Amendment ASA1-AB210

AB210-ASA1,18,20 636.25 Implementing health insurance coverage provisions. Subject to s. 636.35, notwithstanding any inconsistent provision in chs. 600 to 635 or chs. 644 to 646, and unless the commissioner provides otherwise by rule under s. 636.10, all of the following apply:

AB210-ASA1,18,22 (1) Insurers. An insurer shall comply with all of the following provisions of the Public Health Service Act:

AB210-ASA1,18,24 (a) Standards relating to benefits for mothers and newborns. Section 2725 (42 USC 300gg-25).

AB210-ASA1,19,2 (b) Required coverage for reconstructive surgery following mastectomies. Section 2727 (42 USC 300gg-27).

AB210-ASA1,19,4 (c) Coverage of dependent students on medically necessary leave of absence. Section 2728 (42 USC 300gg-28).

AB210-ASA1,19,5 (d) No lifetime limit or annual limits. Section 2711 (42 USC 300gg-11).

AB210-ASA1,19,6 (e) Prohibition on rescissions. Section 2712 (42 USC 300gg-12).

AB210-ASA1,19,8 (f) Prohibition on preexisting condition exclusions for under age 19. Section 2704 (42 USC 300gg-04), but only for enrollees who are under 19 years of age.

AB210-ASA1,19,9 (g) Coverage of preventive health services. Section 2713 (42 USC 300gg-13).

AB210-ASA1,19,10 (h) Extension of dependent coverage. Section 2714 (42 USC 300gg-14).

AB210-ASA1,19,11 (i) Provision of additional information. Section 2715A (42 USC 300gg-15a).

AB210-ASA1,19,13 (j) Patient protections; choice of health care professional. Section 2719A (a) (42 USC 300gg-19a (a)).

AB210-ASA1,19,17 (k) Patient protections; coverage of emergency services. Section 2719A (b) (42 USC 300gg-19a (b)). In addition, an insurer also shall comply with s. 632.85 and an insurer that provides coverage under a defined network plan also shall comply with s. 609.22 (6).

AB210-ASA1,19,19 (2) Grandfathered health plans. A grandfathered health plan shall comply with all of the following provisions of the Public Health Service Act:

AB210-ASA1,19,21 (a) Coverage of dependent students on medically necessary leave of absence. Section 2728 (42 USC 300gg-28).

AB210-ASA1,19,23 (b) Patient protections; coverage of emergency services. Section 2719A (b) (42 USC 300gg-19a (b)).

AB210-ASA1,20,3 (3) Self-insured governmental health plans. A self-insured governmental health plan shall comply with all of the following provisions of the Public Health Service Act:

AB210-ASA1,20,5 (a) Coverage of dependent students on medically necessary leave of absence. Section 2728 (42 USC 300gg-28).

AB210-ASA1,20,6 (b) Extension of dependent coverage. Section 2714 (42 USC 300gg-14).

AB210-ASA1,20,9 (c) Patient protections; coverage of emergency services. Section 2719A (b) (42 USC 300gg-19a (b)). In addition, a self-insured governmental health plan also shall comply with s. 632.85.

AB210-ASA1,20,12 (4) Additional requirements for insurers. With respect to health insurance coverage that is issued or renewed on or after March 23, 2012, all of the following apply:

AB210-ASA1,20,14 (a) Insurers. An insurer shall comply with all of the following provisions of the Public Health Service Act:

AB210-ASA1,20,16 1. `Uniform explanation of coverage documents and standardization of definitions.' Section 2715 (42 USC 300gg-15).

AB210-ASA1,20,17 2. `Ensuring the quality of care.' Section 2717 (42 USC 300gg-17).

AB210-ASA1,20,20 (b) Grandfathered health plans. A grandfathered health plan shall comply with section 2717 of the Public Health Service Act (42 USC 300gg-17), relating to ensuring the quality of care.

AB210-ASA1,20,25 (5) Application of section to grandfathered health plans. In addition to subs. (2) and (4) (b), this section applies to a grandfathered health plan, but only with respect to those provisions of the Public Health Service Act referred to in this section that apply to a grandfathered health plan under section 1251 of the Patient Protection and Affordable Care Act.

AB210-ASA1,21,9 636.35 Applicability if federal law found unconstitutional or repealed. (1) Unconstitutional. (a) If the Patient Protection and Affordable Care Act is found by a final decision of a federal court of competent jurisdiction to be unconstitutional in its entirety and unenforceable in this state, and if all appeals are exhausted or the time for appeal expires, on and after the first day of the 3rd month beginning after the date on which all appeals are exhausted or the time for appeal expires s. 636.10 does not apply, any rules promulgated or requirements established under s. 636.10 are void and may not be enforced, and insurers and self-insured governmental health plans are exempt from all of the following provisions:

AB210-ASA1,21,10 1. Section 625.13 (3).

AB210-ASA1,21,11 2. Section 636.18.

AB210-ASA1,21,13 3. Section 636.25, except for the extension of dependent coverage requirements described in s. 636.25 (1) (h) and (3) (b).

AB210-ASA1,21,15 4. Chapter 625 with respect to small employer health insurance and group and blanket accident and sickness insurance offered in the individual market.

AB210-ASA1,21,21 (b) If the Patient Protection and Affordable Care Act is found by a final decision of a federal court of competent jurisdiction to be unconstitutional in part and unenforceable in part in this state, and if all appeals are exhausted or the time for appeal expires, on and after the first day of the 3rd month beginning after the date on which all appeals are exhausted or the time for appeal expires all of the following apply:

AB210-ASA1,22,2 1. Insurers and self-insured governmental health plans are exempt from any provisions of the Public Health Service Act referred to in ss. 636.18 and 636.25 that correspond to the provisions of the Patient Protection and Affordable Care Act that are found to be unconstitutional, except for the extension of dependent coverage requirements described in s. 636.25 (1) (h) and (3) (b).

AB210-ASA1,22,6 2. Section 636.10 does not apply with respect to the provisions described in subd. 1. from which insurers and self-insured governmental health plans are exempt, and any rules promulgated or requirements established under s. 636.10 with respect to those provisions are void and unenforceable.

AB210-ASA1,22,9 (2) Repealed. If any provision of the Public Health Service Act referred to in this chapter is repealed, on and after the date on which the repeal is effective all of the following apply:

AB210-ASA1,22,13 (a) Insurers and self-insured governmental health plans are exempt from the provision of the Public Health Service Act referred to in this chapter that is repealed, except for the extension of dependent coverage requirements described in s. 636.25 (1) (h) and (3) (b).

AB210-ASA1,22,17 (b) Section 636.10 does not apply with respect to any provision described in par. (a) from which insurers and self-insured governmental health plans are exempt, and any rules promulgated or requirements established under s. 636.10 with respect to the provision are void and unenforceable.

AB210-ASA1,22,18 (3) Inapplicability. This section does not apply after January 1, 2020.

AB210-ASA1, s. 44 Section 44. Nonstatutory provisions.

AB210-ASA1,22,23 (1) Establishment of health benefit exchange. Any health benefit exchange established in this state under section 1311 (b) of the Patient Protection and Affordable Care Act, as defined in section 636.01 (7) of the statutes, as created by this act, must be established by legislation.

AB210-ASA1, s. 45 Section 45 . Initial applicability.

AB210-ASA1,23,6 (1) Miscellaneous coverage requirements. The treatment of sections 40.51 (8) (by Section 2 ) and (8m) (by Section 4 ), 49.67 (3) (am) 2. b., 66.0137 (4) (by Section 7), 111.91 (2) (n) and (nm), 111.998 (2) (n), 120.13 (2) (g) (by Section 14), 185.983 (1) (intro.) (by Section 16 ), 609.755, 632.76 (2) (ac) 1., 2., 3. (intro.), and 4., 632.885, 632.895 (15) (c) (intro.), and 636.25 (1), (2), (3), and (5) of the statutes first applies to all of the following:

AB210-ASA1,23,9 (a) Except as provided in paragraphs (b), (c ), and (d), disability insurance policies that are newly issued, and self-insured governmental or school district health plans that are newly established on the effective date of this paragraph.

AB210-ASA1,23,13 (b) Except as provided in paragraph (d), disability insurance policies, and self-insured governmental or school district health plans, that are grandfathered health plans, as defined in section 636.01 (2) of the statutes, as created by this act, that are renewed, extended, or modified on the effective date of this paragraph.

AB210-ASA1,23,18 (c) Except as provided in paragraph (d), disability insurance policies, and self-insured governmental or school district health plans, covering employees who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are newly issued or newly established on the earlier of the following:

AB210-ASA1,23,19 1. The day on which the collective bargaining agreement expires.

AB210-ASA1,23,21 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

AB210-ASA1,24,2 (d) Disability insurance policies, and self-insured governmental or school district health plans, that are grandfathered health plans, as defined in section 636.01 (2) of the statutes, as created by this act, that cover employees who are affected by a collective bargaining agreement containing provisions inconsistent with this act, and that are renewed, extended, or modified on the earlier of the following:

AB210-ASA1,24,3 1. The day on which the collective bargaining agreement expires.

AB210-ASA1,24,5 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

AB210-ASA1,24,14 (2) Internal and external appeals. The treatment of sections 40.51 (8) (by Section 1) (with respect to internal and external review procedures), 40.51 (8m) (by Section 3) (with respect to internal and external review procedures), 66.0137 (4) (by Section 6) (with respect to internal and external review procedures), 111.91 (2) (s), 111.998 (2) (s), 120.13 (2) (g) (by Section 13) (with respect to internal and external review procedures), 185.983 (1) (intro.) (by Section 15) (with respect to internal and external review procedures), 600.01 (2) (b), 609.655 (4) (b), 632.83, 632.835, 636.12, and 636.15 of the statutes first applies to appeals filed on the effective date of this subsection.

AB210-ASA1, s. 46 Section 46. Effective dates. This act takes effect on the day after publication, except as follows:

AB210-ASA1,24,22 (1) Health insurance coverage provisions. The treatment of sections 40.51 (8) (by Section 2) and (8m) (by Section 4 ), 49.67 (3) (am) 2. b., 66.0137 (4) (by Section 7), 111.91 (2) (n) and (nm), 111.998 (2) (n), 120.13 (2) (g) (by Section 14), 185.983 (1) (intro.) (by Section 16 ), 609.755, 632.76 (2) (ac) 1., 2., 3. (intro.), and 4., 632.885, 632.895 (15) (c) (intro.), 636.25, and 636.35 of the statutes and Section 45 (1) of this act take effect on the first day of the 6th month beginning after publication.

AB210-ASA1,25,2 (2) Individual and small group health insurance rating. The treatment of sections 601.465 (1m) (d), 625.02 (1), (1h), (1p), (2f), and (2s), 625.13 (1) and (3), and 625.14 of the statutes, the renumbering and amendment of section 625.03 (1m) (e) of the statutes, and the creation of section 625.03 (1m) (e) 2. and 3. of the statutes take effect on September 1, 2011, or on the day after publication, whichever is later.

AB210-ASA1,25,3 (End)