Amendment ASA1-AB210

AB210-ASA1, s. 4 Section 4 . 40.51 (8m) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB210-ASA1,4,4 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.85, 632.853, 632.855, 632.885, 632.89, and 632.895 (11) to (17) and, so far as applicable, ch. 636.

AB210-ASA1, s. 5 Section 5. 49.67 (3) (am) 2. b. of the statutes, as affected by 2011 Wisconsin Act 32, is amended to read:

AB210-ASA1,4,11 49.67 (3) (am) 2. b. If the applicant is under 26 years of age, notice that he or she may be eligible for coverage as a dependent under his or her parent's health care plan in accordance with s. 632.885 636.25 (1) (h) or (3) (b), and that his or her parent's plan must include coverage for services that are not covered under the plan under this section.

AB210-ASA1, s. 6 Section 6 . 66.0137 (4) of the statutes is amended to read:

AB210-ASA1,4,19 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4) and, so far as applicable, ch. 636.

AB210-ASA1, s. 7 Section 7 . 66.0137 (4) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB210-ASA1,5,3 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4) and, so far as applicable, ch. 636.

AB210-ASA1, s. 8 Section 8. 111.91 (2) (n) of the statutes is amended to read:

AB210-ASA1,5,7 111.91 (2) (n) The provision to employees of the health insurance coverage required under s. 632.895 (11) to (14), (16), and (16m), and (17) and, so far as applicable, s. 636.25.

AB210-ASA1, s. 9 Section 9. 111.91 (2) (nm) of the statutes is amended to read:

AB210-ASA1,5,11 111.91 (2) (nm) The requirements related to providing coverage for a dependent under s. 632.885 and to continuing coverage for a dependent student on a medical leave of absence under s. 632.895 (15).

AB210-ASA1, s. 10 Section 10. 111.91 (2) (s) of the statutes is amended to read:

AB210-ASA1,5,15 111.91 (2) (s) The requirements related to internal grievance procedures under s. 632.83 and independent review and external appeals of certain health benefit plan determinations established under s. 632.835 636.12.

AB210-ASA1, s. 11 Section 11. 111.998 (2) (n) of the statutes is amended to read:

AB210-ASA1,5,18 111.998 (2) (n) The provision to employees of the health insurance coverage required under s. 632.895 (11) to (14) and, so far as applicable, s. 636.25.

AB210-ASA1, s. 12 Section 12. 111.998 (2) (s) of the statutes is amended to read:

AB210-ASA1,5,22 111.998 (2) (s) The requirements related to internal grievance procedures under s. 632.83 and independent review and external appeals of certain health benefit plan determinations established under s. 632.835 636.12.

AB210-ASA1, s. 13 Section 13 . 120.13 (2) (g) of the statutes is amended to read:

AB210-ASA1,6,2 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4) and, so far as applicable, ch. 636.

AB210-ASA1, s. 14 Section 14 . 120.13 (2) (g) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB210-ASA1,6,8 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4) and, so far as applicable, ch. 636.

AB210-ASA1, s. 15 Section 15 . 185.983 (1) (intro.) of the statutes is amended to read:

AB210-ASA1,6,17 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a cooperative association organized under s. 185.981 shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93, 631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798, 632.85, 632.853, 632.855, 632.87 (2), (2m), (3), (4), (5), and (6), 632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 625, 630, 635, 636, 645, and 646, but the sponsoring association shall:

AB210-ASA1, s. 16 Section 16 . 185.983 (1) (intro.) of the statutes, as affected by 2011 Wisconsin Act .... (this act), is amended to read:

AB210-ASA1,7,2 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a cooperative association organized under s. 185.981 shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93, 631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798, 632.85, 632.853, 632.855, 632.87 (2), (2m), (3), (4), (5), and (6), 632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 625, 630, 635, 636, 645, and 646, but the sponsoring association shall:

AB210-ASA1, s. 17 Section 17. 600.01 (2) (b) of the statutes is amended to read:

AB210-ASA1,7,5 600.01 (2) (b) Group or blanket insurance described in sub. (1) (b) 3. and 4. is not 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 Section 18. 601.31 (1) (Lp) of the statutes is amended to read:

AB210-ASA1,7,8 601.31 (1) (Lp) For certifying as an independent review organization under s. 632.835 636.15 (1) (a), $400.

AB210-ASA1, s. 19 Section 19. 601.31 (1) (Lr) of the statutes is amended to read:

AB210-ASA1,7,11 601.31 (1) (Lr) For each biennial recertification as an independent review organization under s. 632.835 636.15 (1) (a), $100.

AB210-ASA1, s. 20 Section 20. 601.42 (4) of the statutes is amended to read:

AB210-ASA1,7,24 601.42 (4) Replies. Any officer, manager or general agent of any insurer authorized to do or doing an insurance business in this state, any person controlling or having a contract under which the person has a right to control such an insurer, whether exclusively or otherwise, any person with executive authority over or in charge of any segment of such an insurer's affairs, any individual practice association or officer, director or manager of an individual practice association, any insurance agent or other person licensed under chs. 600 to 646, any provider of services under a continuing care contract, as defined in s. 647.01 (2), any independent review organization certified or recertified under s. 632.835 (4) 636.15 (1) (a) or any health care provider, as defined in s. 655.001 (8), shall reply promptly in writing or in other designated form, to any written inquiry from the commissioner requesting a reply.

AB210-ASA1, s. 21 Section 21. 601.465 (1m) (d) of the statutes is created to read:

AB210-ASA1,8,3 601.465 (1m) (d) Information contained in individual or small group health insurance rate and supplementary rate information filed under ch. 625 that the office determines is proprietary.

AB210-ASA1, s. 22 Section 22. 609.655 (4) (b) of the statutes is amended to read:

AB210-ASA1,8,12 609.655 (4) (b) Upon completion of the review under par. (a), the medical director of the defined network plan shall determine whether the policy or certificate will provide coverage of any further treatment for the dependent student's nervous or mental disorder or alcoholism or other drug abuse problems that is provided by a provider located in reasonably close proximity to the school in which the student is enrolled. If the dependent student disputes the medical director's determination, the dependent student may submit a written grievance under the defined network plan's internal grievance procedure established under s. 632.83 636.12.

AB210-ASA1, s. 23 Section 23. 609.755 of the statutes is repealed.

AB210-ASA1, s. 24 Section 24. 625.02 (1) of the statutes is renumbered 625.02 (1m).

AB210-ASA1, s. 25 Section 25. 625.02 (1h) of the statutes is created to read:

AB210-ASA1,8,17 625.02 (1h) "Individual health insurance coverage" has the meaning given in s. 636.01 (4).

AB210-ASA1, s. 26 Section 26. 625.02 (1p) of the statutes is created to read:

AB210-ASA1,8,19 625.02 (1p) "Public Health Service Act" has the meaning given in s. 636.01 (9).

AB210-ASA1, s. 27 Section 27. 625.02 (2f) of the statutes is created to read:

AB210-ASA1,8,22 625.02 (2f) "Secretary" means the secretary of the federal department of health and human services.

AB210-ASA1, s. 28 Section 28. 625.02 (2s) of the statutes is created to read:

AB210-ASA1,9,5 625.02 (2s) "Small employer health insurance" means health insurance coverage as defined in s. 636.01 (3) that is offered in the small group market as defined in section 2791 (e) (5) of the Public Health Service Act (42 USC 300gg-91 (e) (5)). For purposes of this subsection, a small employer is an employer that employed an average of at least one but not more than 50 employees on business days during the preceding calendar year and that employs at least one employee on the first day of the plan year.

