1997 - 1998 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO 1997 SENATE BILL 332
March 5, 1998 - Offered by Committee on Small Business and Economic
Development.
SB332-ASA1,1,9
1An Act to repeal 13.94 (1) (p), 15.07 (1) (b) 21., 15.165 (5), 20.515 (2) (title),
220.515 (2) (a), 20.515 (2) (g) and subchapter X of chapter 40 [precedes 40.98];
3to amend 40.02 (26) (intro.), 40.02 (26) (intro.), 40.02 (28) and 40.02 (28); and
4to create 13.94 (1) (p), 15.07 (1) (b) 21., 15.165 (5), 20.515 (2) (title), 20.515 (2)
5(a), 20.515 (2) (g) and subchapter X of chapter 40 [precedes 40.98] of the
6statutes;
relating to: requiring the department of employe trust funds to
7establish a health care coverage plan for employers in the private sector,
8creating a private employer health care coverage board and making an
9appropriation.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB332-ASA1,2,211
13.94
(1) (p) No later than January 1, 2004, prepare a program evaluation audit
12of the private employer health care coverage plan established under subch. X of ch.
140. The legislative audit bureau shall file a copy of the audit report under this
2paragraph with the distributees specified in par. (b).
SB332-ASA1, s. 2
3Section
2. 13.94 (1) (p) of the statutes, as created by 1997 Wisconsin Act ....
4(this act), is repealed.
SB332-ASA1, s. 3
5Section
3. 15.07 (1) (b) 21. of the statutes is created to read:
SB332-ASA1,2,66
15.07
(1) (b) 21. Private employer health care coverage board.
SB332-ASA1, s. 4
7Section
4. 15.07 (1) (b) 21. of the statutes, as created by 1997 Wisconsin Act
8.... (this act), is repealed.
SB332-ASA1,2,1410
15.165
(5) Private employer health care coverage board. (a) There is created
11in the department of employe trust funds a private employer health care coverage
12board consisting of the secretary of employe trust funds or his or her designee, the
13secretary of health and family services or his or her designee and the following
14members appointed for 3-year terms:
SB332-ASA1,2,1515
1. One member who represents health maintenance organizations.
SB332-ASA1,2,1616
2. One member who represents hospitals.
SB332-ASA1,2,1717
3. One member who represents insurance agents, as defined in s. 628.02 (4).
SB332-ASA1,2,1918
4. Two members who are employes eligible to receive health care coverage
19under subch. X of ch. 40 and whose employer employs not more than 50 employes.
SB332-ASA1,2,2020
5. One member who represents insurers.
SB332-ASA1,2,2321
6. Two members who are, or who represent, employers that employ not more
22than 50 employes and who are eligible to offer health care coverage under subch. X
23of ch. 40.
SB332-ASA1,2,2424
7. One member who is a physician, as defined in s. 448.01 (5).
SB332-ASA1,2,2525
8. Two members who represent the public interest.
SB332-ASA1,3,2
1(b) The secretary of employe trust funds or his or her designee and the secretary
2of health and family services or his or her designee shall be nonvoting members.
SB332-ASA1, s. 6
3Section
6. 15.165 (5) of the statutes, as created by 1997 Wisconsin Act .... (this
4act), is repealed.
SB332-ASA1, s. 7
5Section
7. 20.005 (3) (schedule) of the statutes: at the appropriate place, insert
6the following amounts for the purposes indicated:
-
See PDF for table ![PDF](https://docs.legis.wisconsin.gov/assets/image/file_acrobat.gif)
SB332-ASA1, s. 8
7Section
8. 20.515 (2) (title) of the statutes is created to read:
SB332-ASA1,3,88
20.515
(2) (title)
Private employer health care coverage plan.
SB332-ASA1, s. 9
9Section
9. 20.515 (2) (title) of the statutes, as created by 1997 Wisconsin Act
10.... (this act), is repealed.
