AB768-SA2,5,2013
40.02
(28) "Employer" means the state, including each state agency, any
14county, city, village, town, school district, other governmental unit or
15instrumentality of 2 or more units of government now existing or hereafter created
16within the state, any federated public library system established under s. 43.19
17whose territory lies within a single county with a population of 500,000 or more and
18a local exposition district created under subch. II of ch. 229, except as provided under
19ss. 40.51 (7) and 40.61 (3)
and subch. X. Each employer shall be a separate legal
20jurisdiction for OASDHI purposes.".
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23"
Section 90bv. Subchapter X of chapter 40 [precedes 40.98] of the statutes is
24created to read:
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Subchapter X
3
Private employer health
4
Care coverage
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540.98 Health care coverage. (1) In this subchapter:
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(a) "Board" means the private employer health care coverage board.
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(b) "Dependent" means a spouse, an unmarried child under the age of 19 years,
8an unmarried child who is a full-time student under the age of 21 years and who is
9financially dependent upon the parent, or an unmarried child of any age who is
10medically certified as disabled and who is dependent upon the parent.
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(c) "Employe" means any person who receives earnings as payment for personal
12services rendered for the benefit of any employer including officers of the employer.
13An employe is considered to have separated from the service of an employer at the
14end of the day on which the employe last performed services for the employer, or, if
15later, the day on which the employe-employer relationship is terminated because of
16the expiration or termination of leave without pay, sick leave, vacation or other leave
17of absence. A person shall not be considered an employe if any of the following
18applies:
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1. The person is employed under a contract involving the furnishing of more
20than personal services.
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2. The person is customarily engaged in an independently established trade,
22business or profession providing the same type of services to more than one employer
23and the person's services to an employer are not compensated for on a payroll of that
24employer.
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13. The person is a patient or inmate of a hospital, home or institution and
2performs services in the hospital, home or institution.
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(d) "Employer" means any person who is doing business or operating an
4organization in this state and who employs at least 2 employes, but who is not an
5employer, as defined in s. 40.02 (28).
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(e) "Health care coverage plan" means the health care coverage plan
7established under sub. (2) (a).
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(f) "Insurer" has the meaning given in s. 600.03 (27).
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9(2) (a) The department shall design, establish and administer an actuarially
10sound health care coverage plan for employers that provides coverage beginning not
11later than January 1, 2000. In designing the health care coverage plan, the
12department shall consult with the departments of commerce and health and family
13services and the office of the commissioner of insurance. In establishing the health
14care coverage plan, the department shall solicit and accept bids and enter into
15contracts with insurers who are to provide health care coverage under the health
16care coverage plan. The health care coverage plan is subject to the provisions of chs.
17600 to 646 that apply to group health benefit plans, as defined in s. 632.745 (9), to
18the same extent as any other group health benefit plan, as defined in s. 632.745 (9).
19Before the health care coverage plan may be implemented, the board must approve
20the plan.
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(am) The health care coverage plan established under par. (a) may not be
22combined with any health care coverage plan under subch. IV.
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(b) The health care coverage plan shall require that all insurance rates under
24the plan be published annually in a single publication that is made available to
1employers and employes. The rates shall be listed by county and by any other factor
2that the department considers appropriate.
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(c) The health care coverage plan shall have an enrollment period that is
4established by the board.
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(d) The department shall charge employers who participate in the health care
6coverage plan a fee to cover the department's cost in designing, establishing and
7administering the health care coverage plan. All moneys received under this
8paragraph shall be credited to the appropriation account under s. 20.515 (2) (g).
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(e) The department may not sell any health care coverage plan to an employer
10or enroll any employe in the health care coverage plan, but the department may
11publicize the availability of the health care coverage plan for employers.
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(f) The department may enter into a contract with any person to provide
13services relating to the administration of the health care coverage plan.
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14(3) Any employer who participates in the health care coverage plan shall do all
15of the following:
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(a) Offer health care coverage under the plan to all of its permanent employes
17who have a normal work week of 30 or more hours and may offer health care coverage
18under the plan to any of its other employes.
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(b) Provide health care coverage under the plan to at least 50% of its permanent
20employes who have a normal work week of 30 or more hours and who do not otherwise
21receive health care coverage as a dependent under any other plan that is not offered
22by the employer.
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(c) Pay for each employe at least 50% but not more than 100% of the lowest
24premium rate that would be available to the employer for that employe's coverage
25under the health care coverage plan.
