AB75-ASA1,1603,85 632.32 (6) (g) (intro.) A No policy may provide that the limits under the policy
6for uninsured motorist coverage or underinsured motorist coverage for bodily injury
7or death resulting from any one accident shall be reduced by any of the following that
8apply:
AB75-ASA1, s. 3172 9Section 3172. 632.32 (5) (j) of the statutes is renumbered 632.32 (6) (h), and
10632.32 (6) (h) (intro.), as renumbered, is amended to read:
AB75-ASA1,1603,1311 632.32 (6) (h) (intro.) A No policy may provide that any uninsured motorist
12coverage or underinsured motorist
coverage under the policy does not apply to a loss
13resulting from the use of a motor vehicle that meets all of the following conditions:
AB75-ASA1, s. 3172f 14Section 3172f. 632.35 of the statutes is amended to read:
AB75-ASA1,1603,20 15632.35 Prohibited rejection, cancellation, and nonrenewal. No insurer
16may cancel or refuse to issue or renew an automobile insurance policy wholly or
17partially because of one or more of the following characteristics of any person: age,
18sex, residence, race, color, creed, religion, national origin, ancestry, marital status or,
19occupation, or issuance to the person of a driver card under s. 343.09 or a driver card
20instruction permit under s. 343.07 (1j)
.
AB75-ASA1, s. 3173 21Section 3173. 632.72 (1g) (b) of the statutes is amended to read:
AB75-ASA1,1603,2522 632.72 (1g) (b) "Medical benefits or assistance" means health care services
23funded by a relief block grant under ch. 49, as defined in s. 49.001 (5p); medical
24assistance, as defined under s. 49.43 (8); or maternal and child health services under
25s. 253.05.
AB75-ASA1, s. 3173b
1Section 3173b. 632.725 (1) of the statutes is amended to read:
AB75-ASA1,1604,32 632.725 (1) Definition. In this section, "health care provider" has the meaning
3given in s. 146.81 (1) (a) to (p).
AB75-ASA1, s. 3173d 4Section 3173d. 632.7495 (4) of the statutes is renumbered 632.7495 (4) (intro.)
5and amended to read:
AB75-ASA1,1604,96 632.7495 (4) (intro.) Notwithstanding Except as the commissioner may provide
7by rule under sub. (5) and notwithstanding
subs. (1) and (2) and s. 631.36 (4), an
8insurer is not required to renew individual health benefit plan coverage that
9complies with all of the following:
AB75-ASA1,1604,11 10(a) The coverage is marketed and designed to provide short-term coverage as
11a bridge between coverages.
AB75-ASA1, s. 3173f 12Section 3173f. 632.7495 (4) (b) of the statutes is created to read:
AB75-ASA1,1604,1313 632.7495 (4) (b) The coverage has a term of not more than 12 months.
AB75-ASA1, s. 3173h 14Section 3173h. 632.7495 (4) (c) of the statutes is created to read:
AB75-ASA1,1604,1915 632.7495 (4) (c) The coverage term aggregated with all consecutive periods of
16the insurer's coverage of the insured by individual health benefit plan coverage not
17required to be renewed under this subsection does not exceed 18 months. For
18purposes of this paragraph, coverage periods are consecutive if there are no more
19than 63 days between the coverage periods.
AB75-ASA1, s. 3173j 20Section 3173j. 632.7495 (4) (d) of the statutes is created to read:
AB75-ASA1,1604,2121 632.7495 (4) (d) Rules promulgated by the commissioner under sub. (5).
AB75-ASA1, s. 3173m 22Section 3173m. 632.7495 (5) of the statutes is created to read:
AB75-ASA1,1604,2523 632.7495 (5) The commissioner shall promulgate rules governing disclosures
24related to, and may promulgate rules setting standards for, the sale of individual
25health benefit plans that an insurer is not required to renew under sub. (4).
AB75-ASA1, s. 3174
1Section 3174. 632.7497 of the statutes is created to read:
AB75-ASA1,1605,5 2632.7497 Modifications at renewal. (1) In this section, "individual major
3medical or comprehensive health benefit plan" includes coverage under a group
4policy that is underwritten on an individual basis and issued to individuals or
5families.