SB332-ASA1,3,1512
20.515
(2) (a)
Private employer health care coverage plan; start-up costs. The
13amounts in the schedule for the start-up costs for designing, establishing and
14administering the private employer health care coverage plan under subch. X of ch.
1540.
SB332-ASA1, s. 11
16Section
11. 20.515 (2) (a) of the statutes, as created by 1997 Wisconsin Act ....
17(this act), is repealed.
SB332-ASA1,4,4
120.515
(2) (g)
Private employer health care coverage plan. All moneys received
2under subch. X of ch. 40 from employers who elect to participate in the private
3employer health care coverage plan under subch. X of ch. 40, for the costs of
4designing, establishing and administering the plan.
SB332-ASA1, s. 13
5Section
13. 20.515 (2) (g) of the statutes, as created by 1997 Wisconsin Act ....
6(this act), is repealed.
SB332-ASA1, s. 14
7Section
14
. 40.02 (26) (intro.) of the statutes is amended to read:
SB332-ASA1,4,158
40.02
(26) (intro.) "Employe" means any person who receives earnings as
9payment for personal services rendered for the benefit of any employer including
10officers of the employer
, except as provided in subch. X. An employe is deemed to
11have separated from the service of an employer at the end of the day on which the
12employe last performed services for the employer, or, if later, the day on which the
13employe-employer relationship is terminated because of the expiration or
14termination of leave without pay, sick leave, vacation or other leave of absence. A
15person shall not be considered an employe if a person:
SB332-ASA1, s. 15
16Section
15
. 40.02 (26) (intro.) of the statutes, as affected by 1997 Wisconsin
17Act .... (this act), is amended to read:
SB332-ASA1,4,2518
40.02
(26) (intro.) "Employe" means any person who receives earnings as
19payment for personal services rendered for the benefit of any employer including
20officers of the employer
, except as provided in subch. X. An employe is deemed to
21have separated from the service of an employer at the end of the day on which the
22employe last performed services for the employer, or, if later, the day on which the
23employe-employer relationship is terminated because of the expiration or
24termination of leave without pay, sick leave, vacation or other leave of absence. A
25person shall not be considered an employe if a person:
SB332-ASA1,5,102
40.02
(28) "Employer" means the state, including each state agency, any
3county, city, village, town, school district, other governmental unit or
4instrumentality of 2 or more units of government now existing or hereafter created
5within the state
and, any federated public library system established under s. 43.19
6whose territory lies within a single county with a population of 500,000 or more
and
7a local exposition district created under subch. II of ch. 229, except as provided under
8ss. 40.51 (7) and 40.61 (3)
, or a local exposition district created under subch. II of ch.
9229 and subch. X. Each employer shall be a separate legal jurisdiction for OASDHI
10purposes.
SB332-ASA1, s. 17
11Section
17
. 40.02 (28) of the statutes, as affected by 1997 Wisconsin Act ....
12(this act), is amended to read:
SB332-ASA1,5,2013
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.
SB332-ASA1, s. 18
21Section
18. Subchapter X of chapter 40 [precedes 40.98] of the statutes is
22created to read:
SB332-ASA1,6,3
1Subchapter X
2
Private employer health
3
Care coverage
SB332-ASA1,6,4
440.98 Health care coverage. (1) In this subchapter:
SB332-ASA1,6,55
(a) "Board" means the private employer health care coverage board.
SB332-ASA1,6,96
(b) "Dependent" means a spouse, an unmarried child under the age of 19 years,
7an unmarried child who is a full-time student under the age of 21 years and who is
8financially dependent upon the parent, or an unmarried child of any age who is
9medically certified as disabled and who is dependent upon the parent.
SB332-ASA1,6,1710
(c) "Employe" means any person who receives earnings as payment for personal
11services rendered for the benefit of any employer including officers of the employer.
12An employe is considered to have separated from the service of an employer at the
13end of the day on which the employe last performed services for the employer, or, if
14later, the day on which the employe-employer relationship is terminated because of
15the expiration or termination of leave without pay, sick leave, vacation or other leave
16of absence. A person shall not be considered an employe if any of the following
17applies:
SB332-ASA1,6,1918
1. The person is employed under a contract involving the furnishing of more
19than personal services.
