LRBs0181/1
PJK:cjs:rs
2011 - 2012 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO 2011 ASSEMBLY BILL 210
October 11, 2011 - Offered by Committee on Insurance.
AB210-ASA1,2,2 1An Act to repeal 609.755, 632.83, 632.835 and 632.885; to renumber 625.02 (1);
2to renumber and amend 625.03 (1m) (e); to amend 40.51 (8), 40.51 (8), 40.51
3(8m), 40.51 (8m), 49.67 (3) (am) 2. b., 66.0137 (4), 66.0137 (4), 111.91 (2) (n),
4111.91 (2) (nm), 111.91 (2) (s), 111.998 (2) (n), 111.998 (2) (s), 120.13 (2) (g),
5120.13 (2) (g), 185.983 (1) (intro.), 185.983 (1) (intro.), 600.01 (2) (b), 601.31 (1)
6(Lp), 601.31 (1) (Lr), 601.42 (4), 609.655 (4) (b), 625.13 (1), 625.14, 632.76 (2) (ac)
71., 632.76 (2) (ac) 2., 632.76 (2) (ac) 3. (intro.) and 632.895 (15) (c) (intro.); and
8to create 601.465 (1m) (d), 625.02 (1h), 625.02 (1p), 625.02 (2f), 625.02 (2s),
9625.03 (1m) (e) 2., 625.03 (1m) (e) 3., 625.13 (3), 632.76 (2) (ac) 4. and chapter
10636 of the statutes; relating to: implementing health insurance reform,
11extending the time limit for emergency rule procedures, specifying that any

1health benefit exchange must be established by legislation, and granting
2rule-making authority.
Analysis by the Legislative Reference Bureau
This substitute amendment differs from 2011 Assembly Bill 210 (the bill) in the
following respects:
1. In the bill, the Office of the Commissioner of Insurance (OCI) may
promulgate any rule related to the provisions created in the bill as an emergency rule
and is not required to provide evidence that promulgating the rule as an emergency
rule is necessary for the preservation of public peace, health, safety, or welfare and
is not required to provide a finding of emergency. The substitute amendment
removes this exception so that OCI, in promulgating an emergency rule, would be
required to provide evidence that the emergency rule is necessary for the
preservation of public peace, health, safety, or welfare and required to provide a
finding of emergency.
2. Under the bill, grandfathered plans are required to comply with the federal
Patient Protection and Affordable Care Act (PPACA) relating to requirements for
coverage of preventive health services. The substitute amendment removes this
requirement for grandfathered plans.
3. PPACA defines a small employer as one that employs not more than 100
employees, but allows states to elect to define a small employer, for plan years
beginning before January 1, 2016, as an employer with not more than 50 employees.
The bill defines a small employer for purposes of the PPACA requirements as an
employer with not more than 100 employees but specifically reserves the right to
elect to substitute 50 for 100 for the definition of small employer. The substitute
amendment provides that this election must be done through legislation.
4. The bill provides that if PPACA is found unconstitutional in its entirety and
all appeals are exhausted or the time for appeal expires, insurers and self-insured
governmental health plans are exempt from a number of provisions in the bill. The
substitute amendment adds that, if PPACA is found unconstitutional in its entirety,
the powers of OCI with respect to promulgating rules for, and enforcing, the PPACA
requirements, as well as any rules or requirements already established related to
those requirements, do not apply. The substitute amendment also provides that if
any of PPACA's provisions are repealed, insurers and self-insured governmental
health plans are exempt from those provisions, or if PPACA is found unconstitutional
in part, insurers and self-insured governmental health plans are exempt from any
rebate and report and coverage requirements that are found unconstitutional, and
the powers of OCI with respect to promulgating rules for, and enforcing, provisions
from which insurers and self-insured governmental health plans are exempt, as well
as any rules or requirements already established related to those provisions, do not
apply.