AB75-ASA1,1605,8 6(2) An insurer that issues an individual major medical or comprehensive
7health benefit plan shall, at the time of a coverage renewal, at the request of an
8insured, permit the insured to do either of the following:
AB75-ASA1,1605,99 (a) Change his or her coverage to any of the following:
AB75-ASA1,1605,1110 1. A different but comparable individual major medical or comprehensive
11health benefit plan currently offered by the insurer.
AB75-ASA1,1605,1312 2. An individual major medical or comprehensive health benefit plan currently
13offered by the insurer with more limited benefits.
AB75-ASA1,1605,1514 3. An individual major medical or comprehensive health benefit plan currently
15offered by the insurer with higher deductibles.
AB75-ASA1,1605,1816 (b) Modify his or her existing coverage by electing an optional higher
17deductible, if any, under the individual major medical or comprehensive health
18benefit plan.
AB75-ASA1,1605,22 19(3) (a) The insurer may not impose any new preexisting condition exclusion
20under the new or modified coverage under sub. (2) that did not apply to the insured's
21original coverage and shall allow the insured credit under the new or modified
22coverage for the period of original coverage.
AB75-ASA1,1605,2523 (b) For the new or modified coverage, the insurer may not rate for health status
24other than on the insured's health status at the time the insured applied for the
25original coverage and as the insured disclosed on the original application.
AB75-ASA1,1606,3
1(4) (a) Annually, the insurer shall mail to each insured under an individual
2major medical or comprehensive health benefit plan issued by the insurer, a notice
3that includes all of the following information:
AB75-ASA1,1606,54 1. That the insured has the right to elect alternative coverage as described in
5sub. (2).
AB75-ASA1,1606,66 2. A description of the alternatives available to the insured.
AB75-ASA1,1606,77 3. The procedure for making the election.
AB75-ASA1,1606,98 (b) The insurer shall mail the notice under par. (a) not more than 3 months nor
9less than 60 days before the renewal date of the insured's plan.
AB75-ASA1,1606,12 10(5) (a) Nothing in this section requires an insurer to issue alternative coverage
11under sub. (2) if the insured's coverage may be nonrenewed or discontinued under
12s. 632.7495 (2), (3) (b), or (4).
AB75-ASA1,1606,1613 (b) Notwithstanding s. 600.01 (1) (b) 3. and 4., this section applies to a group
14health benefit plan described in s. 600.01 (1) (b) 3. or 4. if that group health benefit
15plan is an individual major medical or comprehensive health benefit plan as defined
16in sub. (1).
AB75-ASA1, s. 3176 17Section 3176. 632.76 (2) (ac) of the statutes is created to read:
AB75-ASA1,1606,2318 632.76 (2) (ac) 1. Notwithstanding par. (a), no claim or loss incurred or
19disability commencing after 12 months from the date of issue of an individual
20disability insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied
21on the ground that a disease or physical condition existed prior to the effective date
22of coverage, unless the condition was excluded from coverage by name or specific
23description by a provision effective on the date of the loss.
AB75-ASA1,1607,424 2. Except as provided in subd. 3., an individual disability insurance policy, as
25defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495 (4)

1and (5), may not define a preexisting condition more restrictively than a condition,
2whether physical or mental, regardless of the cause of the condition, for which
3medical advice, diagnosis, care, or treatment was recommended or received within
412 months before the effective date of coverage.
AB75-ASA1,1607,75 3. Except as the commissioner provides by rule under s. 632.7495 (5), all of the
6following apply to an individual disability insurance policy that is a short-term
7policy subject to s. 632.7495 (4) and (5):
AB75-ASA1,1607,118 a. The policy may not define a preexisting condition more restrictively than a
9condition, whether physical or mental, regardless of the cause of the condition, for
10which medical advice, diagnosis, care, or treatment was recommended or received
11before the effective date of coverage.
AB75-ASA1,1607,1712 b. The policy shall reduce the length of time during which a preexisting
13condition exclusion may be imposed by the aggregate of the insured's consecutive
14periods of coverage under the insurer's individual disability insurance policies that
15are short-term policies subject to s. 632.7495 (4) and (5). For purposes of this subd.
163. b., coverage periods are consecutive if there are no more than 63 days between the
17coverage periods.
