AB100-ASA1-AA8,464,1816 632.747 (3) (a) The eligible employe was covered as a dependent under
17qualifying creditable coverage when he or she waived coverage under the
18self-insured health plan.
AB100-ASA1-AA8, s. 4921m 19Section 4921m. 632.747 (3) (b) of the statutes, as created by 1995 Wisconsin
20Act 289
, is amended to read:
AB100-ASA1-AA8,465,221 632.747 (3) (b) The eligible employe's coverage under the qualifying creditable
22coverage has terminated or will terminate due to a divorce from the insured under
23the qualifying creditable coverage, the death of the insured under the qualifying
24creditable coverage, loss of employment by the insured under the qualifying

1creditable coverage or involuntary loss of coverage under the qualifying creditable
2coverage by the insured under the qualifying creditable coverage.
AB100-ASA1-AA8, s. 4922m 3Section 4922m. 632.747 (3) (c) of the statutes, as created by 1995 Wisconsin
4Act 289
, is amended to read:
AB100-ASA1-AA8,465,75 632.747 (3) (c) The eligible employe applies for coverage under the self-insured
6health plan not more than 30 days after termination of his or her coverage under the
7qualifying creditable coverage.
AB100-ASA1-AA8, s. 4923m 8Section 4923m. 632.748 of the statutes is created to read:
AB100-ASA1-AA8,465,13 9632.748 Prohibiting discrimination. (1) (a) Subject to subs. (3) and (4), an
10insurer may not establish rules for the eligibility of any individual to enroll, or for
11the continued eligibility of any individual to remain enrolled, under a group health
12benefit plan based on any of the following factors with respect to the individual or
13a dependent of the individual:
AB100-ASA1-AA8,465,1414 1. Health status.
AB100-ASA1-AA8,465,1515 2. Medical condition, including both physical and mental illnesses.
AB100-ASA1-AA8,465,1616 3. Claims experience.
AB100-ASA1-AA8,465,1717 4. Receipt of health care.
AB100-ASA1-AA8,465,1818 5. Medical history.
AB100-ASA1-AA8,465,1919 6. Genetic information.
AB100-ASA1-AA8,465,2120 7. Evidence of insurability, including conditions arising out of acts of domestic
21violence.
AB100-ASA1-AA8,465,2222 8. Disability.
AB100-ASA1-AA8,465,2423 (b) For purposes of par. (a), rules for eligibility to enroll under a group health
24benefit plan include rules defining any applicable waiting periods for enrollment.
AB100-ASA1-AA8,466,5
1(2) An insurer offering a group health benefit plan may not require any
2individual, as a condition of enrollment or continued enrollment under the plan, to
3pay, on the basis of any health status-related factor with respect to the individual
4or a dependent of the individual, a premium or contribution that is greater than the
5premium or contribution for a similarly situated individual enrolled under the plan.
AB100-ASA1-AA8,466,7 6(3) To the extent consistent with s. 632.746, sub. (1) shall not be construed to
7do any of the following:
AB100-ASA1-AA8,466,98 (a) Require a group health benefit plan to provide particular benefits other
9than those provided under the terms of the plan.
AB100-ASA1-AA8,466,1210 (b) Prevent a group health benefit plan from establishing limitations or
11restrictions on the amount, level, extent or nature of benefits or coverage for
12similarly situated individuals enrolled under the plan.
AB100-ASA1-AA8,466,13 13(4) Nothing in sub. (1) shall be construed to do any of the following:
AB100-ASA1-AA8,466,1514 (a) Restrict the amount that an insurer may charge an employer for coverage
15under a group health benefit plan.
AB100-ASA1-AA8,466,1916 (b) Prevent an insurer offering a group health benefit plan from establishing
17premium discounts or rebates, or from modifying otherwise applicable copayments
18or deductibles, in return for adherence to programs of health promotion and disease
19prevention.
AB100-ASA1-AA8,466,2020 (c) Provide an exception from, or limit, the rate regulation under s. 635.05.