AB210-ASA1, s. 29 Section 29. 625.03 (1m) (e) of the statutes is renumbered 625.03 (1m) (e) (intro.) and amended to read:

AB210-ASA1,9,9 625.03 (1m) (e) (intro.) Group and blanket accident and sickness insurance other than credit, except for the following:

AB210-ASA1,9,10 1. Credit accident and sickness insurance.

AB210-ASA1, s. 30 Section 30. 625.03 (1m) (e) 2. of the statutes is created to read:

AB210-ASA1,9,14 625.03 (1m) (e) 2. Subject to s. 636.35, on and after September 1, 2011, small employer health insurance, unless the commissioner provides otherwise by rule, including emergency rule as provided in s. 636.10 (2).

AB210-ASA1, s. 31 Section 31. 625.03 (1m) (e) 3. of the statutes is created to read:

AB210-ASA1,9,19 625.03 (1m) (e) 3. Subject to s. 636.35, on and after September 1, 2011, group and blanket accident and sickness insurance offered in the individual market, as defined in s. 636.01 (5), unless the commissioner provides otherwise by rule, including emergency rule as provided in s. 636.10 (2).

AB210-ASA1, s. 32 Section 32. 625.13 (1) of the statutes is amended to read:

AB210-ASA1,9,24 625.13 (1) Filing procedure. Except as provided in sub. subs. (2) and (3), every authorized insurer and every rate service organization licensed under s. 625.31 which has been designated by any insurer for the filing of rates under s. 625.15 (2) shall file with the commissioner all rates and supplementary rate information and all changes and amendments thereof made by it for use in this state within 30 days after they become effective.

AB210-ASA1, s. 33 Section 33. 625.13 (3) of the statutes is created to read:

AB210-ASA1,10,12 625.13 (3) Individual and small employer health insurance. Subject to s. 636.35, on and after September 1, 2011, unless the commissioner provides otherwise by rule, including emergency rule as provided in s. 636.10 (2), for individual health insurance coverage, group and blanket accident and sickness insurance offered in the individual market, or small employer health insurance an insurer, or a rate service organization licensed under s. 625.31 that has been designated by the insurer for the filing of rates under s. 625.15 (2), shall file with the commissioner all rates and supplementary rate information, and all changes and amendments to the information, before they become effective.

AB210-ASA1, s. 34 Section 34. 625.14 of the statutes is amended to read:

AB210-ASA1,10,17 625.14 Filings open to inspection. Each Subject to s. 601.465 (1m) (d), each filing and any supporting information filed under this chapter shall, as soon as filed, be open to public inspection at any reasonable time. Copies may be obtained by any person on request and upon payment of a reasonable charge therefor.

AB210-ASA1, s. 35 Section 35. 632.76 (2) (ac) 1. of the statutes is amended to read:

AB210-ASA1,10,24 632.76 (2) (ac) 1. Notwithstanding par. (a) and except as provided in subd. 4., no claim or loss incurred or disability commencing after 12 months from the date of issue of an individual disability insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the ground that a disease or physical condition existed prior to the effective date of coverage, unless the condition was excluded from coverage by name or specific description by a provision effective on the date of the loss.

AB210-ASA1, s. 36 Section 36. 632.76 (2) (ac) 2. of the statutes is amended to read:

AB210-ASA1,11,6 632.76 (2) (ac) 2. Except as provided in subd. subds. 3. and 4., an individual disability insurance policy, as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495 (4) and (5), may not define a preexisting condition more restrictively than a condition, whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within 12 months before the effective date of coverage.