AB75-ASA1, s. 3177 18Section 3177. 632.76 (2) (b) of the statutes is amended to read:
AB75-ASA1,1608,1119 632.76 (2) (b) Notwithstanding par. (a), no claim for loss incurred or disability
20commencing after 6 months from the date of issue of a medicare supplement policy,
21medicare replacement policy or long-term care insurance policy may be reduced or
22denied on the ground that a disease or physical condition existed prior to the effective
23date of coverage. A Notwithstanding par. (ac) 2., a medicare supplement policy,
24medicare replacement policy, or long-term care insurance policy may not define a
25preexisting condition more restrictively than a condition for which medical advice

1was given or treatment was recommended by or received from a physician within 6
2months before the effective date of coverage. Notwithstanding par. (a), if on the basis
3of information contained in an application for insurance a medicare supplement
4policy, medicare replacement policy, or long-term care insurance policy excludes
5from coverage a condition by name or specific description, the exclusion must
6terminate no later than 6 months after the date of issue of the medicare supplement
7policy, medicare replacement policy, or long-term care insurance policy. The
8commissioner may by rule exempt from this paragraph certain classes of medicare
9supplement policies, medicare replacement policies, and long-term care insurance
10policies, if the commissioner finds the exemption is not adverse to the interests of
11policyholders and certificate holders.
AB75-ASA1, s. 3178 12Section 3178. 632.835 (title) of the statutes is amended to read:
AB75-ASA1,1608,14 13632.835 (title) Independent review of adverse and experimental
14treatment
coverage denial determinations.
AB75-ASA1, s. 3179 15Section 3179. 632.835 (1) (ag) of the statutes is created to read:
AB75-ASA1,1608,1816 632.835 (1) (ag) "Coverage denial determination" means an adverse
17determination, an experimental treatment determination, a preexisting condition
18exclusion denial determination, or the rescission of a policy or certificate.
AB75-ASA1, s. 3180 19Section 3180. 632.835 (1) (cm) of the statutes is created to read:
AB75-ASA1,1608,2320 632.835 (1) (cm) "Preexisting condition exclusion denial determination" means
21a determination by or on behalf of an insurer that issues a health benefit plan
22denying or terminating treatment or payment for treatment on the basis of a
23preexisting condition exclusion, as defined in s. 632.745 (23).
AB75-ASA1, s. 3181 24Section 3181. 632.835 (2) (a) of the statutes is amended to read:
AB75-ASA1,1609,5
1632.835 (2) (a) Every insurer that issues a health benefit plan shall establish
2an independent review procedure whereby an insured under the health benefit plan,
3or his or her authorized representative, may request and obtain an independent
4review of an adverse determination or an experimental treatment a coverage denial
5determination made with respect to the insured.
AB75-ASA1, s. 3182 6Section 3182. 632.835 (2) (b) of the statutes is amended to read:
AB75-ASA1,1609,147 632.835 (2) (b) If an adverse determination or an experimental treatment a
8coverage denial
determination is made, the insurer involved in the determination
9shall provide notice to the insured of the insured's right to obtain the independent
10review required under this section, how to request the review, and the time within
11which the review must be requested. The notice shall include a current listing of
12independent review organizations certified under sub. (4). An independent review
13under this section may be conducted only by an independent review organization
14certified under sub. (4) and selected by the insured.
AB75-ASA1, s. 3183 15Section 3183. 632.835 (2) (bg) 3. of the statutes is amended to read:
AB75-ASA1,1609,2516 632.835 (2) (bg) 3. For any adverse determination or experimental treatment
17coverage denial determination for which an explanation of benefits is not provided
18to the insured, the insurer provides a notice that the insured may have a right to an
19independent review after the internal grievance process and that an insured may be
20entitled to expedited, independent review with respect to an urgent matter. The
21notice shall also include a reference to the section of the policy or certificate that
22contains the description of the independent review procedure as required under
23subd. 1. The notice shall provide a toll-free telephone number and website, if
24appropriate, where consumers may obtain additional information regarding
25internal grievance and independent review processes.