AB100-ASA1-AA8, s. 4924m 21Section 4924m. 632.749 of the statutes, as created by 1995 Wisconsin Act 289,
22is repealed and recreated to read:
AB100-ASA1-AA8,467,2 23632.749 Contract termination and renewability. (1) (a) Except as
24provided in subs. (2) to (4) and notwithstanding s. 631.36 (2) to (4m), an insurer that

1offers a group health benefit plan shall renew such coverage or continue such
2coverage in force at the option of the employer and, if applicable, plan sponsor.
AB100-ASA1-AA8,467,43 (b) At the time of coverage renewal, the insurer may modify a group health
4benefit plan issued in the large group market.
AB100-ASA1-AA8,467,6 5(2) Notwithstanding s. 631.36 (2) to (4m), an insurer may nonrenew or
6discontinue a group health benefit plan, but only if any of the following applies:
AB100-ASA1-AA8,467,87 (a) The plan sponsor has failed to pay premiums or contributions in accordance
8with the terms of the group health benefit plan or in a timely manner.
AB100-ASA1-AA8,467,119 (b) The plan sponsor has performed an act or engaged in a practice that
10constitutes fraud or made an intentional misrepresentation of material fact under
11the terms of the coverage.
AB100-ASA1-AA8,467,1412 (c) The plan sponsor has failed to comply with a material plan provision that
13is permitted under law relating to employer contribution or group participation
14rules.
AB100-ASA1-AA8,467,1715 (d) The insurer is ceasing to offer coverage in the market in which the group
16health benefit plan is included in accordance with sub. (3) and any other applicable
17state law.
AB100-ASA1-AA8,467,2218 (e) In the case of a group health benefit plan that the insurer offers through a
19network plan, there is no longer an enrollee under the plan who resides, lives or
20works in the service area of the insurer or in an area in which the insurer is
21authorized to do business and, in the case of the small group market, the insurer
22would deny enrollment under the plan under s. 635.19 (2) (a) 1.
AB100-ASA1-AA8,468,223 (f) In the case of a group health benefit plan that is made available only through
24one or more bona fide associations, the employer ceases to be a member of the
25association on which the coverage is based. Coverage may be terminated if this

1paragraph applies only if the coverage is terminated uniformly without regard to any
2health status-related factor of any covered individual.
AB100-ASA1-AA8,468,6 3(3) (a) Notwithstanding s. 631.36 (2) to (4m), an insurer may discontinue
4offering in this state a particular type of group health benefit plan offered in either
5the large group market or the group market other than the large group market, but
6only if all of the following apply:
AB100-ASA1-AA8,468,107 1. The insurer provides notice of the discontinuance to each employer and, if
8applicable, plan sponsor for whom the insurer provides coverage of this type in this
9state, and to the participants and beneficiaries covered under the coverage, at least
1090 days before the date on which the coverage will be discontinued.
AB100-ASA1-AA8,468,1711 2. The insurer offers to each employer and, if applicable, plan sponsor for whom
12the insurer provides coverage of this type in this state the option to purchase from
13among all of the other group health benefit plans that the insurer offers in the market
14in which is included the type of group health benefit plan that is being discontinued,
15except that in the case of the large group market, the insurer must offer each
16employer and, if applicable, plan sponsor the option to purchase one other group
17health benefit plan that the insurer offers in the large group market.
AB100-ASA1-AA8,468,2218 3. In exercising the option to discontinue coverage of this particular type and
19in offering the option to purchase coverage under subd. 2., the insurer acts uniformly
20without regard to any health status-related factor of any covered participants or
21beneficiaries or any participants or beneficiaries who may become eligible for
22coverage.
