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2007 - 2008 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 2,
TO 2007 ASSEMBLY BILL 133
March 4, 2008 - Offered by Committee on Insurance.
AB133-ASA2,1,4
1An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 111.91 (2) (n), 120.13 (2) (g),
2185.981 (4t) and 185.983 (1) (intro.); and
to create 609.86 and 632.895 (16) of
3the statutes;
relating to: requiring health insurance coverage of hearing aids
4and cochlear implants for infants and young children.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB133-ASA2,1,107
40.51
(8) Every health care coverage plan offered by the state under sub. (6)
8shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
9and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to
10(5) (6), 632.895 (5m) and (8) to
(15) (16), and 632.896.
AB133-ASA2,2,3
140.51
(8m) Every health care coverage plan offered by the group insurance
2board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,
3632.748, 632.83, 632.835, 632.85, 632.853, 632.855, and 632.895 (11) to
(15) (16).
AB133-ASA2,2,116
66.0137
(4) Self-insured health plans. If a city, including a 1st class city, or
7a village provides health care benefits under its home rule power, or if a town
8provides health care benefits, to its officers and employees on a self-insured basis,
9the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
10632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4)
and, 11(5),
and (6), 632.895 (9) to
(15)
(16), 632.896, and
767.25 (4m) (d) 767.513 (4).
AB133-ASA2, s. 4
12Section
4. 111.91 (2) (n) of the statutes is amended to read:
AB133-ASA2,2,1413
111.91
(2) (n) The provision to employees of the health insurance coverage
14required under s. 632.895 (11) to (14)
, and (16).
AB133-ASA2,2,2017
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
1849.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
19632.85, 632.853, 632.855, 632.87 (4)
and, (5),
and (6), 632.895 (9) to
(15)
(16), 632.896,
20and
767.25 (4m) (d) 767.513 (4).
AB133-ASA2,3,223
185.981
(4t) A sickness care plan operated by a cooperative association is
24subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85,
1632.853, 632.855, 632.87 (2m), (3), (4),
and (5),
and (6), 632.895 (10) to
(15)
(16), and
2632.897 (10) and chs. 149 and 155.
AB133-ASA2,3,115
185.983
(1) (intro.) Every such voluntary nonprofit sickness care plan shall be
6exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
7601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93,
8631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853,
9632.855, 632.87 (2m), (3), (4),
and (5),
and (6), 632.895 (5) and (9) to
(15) (16), 632.896,
10and 632.897 (10) and chs. 609, 630, 635, 645
, and 646, but the sponsoring association
11shall:
AB133-ASA2,3,14
13609.86 Coverage of hearing aids and cochlear implants for infants and
14young children. Defined network plans are subject to s. 632.895 (16).
AB133-ASA2,3,1716
632.895
(16) Hearing aids and cochlear implants for infants and young
17children. (a) In this subsection:
AB133-ASA2,3,1818
1. "Hearing aid" has the meaning given in s. 459.01 (2).
AB133-ASA2,3,1919
2. "Physician" has the meaning given in s. 448.01 (5).
AB133-ASA2,3,2520
(b) 1. Subject to pars. (c) and (d) and except as provided in par. (e), every
21disability insurance policy, and every self-insured health plan of the state or a
22county, city, town, village, or school district, shall provide coverage of the cost of
23hearing aids or cochlear implants for a child covered under the policy or plan who is
24under 11 years of age and who is certified as deaf or hearing impaired by a physician
25or by an audiologist licensed under subch. II of ch. 459.
AB133-ASA2,4,2
12. Coverage of the cost of hearing aids under this subsection is not required to
2exceed the cost of one hearing aid per ear per child more often than once every 3 years.
AB133-ASA2,4,63
3. The coverage required under this subsection may be subject to any
4cost-sharing provisions, limitations, or exclusions, other than a preexisting
5condition exclusion, that apply generally under the disability insurance policy or
6self-insured health plan.
AB133-ASA2,4,197
(c) If a child who, as a dependent of his or her parent, first obtains coverage
8under a group disability insurance policy or self-insured health plan after the
9effective date of this paragraph .... [revisor inserts date], receives a hearing aid or
10cochlear implant within the first year after the effective date of the coverage and then
11discontinues the coverage before one year from the date on which the coverage was
12effective, the group disability insurance policy or self-insured health plan shall
13provide the coverage as required under this subsection but may require that benefits
14paid for the cost of the hearing aid or cochlear implant be reimbursed if the coverage
15required under par. (b) would have been subject to a preexisting condition exclusion
16but for par. (b) 3. This paragraph does not apply if the child's coverage is discontinued
17because the employer through which the parent received coverage discontinued the
18coverage or because the parent was terminated or laid off from the employment
19through which the parent received the coverage.
AB133-ASA2,4,2220
(d) 1. Notwithstanding par. (b) 3., an individual disability insurance policy may
21impose up to a one-year preexisting condition exclusion with respect to the coverage
22required under this subsection for cochlear implants.
AB133-ASA2,5,623
2. If a child who, as a dependent of his or her parent, first obtains coverage
24under an individual disability insurance policy after the effective date of this
25subdivision .... [revisor inserts date], receives a hearing aid within the first year after
1the effective date of the coverage and then discontinues the coverage before one year
2from the date on which the coverage was effective, the individual disability insurance
3policy shall provide the coverage as required under this subsection but may require
4that benefits paid for the cost of the hearing aid be reimbursed if the coverage
5required under par. (b) with respect to hearing aids would have been subject to a
6preexisting condition exclusion but for par. (b) 3.
AB133-ASA2,5,127
3. If an individual disability insurance policy denies coverage to a child or the
8child's family and the child would be eligible as specified in par. (b) 1. for coverage
9of hearing aids or cochlear implants, the disability insurance policy shall advise the
10child's family of the availability of coverage for hearing aids and cochlear implants
11under the BadgerCare Plus program under s. 49.471 under the benefits described in
12s. 49.46 (2) (a) and (b).
AB133-ASA2,5,1313
(e) This subsection does not apply to any of the following:
AB133-ASA2,5,1414
1. A disability insurance policy that covers only certain specified diseases.
AB133-ASA2,5,1715
2. A health care plan offered by a limited service health organization, as defined
16in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not
17a defined network plan, as defined in s. 609.01 (1b).
AB133-ASA2,5,1818
3. A long-term care insurance policy.
AB133-ASA2,5,1919
4. A medicare replacement policy or a medicare supplement policy.
AB133-ASA2,5,2121
(1) This act first applies to all of the following:
AB133-ASA2,5,2422
(a) Except as provided in paragraphs (b) and (c
), disability insurance policies
23that are issued or renewed, and self-insured health plans that are established,
24extended, modified, or renewed, on the effective date of this paragraph.
AB133-ASA2,6,3
1(b) Disability insurance policies covering employees who are affected by a
2collective bargaining agreement containing provisions inconsistent with this act
3that are issued or renewed on the earlier of the following:
AB133-ASA2,6,4
41. The day on which the collective bargaining agreement expires.
AB133-ASA2,6,6
52. The day on which the collective bargaining agreement is extended, modified,
6or renewed.
AB133-ASA2,6,97
(c) Self-insured health plans covering employees who are affected by a
8collective bargaining agreement containing provisions inconsistent with this act
9that are established, extended, modified, or renewed on the earlier of the following:
AB133-ASA2,6,10
101. The day on which the collective bargaining agreement expires.
AB133-ASA2,6,12
112. The day on which the collective bargaining agreement is extended, modified,
12or renewed.
AB133-ASA2,6,1514
(1) This act takes effect on the first day of the 7th month beginning after
15publication.