SB332-ASA1,6,2320
2. The person is customarily engaged in an independently established trade,
21business or profession providing the same type of services to more than one employer
22and the person's services to an employer are not compensated for on a payroll of that
23employer.
SB332-ASA1,6,2524
3. The person is a patient or inmate of a hospital, home or institution and
25performs services in the hospital, home or institution.
SB332-ASA1,7,3
1(d) "Employer" means any person who is doing business or operating an
2organization in this state and who employs at least 2 employes, but who is not an
3employer, as defined in s. 40.02 (28).
SB332-ASA1,7,54
(e) "Health care coverage plan" means the health care coverage plan
5established under sub. (2) (a).
SB332-ASA1,7,66
(f) "Insurer" has the meaning given in s. 600.03 (27).
SB332-ASA1,7,18
7(2) (a) The department shall design, establish and administer an actuarially
8sound health care coverage plan for employers that provides coverage beginning not
9later than January 1, 2000. In designing the health care coverage plan, the
10department shall consult with the departments of commerce and health and family
11services and the office of the commissioner of insurance. In establishing the health
12care coverage plan, the department shall solicit and accept bids and enter into
13contracts with insurers who are to provide health care coverage under the health
14care coverage plan. The health care coverage plan is subject to the provisions of chs.
15600 to 646 that apply to group health benefit plans, as defined in s. 632.745 (9), to
16the same extent as any other group health benefit plan, as defined in s. 632.745 (9).
17Before the health care coverage plan may be implemented, the board must approve
18the plan.
SB332-ASA1,7,2019
(am) The health care coverage plan established under par. (a) may not be
20combined with any health care coverage plan under subch. IV.
SB332-ASA1,7,2421
(b) The health care coverage plan shall require that all insurance rates under
22the plan be published annually in a single publication that is made available to
23employers and employes. The rates shall be listed by county and by any other factor
24that the department considers appropriate.
SB332-ASA1,8,2
1(c) The health care coverage plan shall have an enrollment period that is
2established by the board.
SB332-ASA1,8,63
(d) The department shall charge employers who participate in the health care
4coverage plan a fee to cover the department's cost in designing, establishing and
5administering the health care coverage plan. All moneys received under this
6paragraph shall be credited to the appropriation account under s. 20.515 (2) (g).
SB332-ASA1,8,97
(e) The department may not sell any health care coverage plan to an employer
8or enroll any employe in the health care coverage plan, but the department may
9publicize the availability of the health care coverage plan for employers.
SB332-ASA1,8,1110
(f) The department may enter into a contract with any person to provide
11services relating to the administration of the health care coverage plan.
SB332-ASA1,8,13
12(3) Any employer who participates in the health care coverage plan shall do all
13of the following:
SB332-ASA1,8,1614
(a) Offer health care coverage under the plan to all of its permanent employes
15who have a normal work week of 30 or more hours and may offer health care coverage
16under the plan to any of its other employes.
SB332-ASA1,8,2017
(b) Provide health care coverage under the plan to the greater of 50% of its
18permanent employes who have a normal work week of 30 or more hours and who do
19not otherwise receive health care coverage as a dependent under any other plan that
20is not offered by the employer or a percentage of such employes specified by the board.
SB332-ASA1,8,2321
(c) Pay for each employe at least 50% but not more than 100% of the lowest
22premium rate that would be available to the employer for that employe's coverage
23under the health care coverage plan.
SB332-ASA1,8,2524
(d) Make premium payments for the health care coverage of its employes in the
25manner specified by the board.
SB332-ASA1,9,3
1(4) Any employer that provides health care coverage for its employes under the
2plan and that voluntarily terminates coverage under the plan is not eligible to
3participate in the plan for at least 3 years from the date that coverage is terminated.
SB332-ASA1,9,84
(5) Any insurer that offers the health care coverage plan shall provide coverage
5under the plan to any employer that applies for coverage, and to all of the employer's
6employes who elect coverage under the health care coverage plan, without regard to
7the health condition or claims experience of any individual who would be covered
8under the health care coverage plan if all of the following apply:
SB332-ASA1,9,109
(a) The employer agrees to pay the premium required for coverage under the
10health care coverage plan.
SB332-ASA1,9,1311
(b) The employer agrees to comply with all provisions of the health care
12coverage plan that apply generally to a policyholder or an insured without regard to
13health condition or claims experience.
SB332-ASA1,9,15
14(6) (a) The health care coverage plan may only be sold by insurance agents
15licensed under ch. 628.
SB332-ASA1,9,1916
(b) An insurance agent may not sell any health care coverage under the health
17care coverage plan on behalf of an insurer unless he or she is employed by the insurer
18or has a contract with the insurer to sell the health care coverage on behalf of the
19insurer.
SB332-ASA1,9,2420
(c) The board shall set, and may adjust as often as semiannually, the
21commission rate for the sale of a policy under the health care coverage plan. The rate
22shall be based on the average commission rate that insurance agents are paid in the
23state for the sale of comparable health insurance policies at the time that the rate
24is set or adjusted.
SB332-ASA1,10,2
1(d) An insurer shall specify on the first page of any policy sold under the health
2care coverage plan the amount of the commission paid to the insurance agent.
SB332-ASA1,10,8
3(7) (a) Annually, on or before December 31, the board shall submit a report to
4the appropriate standing committees under s. 13.172 (3) and to the governor on the
5operation of the health care coverage plan. The report shall specify the number of
6employers participating in the health care coverage plan, calculate the costs of the
7health care coverage plan to employers and their employes and include
8recommendations for improving the health care coverage plan.
SB332-ASA1,10,189
(b) No later than January 1, 2003, the board shall submit a report to the
10appropriate standing committees under s. 13.172 (3) and to the governor that offers
11recommendations as to whether the department should continue to administer the
12health care coverage plan, whether a different state agency should administer the
13health care coverage plan or whether the health care coverage plan should be
14administered by a private nonprofit organization. If the board recommends that a
15different state agency administer the health care coverage plan or that the health
16care coverage plan be administered by a private nonprofit organization, the board
17shall submit proposed legislation to the appropriate standing committees under s.
1813.172 (3) at the time that the board submits its report.
SB332-ASA1, s. 19
19Section
19. Subchapter X of chapter 40 [precedes 40.98] of the statutes, as
20created by 1997 Wisconsin Act .... (this act), is repealed.
SB332-ASA1,10,2522
(1)
Private employer health care coverage board. Notwithstanding the
23length of terms specified for the members of the private employer health care
24coverage board under section 15.165 (5) of the statutes, as created by this act, the
25initial members shall be appointed for the following terms:
SB332-ASA1,11,2
1(a) The members specified under section 15.165 (5) (a) 1., 3. and 7. of the
2statutes, as created by this act, for terms expiring on May 1, 2000.
SB332-ASA1,11,4
3(b) The members specified under section 15.165 (5) (a) 2., 5. and 8. of the
4statutes, as created by this act, for terms expiring on May 1, 2001.
SB332-ASA1,11,6
5(c) The members specified under section 15.165 (5) (a) 4. and 6. of the statutes,
6as created by this act, for terms expiring on May 1, 2002.
SB332-ASA1,11,137
(2)
Position authorizations for the department of employe trust funds. The
8authorized FTE positions for the department of employe trust funds are increased
9by 3.5 GPR positions on the effective date of this subsection, to be funded from the
10appropriation under section 20.515 (2) (a) of the statutes, as created by this act, for
11the purpose of designing, establishing and administering the private employer
12health care coverage plan under subchapter X of chapter 40 of the statutes, as
13created by this act.
SB332-ASA1, s. 21
14Section
21.
Effective dates. This act takes effect on the day after publication,
15except as follows: