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any of PPACA's provisions are repealed, insurers and self-insured governmental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).
AB210-ASA1, s. 26 18Section 26. 625.02 (1p) of the statutes is created to read:
AB210-ASA1,8,1919 625.02 (1p) "Public Health Service Act" has the meaning given in s. 636.01 (9).
AB210-ASA1, s. 27 20Section 27. 625.02 (2f) of the statutes is created to read:
AB210-ASA1,8,2221 625.02 (2f) "Secretary" means the secretary of the federal department of health
22and human services.
AB210-ASA1, s. 28 23Section 28. 625.02 (2s) of the statutes is created to read:
AB210-ASA1,9,524 625.02 (2s) "Small employer health insurance" means health insurance
25coverage as defined in s. 636.01 (3) that is offered in the small group market as

1defined in section 2791 (e) (5) of the Public Health Service Act (42 USC 300gg-91 (e)
2(5)). For purposes of this subsection, a small employer is an employer that employed
3an average of at least one but not more than 50 employees on business days during
4the preceding calendar year and that employs at least one employee on the first day
5of the plan year.
AB210-ASA1, s. 29 6Section 29. 625.03 (1m) (e) of the statutes is renumbered 625.03 (1m) (e)
7(intro.) and amended to read:
AB210-ASA1,9,98 625.03 (1m) (e) (intro.) Group and blanket accident and sickness insurance
9other than credit, except for the following:
AB210-ASA1,9,10 101. Credit accident and sickness insurance.
AB210-ASA1, s. 30 11Section 30. 625.03 (1m) (e) 2. of the statutes is created to read:
AB210-ASA1,9,1412 625.03 (1m) (e) 2. Subject to s. 636.35, on and after September 1, 2011, small
13employer health insurance, unless the commissioner provides otherwise by rule,
14including emergency rule as provided in s. 636.10 (2).
AB210-ASA1, s. 31 15Section 31. 625.03 (1m) (e) 3. of the statutes is created to read:
AB210-ASA1,9,1916 625.03 (1m) (e) 3. Subject to s. 636.35, on and after September 1, 2011, group
17and blanket accident and sickness insurance offered in the individual market, as
18defined in s. 636.01 (5), unless the commissioner provides otherwise by rule,
19including emergency rule as provided in s. 636.10 (2).
AB210-ASA1, s. 32 20Section 32. 625.13 (1) of the statutes is amended to read:
AB210-ASA1,9,2421 625.13 (1) Filing procedure. Except as provided in sub. subs. (2) and (3), every
22authorized insurer and every rate service organization licensed under s. 625.31
23which has been designated by any insurer for the filing of rates under s. 625.15 (2)
24shall file with the commissioner all rates and supplementary rate information and

1all changes and amendments thereof made by it for use in this state within 30 days
2after they become effective.
AB210-ASA1, s. 33 3Section 33. 625.13 (3) of the statutes is created to read:
AB210-ASA1,10,124 625.13 (3) Individual and small employer health insurance. Subject to s.
5636.35, on and after September 1, 2011, unless the commissioner provides otherwise
6by rule, including emergency rule as provided in s. 636.10 (2), for individual health
7insurance coverage, group and blanket accident and sickness insurance offered in
8the individual market, or small employer health insurance an insurer, or a rate
9service organization licensed under s. 625.31 that has been designated by the insurer
10for the filing of rates under s. 625.15 (2), shall file with the commissioner all rates
11and supplementary rate information, and all changes and amendments to the
12information, before they become effective.
AB210-ASA1, s. 34 13Section 34. 625.14 of the statutes is amended to read:
AB210-ASA1,10,17 14625.14 Filings open to inspection. Each Subject to s. 601.465 (1m) (d), each
15filing and any supporting information filed under this chapter shall, as soon as filed,
16be open to public inspection at any reasonable time. Copies may be obtained by any
17person on request and upon payment of a reasonable charge therefor.
AB210-ASA1, s. 35 18Section 35. 632.76 (2) (ac) 1. of the statutes is amended to read:
AB210-ASA1,10,2419 632.76 (2) (ac) 1. Notwithstanding par. (a) and except as provided in subd. 4.,
20no claim or loss incurred or disability commencing after 12 months from the date of
21issue of an individual disability insurance policy, as defined in s. 632.895 (1) (a), may
22be reduced or denied on the ground that a disease or physical condition existed prior
23to the effective date of coverage, unless the condition was excluded from coverage by
24name or specific description by a provision effective on the date of the loss.
AB210-ASA1, s. 36 25Section 36. 632.76 (2) (ac) 2. of the statutes is amended to read:
AB210-ASA1,11,6
1632.76 (2) (ac) 2. Except as provided in subd. subds. 3. and 4., an individual
2disability insurance policy, as defined in s. 632.895 (1) (a), other than a short-term
3policy subject to s. 632.7495 (4) and (5), may not define a preexisting condition more
4restrictively than a condition, whether physical or mental, regardless of the cause
5of the condition, for which medical advice, diagnosis, care, or treatment was
6recommended or received within 12 months before the effective date of coverage.
AB210-ASA1, s. 37 7Section 37. 632.76 (2) (ac) 3. (intro.) of the statutes is amended to read:
AB210-ASA1,11,118 632.76 (2) (ac) 3. (intro.) Except as provided in subd. 4. and except as the
9commissioner provides by rule under s. 632.7495 (5), all of the following apply to an
10individual disability insurance policy that is a short-term policy subject to s.
11632.7495 (4) and (5):
AB210-ASA1, s. 38 12Section 38. 632.76 (2) (ac) 4. of the statutes is created to read:
AB210-ASA1,11,1713 632.76 (2) (ac) 4. Subdivisions 1., 2., and 3. do not apply to an individual
14disability insurance policy, as defined in s. 632.895 (1) (a), issued on or after
15September 23, 2010, and before January 1, 2014, that covers an individual who is
16under 19 years of age, with respect to coverage of that individual. Section 636.25 (1)
17(f) applies to such a policy with respect to coverage of that individual.
AB210-ASA1, s. 39 18Section 39. 632.83 of the statutes is repealed.
AB210-ASA1, s. 40 19Section 40. 632.835 of the statutes is repealed.
AB210-ASA1, s. 41 20Section 41. 632.885 of the statutes, as affected by 2011 Wisconsin Act 32, is
21repealed.
AB210-ASA1, s. 42 22Section 42. 632.895 (15) (c) (intro.) of the statutes is amended to read:
AB210-ASA1,11,2523 632.895 (15) (c) (intro.) A Except as otherwise required under s. 636.25 (1) (c),
24(2) (a), or (3) (a), a
policy or plan is required to continue coverage under par. (a) only
25until any of the following occurs:
AB210-ASA1, s. 43
1Section 43. Chapter 636 of the statutes is created to read:
AB210-ASA1,12,22 Chapter 636
AB210-ASA1,12,33 Health insurance reform
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