AB100-ASA1-AA8-AA8,11,2314 619.14 (3) Covered expenses. (intro.) Except as restricted by cost containment
15provisions under s. 619.17 (4) and except as reduced by the board under s. 619.15 (3)
16(e) or by the commissioner under s. 619.143 (2) (a) 3. or (3) or 619.144, covered
17expenses for the coverage under this section shall be the usual and customary
18charges for the services provided by persons licensed under ch. 446. Except as
19restricted by cost containment provisions under s. 619.17 (4) and except as reduced
20by the board under s. 619.15 (3) (e) or by the commissioner under s. 619.143 (2) (a)
213. or (3) or 619.144
, covered expenses for the coverage under this section shall also
22be the usual and customary charges for the following services and articles when
23prescribed by a physician licensed under ch. 448 or in another state:
AB100-ASA1-AA8-AA8, s. 4850cm 24Section 4850cm. 619.14 (4) (intro.) of the statutes is amended to read:
AB100-ASA1-AA8-AA8,12,2
1619.14 (4)Exclusions. (intro.) Covered expenses for the coverage under this
2section
shall not include the following:
AB100-ASA1-AA8-AA8, s. 4850dh 3Section 4850dh. 619.14 (4) (a) of the statutes is amended to read:
AB100-ASA1-AA8-AA8,12,74 619.14 (4) (a) Any charge for treatment for cosmetic purposes other than
5surgery for the repair or treatment of an injury or a congenital bodily defect. Breast
6reconstruction incident to a mastectomy shall not be considered treatment for
7cosmetic purposes.
AB100-ASA1-AA8-AA8, s. 4850fm 8Section 4850fm. 619.14 (4m) of the statutes is created to read:
AB100-ASA1-AA8-AA8,12,149 619.14 (4m) Discounted payment is payment in full. A provider of a covered
10service or article shall accept as payment in full for the covered service or article the
11discounted reimbursement rate determined under ss. 619.143 (2) (a) 3. and (3),
12619.144 and 619.15 (3) (e) and may not bill an eligible person who receives the service
13or article for any amount by which the charge for the service or article is reduced
14under s. 619.143 (2) (a) 3. or (3), 619.144 or 619.15 (3) (e).
AB100-ASA1-AA8-AA8, s. 4850hm 15Section 4850hm. 619.14 (5) (title) of the statutes is amended to read:
AB100-ASA1-AA8-AA8,12,1616 619.14 (5) (title) Premiums, deductibles Deductibles and coinsurance.
AB100-ASA1-AA8-AA8, s. 4850mm 17Section 4850mm. 619.14 (5) (a) of the statutes is amended to read:
AB100-ASA1-AA8-AA8,13,918 619.14 (5) (a) The plan shall offer a deductible in combination with appropriate
19premiums determined under this subchapter for major medical expense coverage
20required under this section. For coverage offered to those persons eligible for
21medicare, the plan shall offer a deductible equal to the deductible charged by part
22A of title XVIII of the federal social security act, as amended. The deductible
23amounts for all other eligible persons shall be dependent upon household income as
24determined under s. 619.165. For eligible persons under s. 619.165 (1) (b) 1., the
25deductible shall be $500. For eligible persons under s. 619.165 (1) (b) 2., the

1deductible shall be $600. For eligible persons under s. 619.165 (1) (b) 3., the
2deductible shall be $700. For eligible persons under s. 619.165 (1) (b) 4., the
3deductible shall be $800. For all other eligible persons who are not eligible for
4medicare, the deductible shall be $1,000. With respect to all eligible persons,
5expenses used to satisfy the deductible during the last 90 days of a calendar year
6shall also be applied to satisfy the deductible for the following calendar year. The
7schedule of premiums shall be promulgated by rule by the commissioner. The
8commissioner shall set rates at 60% of the operating and administrative costs of the
9plan.
AB100-ASA1-AA8-AA8, s. 4853cm 10Section 4853cm. 619.14 (5) (d) of the statutes is amended to read:
AB100-ASA1-AA8-AA8,13,1611 619.14 (5) (d) Notwithstanding pars. (a) to (c), the board may establish
12different deductible amounts, a different coinsurance percentage and different
13covered costs and deductible aggregate amounts from those specified in pars. (a) to
14(c) in accordance with cost containment provisions established by the commissioner
15under s. 619.17 (4) (a) and for individuals who enroll in an alternative plan under s.
