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:".
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).
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