SB418-SSA1,9,1914 153.21 (3) The entity under contract under s. 153.05 (2m) (a) shall, using data
15collected under s. 153.05 (1) (b), annually identify the 75 diagnosis related groups for
16which hospitals in this state most frequently provide inpatient care and the 75
17outpatient surgical procedures most frequently performed by hospitals in this state,
18and shall distribute a list of the identified diagnosis related groups and surgical
19procedures to all hospitals in the state and to the department.
SB418-SSA1, s. 8 20Section 8. 185.981 (4t) of the statutes, as affected by 2009 Wisconsin Act 28,
21is amended to read:
SB418-SSA1,9,2522 185.981 (4t) A sickness care plan operated by a cooperative association is
23subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.798,
24632.85, 632.853, 632.855, 632.87 (2m), (3), (4), (5), and (6), 632.885, 632.895 (10) to
25(17), and 632.897 (10) and chs. 149 and 155.
SB418-SSA1, s. 9
1Section 9. 185.983 (1) (intro.) of the statutes, as affected by 2009 Wisconsin
2Act 28
, is amended to read:
SB418-SSA1,10,93 185.983 (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), 631.17, 631.89, 631.93,
6631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798, 632.85,
7632.853, 632.855, 632.87 (2m), (3), (4), (5), and (6), 632.885, 632.895 (5) and (9) to (17),
8632.896, and 632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring
9association shall:
SB418-SSA1, s. 10 10Section 10. 609.71 of the statutes is created to read:
SB418-SSA1,10,12 11609.71 Disclosure of payments. Limited service health organizations,
12preferred provider plans, and defined network plans are subject to s. 632.798.
SB418-SSA1, s. 11 13Section 11. 632.798 of the statutes is created to read:
SB418-SSA1,10,14 14632.798 Out-of-pocket costs. (1) Definitions. In this section:
SB418-SSA1,10,1515 (a) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
SB418-SSA1,10,1716 (b) "Health care provider" has the meaning given in s. 146.903 (1) (c) and
17includes a hospital, as defined in s. 50.33 (2).
SB418-SSA1,10,1918 (c) "Insured" includes an enrollee under a self-insured health plan and a
19representative or designee of an insured or enrollee.
SB418-SSA1,10,2120 (d) "Self-insured health plan" means a self-insured health plan of the state or
21a county, city, village, town, or school district.
SB418-SSA1,11,3 22(2) Provide estimate. (a) A self-insured health plan or an insurer that
23provides coverage under a disability insurance policy shall, at the request of an
24insured, provide to the insured a good faith estimate, as of the date of the request and
25assuming no medical complications or modifications in the insured's treatment plan,

1of the insured's total out-of-pocket cost according to the insured's benefit terms for
2a specified health care service in the geographic region in which the health care
3service will be provided.
SB418-SSA1,11,54 (b) An estimate provided by an insurer or self-insured health plan under this
5section is not a legally binding estimate of the out-of-pocket cost.
SB418-SSA1,11,76 (c) An insurer or self-insured health plan may not charge an insured for
7providing the information under this section.
SB418-SSA1,11,108 (d) Before providing the information requested under par. (a), the insurer or
9self-insured health plan may require the insured to provide in writing any of the
10following information:
SB418-SSA1,11,1111 1. The name of the health care provider providing the service.
SB418-SSA1,11,1212 2. The facility at which the service will be provided.
SB418-SSA1,11,1313 3. The date the service will be provided.
SB418-SSA1,11,1414 4. The health care provider's estimate of the charge for the service.
SB418-SSA1,11,1715 5. The codes for the service under the Current Procedural Terminology of the
16American Medical Association or under the Current Dental Terminology of the
17American Dental Association.
SB418-SSA1,11,2018 (e) The requirement to provide the information requested under par. (a) does
19not apply if the health care provider providing the health care service is any of the
20following:
SB418-SSA1,11,2221 1. A health care provider that practices individually or in association with not
22more than 2 other individual health care providers.
SB418-SSA1,11,2423 2. A health care provider that is an association of 3 or fewer individual health
24care providers.
SB418-SSA1, s. 12 25Section 12. Initial applicability.
SB418-SSA1,12,7
1(1) Disclosures. If a disability insurance policy or a governmental self-insured
2health plan that is in effect on the effective date of this subsection, or a contract or
3agreement between a provider and a health care plan that is in effect on the effective
4date of this subsection, contains a provision that is inconsistent with this act, this act
5first applies to that disability insurance policy, governmental self-insured health
6plan, or contract or agreement on the date on which it is modified, extended, or
7renewed.
SB418-SSA1, s. 13 8Section 13. Effective date.
SB418-SSA1,12,109 (1) This act takes effect on the first day of the 10th month beginning after
10publication.
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