AB75-ASA1, s. 3184
1Section 3184. 632.835 (2) (c) of the statutes is amended to read:
AB75-ASA1,1610,72 632.835 (2) (c) Except as provided in par. (d), an insured must exhaust the
3internal grievance procedure under s. 632.83 before the insured may request an
4independent review under this section. Except as provided in sub. (9) (a), an insured
5who uses the internal grievance procedure must request an independent review as
6provided in sub. (3) (a) within 4 months after the insured receives notice of the
7disposition of his or her grievance under s. 632.83 (3) (d).
AB75-ASA1, s. 3185 8Section 3185. 632.835 (2) (e) of the statutes is created to read:
AB75-ASA1,1610,109 632.835 (2) (e) Nothing in this section affects an insured's right to commence
10a civil proceeding relating to a coverage denial determination.
AB75-ASA1, s. 3186 11Section 3186. 632.835 (3) (a) of the statutes is amended to read:
AB75-ASA1,1610,2412 632.835 (3) (a) To request an independent review, an insured or his or her
13authorized representative shall provide timely written notice of the request for
14independent review, and of the independent review organization selected, to the
15insurer that made or on whose behalf was made the adverse or experimental
16treatment
coverage denial determination. The insurer shall immediately notify the
17commissioner and the independent review organization selected by the insured of
18the request for independent review. The insured or his or her authorized
19representative must pay a $25 fee to the independent review organization. If the
20insured prevails on the review, in whole or in part, the entire amount paid by the
21insured or his or her authorized representative shall be refunded by the insurer to
22the insured or his or her authorized representative.
For each independent review in
23which it is involved, an insurer shall pay a fee to the independent review
24organization.
AB75-ASA1, s. 3187 25Section 3187. 632.835 (3) (e) of the statutes is amended to read:
AB75-ASA1,1611,11
1632.835 (3) (e) In addition to the information under pars. (b) and (c), the
2independent review organization may accept for consideration any typed or printed,
3verifiable medical or scientific evidence that the independent review organization
4determines is relevant, regardless of whether the evidence has been submitted for
5consideration at any time previously. The insurer and the insured shall submit to
6the other party to the independent review any information submitted to the
7independent review organization under this paragraph and pars. (b) and (c). If, on
8the basis of any additional information, the insurer reconsiders the insured's
9grievance and determines that the treatment that was the subject of the grievance
10should be covered, or that the policy or certificate that was rescinded should be
11reinstated,
the independent review is terminated.
AB75-ASA1, s. 3188 12Section 3188. 632.835 (3) (f) of the statutes is renumbered 632.835 (3) (f) 1.
13and amended to read:
AB75-ASA1,1611,2114 632.835 (3) (f) 1. If the independent review is not terminated under par. (e), the
15independent review organization shall, within 30 business days after the expiration
16of all time limits that apply in the matter, make a decision on the basis of the
17documents and information submitted under this subsection. The decision shall be
18in writing, signed on behalf of the independent review organization and served by
19personal delivery or by mailing a copy to the insured or his or her authorized
20representative and to the insurer. A Except as provided in subd. 2., a decision of an
21independent review organization is binding on the insured and the insurer.
AB75-ASA1, s. 3189 22Section 3189. 632.835 (3) (f) 2. of the statutes is created to read:
AB75-ASA1,1611,2523 632.835 (3) (f) 2. A decision of an independent review organization regarding
24a preexisting condition exclusion denial determination or a rescission is not binding
25on the insured.
AB75-ASA1, s. 3190
1Section 3190. 632.835 (3m) (a) of the statutes is amended to read:
AB75-ASA1,1612,52 632.835 (3m) (a) A decision of an independent review organization regarding
3an adverse determination or a preexisting condition exclusion denial determination
4must be consistent with the terms of the health benefit plan under which the adverse
5determination or preexisting condition exclusion denial determination was made.
AB75-ASA1, s. 3192 6Section 3192. 632.835 (7) (b) of the statutes is amended to read:
AB75-ASA1,1612,117 632.835 (7) (b) A health benefit plan that is the subject of an independent
8review and the insurer that issued the health benefit plan shall not be liable to any
9person for damages attributable to the insurer's or plan's actions taken in compliance
10with any decision regarding an adverse determination or an experimental treatment
11determination
rendered by a certified independent review organization.