16619.145
.
AB100-ASA1-AA8-AA8, s. 4854mm 17Section 4854mm. 619.14 (5) (e) of the statutes is repealed.
AB100-ASA1-AA8-AA8, s. 4855mm 18Section 4855mm. 619.14 (6) of the statutes is renumbered 619.14 (6) (a) and
19amended to read:
AB100-ASA1-AA8-AA8,13,2320 619.14 (6) (a) No Except as provided in par. (b), no person who obtains coverage
21under the plan may be covered for any preexisting condition during the first 6 months
22of coverage under the plan if the person was diagnosed or treated for that condition
23during the 6 months immediately preceding the filing of an application with the plan.
AB100-ASA1-AA8-AA8, s. 4856mm 24Section 4856mm. 619.14 (6) (b) of the statutes is created to read:
AB100-ASA1-AA8-AA8,14,2
1619.14 (6) (b) An eligible individual who obtains coverage under the plan may
2not be subject to any preexisting condition exclusion under the plan.
AB100-ASA1-AA8-AA8, s. 4857d 3Section 4857d. 619.143 of the statutes is created to read:
AB100-ASA1-AA8-AA8,14,5 4619.143 Payment of plan costs. (1) The operating, administrative and
5subsidy costs of the plan shall be paid as follows:
AB100-ASA1-AA8-AA8,14,66 (a) First from the appropriation under s. 20.145 (7) (af).
AB100-ASA1-AA8-AA8,14,77 (b) The remainder of the costs as follows:
AB100-ASA1-AA8-AA8,14,88 1. A total of 60% from all of the following:
AB100-ASA1-AA8-AA8,14,99 a. The appropriations under s. 20.145 (7) (a) and (g).
AB100-ASA1-AA8-AA8,14,1110 b. Insurer assessments and provider reimbursement discounts under s.
11619.144.
AB100-ASA1-AA8-AA8,14,1312 c. Subject to sub. (2) (a) 1. and s. 619.146 (2) (b), premiums collected from
13eligible persons.
AB100-ASA1-AA8-AA8,14,1414 2. A total of 40% as follows:
AB100-ASA1-AA8-AA8,14,1615 a. Fifty percent from insurer assessments, excluding assessments under s.
16619.144 and moneys in the appropriation account under s. 20.145 (7) (g).
AB100-ASA1-AA8-AA8,14,1817 b. Fifty percent from discounts to provider reimbursement rates, excluding
18discounts under ss. 619.144 and 619.15 (3) (e).
AB100-ASA1-AA8-AA8,14,22 19(2) (a) Prior to each plan year, the commissioner, in consultation with the board,
20shall estimate the operating, administrative and subsidy costs of the plan for the new
21plan year and, taking into consideration the funds expected to be available under s.
2220.145 (7) (a), (af) and (g), do all of the following:
AB100-ASA1-AA8-AA8,15,323 1. By rule set premium rates for the new plan year, including the rates under
24s. 619.146 (2) (b), by estimating the rates necessary to equal the amount specified in
25sub. (1) (b) 1. c., except that a rate for coverage under s. 619.14 may not be less than

1135% nor more than 190% of the rate that a standard risk would be charged under
2an individual policy providing substantially the same coverage and deductibles as
3are provided under the plan.
AB100-ASA1-AA8-AA8,15,64 2. By rule set the total insurer assessments under s. 619.13 for the new plan
5year by estimating the amount necessary to equal the amount specified in sub. (1)
6(b) 2. a.
AB100-ASA1-AA8-AA8,15,97 3. By the same rule as required under subd. 2. set the rate at which provider
8charges shall be discounted for the new plan year by estimating the rate necessary
9to equal the amount specified in sub. (1) (b) 2. b.
AB100-ASA1-AA8-AA8,15,1410 (b) In setting the rates under par. (a) 1. and 3. and the amount under par. (a)
112. for the new plan year, the commissioner shall include any increase or decrease
12necessary to reflect the amount, if any, by which the rates and amount set under par.
13(a) for the current plan year differed from the rates and amount which would have
14equaled the amounts specified in sub. (1) in the current plan year.
