Amendment SSA1-SB218

SB218-SSA1,23,14 (5) An insurer or an intermediary may not induce or otherwise encourage an employer to separate or otherwise exclude an employe from health coverage or benefits provided in connection with the employe's employment.

SB218-SSA1,23,16 (6) Denial by an insurer of an application for coverage under a health benefit plan shall be in writing and shall state the reason or reasons for the denial.

SB218-SSA1,23,20 (7) A 3rd-party administrator that enters into a contract, agreement or other arrangement with an insurer to provide administrative, marketing or other services related to the offering of health benefit plans to employers or individuals in this state is subject to this section and ss. 632.745 to 632.7498 as if it were an insurer.

SB218-SSA1,23,23 (8) The commissioner may by rule establish additional standards to provide for the fair marketing and broad availability of health benefit plans to employers and individuals in this state.

SB218-SSA1, s. 47 Section 47. 632.76 (2) (a) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB218-SSA1,24,6 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years from the date of issue of the policy may be reduced or denied on the ground that a disease or physical condition existed prior to the effective date of coverage, unless the condition was excluded from coverage by name or specific description by a provision effective on the date of loss. This paragraph does not apply to a group health benefit plan, as defined in s. 632.745 (9) (11), which is subject to s. 632.746 or 632.7494.

SB218-SSA1, s. 48 Section 48. 632.896 (4) of the statutes, as affected by 1997 Wisconsin Act 27, is amended to read:

SB218-SSA1,24,14 632.896 (4) Preexisting conditions. Notwithstanding ss. 632.746, 632.7494 and 632.76 (2) (a), a disability insurance policy that is subject to sub. (2) and that is in effect when a court makes a final order granting adoption or when the child is placed for adoption may not exclude or limit coverage of a disease or physical condition of the child on the ground that the disease or physical condition existed before coverage is required to begin under sub. (3).

SB218-SSA1, s. 49 Section 49. Chapter 635 of the statutes, as affected by 1997 Wisconsin Act 27, is repealed.

SB218-SSA1, s. 50 Section 50 . Nonstatutory provisions.

SB218-SSA1,24,23 (1) Risk adjustment committee. The commissioner of insurance shall appoint a committee on risk adjustment under section 15.04 (1) (c) of the statutes, consisting of 5 to 8 members, to advise the commissioner on, and to assist the commissioner in developing rules for, the group risk adjustment mechanism under section 633.7465 (4) of the statutes, as created by this act. The commissioner shall appoint at least 5 representatives of insurers to be members of the committee.

SB218-SSA1,25,6 (2) Risk adjustment mechanism emergency rule-making authority. Using the procedure under section 227.24 of the statutes, the commissioner of insurance may promulgate rules under section 632.7465 (5) (e) of the statutes, as created by this act, for the period before the effective date of the permanent rules promulgated under section 632.7465 (5) (e) of the statutes, as created by this act, but not to exceed the period authorized under section 227.24 (1) (c) and (2) of the statutes. Notwithstanding section 227.24 (1) and (3) of the statutes, the commissioner is not required to make a finding of emergency.

SB218-SSA1,25,7 (3) Evaluation of market reforms.

SB218-SSA1,25,12 (a) The commissioner of insurance shall evaluate the effectiveness of the health insurance market reforms under sections 632.745 to 632.7499 of the statutes, as affected by this act, and under the federal Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, including the effectiveness of the reforms with respect to all of the following:

SB218-SSA1,25,14 1. Accessibility of health insurance coverage, including such accessibility for persons who reside in rural areas of the state.

SB218-SSA1,25,15 2. Availability of health insurance coverage for uninsured persons.

SB218-SSA1,25,16 3. Affordability of health insurance coverage.

SB218-SSA1,25,20 (b) The commissioner shall submit a report of the results of the evaluation and any recommendations to the legislature in the manner provided under section 13.172 (2) of the statutes no later than the first day of the 24th month beginning after publication.

SB218-SSA1, s. 51 Section 51 . Initial applicability.

SB218-SSA1,25,22 (1) Unless otherwise specified, this act first applies to all of the following:

SB218-SSA1,25,25 (a) Except as provided in paragraphs (b) and (c ), health benefit plans that are issued or renewed, and self-insured health plans that are established, extended, modified or renewed, on the effective date of this paragraph.

SB218-SSA1,26,3 (b) Health benefit plans covering employes who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are issued or renewed on the earlier of the following:

SB218-SSA1,26,4 1. The day on which the collective bargaining agreement expires.

SB218-SSA1,26,6 2. The day on which the collective bargaining agreement is extended, modified or renewed.

SB218-SSA1,26,9 (c) Self-insured health plans covering employes who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are established, extended, modified or renewed on the earlier of the following:

SB218-SSA1,26,10 1. The day on which the collective bargaining agreement expires.

SB218-SSA1,26,12 2. The day on which the collective bargaining agreement is extended, modified or renewed.

SB218-SSA1, s. 52 Section 52. Effective dates. This act takes effect on the first day of the 7th month beginning after publication, except as follows:

SB218-SSA1,26,15 (1) Section 50 (1 ) and (2) of this act takes effect on the day after publication.

SB218-SSA1,26,16 (End)