AB100-ASA1-AA8,469,223 (b) Notwithstanding s. 631.36 (2) to (4m), an insurer may discontinue offering
24in this state all group health benefit plans in the large group market or in the group

1market other than the large group market, or in both such group markets, but only
2if all of the following apply:
AB100-ASA1-AA8,469,73 1. The insurer provides notice of the discontinuance to the commissioner and
4to each employer and, if applicable, plan sponsor for whom the insurer provides
5coverage of this type in this state, and to the participants and beneficiaries covered
6under the coverage, at least 180 days before the date on which the coverage will be
7discontinued.
AB100-ASA1-AA8,469,108 2. All group health benefit plans issued or delivered for issuance in this state
9in the affected market or markets are discontinued and coverage under such group
10health benefit plans is not renewed.
AB100-ASA1-AA8,469,1311 3. The insurer does not issue or deliver for issuance in this state any group
12health benefit plan in the affected market or markets before 5 years after the day on
13which the last group health benefit plan is discontinued under subd. 2.
AB100-ASA1-AA8,469,15 14(4) This section does not apply to a group health benefit plan offered by the
15state under s. 40.51 (6) or by the group insurance board under s. 40.51 (7).
AB100-ASA1-AA8, s. 4925m 16Section 4925m. 632.7495 of the statutes is created to read:
AB100-ASA1-AA8,469,22 17632.7495 Guaranteed renewability of individual health insurance
18coverage.
(1) (a) Except as provided in subs. (2) and (3) and notwithstanding s.
19631.36 (2) to (4m), an insurer that provides individual health benefit plan coverage
20shall renew such coverage or continue such coverage in force at the option of the
21insured individual and, if applicable, the association through which the individual
22has coverage.
AB100-ASA1-AA8,470,223 (b) At the time of coverage renewal, the insurer may modify the individual
24health benefit plan coverage policy form as long as the modification is consistent with

1state law and effective on a uniform basis among all individuals with coverage under
2that policy form.
AB100-ASA1-AA8,470,5 3(2) Notwithstanding s. 631.36 (2) to (4m), an insurer may nonrenew or
4discontinue the individual health benefit plan coverage of an individual, but only if
5any of the following applies:
AB100-ASA1-AA8,470,86 (a) The individual or, if applicable, the association through which the
7individual has coverage has failed to pay premiums or contributions in accordance
8with the terms of the health insurance coverage or in a timely manner.
AB100-ASA1-AA8,470,129 (b) The individual or, if applicable, the association through which the
10individual has coverage has performed an act or engaged in a practice that
11constitutes fraud or made an intentional misrepresentation of material fact under
12the terms of the health insurance coverage.
AB100-ASA1-AA8,470,1413 (c) The insurer is ceasing to offer individual health benefit plan coverage in
14accordance with sub. (3) and any other applicable state law.
AB100-ASA1-AA8,470,1915 (d) In the case of individual health benefit plan coverage that the insurer offers
16through a network plan, the individual no longer resides, lives or works in the service
17area or in an area in which the insurer is authorized to do business. Coverage may
18be terminated if this paragraph applies only if the coverage is terminated uniformly
19without regard to any health status-related factor of covered individuals.
AB100-ASA1-AA8,470,2420 (e) In the case of individual health benefit plan coverage that the insurer offers
21only through one or more bona fide associations, the individual ceases to be a member
22of the association on which the coverage is based. Coverage may be terminated if this
23paragraph applies only if the coverage is terminated uniformly without regard to any
24health status-related factor of covered individuals.
AB100-ASA1-AA8,471,2
1(f) The individual is eligible for medicare and the commissioner by rule permits
2coverage to be terminated.
AB100-ASA1-AA8,471,5 3(3) (a) Notwithstanding s. 631.36 (2) to (4m), an insurer may discontinue
4offering in this state a particular type of individual health benefit plan coverage, but
5only if all of the following apply:
AB100-ASA1-AA8,471,96 1. The insurer provides notice of the discontinuance to each individual for
7whom the insurer provides coverage of this type in this state and, if applicable, to the
8association through which the individual has coverage at least 90 days before the
9date on which the coverage will be discontinued.