AB100-ASA1-AA8-AA8,15,23 15(3) (a) If, during a plan year, the commissioner determines that the moneys
16under s. 20.145 (7) (a), (af) and (g), the amounts set under sub. (2) (a) and any
17increases in insurer assessments and provider discounts under s. 619.144 are not
18sufficient to cover plan costs, the commissioner may by rule increase the premium
19rates set under sub. (2) (a) 1. for the remainder of the plan year, subject to subs. (1)
20(b) 1. and (2) (a) 1. and s. 619.146 (2) (b), increase the assessments set under sub. (2)
21(a) 2. for the remainder of the plan year, subject to sub. (1) (b) 2. a., and increase the
22discount rate set under sub. (2) (a) 3. for the remainder of the plan year, subject to
23sub. (1) (b) 2. b.
AB100-ASA1-AA8-AA8,16,624 (b) If, after increasing premium rates, assessments and discount rates under
25par. (a), the commissioner determines that there will still be a deficit and that

1premium rates have been increased to the maximum extent allowable under par. (a),
2the commissioner shall further increase, in equal proportions, assessments set under
3sub. (2) (a) 2. and discount rates set under sub. (2) (a) 3., without regard to sub. (1)
4(b) 2. Insurers and providers affected by this paragraph may recover the assessment
5increase and the discount rate increase in the normal course of their respective
6businesses without time limitation, subject to s. 619.14 (4m).
AB100-ASA1-AA8-AA8,16,11 7(4) Using the procedure under s. 227.24, the commissioner may promulgate
8rules under sub. (2) or (3) for the period before the effective date of any permanent
9rules promulgated under sub. (2) or (3), but not to exceed the period authorized under
10s. 227.24 (1) (c) and (2). Notwithstanding s. 227.24 (1) and (3), the commissioner is
11not required to make a finding of emergency.
AB100-ASA1-AA8-AA8,16,16 12(5) Notwithstanding sub. (2) (a) (intro.), the commissioner shall set premium
13rates, insurer assessments and provider discount rates for the period beginning on
14January 1, 1998, and ending on June 30, 1998, in the manner provided in subs. (1),
15(2) (a), (3) and (4). This subsection applies to policies in effect on January 1, 1998,
16as well as to policies issued or renewed on or after January 1, 1998.
AB100-ASA1-AA8-AA8, s. 4859cm 17Section 4859cm. 619.145 of the statutes is repealed.
AB100-ASA1-AA8-AA8, s. 4859mm 18Section 4859mm. 619.146 of the statutes is created to read:
AB100-ASA1-AA8-AA8,16,22 19619.146 Choice of coverage. (1) (a) Beginning on January 1, 1998, in
20addition to the coverage required under s. 619.14, the plan shall offer to all eligible
21persons a choice of coverage, as described in section 2744 (a) (1) (C) of P.L. 104-191.
22Any such choice of coverage shall be major medical expense coverage.
AB100-ASA1-AA8-AA8,17,623 (b) An eligible person may elect once each year, at the time and according to
24procedures established by the board, among the coverages offered under this section
25and s. 619.14. If an eligible person elects new coverage, any preexisting condition

1exclusion imposed under the new coverage is met to the extent that the eligible
2person has been previously and continuously covered under this subchapter. No
3preexisting condition exclusion may be imposed on an eligible person who elects new
4coverage if the person was an eligible individual when first covered under this
5subchapter and the person remained continuously covered under this subchapter up
6to the time of electing new coverage.
AB100-ASA1-AA8-AA8,17,10 7(2) (a) Except as specified by the board, the terms of coverage under s. 619.14,
8including deductible reductions under s. 619.14 (5) (a), do not apply to the coverage
9offered under this section. Premium reductions under s. 619.165 do not apply to the
10coverage offered under this section.
AB100-ASA1-AA8-AA8,17,1511 (b) The schedule of premiums for coverage under this section shall be
12promulgated by rule by the commissioner, as provided in s. 619.143. The rates for
13coverage under this section shall be set such that they differ from the rates for
14coverage under s. 619.14 by the same percentage as the percentage difference
15between the following:
AB100-ASA1-AA8-AA8,17,1816 1. The rate that a standard risk would be charged under an individual policy
17providing substantially the same coverage and deductibles as provided under s.
18619.14.
AB100-ASA1-AA8-AA8,17,2119 2. The rate that a standard risk would be charged under an individual policy
20providing substantially the same coverage and deductibles as the coverage offered
21under this section.
