Amendment AA8-ASA1-AB100

AB100-ASA1-AA8,442,13 "(a) Any charge for treatment for cosmetic purposes other than surgery for the repair or treatment of an injury or a congenital bodily defect. Breast reconstruction incident to a mastectomy shall not be considered treatment for cosmetic purposes.".

AB100-ASA1-AA8,442,15 1367. Page 1818, line 15: on lines 15 and 23, delete "board" and substitute "board department".

AB100-ASA1-AA8,442,16 1368. Page 1821, line 1: delete "by" and substitute "by".

AB100-ASA1-AA8,442,17 1369. Page 1821, line 16: delete lines 16 to 20 and substitute:

AB100-ASA1-AA8,442,19 " Section 4869m. 619.15 (3) (f) of the statutes, as created by 1997 Wisconsin Act .... (this act), is repealed.".

AB100-ASA1-AA8,442,20 1370. Page 1824, line 8: delete lines 8 to 11 and substitute:

AB100-ASA1-AA8,442,22 " Section 4891c. 619.165 (1) (d) of the statutes is renumbered 619.165 (1) (d) 1. and amended to read:

AB100-ASA1-AA8,443,3 619.165 (1) (d) 1. The Subject to subd. 2., the board shall establish and implement the method for determining the household income of an eligible person under par. (b).

AB100-ASA1-AA8, s. 4891r Section 4891r. 619.165 (1) (d) of the statutes, as affected by 1997 Wisconsin Act .... (this act), is renumbered 149.165 (3), and 149.165 (3) (a) and (b) (intro.), as renumbered, are amended to read:

AB100-ASA1-AA8,443,9 149.165 (3) (a) Subject to subd. 2., the board par. (b), the department shall establish and implement the method for determining the household income of an eligible person under par. (b) sub. (2).

AB100-ASA1-AA8,443,13 (b) (intro.) In determining household income under par. (b), the board sub. (2), the department shall consider information submitted by an eligible person on a completed federal profit or loss from farming form, schedule F, if all of the following apply:

AB100-ASA1-AA8, s. 4891m Section 4891m. 619.165 (1) (d) 2. of the statutes is created to read:

AB100-ASA1-AA8,443,17 619.165 (1) (d) 2. In determining household income under par. (b), the board shall consider information submitted by an eligible person on a completed federal profit or loss from farming form, schedule F, if all of the following apply:

AB100-ASA1-AA8,443,18 a. The person is a farmer, as defined in s. 102.04 (3).

AB100-ASA1-AA8,443,20 b. The person was not eligible to claim the homestead credit under subch. VIII of ch. 71 in the preceding taxable year.".

AB100-ASA1-AA8,443,21 1371. Page 1825, line 21: after that line insert:

AB100-ASA1-AA8,443,23 " Section 4910c. 628.34 (3) (a) of the statutes, as affected by 1995 Wisconsin Act 289, is amended to read:

AB100-ASA1-AA8,444,7 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by charging different premiums or by offering different terms of coverage except on the basis of classifications related to the nature and the degree of the risk covered or the expenses involved, subject to ss. 632.365 and, 632.745 and 632.748. Rates are not unfairly discriminatory if they are averaged broadly among persons insured under a group, blanket or franchise policy, and terms are not unfairly discriminatory merely because they are more favorable than in a similar individual policy.

AB100-ASA1-AA8, s. 4910e Section 4910e. 628.34 (3) (b) of the statutes, as affected by 1995 Wisconsin Act 289, is amended to read:

AB100-ASA1-AA8,444,16 628.34 (3) (b) No insurer may refuse to insure or refuse to continue to insure, or limit the amount, extent or kind of coverage available to an individual, or charge an individual a different rate for the same coverage because of a mental or physical disability except when the refusal, limitation or rate differential is based on either sound actuarial principles supported by reliable data or actual or reasonably anticipated experience, subject to ss. 632.745, 632.747, 632.749, 635.09 and 635.26 632.746 to 632.7495.

AB100-ASA1-AA8, s. 4910g Section 4910g. 628.36 (2) (b) 1. of the statutes is amended to read:

AB100-ASA1-AA8,444,23 628.36 (2) (b) 1. Except for health maintenance organizations, preferred provider plans, and limited service health organizations and the small employer health insurance plan under subch. II of ch. 635, no health care plan may prevent any person covered under the plan from choosing freely among providers who have agreed to participate in the plan and abide by its terms, except by requiring the person covered to select primary providers to be used when reasonably possible.

AB100-ASA1-AA8, s. 4910i Section 4910i. 628.36 (2) (b) 3. of the statutes is amended to read:

AB100-ASA1-AA8,445,5 628.36 (2) (b) 3. Except as provided in subd. 4., no provider may be denied the opportunity to participate in a health care plan, other than a health maintenance organization, a limited service health organization, or a preferred provider plan or the small employer health insurance plan under subch. II of ch. 635, under the terms of the plan.

