Amendment AA2-ASA1-AB133

AB133-ASA1-AA2,125,21 413. Page 533, line 23: after that line insert:

AB133-ASA1-AA2,125,22 " Section 936c. 40.02 (48) (c) of the statutes is amended to read:

AB133-ASA1-AA2,126,10 40.02 (48) (c) In s. 40.65, "protective occupation participant" means a participating employe who is a police officer, fire fighter, an individual determined by a participating employer under par. (a) or (bm) to be a protective occupation participant, county undersheriff, deputy sheriff, state probation and parole officer, county traffic police officer, conservation warden, state forest ranger, field conservation employe of the department of natural resources who is subject to call for forest fire control or warden duty, member of the state traffic patrol, state motor vehicle inspector, university of Wisconsin system full-time police officer, guard or any other employe whose principal duties are supervision and discipline of inmates at a state penal institution, excise tax investigator employed by the department of revenue, person employed under s. 61.66 (1), or special criminal investigation agent employed by the department of justice or sex offender registration specialist.

AB133-ASA1-AA2, s. 936r Section 936r. 40.02 (53m) of the statutes is created to read:

AB133-ASA1-AA2,126,14 40.02 (53m) "Sex offender registration specialist" means an employe of the department of corrections whose primary duties require direct and ongoing contact with persons registered under s. 301.45 and with the public under s. 301.46.".

AB133-ASA1-AA2,126,15 414. Page 533, line 23: after that line insert:

AB133-ASA1-AA2,126,16 " Section 936s. 40.02 (54) (a) of the statutes is repealed.".

AB133-ASA1-AA2,126,18 415. Page 533, line 24: delete the material beginning with that line and ending with page 534, line 25.

AB133-ASA1-AA2,126,19 416. Page 535, line 6: after that line insert:

AB133-ASA1-AA2,126,20 " Section 941m. 40.22 (2) (c) of the statutes is amended to read:

AB133-ASA1-AA2,126,22 40.22 (2) (c) The employe is excluded from participation by s. 40.02 (54) (a) or 40.21 (3) or (4).".

AB133-ASA1-AA2,126,24 417. Page 535, line 7: delete the material beginning with that line and ending with page 536, line 3.

AB133-ASA1-AA2,127,1 418. Page 536, line 3: after that line insert:

AB133-ASA1-AA2,127,2 " Section 941d. 40.51 (8) of the statutes is amended to read:

AB133-ASA1-AA2,127,6 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.746 (1) to (8) and (10), 632.747, 632.748, 632.85, 632.853, 632.855, 632.87 (3) to (5), 632.872, 632.895 (5m) and (8) to (13) and 632.896.

AB133-ASA1-AA2, s. 941g Section 941g. 40.51 (8m) of the statutes is amended to read:

AB133-ASA1-AA2,127,10 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 632.746 (1) to (8) and (10), 632.747, 632.748, 632.85, 632.853, 632.855, 632.872 and 632.895 (11) to (13).".

AB133-ASA1-AA2,127,11 419. Page 536, line 3: after that line insert:

AB133-ASA1-AA2,127,12 " Section 939tc. 40.41 (6) (b) of the statutes is amended to read:

AB133-ASA1-AA2,127,17 40.41 (6) (b) Services performed by a student or a member of a board or commission, except members of governing bodies, in a position or office which does not normally require actual performance of duty for at least 600 hours in each calendar year. For purposes of this paragraph, a "board" or "commission" is a body referred to in the statutes as a board or commission.

AB133-ASA1-AA2, s. 939tr Section 939tr. 40.41 (6) (c) of the statutes is created to read:

AB133-ASA1-AA2,127,21 40.41 (6) (c) Service performed in the employ of a school, college or university, if the service is performed by a student who is enrolled and regularly attending classes at the school, college or university.".

AB133-ASA1-AA2,127,22 420. Page 536, line 3: after that line insert:

AB133-ASA1-AA2,127,23 " Section 944j. 40.56 of the statutes is created to read:

AB133-ASA1-AA2,128,4 40.56 Prohibited insurance coverage. The state may not provide any insurance coverage under this subchapter to an adult who resides with an employe and who is not related to the employe or the employe's spouse by blood, marriage or adoption.".

