read:
AB100-ASA1-AA8,477,1816 635.11 (1m) (intro.) Before the sale of a plan or policy subject to this subchapter
17chapter, a small employer insurer shall disclose to a small employer all of the
18following:
AB100-ASA1-AA8, s. 4933c 19Section 4933c. 635.11 (1m) (e) of the statutes is created to read:
AB100-ASA1-AA8,477,2120 635.11 (1m) (e) As part of the small employer insurer's solicitation and sales
21materials, the availability of the information under par. (f).
AB100-ASA1-AA8, s. 4933e 22Section 4933e. 635.11 (1m) (f) of the statutes is created to read:
AB100-ASA1-AA8,477,2423 635.11 (1m) (f) Upon the request of the small employer, the following
24information:
AB100-ASA1-AA8,478,2
11. The provisions, if any, of the plan or policy relating to preexisting condition
2exclusions.
AB100-ASA1-AA8,478,43 2. The benefits and premiums available under all health insurance coverage
4offered by the small employer insurer for which the small employer is qualified.
AB100-ASA1-AA8, s. 4933g 5Section 4933g. 635.11 (2m) of the statutes is created to read:
AB100-ASA1-AA8,478,96 635.11 (2m) Information required to be disclosed under this section shall be
7provided in a manner that is understandable to a small employer and shall be
8sufficient to reasonably inform a small employer of the small employer's rights and
9obligations under the health insurance coverage.
AB100-ASA1-AA8, s. 4933i 10Section 4933i. 635.11 (3m) of the statutes is created to read:
AB100-ASA1-AA8,478,1311 635.11 (3m) A small employer insurer is not required under this section to
12disclose information that is proprietary or trade secret information under applicable
13law.
AB100-ASA1-AA8, s. 4934c 14Section 4934c. 635.13 (1) of the statutes is amended to read:
AB100-ASA1-AA8,478,1915 635.13 (1) Records. A small employer insurer shall maintain at its principal
16place of business complete and detailed records relating to its rating methods and
17practices and its renewal underwriting methods and practices, and shall make the
18records available to the commissioner and the small employer insurance board upon
19request.
AB100-ASA1-AA8, s. 4935m 20Section 4935m. 635.18 (1) of the statutes is amended to read:
AB100-ASA1-AA8,479,221 635.18 (1) Every small employer insurer shall actively market health benefit
22plan coverage, including basic health benefit plans, to small employers in the state.
23If a small employer insurer denies coverage to a small employer under a health
24benefit plan that is not a basic health benefit plan on the basis of the health status
25or claims experience of the small employer or its eligible employes or their

1dependents, the small employer insurer shall offer the small employer the
2opportunity to purchase a basic health benefit plan.
AB100-ASA1-AA8, s. 4935p 3Section 4935p. 635.18 (3) (c) of the statutes is repealed.
AB100-ASA1-AA8, s. 4935r 4Section 4935r. 635.18 (7) of the statutes is amended to read:
AB100-ASA1-AA8,479,95 635.18 (7) A 3rd-party administrator that enters into a contract, agreement
6or other arrangement with a small employer insurer to provide administrative,
7marketing or other services related to the offering of health benefit plans to small
8employers in this state is subject to this subchapter chapter as if it were a small
9employer insurer.
AB100-ASA1-AA8, s. 4936c 10Section 4936c. 635.19 of the statutes is created to read:
AB100-ASA1-AA8,479,13 11635.19 Issuance of coverage in small group market. (1) (a) Except as
12provided in subs. (2) to (6), a small employer insurer that offers a group health benefit
13plan in the small group market shall do all of the following:
AB100-ASA1-AA8,479,1414 1. Accept any small employer in the state that applies for such coverage.
AB100-ASA1-AA8,479,1715 2. Accept for enrollment under such coverage any eligible individual who
16applies for enrollment during the period in which the individual first becomes
17eligible to enroll under the terms of the group health benefit plan.
AB100-ASA1-AA8,479,1918 3. Place no restriction on an eligible individual under par. (b) that is
19inconsistent with s. 632.746 or 632.748.
AB100-ASA1-AA8,479,2220 (b) For purposes of this section, whether an individual is an "eligible
21individual" in relation to a small employer shall be determined in accordance with
22all of the following:
AB100-ASA1-AA8,479,2423 1. The terms of the group health benefit plan under which the individual is
24applying for enrollment.
AB100-ASA1-AA8,480,3
12. Rules of the small employer insurer offering the group health benefit plan
2under which the individual is applying for enrollment, which rules must apply
3uniformly in this state to small employers in the small group market.
AB100-ASA1-AA8,480,54 3. All state laws that apply to small employer insurers and the small group
5market.
AB100-ASA1-AA8,480,7 6(2) (a) A small employer insurer that offers a group health benefit plan in the
7small group market through a network plan may do any of the following:
AB100-ASA1-AA8,480,98 1. Limit the small employers that may apply for such coverage to those with
9eligible individuals who reside, live or work in the service area of the network plan.
AB100-ASA1-AA8,480,1210 2. Within the service area of the network plan, deny such coverage to small
11employers if the small employer insurer demonstrates to the commissioner all of the
12following:
AB100-ASA1-AA8,480,1513 a. That the insurer does not have the capacity to deliver services adequately
14to enrollees of any additional groups because of its obligations to existing group
15contract holders and enrollees.
AB100-ASA1-AA8,480,1916 b. That the insurer is applying this subdivision uniformly to all small
17employers without regard to the claims experience of those small employers or their
18employes or employes' dependents or any other health status-related factor of those
19employes or their dependents.
AB100-ASA1-AA8,480,2220 (b) A small employer insurer that denies coverage under par. (a) 2. in any
21service area may not offer coverage in the small group market in that service area
22for 180 days after the date on which the coverage was denied.
AB100-ASA1-AA8,481,2 23(3) (a) A small employer insurer that offers a group health benefit plan in the
24small group market may deny small employers coverage under such a plan in the

1small group market if the small employer insurer demonstrates to the commissioner
2all of the following:
AB100-ASA1-AA8,481,43 1. That the insurer does not have the financial reserves necessary to
4underwrite additional coverage.
AB100-ASA1-AA8,481,95 2. That the insurer is applying this paragraph uniformly to all small employers
6in the small group market in the state in accordance with applicable state law and
7without regard to the claims experience of those small employers or their employes
8or employes' dependents or any other health status-related factor of those employes
9or their dependents.
AB100-ASA1-AA8,481,1410 (b) A small employer insurer that denies coverage under par. (a) may not offer
11a group health benefit plan in the small group market in the state for 180 days after
12the date on which the coverage was denied or until the insurer demonstrates to the
13commissioner that the insurer has sufficient financial reserves to underwrite
14additional coverage, whichever is later.
AB100-ASA1-AA8,481,17 15(4) Subsection (1) shall not be construed to preclude a small employer insurer
16from establishing, for the offering of a group health benefit plan in the small group
17market, any of the following:
AB100-ASA1-AA8,481,2018 (a) Rules or requirements relating to the minimum level or amount of small
19employer contribution toward the premium for the enrollment of participants and
20beneficiaries.
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