SB218-SSA1,3,2421 185.981 (4t) A sickness care plan operated by a cooperative association is
22subject to ss. 252.14, 631.89, 632.72 (2), 632.745 to 632.749 632.7492, 632.7497 to
23632.7499
, 632.87 (2m), (3), (4) and (5), 632.895 (10) to (13) and 632.897 (10) and chs.
24149 and 155.
SB218-SSA1, s. 8
1Section 8. 185.983 (1) (intro.) of the statutes, as affected by 1997 Wisconsin
2Act 27
, section 3134m, is amended to read:
SB218-SSA1,4,83 185.983 (1) (intro.)  Every such voluntary nonprofit sickness care plan shall be
4exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
5601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72
6(2), 632.745 to 632.749 632.7492, 632.7497 to 632.7499, 632.775, 632.79, 632.795,
7632.87 (2m), (3), (4) and (5), 632.895 (5) and (9) to (13), 632.896 and 632.897 (10) and
8chs. 609, 630, 635, 645 and 646, but the sponsoring association shall:
SB218-SSA1, s. 9 9Section 9. 185.983 (1g) of the statutes is repealed.
SB218-SSA1, s. 10 10Section 10. 600.01 (2) (b) of the statutes, as affected by 1997 Wisconsin Act 27,
11is amended to read:
SB218-SSA1,4,1412 600.01 (2) (b) Group or blanket insurance described in sub. (1) (b) 3. and 4. is
13not exempt from ss. 632.745 to 632.749 632.7492 or 632.7497 to 632.7499 or ch. 633
14or 635.
SB218-SSA1, s. 11 15Section 11. 613.03 (3) of the statutes, as affected by 1997 Wisconsin Act 27,
16is amended to read:
SB218-SSA1,4,2017 613.03 (3) Applicability of insurance laws. Except as otherwise specifically
18provided, service insurance corporations organized or operating under this chapter
19are subject to ss. 610.01, 610.11, 610.21, 610.23 and 610.24 and chs. 600, 601, 609,
20617, 620, 623, 625, 627, 628, 631, 632, 635 and 645 and to no other insurance laws.
SB218-SSA1, s. 12 21Section 12. 625.12 (2) of the statutes is amended to read:
SB218-SSA1,5,522 625.12 (2) Classification. Risks Subject to s. 632.7497, risks may be classified
23in any reasonable way for the establishment of rates and minimum premiums,
24except that no classifications may be based on race, color, creed or national origin,
25and classifications in automobile insurance may not be based on physical condition

1or developmental disability as defined in s. 51.01 (5). Subject to s. ss. 632.365 and
2632.7497
, rates thus produced may be modified for individual risks in accordance
3with rating plans or schedules that establish reasonable standards for measuring
4probable variations in hazards, expenses, or both. Rates may also be modified for
5individual risks under s. 625.13 (2).
SB218-SSA1, s. 13 6Section 13. 628.34 (3) (a) of the statutes, as affected by 1997 Wisconsin Act 27,
7is amended to read:
SB218-SSA1,5,158 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by
9charging different premiums or by offering different terms of coverage except on the
10basis of classifications related to the nature and the degree of the risk covered or the
11expenses involved, subject to ss. 632.365, 632.745 and 632.746, 632.748, 632.7494
12and 632.7497
. Rates are not unfairly discriminatory if they are averaged broadly
13among persons insured under a group, blanket or franchise policy, and terms are not
14unfairly discriminatory merely because they are more favorable than in a similar
15individual policy.
SB218-SSA1, s. 14 16Section 14. 628.34 (3) (b) of the statutes, as affected by 1997 Wisconsin Act 27,
17is amended to read:
SB218-SSA1,5,2418 628.34 (3) (b) No insurer may refuse to insure or refuse to continue to insure,
19or limit the amount, extent or kind of coverage available to an individual, or charge
20an individual a different rate for the same coverage because of a mental or physical
21disability except when the refusal, limitation or rate differential is based on either
22sound actuarial principles supported by reliable data or actual or reasonably
23anticipated experience, subject to ss. 632.746 to 632.749, 632.7494, 632.7495 and
24632.7497
.