AB100-ASA1-AA8,471,1310 2. The insurer offers to each individual for whom the insurer provides coverage
11of this type in this state and, if applicable, to the association through which the
12individual has coverage the option to purchase any other type of individual health
13insurance coverage that the insurer offers for individuals.
AB100-ASA1-AA8,471,1714 3. In electing to discontinue coverage of this particular type and in offering the
15option to purchase coverage under subd. 2., the insurer acts uniformly without
16regard to any health status-related factor of enrolled individuals or individuals who
17may become eligible for the type of coverage described under subd. 2.
AB100-ASA1-AA8,471,2018 (b) Notwithstanding s. 631.36 (2) to (4m), an insurer may discontinue offering
19individual health benefit plan coverage in this state, but only if all of the following
20apply:
AB100-ASA1-AA8,471,2521 1. The insurer provides notice of the discontinuance to the commissioner and
22to each individual for whom the insurer provides individual health benefit plan
23coverage in this state and, if applicable, to the association through which the
24individual has coverage at least 180 days before the date on which the coverage will
25be discontinued.
AB100-ASA1-AA8,472,2
12. All individual health benefit plan coverage issued or delivered for issuance
2in this state is discontinued and coverage under such coverage is not renewed.
AB100-ASA1-AA8,472,53 3. The insurer does not issue or deliver for issuance in this state any individual
4health benefit plan coverage before 5 years after the day on which the last individual
5health benefit plan coverage is discontinued under subd. 2.
AB100-ASA1-AA8, s. 4929w 6Section 4929w. 632.76 (2) (a) of the statutes, as affected by 1995 Wisconsin
7Act 289
, is amended to read:
AB100-ASA1-AA8,472,138 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
9from the date of issue of the policy may be reduced or denied on the ground that a
10disease or physical condition existed prior to the effective date of coverage, unless the
11condition was excluded from coverage by name or specific description by a provision
12effective on the date of loss. This paragraph does not apply to a group health benefit
13plan, as defined in s. 632.745 (1) (c) (9), which is subject to s. 632.745 (2) 632.746.".
AB100-ASA1-AA8,472,14 141373. Page 1826, line 22: after that line insert:
AB100-ASA1-AA8,472,15 15" Section 4929m. 632.755 (title) of the statutes is amended to read:
AB100-ASA1-AA8,472,16 16632.755 (title) Public assistance and early intervention services.
AB100-ASA1-AA8, s. 4929n 17Section 4929n. 632.755 (1g) (a) of the statutes is amended to read:
AB100-ASA1-AA8,472,2118 632.755 (1g) (a) A disability insurance policy may not exclude a person or a
19person's dependent from coverage because the person or the dependent is eligible for
20assistance under ch. 49 or because the dependent is eligible for early intervention
21services under s. 51.44
.
AB100-ASA1-AA8, s. 4929p 22Section 4929p. 632.755 (1g) (b) of the statutes is amended to read:
AB100-ASA1-AA8,473,223 632.755 (1g) (b) A disability insurance policy may not terminate its coverage
24of a person or a person's dependent because the person or the dependent is eligible

1for assistance under ch. 49 or because the dependent is eligible for early intervention
2services under s. 51.44
.
AB100-ASA1-AA8, s. 4929r 3Section 4929r. 632.755 (1g) (c) of the statutes is amended to read:
AB100-ASA1-AA8,473,94 632.755 (1g) (c) A disability insurance policy may not provide different benefits
5of coverage to a person or the person's dependent because the person or the
6dependent is eligible for assistance under ch. 49 or because the dependent is eligible
7for early intervention services under s. 51.44
than it provides to persons and their
8dependents who are not eligible for assistance under ch. 49 or for early intervention
9services under s. 51.44
.
AB100-ASA1-AA8, s. 4929t 10Section 4929t. 632.755 (2) of the statutes is amended to read:
AB100-ASA1-AA8,473,1211 632.755 (2) Benefits provided by a disability insurance policy shall be primary
12to those benefits provided under ch. 49 or under s. 51.44 or 253.05.".
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:".
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