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1(d) Make premium payments for the health care coverage of its employes in the
2manner specified by the board.
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3(4) Any employer that provides health care coverage for its employes under the
4plan and that voluntarily terminates coverage under the plan is not eligible to
5participate in the plan for at least 3 years from the date that coverage is terminated.
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6(5) Any insurer that offers the health care coverage plan shall provide coverage
7under the plan to any employer that applies for coverage, and to all of the employer's
8employes who elect coverage under the health care coverage plan, without regard to
9the health condition or claims experience of any individual who would be covered
10under the health care coverage plan if all of the following apply:
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(a) The employer agrees to pay the premium required for coverage under the
12health care coverage plan.
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(b) The employer agrees to comply with all provisions of the health care
14coverage plan that apply generally to a policyholder or an insured without regard to
15health condition or claims experience.
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16(6) (a) The health care coverage plan may only be sold by insurance agents
17licensed under ch. 628.
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(b) An insurance agent may not sell any health care coverage under the health
19care coverage plan on behalf of an insurer unless he or she is employed by the insurer
20or has a contract with the insurer to sell the health care coverage on behalf of the
21insurer.
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(c) The board shall set, and may adjust as often as semiannually, the
23commission rate at which an insurer shall compensate an insurance agent for the
24sale of a policy under the health care coverage plan. The rate shall be based on the
1average commission rate that insurance agents are paid in the state for the sale of
2comparable health insurance policies at the time that the rate is set or adjusted.
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(d) An insurer shall specify on the first page of any policy sold under the health
4care coverage plan the amount of the commission paid to the insurance agent.
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5(7) (a) Annually, on or before December 31, the board shall submit a report to
6the appropriate standing committees under s. 13.172 (3) and to the governor on the
7operation of the health care coverage plan. The report shall specify the number of
8employers participating in the health care coverage plan, calculate the costs of the
9health care coverage plan to employers and their employes and include
10recommendations for improving the health care coverage plan.
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(b) No later than January 1, 2003, the board shall submit a report to the
12appropriate standing committees under s. 13.172 (3) and to the governor that offers
13recommendations as to whether the department should continue to administer the
14health care coverage plan, whether a different state agency should administer the
15health care coverage plan or whether the health care coverage plan should be
16administered by a private nonprofit organization. If the board recommends that a
17different state agency administer the health care coverage plan or that the health
18care coverage plan be administered by a private nonprofit organization, the board
19shall submit proposed legislation to the appropriate standing committees under s.
2013.172 (3) at the time that the board submits its report.
AB768-SA2, s. 90bvc
21Section 90bvc. Subchapter X of chapter 40 [precedes 40.98] of the statutes,
22as created by 1997 Wisconsin Act .... (this act), is repealed.".
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24"
Section 9115.
Nonstatutory provisions; employe trust funds.
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1(1xv)
Private employer health care coverage board. Notwithstanding the
2length of terms specified for the members of the private employer health care
3coverage board under section 15.165 (5) of the statutes, as created by this act, the
4initial members shall be appointed for the following terms:
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5(a) The members specified under section 15.165 (5) (a) 1., 3. and 7. of the
6statutes, as created by this act, for terms expiring on May 1, 2000.
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7(b) The members specified under section 15.165 (5) (a) 2., 5. and 8. of the
8statutes, as created by this act, for terms expiring on May 1, 2001.
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9(c) The members specified under section 15.165 (5) (a) 4. and 6. of the statutes,
10as created by this act, for terms expiring on May 1, 2002.
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11(1xw) Position authorizations for the department of employe trust funds.
12The authorized FTE positions for the department of employe trust funds are
13increased by 3.5 GPR positions on the effective date of this subsection, to be funded
14from the appropriation under section 20.515 (2) (a) of the statutes, as created by this
15act, for the purpose of designing, establishing and administering the private
16employer health care coverage plan under subchapter X of chapter 40 of the statutes,
17as created by this act.".
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19"
(2xv) Private employer health care coverage plan.
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20(a) The repeal of section 20.515 (2) (a) of the statutes takes effect on January
211, 2000.
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22(b) The amendment of section 40.02 (26) (intro.) (by
Section 83xcm) and (28) (by
23Section 83xdm) of the statutes takes effect on January 1, 2007.
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1(c) The repeal of sections 13.94 (1) (p), 15.07 (1) (b) 22., 15.165 (5) and 20.515
2(2) (title) and (g) and subchapter X of chapter 40 of the statutes takes effect on
3January 1, 2007.".