AB100-ASA1-AA8, s. 4910k Section 4910k. 628.36 (2) (b) 5. of the statutes is amended to read:

AB100-ASA1-AA8,445,11 628.36 (2) (b) 5. Except for the small employer health insurance plan under subch. II of ch. 635 to the extent determined by the small employer insurance board under s. 635.23 (1) (b), all All health care plans, including health maintenance organizations, limited service health organizations and preferred provider plans are subject to s. 632.87 (3).

AB100-ASA1-AA8, s. 4910m Section 4910m. 631.01 (4) of the statutes is amended to read:

AB100-ASA1-AA8,445,23 631.01 (4) Annuities and group policies for eleemosynary institutions. This chapter, and ch. 632 and the health insurance mandates under ch. 632 that apply to the plan under subch. II of ch. 635 do not apply to annuities or group policies that are provided on a basis as uniform nationally as state statutes permit to educational, scientific research, religious or charitable institutions organized without profit to any person, for the benefit of employes of such institutions. The commissioner may by order subject such contracts issued by a particular insurer to this chapter, or ch. 632 or the health insurance mandates under ch. 632 that apply to the plan under subch. II of ch. 635 or any portion of those provisions upon a finding, after a hearing, that the interests of Wisconsin insureds or creditors or the public of this state so require.".

AB100-ASA1-AA8,445,24 1372. Page 1826, line 3: delete lines 3 to 22 and substitute:

AB100-ASA1-AA8,446,1 " Section 4915m. 632.70 of the statutes is repealed.

AB100-ASA1-AA8, s. 4916m Section 4916m. 632.745 of the statutes, as affected by 1995 Wisconsin Acts 289 and 453, is repealed and recreated to read:

AB100-ASA1-AA8,446,5 632.745 Coverage requirements for group and individual health benefit plans; definitions. In this section and ss. 632.746 to 632.7495:

AB100-ASA1-AA8,446,8 (1) "Affiliation period" means the period which, under the terms of health insurance coverage offered by a health maintenance organization, must expire before the health insurance coverage becomes effective.

AB100-ASA1-AA8,446,10 (2) "Beneficiary" has the meaning given in section 3 (8) of the federal Employee Retirement Income Security Act of 1974.

AB100-ASA1-AA8,446,12 (3) "Bona fide association" means an association that satisfies all of the following:

AB100-ASA1-AA8,446,13 (a) The association has been actively in existence for at least 5 years.

AB100-ASA1-AA8,446,15 (b) The association has been formed and maintained in good faith for purposes other than obtaining insurance.

AB100-ASA1-AA8,446,18 (c) The association does not condition membership in the association on any health status-related factor of an individual, including an employe of an employer or a dependent of an employe.

AB100-ASA1-AA8,446,21 (d) The association makes health insurance coverage offered through the association available to all members, regardless of any health status-related factor of those members or individuals eligible for coverage through a member.

AB100-ASA1-AA8,446,23 (e) The association does not make health insurance coverage offered through the association available other than in connection with a member of the association.

AB100-ASA1-AA8,447,3 (f) The association meets any additional requirements that are imposed by a rule of the commissioner designed to prevent the use of an association for risk segmentation.

AB100-ASA1-AA8,447,5 (4) (a) Except as provided in par. (b), "creditable coverage" means coverage under any of the following:

AB100-ASA1-AA8,447,6 1. A group health plan.

AB100-ASA1-AA8,447,7 2. Health insurance.

AB100-ASA1-AA8,447,8 3. Part A or part B of title XVIII of the federal Social Security Act.

AB100-ASA1-AA8,447,10 4. Title XIX of the federal Social Security Act, except for coverage consisting solely of benefits under section 1928 of that act.

AB100-ASA1-AA8,447,11 5. Chapter 55 of title 10 of the United States Code.

AB100-ASA1-AA8,447,13 6. A medical care program of the federal Indian health service or of an American Indian tribal organization.

AB100-ASA1-AA8,447,14 7. A state health benefits risk pool.

AB100-ASA1-AA8,447,15 8. A health plan offered under chapter 89 of title 5 of the United States Code.

AB100-ASA1-AA8,447,17 9. A public health plan, as defined in regulations issued by the federal department of health and human services.

AB100-ASA1-AA8,447,19 10. A health coverage plan under section 5 (e) of the federal Peace Corps Act, 22 USC 2504 (e).

AB100-ASA1-AA8,447,21 (b) "Creditable coverage" does not include coverage consisting solely of coverage of excepted benefits, as defined in section 2791 (c) of P.L. 104-191.

AB100-ASA1-AA8,448,3 (5) (a) Except as provided in par. (b), "eligible employe" means an employe who works on a permanent basis and has a normal work week of 30 or more hours. The term includes a sole proprietor, a business owner, including the owner of a farm business, a partner of a partnership and a member of a limited liability company if the sole proprietor, business owner, partner or member is included as an employe under a health benefit plan of an employer, but the term does not include an employe who works on a temporary or substitute basis.

AB100-ASA1-AA8,448,6 (b) For purposes of a group health benefit plan, or a self-insured health plan, that is offered by the state under s. 40.51 (6) or by the group insurance board under s. 40.51 (7), "eligible employe" has the meaning given in s. 40.02 (25).