5. The substitute amendment specifies that any health benefit exchange
established in this state under PPACA must be done so by legislation. The bill does
not address the establishment of a health benefit exchange.
For further information, see the analysis for the bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB210-ASA1, s. 1 1Section 1 . 40.51 (8) of the statutes is amended to read:
AB210-ASA1,3,62 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
3shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
4and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855,
5632.87 (3) to (6), 632.885, 632.89, 632.895 (5m) and (8) to (17), and 632.896 and, so
6far as applicable, ch. 636
.
AB210-ASA1, s. 2 7Section 2 . 40.51 (8) of the statutes, as affected by 2011 Wisconsin Act .... (this
8act), is amended to read:
AB210-ASA1,3,139 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
10shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
11and (10), 632.747, 632.748, 632.798, 632.85, 632.853, 632.855, 632.87 (3) to (6),
12632.885, 632.89, 632.895 (5m) and (8) to (17), and 632.896 and, so far as applicable,
13ch. 636.
AB210-ASA1, s. 3 14Section 3 . 40.51 (8m) of the statutes is amended to read:
AB210-ASA1,3,1815 40.51 (8m) Every health care coverage plan offered by the group insurance
16board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,
17632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.885, 632.89, and
18632.895 (11) to (17) and, so far as applicable, ch. 636.
AB210-ASA1, s. 4 19Section 4 . 40.51 (8m) of the statutes, as affected by 2011 Wisconsin Act .... (this
20act), is amended to read:
AB210-ASA1,4,4
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, 632.798, 632.85, 632.853, 632.855, 632.885, 632.89, and 632.895 (11) to (17)
4and, so far as applicable, ch. 636.
AB210-ASA1, s. 5 5Section 5. 49.67 (3) (am) 2. b. of the statutes, as affected by 2011 Wisconsin
6Act 32
, is amended to read:
AB210-ASA1,4,117 49.67 (3) (am) 2. b. If the applicant is under 26 years of age, notice that he or
8she may be eligible for coverage as a dependent under his or her parent's health care
9plan in accordance with s. 632.885 636.25 (1) (h) or (3) (b), and that his or her parent's
10plan must include coverage for services that are not covered under the plan under
11this section.
AB210-ASA1, s. 6 12Section 6 . 66.0137 (4) of the statutes is amended to read:
AB210-ASA1,4,1913 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
14a village provides health care benefits under its home rule power, or if a town
15provides health care benefits, to its officers and employees on a self-insured basis,
16the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
17632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.87
18(4), (5), and (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4) and, so
19far as applicable, ch. 636
.
AB210-ASA1, s. 7 20Section 7 . 66.0137 (4) of the statutes, as affected by 2011 Wisconsin Act ....
21(this act), is amended to read:
AB210-ASA1,5,322 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
23a village provides health care benefits under its home rule power, or if a town
24provides health care benefits, to its officers and employees on a self-insured basis,
25the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),

1632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.87
2(4), (5), and (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4) and, so
3far as applicable, ch. 636.
AB210-ASA1, s. 8 4Section 8. 111.91 (2) (n) of the statutes is amended to read:
AB210-ASA1,5,75 111.91 (2) (n) The provision to employees of the health insurance coverage
6required under s. 632.895 (11) to (14), (16), and (16m), and (17) and, so far as
7applicable, s. 636.25
.
AB210-ASA1, s. 9 8Section 9. 111.91 (2) (nm) of the statutes is amended to read:
AB210-ASA1,5,119 111.91 (2) (nm) The requirements related to providing coverage for a dependent
10under s. 632.885 and to
continuing coverage for a dependent student on a medical
11leave of absence under s. 632.895 (15).
AB210-ASA1, s. 10 12Section 10. 111.91 (2) (s) of the statutes is amended to read:
AB210-ASA1,5,1513 111.91 (2) (s) The requirements related to internal grievance procedures under
14s. 632.83 and independent review
and external appeals of certain health benefit plan
15determinations established under s. 632.835 636.12.
AB210-ASA1, s. 11 16Section 11. 111.998 (2) (n) of the statutes is amended to read:
AB210-ASA1,5,1817 111.998 (2) (n) The provision to employees of the health insurance coverage
18required under s. 632.895 (11) to (14) and, so far as applicable, s. 636.25.
AB210-ASA1, s. 12 19Section 12. 111.998 (2) (s) of the statutes is amended to read:
AB210-ASA1,5,2220 111.998 (2) (s) The requirements related to internal grievance procedures
21under s. 632.83 and independent review
and external appeals of certain health
22benefit plan determinations established under s. 632.835 636.12.
AB210-ASA1, s. 13 23Section 13 . 120.13 (2) (g) of the statutes is amended to read:
AB210-ASA1,6,224 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
2549.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),

1632.798, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.885, 632.89, 632.895
2(9) to (17), 632.896, and 767.513 (4) and, so far as applicable, ch. 636.
AB210-ASA1, s. 14 3Section 14 . 120.13 (2) (g) of the statutes, as affected by 2011 Wisconsin Act ....
4(this act), is amended to read:
AB210-ASA1,6,85 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
649.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
7632.798, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.885, 632.89, 632.895
8(9) to (17), 632.896, and 767.513 (4) and, so far as applicable, ch. 636.
AB210-ASA1, s. 15 9Section 15 . 185.983 (1) (intro.) of the statutes is amended to read:
AB210-ASA1,6,1710 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
11cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
12646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
13601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
14631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798, 632.85,
15632.853, 632.855, 632.87 (2), (2m), (3), (4), (5), and (6), 632.885, 632.89, 632.895 (5)
16and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 625, 630, 635, 636, 645,
17and 646, but the sponsoring association shall:
AB210-ASA1, s. 16 18Section 16 . 185.983 (1) (intro.) of the statutes, as affected by 2011 Wisconsin
19Act .... (this act), is amended to read:
AB210-ASA1,7,220 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
21cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
22646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
23601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
24631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798, 632.85,
25632.853, 632.855, 632.87 (2), (2m), (3), (4), (5), and (6), 632.885, 632.89, 632.895 (5)

1and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 625, 630, 635, 636, 645,
2and 646, but the sponsoring association shall:
AB210-ASA1, s. 17 3Section 17. 600.01 (2) (b) of the statutes is amended to read:
AB210-ASA1,7,54 600.01 (2) (b) Group or blanket insurance described in sub. (1) (b) 3. and 4. is
5not exempt from ss. 632.745 to 632.749, 632.83 or 632.835 or 636.12 or ch. 633 or 635.
AB210-ASA1, s. 18 6Section 18. 601.31 (1) (Lp) of the statutes is amended to read:
AB210-ASA1,7,87 601.31 (1) (Lp) For certifying as an independent review organization under s.
8632.835 636.15 (1) (a), $400.
AB210-ASA1, s. 19 9Section 19. 601.31 (1) (Lr) of the statutes is amended to read:
AB210-ASA1,7,1110 601.31 (1) (Lr) For each biennial recertification as an independent review
11organization under s. 632.835 636.15 (1) (a), $100.
AB210-ASA1, s. 20 12Section 20. 601.42 (4) of the statutes is amended to read:
AB210-ASA1,7,2413 601.42 (4) Replies. Any officer, manager or general agent of any insurer
14authorized to do or doing an insurance business in this state, any person controlling
15or having a contract under which the person has a right to control such an insurer,
16whether exclusively or otherwise, any person with executive authority over or in
17charge of any segment of such an insurer's affairs, any individual practice
18association or officer, director or manager of an individual practice association, any
19insurance agent or other person licensed under chs. 600 to 646, any provider of
20services under a continuing care contract, as defined in s. 647.01 (2), any
21independent review organization certified or recertified under s. 632.835 (4) 636.15
22(1) (a)
or any health care provider, as defined in s. 655.001 (8), shall reply promptly
23in writing or in other designated form, to any written inquiry from the commissioner
24requesting a reply.
AB210-ASA1, s. 21 25Section 21. 601.465 (1m) (d) of the statutes is created to read:
AB210-ASA1,8,3
1601.465 (1m) (d) Information contained in individual or small group health
2insurance rate and supplementary rate information filed under ch. 625 that the
3office determines is proprietary.
AB210-ASA1, s. 22 4Section 22. 609.655 (4) (b) of the statutes is amended to read:
AB210-ASA1,8,125 609.655 (4) (b) Upon completion of the review under par. (a), the medical
6director of the defined network plan shall determine whether the policy or certificate
7will provide coverage of any further treatment for the dependent student's nervous
8or mental disorder or alcoholism or other drug abuse problems that is provided by
9a provider located in reasonably close proximity to the school in which the student
10is enrolled. If the dependent student disputes the medical director's determination,
11the dependent student may submit a written grievance under the defined network
12plan's internal grievance procedure established under s. 632.83 636.12.
AB210-ASA1, s. 23 13Section 23. 609.755 of the statutes is repealed.
AB210-ASA1, s. 24 14Section 24. 625.02 (1) of the statutes is renumbered 625.02 (1m).
AB210-ASA1, s. 25 15Section 25. 625.02 (1h) of the statutes is created to read:
AB210-ASA1,8,1716 625.02 (1h) "Individual health insurance coverage" has the meaning given in
17s. 636.01 (4).
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