SB218-SSA1, s. 15
1Section 15. 632.745 (intro.) of the statutes, as affected by 1997 Wisconsin Act
227
, is amended to read:
SB218-SSA1,6,5 3632.745 Coverage requirements for group and individual health
4benefit plans; definitions.
(intro.) In this section and ss. 632.746 to 632.7495
5632.7499:
SB218-SSA1, s. 16 6Section 16. 632.745 (1m) of the statutes is created to read:
SB218-SSA1,6,97 632.745 (1m) "Base premium rate" means the lowest premium rate chargeable
8under a rating system to employers or individuals with similar case characteristics
9and the same or similar benefit design characteristics.
SB218-SSA1, s. 17 10Section 17. 632.745 (2m) of the statutes is created to read:
SB218-SSA1,6,1311 632.745 (2m) "Benefit design characteristics" means covered services, cost
12sharing, utilization management, managed care networks and other features that
13differentiate plan or coverage designs.
SB218-SSA1, s. 18 14Section 18. 632.745 (3m) of the statutes is created to read:
SB218-SSA1,6,1615 632.745 (3m) "Case characteristics" means the age, gender, geographic
16location and tobacco use of the individuals covered under a health benefit plan.
SB218-SSA1, s. 19 17Section 19. 632.745 (7) of the statutes, as affected by 1997 Wisconsin Act 27,
18is amended to read:
SB218-SSA1,6,2219 632.745 (7) "Enrollment date" means, with respect to an individual covered
20under a self-insured health plan, group health plan or health insurance, the date of
21enrollment of the individual under the plan or insurance or, if earlier, the first day
22of the waiting period for such enrollment.
SB218-SSA1, s. 20 23Section 20. 632.745 (7m) of the statutes is created to read:
SB218-SSA1,7,3
1632.745 (7m) "Established geographic service area" means a geographic area
2within which an insurer provides coverage and that has been approved by the
3commissioner.
SB218-SSA1, s. 21 4Section 21. 632.745 (18) (intro.) of the statutes, as affected by 1997 Wisconsin
5Act 27
, is amended to read:
SB218-SSA1,7,96 632.745 (18) (intro.) "Late enrollee" means, with respect to coverage under a
7self-insured health plan,
a group health plan or health insurance coverage, a
8participant, beneficiary or individual who enrolls under the plan or coverage at any
9time other than during any of the following:
SB218-SSA1, s. 22 10Section 22. 632.745 (18m) of the statutes is created to read:
SB218-SSA1,7,1211 632.745 (18m) "Midpoint rate" means the arithmetic average of the base
12premium rate and the corresponding highest premium rate.
SB218-SSA1, s. 23 13Section 23. 632.745 (19m) of the statutes is created to read:
SB218-SSA1,7,1614 632.745 (19m) "New business premium rate" means the premium rate charged
15or offered to employers or individuals with similar case characteristics for newly
16issued health insurance with the same or similar benefit design characteristics.
SB218-SSA1, s. 24 17Section 24. 632.745 (23m) of the statutes is created to read:
SB218-SSA1,7,1918 632.745 (23m) "Rating period" means the period, determined by an insurer,
19during which a premium rate established by the insurer remains in effect.
SB218-SSA1, s. 25 20Section 25. 632.745 (23p) of the statutes is created to read:
SB218-SSA1,7,2421 632.745 (23p) "Restricted network provision" means a provision of a health
22benefit plan that conditions the payment of benefits, in whole or in part, on obtaining
23services or articles from health care providers that have contracted with the insurer
24to provide health care services or articles to covered individuals.
SB218-SSA1, s. 26
1Section 26. 632.745 (25) of the statutes, as affected by 1997 Wisconsin Act 27,
2is repealed and recreated to read:
SB218-SSA1,8,93 632.745 (25) "Small employer" means, with respect to a calendar year and a
4plan year, an employer that employed an average of at least 2 but not more than 50
5employes on business days during the preceding calendar year, or that is reasonably
6expected to employ an average of at least 2 but not more than 50 employes on
7business days during the current calendar year if the employer was not in existence
8during the preceding calendar year, and that employs at least 2 employes on the first
9day of the plan year.
SB218-SSA1, s. 27 10Section 27. 632.745 (26m) of the statutes is created to read:
SB218-SSA1,8,1511 632.745 (26m) "Student-only medical plan" means a limited nonmedically
12underwritten individual or group health benefit plan that is guaranteed renewable
13while the covered person is enrolled as a regular, full-time undergraduate or
14graduate student at an accredited technical or trade school, college or university and
15to which any of the following applied at issuance:
SB218-SSA1,8,1616 (a) The student was not insured under a health benefit plan.
SB218-SSA1,8,1917 (b) The student was eligible for coverage under a health benefit plan of his or
18her parent, stepparent or guardian but was unable to access the full health benefits
19of the plan due to limitations in the plan's geographic service area.
SB218-SSA1, s. 28 20Section 28. 632.745 (27) of the statutes, as affected by 1997 Wisconsin Act 27,
21is amended to read:
SB218-SSA1,9,222 632.745 (27) "Waiting period" means, with respect to a self-insured health
23plan,
a group health plan or health insurance coverage and an individual who is a
24potential participant or beneficiary in the self-insured health plan or group health
25plan or who is potentially covered by the health insurance coverage, the period that

1must pass with respect to the individual before the individual is eligible for benefits
2under the terms of the plan or coverage.
SB218-SSA1, s. 29 3Section 29. 632.746 (title) of the statutes, as created by 1997 Wisconsin Act
427
, is amended to read:
SB218-SSA1,9,6 5632.746 (title) Preexisting condition conditions; portability;
6restrictions; and special enrollment periods
for group health benefit plans.
SB218-SSA1, s. 30 7Section 30. 632.746 (1) (a) of the statutes, as created by 1997 Wisconsin Act
827
, is amended to read:
SB218-SSA1,9,159 632.746 (1) (a) Subject to subs. (2) and (3), a self-insured health plan or an
10insurer that offers a group health benefit plan may, with respect to a participant or
11beneficiary under the plan, impose a preexisting condition exclusion only if the
12exclusion relates to a condition, whether physical or mental, regardless of the cause
13of the condition, for which medical advice, diagnosis, care or treatment was
14recommended or received within the 6-month period ending on the participant's or
15beneficiary's enrollment date under the plan.
SB218-SSA1, s. 31 16Section 31. 632.746 (2) of the statutes, as created by 1997 Wisconsin Act 27,
17is amended to read:
SB218-SSA1,9,2018 632.746 (2) An A self-insured health plan or an insurer offering a group health
19benefit plan may not treat genetic information as a preexisting condition under sub.
20(1) without a diagnosis of a condition related to the information.
SB218-SSA1,9,2321 (b) An A self-insured health plan or an insurer offering a group health benefit
22plan may not impose a preexisting condition exclusion relating to pregnancy as a
23preexisting condition.
SB218-SSA1,9,2524 (c) Subject to par. (e), a self-insured health plan or an insurer offering a group
25health benefit plan may not impose a preexisting condition exclusion with respect to

1an individual who is covered under creditable coverage on the last day of the 30-day
2period beginning with the day on which the individual is born.
SB218-SSA1,10,93 (d) Subject to par. (e), a self-insured health plan or an insurer offering a group
4health benefit plan may not impose a preexisting condition exclusion with respect to
5an individual who is adopted or placed for adoption before attaining the age of 18
6years and who is covered under creditable coverage on the last day of the 30-day
7period beginning with the day on which the individual is adopted or placed for
8adoption. This paragraph does not apply to coverage before the day on which the
9individual is adopted or placed for adoption.
SB218-SSA1,10,1610 (e) Paragraphs (c) and (d) do not apply to an individual after the end of the first
11continuous period during which the individual was not covered under any creditable
12coverage for at least 63 days. For purposes of this paragraph, any waiting period or
13affiliation period for coverage under a self-insured health plan, group health plan
14or group health benefit plan shall not be taken into account in determining the period
15before enrollment in the self-insured health plan, group health plan or group health
16benefit plan.
SB218-SSA1, s. 32 17Section 32. 632.746 (3) (a), (b) and (d) 1., of the statutes, as created by 1997
18Wisconsin Act 27
, are amended to read:
SB218-SSA1,10,2219 632.746 (3) (a) The length of time during which any preexisting condition
20exclusion under sub. (1) may be imposed shall be reduced by the aggregate of the
21participant's or beneficiary's periods of creditable coverage on his or her enrollment
22date under the self-insured health plan or group health benefit plan.
SB218-SSA1,11,623 (b) With respect to enrollment of an individual under a self-insured health
24plan, a
group health plan or a group health benefit plan, a period of creditable
25coverage after which the individual was not covered under any creditable coverage

1for a period of at least 63 days before enrollment in the self-insured health plan,
2group health plan or group health benefit plan may not be counted. For purposes of
3this paragraph, any waiting period or affiliation period for coverage under the
4self-insured health plan, group health plan or group health benefit plan shall not be
5taken into account in determining the period before enrollment in the self-insured
6health plan,
group health plan or group health benefit plan.
SB218-SSA1,11,97 (d) 1. An A self-insured health plan or an insurer offering a group health
8benefit plan shall count a period of creditable coverage without regard to the specific
9benefits for which the individual had coverage during the period.
SB218-SSA1, s. 33 10Section 33. 632.746 (6) of the statutes, as created by 1997 Wisconsin Act 27,
11is amended to read:
SB218-SSA1,11,1712 632.746 (6) An A self-insured health plan or an insurer offering a group health
13benefit plan shall permit an employe who is not enrolled but who is eligible for
14coverage under the terms of the self-insured health plan or group health benefit
15plan, or a participant's or employe's dependent who is not enrolled but who is eligible
16for coverage under the terms of the self-insured health plan or group health benefit
17plan, to enroll for coverage under the terms of the plan if all of the following apply:
SB218-SSA1,11,2018 (a) The employe or dependent was covered under a self-insured health plan or
19group health plan or had health insurance coverage at the time coverage was
20previously offered to the employe or dependent.
SB218-SSA1,12,321 (b) The employe or participant stated in writing at the time coverage was
22previously offered that coverage under a self-insured health plan or group health
23plan or health insurance coverage was the reason for declining enrollment under the
24self-insured health plan or insurer's group health benefit plan. This paragraph
25applies only if the self-insured health plan or insurer required such a statement at

1the time coverage was previously offered and provided the employe or participant,
2at the time coverage was previously offered, with notice of the requirement and the
3consequences of the requirement.
SB218-SSA1,12,84 (c) The employe or dependent is currently covered under the self-insured
5health plan,
group health plan or health insurance or, under the terms of the
6self-insured health plan or group health benefit plan, the employe or participant
7requests enrollment no later than 30 days after the date on which the coverage under
8par. (a) is exhausted or terminated.
SB218-SSA1, s. 34 9Section 34. 632.746 (7) (a) (intro.), (b) (intro.) and 1. and (c) 1., of the statutes,
10as created by 1997 Wisconsin Act 27, are amended to read:
SB218-SSA1,12,1311 632.746 (7) (a) (intro.) If par. (b) applies, a self-insured health plan or an
12insurer offering a group health benefit plan shall provide for a special enrollment
13period during which any of the following may occur:
SB218-SSA1,12,1514 (b) (intro.) An A self-insured health plan or an insurer under par. (a) is required
15to provide for a special enrollment period if all of the following apply:
SB218-SSA1,12,1716 1. The self-insured health plan or group health benefit plan makes coverage
17available for dependents of participants under the plan.
SB218-SSA1,12,1918 (c) 1. The date dependent coverage is made available under the self-insured
19health plan or
group health benefit plan.
SB218-SSA1, s. 35 20Section 35. 632.7465 of the statutes is created to read:
SB218-SSA1,13,3 21632.7465 Guaranteed issue for group health benefit plans. (1) In this
22section, "employer" means, with respect to a calendar year and a plan year, an
23employer that employed an average of at least 2 but not more than 100 employes on
24business days during the preceding calendar year, or that is reasonably expected to
25employ an average of at least 2 but not more than 100 employes on business days

1during the current calendar year if the employer was not in existence during the
2preceding calendar year, and that employs at least 2 employes on the first day of the
3plan year.
SB218-SSA1,13,7 4(2) Except as provided in subs. (4) and (5), an insurer shall provide coverage
5under a group health benefit plan to an employer and to all of the employer's eligible
6employes and their dependents, regardless of health condition or claims experience,
7if all of the following apply:
SB218-SSA1,13,88 (a) The insurer has in force a group health benefit plan.
SB218-SSA1,13,109 (b) The employer agrees to pay the premium required for coverage under the
10group health benefit plan.
SB218-SSA1,13,1311 (c) The employer agrees to comply with all other provisions of the group health
12benefit plan that apply generally to a policyholder or an insured without regard to
13health condition or claims experience.
SB218-SSA1,13,15 14(3) An insurer that provides coverage under sub. (2) may impose payment
15security provisions that are reasonably related to the risk covered.
SB218-SSA1,13,19 16(4) (a) An insurer that is otherwise required to provide coverage under sub. (2)
17may refuse to issue a group health benefit plan to an employer if all of the individuals
18in the employer group that are to be covered under the group health benefit plan may
19be covered under one individual health benefit plan providing family coverage.
SB218-SSA1,13,2220 (b) Subsection (2) does not require an insurer to issue coverage that the insurer
21is not authorized to issue under its bylaws, charter or certificate of incorporation or
22authority.
SB218-SSA1,14,223 (c) Subsection (2) does not require an insurer that provides coverage to an
24employer under a group health benefit plan to issue a different group health benefit

1plan to the employer before the expiration of the agreed term of the group health
2benefit plan under which the employer has coverage.
SB218-SSA1,14,63 (d) An insurer that offers health care coverage exclusively to a single category
4or limited categories of employers may, with prior approval of the commissioner, limit
5its compliance with sub. (2) to that single category or those limited categories of
6employers.
SB218-SSA1,14,107 (e) The commissioner may exempt an insurer from the requirements of sub. (2)
8if the commissioner determines that it is in the public interest to exempt the insurer
9from the requirements under sub. (2) because the insurer is in financially hazardous
10condition.
SB218-SSA1,14,1511 (f) If an employer loses coverage under a group health benefit plan for failure
12to pay a premium when due, an insurer that is otherwise required to provide
13coverage under sub. (2) may refuse to issue a group health benefit plan to that
14employer during the 12-month period beginning on the day on which the employer
15lost coverage.
SB218-SSA1,14,2116 (g) An insurer that previously issued group health benefit plans but, prior to
17the effective date of this paragraph .... [revisor inserts date], discontinued offering
18such plans to small employers shall within 60 days after the effective date of this
19paragraph .... [revisor inserts date], again offer group health benefit plans to small
20employers or be subject to the requirements under s. 632.749 as if the insurer had
21elected to discontinue offering a group health benefit plan.
SB218-SSA1,14,24 22(5) (a) In this subsection, "high-risk individual" means an individual with a
23high-risk medical condition who has coverage under a group health benefit plan
24with a premium rate at the insurer's highest premium rate level.
SB218-SSA1,15,3
1(b) An insurer that is otherwise required to provide coverage under sub. (2)
2shall be exempt from the requirement under sub. (2) for the remainder of a calendar
3year after all of the following occur:
SB218-SSA1,15,54 1. The number of high-risk individuals covered by the insurer at least equals
5the threshold level determined under par. (e) 3.
SB218-SSA1,15,126 2. The insurer applies for exemption from the requirement under sub. (2) by
7certifying its qualification under subd. 1. to the commissioner and the commissioner,
8within 30 days after the insurer submits its certifying information, makes no
9objection and does not request additional information. If the commissioner does
10timely object or request additional information, the insurer shall be exempt from the
11requirements under sub. (2) 30 days after the commissioner objects or the insurer
12submits the additional information if the commissioner takes no further action.
SB218-SSA1,15,1613 (c) Whenever an insurer becomes exempt from the requirement under sub. (2)
14by satisfying the criteria under par. (b), the commissioner shall provide notice of that
15exemption to all insurers offering group health benefit plans to employers in this
16state and to all insurance agents listed under s. 628.11 by those insurers.
SB218-SSA1,15,1917 (d) An insurer that satisfies the criterion under par. (b) 1. is not required to
18apply for exemption from the requirement under sub. (2). An insurer that does not
19apply for exemption shall remain subject to the requirement under sub. (2).
SB218-SSA1,15,2220 (e) In consultation with the committee on risk adjustment, the commissioner
21shall promulgate rules for the operation of the risk adjustment mechanism under
22this subsection, including rules that specify at least all of the following:
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