AB100-ASA1-AA8,448,7 (6) (a) "Employer" means any of the following:

AB100-ASA1-AA8,448,10 1. An individual, firm, corporation, partnership, limited liability company or association that is actively engaged in a business enterprise in this state, including a farm business.

AB100-ASA1-AA8,448,11 2. A municipality, as defined in s. 16.70 (8).

AB100-ASA1-AA8,448,12 3. The state.

AB100-ASA1-AA8,448,13 (b) For purposes of this definition, all of the following apply:

AB100-ASA1-AA8,448,15 1. All persons treated as a single employer under subsection (b), (c), (m) or (o) of section 414 of the Internal Revenue Code of 1986 shall be treated as one employer.

AB100-ASA1-AA8,448,16 2. "Employer" includes any predecessor of an employer.

AB100-ASA1-AA8,448,20 (7) "Enrollment date" means, with respect to an individual covered under a group health plan or health insurance, the date of enrollment of the individual under the plan or insurance or, if earlier, the first day of the waiting period for such enrollment.

AB100-ASA1-AA8,448,21 (8) "Federal continuation provision" means any of the following:

AB100-ASA1-AA8,448,23 (a) Section 4980B of the Internal Revenue Code of 1986, except for section 4980B (f) (1) of that code insofar as it relates to pediatric vaccines.

AB100-ASA1-AA8,448,25 (b) Part 6 of subtitle B of title I of the federal Employee Retirement Income Security Act of 1974, except for section 609 of that act.

AB100-ASA1-AA8,449,1 (c) Title XXII of P.L. 104-191.

AB100-ASA1-AA8,449,6 (9) "Group health benefit plan" means a health benefit plan that is issued by an insurer to or through an employer on behalf of a group consisting of at least 2 employes or a group including at least 2 eligible employes. The term includes individual health benefit plans covering eligible employes when 3 or more are sold to or through an employer.

AB100-ASA1-AA8,449,7 (10) "Group health plan" means any of the following:

AB100-ASA1-AA8,449,12 (a) An employe welfare plan, as defined in section 3 (1) of the federal Employee Retirement Security Act of 1974, to the extent that the employe welfare plan provides medical care, including items and services paid for as medical care, to employes or to their dependents, as defined under the terms of the employe welfare plan, directly or through insurance, reimbursement or otherwise.

AB100-ASA1-AA8,449,18 (b) Any program that would not otherwise be an employe welfare benefit plan and that is established or maintained by a partnership, to the extent that the program provides medical care, including items and services paid for as medical care, to present or former partners of the partnership or to their dependents, as defined under the terms of the program, directly or through insurance, reimbursement or otherwise.

AB100-ASA1-AA8,449,20 (11) (a) Except as provided in par. (b), "health benefit plan" means any hospital or medical policy or certificate.

AB100-ASA1-AA8,449,21 (b) "Health benefit plan" does not include any of the following:

AB100-ASA1-AA8,449,23 1. Coverage that is only accident or disability income insurance, or any combination of the 2 types.

AB100-ASA1-AA8,449,24 2. Coverage issued as a supplement to liability insurance.

AB100-ASA1-AA8,450,2 3. Liability insurance, including general liability insurance and automobile liability insurance.

AB100-ASA1-AA8,450,3 4. Worker's compensation or similar insurance.

AB100-ASA1-AA8,450,4 5. Automobile medical payment insurance.

AB100-ASA1-AA8,450,5 6. Credit-only insurance.

AB100-ASA1-AA8,450,6 7. Coverage for on-site medical clinics.

AB100-ASA1-AA8,450,9 8. Other similar insurance coverage, as specified in regulations issued by the federal department of health and human services, under which benefits for medical care are secondary or incidental to other insurance benefits.

AB100-ASA1-AA8,450,15 9. If provided under a separate policy, certificate or contract of insurance, or if otherwise not an integral part of the policy, certificate or contract of insurance: limited-scope dental or vision benefits; benefits for long-term care, nursing home care, home health care, community-based care, or any combination of those benefits; and such other similar, limited benefits as are specified in regulations issued by the federal department of health and human services under section 2791 of P.L. 104-191.

AB100-ASA1-AA8,450,17 10. Hospital indemnity or other fixed indemnity insurance or coverage only for a specified disease or illness, if all of the following apply:

AB100-ASA1-AA8,450,19 a. The benefits are provided under a separate policy, certificate or contract of insurance.

AB100-ASA1-AA8,450,22 b. There is no coordination between the provision of such benefits and any exclusion of benefits under any group health plan maintained by the same plan sponsor.

AB100-ASA1-AA8,450,25 c. Such benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor.

AB100-ASA1-AA8,451,6 11. Benefits that are provided under a separate policy, certificate or contract of insurance and that are medicare supplemental health insurance, as defined in section 1882 (g) (1) of the federal Social Security Act, coverage supplemental to the coverage provided under chapter 55 of title 10 of the United States Code or similar supplemental coverage provided as supplemental to coverage under a group health plan.

AB100-ASA1-AA8,451,7 12. Other insurance exempted by rule of the commissioner.

AB100-ASA1-AA8,451,9 (12) "Health insurance" includes health benefit plans but does not include group health plans.