AB210-ASA1, s. 37 Section 37. 632.76 (2) (ac) 3. (intro.) of the statutes is amended to read:

AB210-ASA1,11,11 632.76 (2) (ac) 3. (intro.) Except as provided in subd. 4. and except as the commissioner provides by rule under s. 632.7495 (5), all of the following apply to an individual disability insurance policy that is a short-term policy subject to s. 632.7495 (4) and (5):

AB210-ASA1, s. 38 Section 38. 632.76 (2) (ac) 4. of the statutes is created to read:

AB210-ASA1,11,17 632.76 (2) (ac) 4. Subdivisions 1., 2., and 3. do not apply to an individual disability insurance policy, as defined in s. 632.895 (1) (a), issued on or after September 23, 2010, and before January 1, 2014, that covers an individual who is under 19 years of age, with respect to coverage of that individual. Section 636.25 (1) (f) applies to such a policy with respect to coverage of that individual.

AB210-ASA1, s. 39 Section 39. 632.83 of the statutes is repealed.

AB210-ASA1, s. 40 Section 40. 632.835 of the statutes is repealed.

AB210-ASA1, s. 41 Section 41. 632.885 of the statutes, as affected by 2011 Wisconsin Act 32, is repealed.

AB210-ASA1, s. 42 Section 42. 632.895 (15) (c) (intro.) of the statutes is amended to read:

AB210-ASA1,11,25 632.895 (15) (c) (intro.) A Except as otherwise required under s. 636.25 (1) (c), (2) (a), or (3) (a), a policy or plan is required to continue coverage under par. (a) only until any of the following occurs:

AB210-ASA1, s. 43 Section 43. Chapter 636 of the statutes is created to read:

AB210-ASA1,12,2 Chapter 636

AB210-ASA1,12,3 Health insurance reform

AB210-ASA1,12,4 636.01 Definitions. In this chapter, unless the context requires otherwise:

AB210-ASA1,12,5 (1) "Defined network plan" has the meaning given in s. 609.01 (1b).

AB210-ASA1,12,7 (2) "Grandfathered health plan" has the meaning given in section 1251 (e) of the Patient Protection and Affordable Care Act.

AB210-ASA1,12,14 (3) "Health insurance coverage" has the meaning given in section 2791 (b) (1) of the Public Health Service Act (42 USC 300gg-91 (b) (1)). "Health insurance coverage" includes coverage issued by an insurer and insurance that is a group health plan, as defined in section 2791 (a) (1) of the Public Health Service Act (42 USC 300gg-91 (a) (1)). "Health insurance coverage" does not include excepted benefits that are excluded under section 2722 (b) or (c) of the Public Health Service Act (42 USC 300gg-21 (b) or (c)).

AB210-ASA1,12,17 (4) "Individual health insurance coverage" means health insurance coverage offered to individuals in the individual market. "Individual health insurance coverage" does not include short-term limited duration insurance.

AB210-ASA1,12,19 (5) "Individual market" has the meaning given in section 1304 (a) (2) of the Patient Protection and Affordable Care Act.

AB210-ASA1,12,23 (6) "Limited-scope dental or vision benefits" means limited-scope dental or vision benefits provided under a separate policy, certificate, or contract of insurance or plan, or otherwise not provided as an integral part of the policy, certificate, or contract of insurance or plan.

AB210-ASA1,13,3 (7) "Patient Protection and Affordable Care Act" means the federal Patient Protection and Affordable Care Act, P.L. 111-148, as amended by the federal Health Care and Education Reconciliation Act of 2010, P.L. 111-152.

AB210-ASA1,13,7 (8) "Preexisting condition exclusion denial determination" means a determination by or on behalf of an insurer that issues a health benefit plan denying or terminating treatment or payment for treatment on the basis of a preexisting condition exclusion, as defined in s. 632.745 (23).

AB210-ASA1,13,10 (9) "Public Health Service Act" means the federal Public Health Service Act of 1944, as amended, including by the Patient Protection and Affordable Care Act (42 USC 300gg et seq.).

AB210-ASA1,13,12 (10) "Secretary" means the secretary of the federal department of health and human services.

AB210-ASA1,13,14 (11) "Self-insured governmental health plan" means a self-insured health plan of the state or a county, city, village, town, or school district.