AB133-ASA1-AA2,128,5 421. Page 536, line 12: after that line insert:

AB133-ASA1-AA2,128,6 " Section 944r. 40.65 (4w) of the statutes is created to read:

AB133-ASA1-AA2,128,11 40.65 (4w) A sex offender registration specialist who becomes a protective occupation participant on or after the effective date of this subsection .... [revisor inserts date], is not entitled to a duty disability benefit under this section for an injury or disease occurring before the effective date of this subsection .... [revisor inserts date].".

AB133-ASA1-AA2,128,12 422. Page 536, line 13: before that line insert:

AB133-ASA1-AA2,128,14 " Section 944ym. Subchapter X of chapter 40 [precedes 40.98] of the statutes is created to read:

AB133-ASA1-AA2,128,15 Chapter 40

AB133-ASA1-AA2,128,18 Subchapter X Private employer health Care coverage

AB133-ASA1-AA2,128,19 40.98 Health care coverage. (1) In this subchapter:

AB133-ASA1-AA2,128,24 (ag) "Abortion" means the use of an instrument, medicine, drug or other substance or device with intent to terminate the pregnancy of a woman known to be pregnant or for whom there is reason to believe that she may be pregnant and with intent other than to increase the probability of a live birth, to preserve the life or health of the infant after live birth or to remove a dead fetus.

AB133-ASA1-AA2,129,1 (ar) "Board" means the private employer health care coverage board.

AB133-ASA1-AA2,129,5 (b) "Dependent" means a spouse, an unmarried child under the age of 19 years, an unmarried child who is a full-time student under the age of 21 years and who is financially dependent upon the parent, or an unmarried child of any age who is medically certified as disabled and who is dependent upon the parent.

AB133-ASA1-AA2,129,13 (c) "Employe" means any person who receives earnings as payment for personal services rendered for the benefit of any employer including officers of the employer. An employe is considered to have separated from the service of an employer at the end of the day on which the employe last performed services for the employer, or, if later, the day on which the employe-employer relationship is terminated because of the expiration or termination of leave without pay, sick leave, vacation or other leave of absence. A person shall not be considered an employe if any of the following applies:

AB133-ASA1-AA2,129,15 1. The person is employed under a contract involving the furnishing of more than personal services.

AB133-ASA1-AA2,129,19 2. The person is customarily engaged in an independently established trade, business or profession providing the same type of services to more than one employer and the person's services to an employer are not compensated for on a payroll of that employer.

AB133-ASA1-AA2,129,21 3. The person is a patient or inmate of a hospital, home or institution and performs services in the hospital, home or institution.

AB133-ASA1-AA2,129,24 (d) "Employer" means any person doing business or operating an organization in this state and employing at least 2 employes. "Employer" does not include an employer as defined in s. 40.02 (28).

AB133-ASA1-AA2,130,2 (e) "Health care coverage program" means the health care coverage program established under sub. (2) (a).

AB133-ASA1-AA2,130,3 (f) "Insurer" has the meaning given in s. 600.03 (27).

AB133-ASA1-AA2,130,5 (g) "Nontherapeutic abortion" means an abortion that is not directly and medically necessary to prevent the death of the woman.

AB133-ASA1-AA2,130,13 (2) (a) 1. The department shall design an actuarially sound health care coverage program for employers that includes more than one group health care coverage plan and that provides coverage beginning not later than June 30, 2002. The health care coverage program shall be known as the "Private Employer Health Care Purchasing Alliance". In designing the health care coverage program, the department shall consult with the office of the commissioner of insurance. The health care coverage program may not be implemented until it is approved by the board.

AB133-ASA1-AA2,131,2 2. The department shall solicit and accept bids and make every reasonable effort to enter into a contract for the administration of the health care coverage plans under the program, based on criteria established by the board. If the department has not entered into a contract for the administration of the health care coverage plans under the program for coverage to begin before June 30, 2002, the department shall submit a report to the cochairpersons of the joint committee on finance specifying the department's reasons for not entering into a contract. After submitting the report to the cochairpersons of the joint committee on finance and after receiving the approval of the board, the department shall provide all administrative services necessary for the provision of the health care coverage plans under the program. During the period that the department is providing the administrative services, the department shall continue to make every reasonable effort to contract for the administration of the health care coverage plans under the program.