AB75-ASA1, s. 3193 12Section 3193. 632.835 (8) of the statutes is renumbered 632.835 (8) (a) and
13amended to read:
AB75-ASA1,1612,2214 632.835 (8) (a) Adverse and experimental treatment determinations. The
15commissioner shall make a determination that at least one independent review
16organization has been certified under sub. (4) that is able to effectively provide the
17independent reviews required under this section for adverse determinations and
18experimental treatment determinations
and shall publish a notice in the Wisconsin
19Administrative Register that states a date that is 2 months after the commissioner
20makes that determination. The date stated in the notice shall be the date on which
21the independent review procedure under this section begins operating with respect
22to adverse determinations and experimental treatment determinations
.
AB75-ASA1, s. 3194 23Section 3194. 632.835 (8) (b) of the statutes is created to read:
AB75-ASA1,1613,724 632.835 (8) (b) Preexisting condition exclusion denials and rescissions. The
25commissioner shall make a determination that at least one independent review

1organization has been certified under sub. (4) that is able to effectively provide the
2independent reviews required under this section for preexisting condition exclusion
3denial determinations and rescissions and shall publish a notice in the Wisconsin
4Administrative Register that states a date that is 2 months after the commissioner
5makes that determination. The date stated in the notice shall be the date on which
6the independent review procedure under this section begins operating with respect
7to preexisting condition exclusion denial determinations and rescissions.
AB75-ASA1, s. 3195 8Section 3195. 632.835 (9) of the statutes is renumbered 632.835 (9) (a) and
9amended to read:
AB75-ASA1,1613,1810 632.835 (9) (a) Adverse and experimental treatment determinations. The
11independent review required under this section with respect to an adverse
12determination or an experimental treatment determination
shall be available to an
13insured who receives notice of the disposition of his or her grievance under s. 632.83
14(3) (d) on or after December 1, 2000. Notwithstanding sub. (2) (c), an insured who
15receives notice of the disposition of his or her grievance under s. 632.83 (3) (d) on or
16after December 1, 2000, but before June 15, 2002, with respect to an adverse
17determination or an experimental treatment determination
must request an
18independent review no later than 4 months after June 15, 2002.
AB75-ASA1, s. 3196 19Section 3196. 632.835 (9) (b) of the statutes is created to read:
AB75-ASA1,1613,2520 632.835 (9) (b) Preexisting condition exclusion denials and rescissions. The
21independent review required under this section with respect to a preexisting
22condition exclusion denial determination or a rescission shall be available to an
23insured who receives notice of the disposition of his or her grievance under s. 632.83
24(3) (d) on or after the date stated in the notice published in the Wisconsin
25Administrative Register by the commissioner under sub. (8) (b).
AB75-ASA1, s. 3197
1Section 3197. 632.845 of the statutes is created to read:
AB75-ASA1,1614,4 2632.845 Prohibiting refusal to cover services because liability policy
3may cover.
(1) In this section, "health care plan" has the meaning given in s. 628.36
4(2) (a) 1.
AB75-ASA1,1614,8 5(2) An insurer that provides coverage under a health care plan may not refuse
6to cover health care services that are provided to an insured under the plan and for
7which there is coverage under the plan on the basis that there may be coverage for
8the services under a liability insurance policy.
AB75-ASA1, s. 3197n 9Section 3197n. 632.87 (4) of the statutes is amended to read:
AB75-ASA1,1614,1410 632.87 (4) No policy, plan or contract may exclude coverage for diagnosis and
11treatment of a condition or complaint by a licensed dentist within the scope of the
12dentist's license, if the policy, plan or contract covers diagnosis and treatment of the
13condition or complaint by another health care provider, as defined in s. 146.81 (1) (a)
14to (p)
.
AB75-ASA1, s. 3197r 15Section 3197r. 632.89 (1) (dm) of the statutes is created to read:
AB75-ASA1,1614,1816 632.89 (1) (dm) "Licensed mental health professional" means a clinical social
17worker who is licensed under ch. 457, a marriage and family therapist who is licensed
18under s. 457.10, or a professional counselor who is licensed under s. 457.12.
AB75-ASA1, s. 3197s 19Section 3197s. 632.89 (1) (e) 3. of the statutes is repealed and recreated to
20read:
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