AB100-ASA1-AA8-AA8, s. 4862m 22Section 4862m. 619.15 (1) of the statutes is amended to read:
AB100-ASA1-AA8-AA8,18,1523 619.15 (1) The plan shall operate subject to the supervision and approval of a
24board of governors consisting of representatives of 2 participating insurers which are
25nonprofit corporations, representatives of 2 other participating insurers, 3 health

1care provider representatives, including one representative of the State Medical
2Society of Wisconsin, one representative of the Wisconsin Health and Hospital
3Association and one representative of an integrated multidisciplinary health
4system,
and 3 public members, including one representative of small businesses in
5the state,
appointed by the commissioner for staggered 3-year terms. In addition,
6the commissioner, or a designated representative from the office of the commissioner,
7and the chairperson of the standing committee of each house of the legislature with
8jurisdiction over insurance
shall be a member members of the board. The public
9members shall not be professionally affiliated with the practice of medicine, a
10hospital or an insurer. At least 2 of the public members shall be individuals
11reasonably expected to qualify for coverage under the plan or the parent or spouse
12of such an individual. The commissioner or the commissioner's representative shall
13be the chairperson of the board. Board members, except the commissioner or the
14commissioner's representative and the chairpersons of the standing committees,
15shall be compensated at the rate of $50 per diem plus actual and necessary expenses.
AB100-ASA1-AA8-AA8, s. 4863m 16Section 4863m. 619.15 (2) of the statutes is amended to read:
AB100-ASA1-AA8-AA8,18,2217 619.15 (2) Annually, the board shall make a report to the members of the plan
18and to the chief clerk of each house of the legislature, for distribution to the

19appropriate standing committees under s. 13.172 (3), and to the members of the plan
20summarizing the activities of the plan in the preceding calendar year. The annual
21report shall define the cost burden imposed by the plan on all policyholders in this
22state.
AB100-ASA1-AA8-AA8, s. 4863pm 23Section 4863pm. 619.15 (2m) of the statutes is created to read:
AB100-ASA1-AA8-AA8,19,3
1619.15 (2m) Annually, beginning in 1999, the board shall submit a report on
2or before June 30 to the legislature under s. 13.172 (2) and to the governor on the
3operation of the plan, including any recommendations for changes to the plan.
AB100-ASA1-AA8-AA8, s. 4867cm 4Section 4867cm. 619.15 (3) (c) of the statutes is amended to read:
AB100-ASA1-AA8-AA8,19,115 619.15 (3) (c) Collect assessments from all insurers to provide for claims paid
6under the plan and for administrative expenses incurred or estimated to be incurred
7during the period for which the assessment is made. The level of payments shall be
8established by the board as provided under s. 619.143. Assessment of the insurers
9shall occur at the end of each calendar year or other fiscal year end established by
10the board. Assessments are due and payable within 30 days of receipt by the insurer
11of the assessment notice.
AB100-ASA1-AA8-AA8, s. 4869cm 12Section 4869cm. 619.15 (3) (e) of the statutes is amended to read:
AB100-ASA1-AA8-AA8,19,1713 619.15 (3) (e) Establish for payment of covered expenses, a payment rate that
14is 10% less than the charges approved by the administering carrier for
15reimbursement of covered expenses under s. 619.14 (3). A provider of a covered
16service or article may not bill an eligible person who receives the service or article
17for any amount by which the charge is reduced under this paragraph.
AB100-ASA1-AA8-AA8, s. 4869mm 18Section 4869mm. 619.15 (3) (f) of the statutes is created to read:
AB100-ASA1-AA8-AA8,19,2019 619.15 (3) (f) In consultation with the office, establish a choice of coverage
20under s. 619.146.
AB100-ASA1-AA8-AA8, s. 4872mm 21Section 4872mm. 619.15 (4) (c) of the statutes is repealed.
AB100-ASA1-AA8-AA8, s. 4873mm 22Section 4873mm. 619.15 (4) (d) of the statutes is repealed.
AB100-ASA1-AA8-AA8, s. 4873pm 23Section 4873pm. 619.15 (4) (e) of the statutes is repealed.
AB100-ASA1-AA8-AA8, s. 4887cm 24Section 4887cm. 619.16 (3) (em) of the statutes is repealed.
AB100-ASA1-AA8-AA8, s. 4890c 25Section 4890c. 619.165 (1) (a) of the statutes is amended to read:
AB100-ASA1-AA8-AA8,20,4
1619.165 (1) (a) The Except as provided in s. 619.146 (2) (a), the board shall
2reduce the premiums established by the commissioner under s. 619.11 in conformity
3with ss. 619.14 (5) 619.143 and 619.17, for the eligible persons and in the manner set
4forth in pars. (b) to (d).
AB100-ASA1-AA8-AA8, s. 4891cm 5Section 4891cm. 619.165 (1) (d) of the statutes is renumbered 619.165 (1) (d)
61. and amended to read:
AB100-ASA1-AA8-AA8,20,97 619.165 (1) (d) 1. The Subject to subd. 2., the board shall establish and
8implement the method for determining the household income of an eligible person
9under par. (b).
AB100-ASA1-AA8-AA8, s. 4891mm 10Section 4891mm. 619.165 (1) (d) 2. of the statutes is created to read:
AB100-ASA1-AA8-AA8,20,1311 619.165 (1) (d) 2. In determining household income under par. (b), the board
12may consider information submitted by an eligible person on a completed federal
13profit or loss from farming form, schedule F, if all of the following apply:
AB100-ASA1-AA8-AA8,20,1414 a. The person is a farmer, as defined in s. 102.04 (3).
AB100-ASA1-AA8-AA8,20,1615 b. The person was not eligible to claim the homestead credit under subch. VIII
16of ch. 71 in the preceding taxable year.
AB100-ASA1-AA8-AA8, s. 4891rm 17Section 4891rm. 619.165 (3) of the statutes is amended to read:
AB100-ASA1-AA8-AA8,20,2018 619.165 (3) The commissioner shall forward to the board moneys received
19under s. 20.145 (7) (a) and (g) in an amount sufficient to reimburse the plan for
20premium reductions under sub. (1) and deductible reductions under s. 619.14 (5) (a).
AB100-ASA1-AA8-AA8, s. 4895c 21Section 4895c. 619.167 of the statutes is repealed.
AB100-ASA1-AA8-AA8, s. 4897m 22Section 4897m. 619.17 (1) of the statutes is amended to read:
AB100-ASA1-AA8-AA8,20,2423 619.17 (1) Subject to s. 619.14 (5) (a) ss. 619.143 and 619.146 (2) (b), a rating
24plan calculated in accordance with generally accepted actuarial principles.
AB100-ASA1-AA8-AA8, s. 4900m 25Section 4900m. 619.17 (4) (a) of the statutes is amended to read:
AB100-ASA1-AA8-AA8,21,2
1619.17 (4) (a) Cost containment provisions established by the commissioner by
2rule, including managed care requirements.
AB100-ASA1-AA8-AA8, s. 4901cm 3Section 4901cm. 619.175 of the statutes is amended to read:
AB100-ASA1-AA8-AA8,21,8 4619.175 Waiver or exemption from provisions prohibited. Except as
5provided in s. 619.13 (1) (a), the commissioner may not waive, or authorize the board
6to waive, any of the requirements of this subchapter or exempt, or authorize the
7board to exempt, an individual or a class of individuals from any of the requirements
8of this subchapter.".".
AB100-ASA1-AA8-AA8,21,9 915. Page 445, line 23: after that line insert:
AB100-ASA1-AA8-AA8,21,11 10"1371w. Page 1825, line 22: delete the material beginning with that line and
11ending with page 1826, line 2.".
AB100-ASA1-AA8-AA8,21,12 1216. Page 473, line 12: after that line insert:
AB100-ASA1-AA8-AA8,21,14 13"1373c. Page 1826, line 23: delete the material beginning with that line and
14ending with page 1827, line 5.".
AB100-ASA1-AA8-AA8,21,15 1517. Page 521, line 2: after that line insert:
AB100-ASA1-AA8-AA8,21,16 16"1455c. Page 1978, line 1: delete lines 1 to 9.".
AB100-ASA1-AA8-AA8,21,17 1718. Page 521, line 19: delete that line and substitute:
AB100-ASA1-AA8-AA8,21,18 18"1459c. Page 1982, line 6: delete lines 6 to 17.".
AB100-ASA1-AA8-AA8,21,19 1919. Page 525, line 15: after that line insert:
AB100-ASA1-AA8-AA8,21,21 20"1470c. Page 1987, line 18: delete the material beginning with that line and
21ending with page 1989, line 25.".
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