Amendment ASA1-AB768

AB768-ASA1,454,21 632.68 (2) (bc) 2. The commissioner may disclose a social security number or federal employer identification number received under par. (b) or (e) to the department of revenue for the purpose of requesting certifications under s. 73.0301.

AB768-ASA1, s. 578m Section 578m. 632.68 (2) (bm) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 632.68 (2) (bm) 1.

AB768-ASA1, s. 579 Section 579. 632.68 (2) (bm) 2. of the statutes is created to read:

AB768-ASA1,455,3 632.68 (2) (bm) 2. Notwithstanding par. (b), the commissioner may not issue a license under this subsection if the department of revenue certifies under s. 73.0301 that the applicant is liable for delinquent taxes.

AB768-ASA1, s. 580m Section 580m. 632.68 (2) (cm) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 632.68 (2) (cm) 1.

AB768-ASA1, s. 581 Section 581. 632.68 (2) (cm) 2. of the statutes is created to read:

AB768-ASA1,455,9 632.68 (2) (cm) 2. If the commissioner denies an application for a license under this subsection for delinquent taxes, the applicant is entitled to a hearing under s. 73.0301 (5) (a) but is not entitled to a hearing under par. (c).

AB768-ASA1, s. 582b Section 582b. 632.68 (2) (e) of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is repealed and recreated to read:

AB768-ASA1,455,16 632.68 (2) (e) Except as provided in sub. (3), a license issued under this subsection shall be renewed annually on the anniversary date upon payment of the fee specified in s. 601.31 (1) (mp) and upon providing the licensee's social security number or federal employer identification number, as applicable, if not previously provided on the application for the license or at a previous renewal of the license.

AB768-ASA1, s. 584m Section 584m. 632.68 (3) (b) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 632.68 (3) (b) 1.

AB768-ASA1, s. 585 Section 585. 632.68 (3) (b) 2. of the statutes is created to read:

AB768-ASA1,455,22 632.68 (3) (b) 2. The commissioner shall revoke or refuse to renew a viatical settlement provider license if the department of revenue certifies under s. 73.0301 that the licensee is liable for delinquent taxes.

AB768-ASA1, s. 586b Section 586b. 632.68 (4) (b) of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is repealed and recreated to read:

AB768-ASA1,456,8 632.68 (4) (b) A person may apply to the commissioner for a viatical settlement broker license on a form prescribed by the commissioner for that purpose. The application form shall require the applicant to provide the applicant's social security number, if the applicant is a natural person, or the applicant's federal employer identification number, if the applicant is not a natural person. The fee specified in s. 601.31 (1) (mr) shall accompany the application. The commissioner may not issue a license under this subsection unless the applicant provides his or her social security number or its federal employer identification number, whichever is applicable.

AB768-ASA1, s. 586m Section 586m. 632.68 (4) (bc) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 632.68 (4) (bc) 1.

AB768-ASA1, s. 587 Section 587. 632.68 (4) (bc) 2. of the statutes is created to read:

AB768-ASA1,456,14 632.68 (4) (bc) 2. The commissioner may disclose a social security number or federal employer identification number received under par. (b) or (c) to the department of revenue for the purpose of requesting certifications under s. 73.0301.

AB768-ASA1, s. 587m Section 587m. 632.68 (4) (bm) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 632.68 (4) (bm) 1.

AB768-ASA1, s. 588 Section 588. 632.68 (4) (bm) 2. of the statutes is created to read:

AB768-ASA1,456,20 632.68 (4) (bm) 2. The commissioner may not issue a license under this subsection if the department of revenue certifies under s. 73.0301 that the applicant is liable for delinquent taxes.

AB768-ASA1, s. 589c Section 589c. 632.68 (4) (c) of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is repealed and recreated to read:

AB768-ASA1,457,2 632.68 (4) (c) Except as provided in sub. (5), a license issued under this subsection shall be renewed annually on the anniversary date upon payment of the fee specified in s. 601.31 (1) (ms) and upon providing the licensee's social security number or federal employer identification number, as applicable, if not previously provided on the application for the license or at a previous renewal of the license.