AB133-ASA1-AA2,131,6 3. The administrator selected under subd. 2., or the department if no administrator has been selected under subd. 2., shall enter into contracts with insurers who are to provide health care coverage under the health care coverage program.

AB133-ASA1-AA2,131,8 4. The department shall solicit and accept bids and shall enter into a contract for marketing the health care coverage program.

AB133-ASA1-AA2,131,10 5. The department shall maintain a toll-free telephone number to provide information on the health care coverage program.

AB133-ASA1-AA2,131,14 (b) 1. Except as provided in subd. 2., every health care coverage plan under the health care coverage program is subject to the provisions of chs. 600 to 646 that apply to group health benefit plans, as defined in s. 632.745 (9), to the same extent as any other group health benefit plan, as defined in s. 632.745 (9).

AB133-ASA1-AA2,131,18 2. Notwithstanding ss. 632.85, 632.87 (2), (3), (4) and (5), 632.89 and 632.895 (2), (3), (4), (5), (5m), (6), (7), (8), (9), (10), (11), (12) and (13), and subject to subd. 3., the department may include in the health care coverage program one or more health care coverage plans that do not include one or more of the following coverages:

AB133-ASA1-AA2,131,20 a. Coverage related to treatment of an emergency medical condition, as required under s. 632.85.

AB133-ASA1-AA2,131,22 b. Coverage of vision care provided by an optometrist, as required under s. 632.87 (2).

AB133-ASA1-AA2,131,23 c. Coverage of chiropractic services, as required under s. 632.87 (3).

AB133-ASA1-AA2,131,25 d. Coverage of the diagnosis and treatment of a condition by a dentist, as required under s. 632.87 (4).

AB133-ASA1-AA2,132,2 e. Coverage of Papanicolaou tests performed by a nurse practitioner, as required under s. 632.87 (5).

AB133-ASA1-AA2,132,4 f. Coverage of the treatment of alcoholism and nervous and mental disorders, as required under s. 632.89.

AB133-ASA1-AA2,132,5 g. Coverage of home care, as required under s. 632.895 (2).

AB133-ASA1-AA2,132,6 h. Coverage of skilled nursing care, as required under s. 632.895 (3).

AB133-ASA1-AA2,132,7 i. Coverage of kidney disease treatment, as required under s. 632.895 (4).

AB133-ASA1-AA2,132,8 j. Coverage for a newly born child, as required under s. 632.895 (5).

AB133-ASA1-AA2,132,9 k. Coverage for a child of a covered child, as required under s. 632.895 (5m).

AB133-ASA1-AA2,132,10 L. Coverage of diabetes treatment, as required under s. 632.895 (6).

AB133-ASA1-AA2,132,11 m. Maternity coverage, as required under s. 632.895 (7).

AB133-ASA1-AA2,132,12 n. Coverage of mammograms, as required under s. 632.895 (8).

AB133-ASA1-AA2,132,14 o. Coverage of prescription medication for the treatment of human immunodeficiency virus infection, as required under s. 632.895 (9).

AB133-ASA1-AA2,132,15 p. Coverage of blood lead tests for children, as required under s. 632.895 (10).

AB133-ASA1-AA2,132,17 q. Coverage of treatment for the correction of temporomandibular disorders, as required under s. 632.895 (11).

AB133-ASA1-AA2,132,19 r. Coverage related to hospital or ambulatory surgery center charges and anesthetics associated with dental care, as required under s. 632.895 (12).

AB133-ASA1-AA2,132,21 s. Coverage of breast reconstruction incident to a mastectomy, as required under s. 632.895 (13).

AB133-ASA1-AA2,132,23 3. The department shall ensure that at least one health care coverage plan includes all of the coverages specified in subd. 2.

AB133-ASA1-AA2,133,11 (bm) No health care coverage plan under the health care coverage program may provide coverage of a nontherapeutic abortion except by an optional rider or supplemental coverage provision that is offered and provided on an individual basis and for which an additional, separate premium or charge is paid by the individual to be covered under the rider or supplemental coverage provision. Only funds attributable to premiums or charges paid for coverage under the rider or supplemental coverage provision may be used for the payment of any claim, and related administrative expenses, that relates to a nontherapeutic abortion. Such funds may not be used for the payment of any claim or administrative expenses that relate to any other type of coverage provided by the insurer under the health care coverage plan. Nothing in this paragraph requires an insurer or an employer to offer or provide coverage of an abortion under a health care coverage plan under the health care coverage program.

AB133-ASA1-AA2,133,14 (c) The health care coverage program established under par. (a), or any health care coverage plan included in the program, may not be combined with any health care coverage plan under subch. IV.

AB133-ASA1-AA2,133,18 (d) All insurance rates for health care coverage under the program shall be published annually in a single publication that is made available to employers and employes. The rates may be listed by county or by any other regional factor that the board considers appropriate.

AB133-ASA1-AA2,133,20 (e) All plans under the health care coverage program shall have an enrollment period that is established by the board.

AB133-ASA1-AA2,134,3 (f) 1. If the department has selected an administrator under par. (a) 2., the administrator shall charge employers who participate in the health care coverage program a fee to cover the cost of administrative services for the health care coverage program. The administrator shall reimburse the department for the expenses incurred by the department in designing, marketing and contracting for administrative services for the program. All moneys received by the department under this subdivision shall be credited to the appropriation account under s. 20.515 (2) (g).

AB133-ASA1-AA2,134,9 2. If the department has not selected an administrator under par. (a) 2., the department shall charge employers who participate in the health care coverage program a fee to cover the costs incurred by the department in designing, marketing and providing administrative services for the health care coverage program. All moneys received by the department under this subdivision shall be credited to the appropriation account under s. 20.515 (2) (g).

AB133-ASA1-AA2,134,13 (g) The department may not sell any health care coverage under the health care coverage program to an employer or enroll any employe in the health care coverage program, but the department shall make information about the program available to employers on a statewide basis.

AB133-ASA1-AA2,134,15 (3) Any employer who participates in the health care coverage program shall do all of the following:

AB133-ASA1-AA2,134,18 (a) Offer health care coverage under one or more plans to all of its permanent employes who have a normal work week of 30 or more hours and may offer health care coverage under one or more plans to any of its other employes.

AB133-ASA1-AA2,134,23 (b) Provide health care coverage under one or more plans to at least 50% of its permanent employes who have a normal work week of 30 or more hours and who do not otherwise receive health care coverage as a dependent under any other plan that is not offered by the employer or a percentage of such employes specified by the board, whichever percentage is greater.

AB133-ASA1-AA2,135,3 (c) Pay for each employe at least 50% but not more than 100% of the lowest premium rate that would be available to the employer for that employe's coverage under the health care coverage program.

AB133-ASA1-AA2,135,5 (d) Make premium payments for the health care coverage of its employes in the manner specified by the board.

AB133-ASA1-AA2,135,9 (4) Any employer that provides health care coverage for its employes under the program and that voluntarily terminates coverage under the program is not eligible to participate in the program for at least 3 years from the date that coverage is terminated.

AB133-ASA1-AA2,135,15 (5) Any insurer that offers a health care coverage plan under the health care coverage program shall provide coverage under the plan to any employer that applies for coverage, and to all of the employer's employes who elect coverage under the health care coverage plan, without regard to the health condition or claims experience of any individual who would be covered under the health care coverage plan if all of the following apply:

AB133-ASA1-AA2,135,17 (a) The employer agrees to pay the premium required for coverage under the health care coverage plan.

AB133-ASA1-AA2,135,20 (b) The employer agrees to comply with all provisions of the health care coverage plan that apply generally to a policyholder or an insured without regard to health condition or claims experience.

AB133-ASA1-AA2,135,22 (6) (a) Health care coverage under the health care coverage program may only be sold by insurance agents licensed under ch. 628.

AB133-ASA1-AA2,136,2 (b) An insurance agent may not sell any health care coverage under the health care coverage program on behalf of an insurer unless he or she is employed by the insurer or has a contract with the insurer to sell the health care coverage on behalf of the insurer.