AB768-ASA1, s. 591m Section 591m. 632.68 (5) (b) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 632.68 (5) (b) 1.

AB768-ASA1, s. 592 Section 592. 632.68 (5) (b) 2. of the statutes is created to read:

AB768-ASA1,457,8 632.68 (5) (b) 2. The commissioner shall revoke or refuse to renew a viatical settlement broker license if the department of revenue certifies under s. 73.0301 that the licensee is liable for delinquent taxes.

AB768-ASA1, s. 593 Section 593. 632.7495 (1) (a) of the statutes, as created by 1997 Wisconsin Act 27, is amended to read:

AB768-ASA1,457,15 632.7495 (1) (a) Except as provided in subs. (2) and (3) to (4) and notwithstanding s. 631.36 (2) to (4m), an insurer that provides individual health benefit plan coverage shall renew such coverage or continue such coverage in force at the option of the insured individual and, if applicable, the association through which the individual has coverage.

AB768-ASA1, s. 594 Section 594. 632.7495 (4) of the statutes is created to read:

AB768-ASA1,457,19 632.7495 (4) Notwithstanding subs. (1) and (2) and s. 631.36 (4), an insurer is not required to renew individual health benefit plan coverage that is marketed and designed to provide short-term coverage as a bridge between coverages.

AB768-ASA1, s. 594c Section 594c. 632.853 of the statutes is created to read:

AB768-ASA1,458,2 632.853 Coverage of drugs and devices. A health care plan, as defined in s. 628.36 (2) (a) 1., or a self-insured health plan, as defined in s. 632.85 (1) (c), that provides coverage of only certain specified prescription drugs or devices shall develop a process through which a physician may present medical evidence to obtain an individual patient exception for coverage of a prescription drug or device not routinely covered by the plan. The process shall include timelines for both urgent and nonurgent review.

AB768-ASA1, s. 594d Section 594d. 632.855 of the statutes is created to read:

AB768-ASA1,458,5 632.855 Requirements if experimental treatment limited. (1) Definitions. In this section:

AB768-ASA1,458,6 (a) "Health care plan" has the meaning given in s. 628.36 (2) (a) 1.

AB768-ASA1,458,7 (b) "Self-insured health plan" has the meaning given in s. 632.85 (1) (c).

AB768-ASA1,458,11 (2) Disclosure of limitations. A health care plan or a self-insured health plan that limits coverage of experimental treatment shall define the limitation and disclose the limits in any agreement, policy or certificate of coverage. This disclosure shall include the following information:

AB768-ASA1,458,12 (a) Who is authorized to make a determination on the limitation.

AB768-ASA1,458,14 (b) The criteria the plan uses to determine whether a treatment, procedure, drug or device is experimental.

AB768-ASA1,458,22 (3) Denial of treatment. A health care plan or a self-insured health plan that receives a request for prior authorization of an experimental procedure that includes all of the required information upon which to make a decision shall, within 5 working days after receiving the request, issue a coverage decision. If the health care plan or self-insured health plan denies coverage of an experimental treatment, procedure, drug or device for an insured who has a terminal condition or illness, the health care plan or self-insured health plan shall, as part of its coverage decision, provide the insured with a denial letter that includes all of the following:

AB768-ASA1,458,24 (a) A statement setting forth the specific medical and scientific reasons for denying coverage.

AB768-ASA1,459,2 (b) Notice of the insured's right to appeal and a description of the appeal procedure.

AB768-ASA1, s. 594m Section 594m. 632.895 (11) (a) (intro.) of the statutes, as created by 1997 Wisconsin Act 27, is amended to read:

AB768-ASA1,459,10 632.895 (11) (a) (intro.) Every Except as provided in par. (e), every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, that provides coverage of any diagnostic or surgical procedure involving a bone, joint, muscle or tissue shall provide coverage for diagnostic procedures and medically necessary surgical or nonsurgical treatment for the correction of temporomandibular disorders if all of the following apply:

AB768-ASA1, s. 594n Section 594n. 632.895 (11) (c) of the statutes, as created by 1997 Wisconsin Act 27, is renumbered 632.895 (11) (c) 1.

AB768-ASA1, s. 594nm Section 594nm. 632.895 (11) (c) 2. of the statutes is created to read:

AB768-ASA1,459,16 632.895 (11) (c) 2. Notwithstanding subd. 1., the coverage required under this subsection for diagnostic procedures and medically necessary nonsurgical treatment for the correction of temporomandibular disorders may not exceed $1,250 annually.

AB768-ASA1, s. 594p Section 594p. 632.895 (11) (d) of the statutes is created to read:

AB768-ASA1,459,22 632.895 (11) (d) Notwithstanding par. (c) 1., an insurer or a self-insured health plan of the state or a county, city, village, town or school district may require that an insured obtain prior authorization for any diagnostic procedures or medically necessary surgical or nonsurgical treatment for the correction of temporomandibular disorders.

AB768-ASA1, s. 594q Section 594q. 632.895 (11) (e) of the statutes is created to read:

AB768-ASA1,459,24 632.895 (11) (e) This subsection does not apply to any of the following:

AB768-ASA1,459,25 1. A disability insurance policy that covers only dental care.

AB768-ASA1,460,1 2. A medicare supplement policy, as defined in s. 600.03 (28r).

AB768-ASA1, s. 594r Section 594r. 632.895 (12) (b) (intro.) of the statutes, as created by 1997 Wisconsin Act 27, is amended to read:

AB768-ASA1,460,9 632.895 (12) (b) (intro.) Every Except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, shall cover hospital or ambulatory surgery center charges incurred, and anesthetics provided, in conjunction with dental care that is provided to a covered individual in a hospital or ambulatory surgery center, if any of the following applies:

AB768-ASA1, s. 594s Section 594s. 632.895 (12) (d) of the statutes is created to read:

AB768-ASA1,460,12 632.895 (12) (d) This subsection does not apply to a disability insurance policy that covers only dental care.

AB768-ASA1, s. 595 Section 595. 632.897 (4) (d) (intro.) of the statutes is amended to read:

AB768-ASA1,460,21 632.897 (4) (d) (intro.) This subsection does not require individual coverage to be offered by an insurer offering group policies only. This subsection does not require an insurer to issue, or continue in force, an individual conversion policy covering a terminated insured or his or her spouse or dependent if benefits provided or available to the covered person under subds. 1. to 3., together with the converted policy's benefits, would result in overinsurance according to the insurer's standards for overinsurance, and these standards have been filed with and approved by the commissioner prior to use:

AB768-ASA1, s. 597 Section 597. 633.14 (2) (d) of the statutes is created to read:

AB768-ASA1,460,23 633.14 (2) (d) Provides its federal employer identification number.

AB768-ASA1, s. 597m Section 597m. 633.14 (2c) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 633.14 (2c) (a).

AB768-ASA1, s. 598 Section 598. 633.14 (2c) (b) of the statutes is created to read:

AB768-ASA1,461,4 633.14 (2c) (b) The commissioner may disclose any information received under sub. (1) (d) or (2) (d) or s. 633.15 (1m) to the department of revenue for the purpose of requesting certifications under s. 73.0301.

AB768-ASA1, s. 598m Section 598m. 633.14 (2m) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is renumbered 633.14 (2m) (a).

AB768-ASA1, s. 599 Section 599. 633.14 (2m) (b) of the statutes is created to read:

AB768-ASA1,461,10 633.14 (2m) (b) Notwithstanding subs. (1) and (2), the commissioner may not issue a license under this section if the department of revenue certifies under s. 73.0301 that the applicant is liable for delinquent taxes.

AB768-ASA1, s. 600 Section 600. 633.15 (1m) of the statutes, as created by 1997 Wisconsin Act .... (Senate Bill 494), is repealed and recreated to read:

AB768-ASA1,461,18 633.15 (1m) Social security or federal employer identification number. At an annual renewal, an administrator shall provide his or her social security number, if the administrator is an individual, or its federal employer identification number, if the administrator is a corporation, limited liability company or partnership, if the social security number or federal employer identification number was not previously provided on the application for the license or at a previous renewal of the license.

AB768-ASA1, s. 600c Section 600c. 633.15 (2) (a) (title) of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is amended to read:

AB768-ASA1,461,22 633.15 (2) (a) (title) Nonpayment of annual renewal fee or failure to provide social security number or federal employer identification number.

AB768-ASA1, s. 600d Section 600d. 633.15 (2) (a) 1. of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is amended to read:

AB768-ASA1,462,6 633.15 (2) (a) 1. If an administrator fails to pay the annual renewal fee as provided under sub. (1) or fails to provide a social security number or federal employer identification number as required under sub. (1m), the commissioner shall suspend the administrator's license effective the day following the last day when the annual renewal fee may be paid, if the commissioner has given the administrator reasonable notice of when the fee must be paid to avoid suspension.

AB768-ASA1, s. 600e Section 600e. 633.15 (2) (a) 2. of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is amended to read:

AB768-ASA1,462,13 633.15 (2) (a) 2. If, within 60 days from the effective date of suspension under subd. 1., an administrator pays the annual renewal fee or provides the social security number or federal employer identification number, or both if the suspension was based upon a failure to do both, the commissioner shall reinstate the administrator's license effective as of the date of suspension.

AB768-ASA1, s. 600f Section 600f. 633.15 (2) (a) 3. of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is amended to read:

AB768-ASA1,462,19 633.15 (2) (a) 3. If payment is not made or the social security number or federal employer identification number is not provided within 60 days from the effective date of suspension under subd. 1., the commissioner shall revoke the administrator's license.

AB768-ASA1, s. 601 Section 601. 633.15 (2) (b) 1. (intro.) of the statutes, as affected by 1997 Wisconsin Act .... (Senate Bill 494), is amended to read:

AB768-ASA1,462,24 633.15 (2) (b) 1. (intro.) Except as provided in par. pars. (c) and (d), the commissioner may revoke, suspend or limit the license of an administrator after a hearing if the commissioner makes any of the following findings:

AB768-ASA1, s. 602 Section 602. 633.15 (2) (d) of the statutes is created to read:

AB768-ASA1,463,3 633.15 (2) (d) For liability for delinquent taxes. The commissioner shall revoke or refuse to renew a license issued under s. 633.14 if the department of revenue certifies under s. 73.0301 that the licensee is liable for delinquent taxes.

AB768-ASA1, s. 602c Section 602c. 645.69 (1) of the statutes is amended to read:

AB768-ASA1,463,9 645.69 (1) A claim against a health maintenance organization insurer or an insurer described in s. 609.91 (1m) for health care costs, as defined in s. 609.01 (1j), for which an enrolled participant enrollee, as defined in s. 609.01 (1d), policyholder or insured of the health maintenance organization insurer or other insurer is not liable under ss. 609.91 to 609.935.

AB768-ASA1, s. 602e Section 602e. 645.69 (2) of the statutes is amended to read:

AB768-ASA1,463,13 645.69 (2) A claim for health care costs, as defined in s. 609.01 (1j), for which an enrolled participant enrollee, as defined in s. 609.01 (1d), or policyholder of a health maintenance organization is not liable for any reason.

AB768-ASA1, s. 602g Section 602g. 646.31 (1) (d) 8. of the statutes is amended to read:

AB768-ASA1,463,17 646.31 (1) (d) 8. Made for health care costs, as defined in s. 609.01 (1j), for which an enrolled participant enrollee, as defined in s. 609.01 (1d), or policyholder of a health maintenance organization insurer is not liable under ss. 609.91 to 609.935.

AB768-ASA1, s. 602i Section 602i. 646.31 (1) (d) 9. of the statutes is amended to read:

AB768-ASA1,463,21 646.31 (1) (d) 9. Made for health care costs, as defined in s. 609.01 (1j), for which an enrolled participant enrollee, as defined in s. 609.01 (1d), or policyholder of a health maintenance organization is not liable for any reason.

AB768-ASA1, s. 603 Section 603. 701.06 (5) (intro.) of the statutes is amended to read: