AB64-ASA1-AA8,12,2 2253.07 (title) Women's health block grant; state family planning funds.
AB64-ASA1-AA8,1791dh 3Section 1791dh. 253.07 (6) of the statutes is created to read:
AB64-ASA1-AA8,12,44 253.07 (6) State-funded family planning program. (a) In this subsection:
AB64-ASA1-AA8,12,95 1. “Federal funding prohibition” means an enacted federal law, a regulation,
6or an executive order or action that prohibits federal moneys from being paid by the
7state to or directly to a provider under Title X of the federal Public Health Service
8Act, 42 USC 300 to 300a-6, because of the scope of services offered by the provider
9or the scope of services for which the provider offers referrals.
AB64-ASA1-AA8,12,1310 2. “Nonpublic family planning provider” means an entity other than a public
11entity or governmental unit that is a provider of services for family planning and that
12is eligible to apply for grant funding under Title X of the federal Public Health Service
13Act, 42 USC 300 to 300a-6, on December 31, 2016.
AB64-ASA1-AA8,12,1914 (b) Notwithstanding sub. (5), if a nonpublic family planning provider becomes
15subject to a federal funding prohibition, the department shall establish a
16state-funded family planning program to ensure continuity of family planning
17services in the state and distribute state funds to any nonpublic family planning
18providers that are subject to a federal funding prohibition to be used to provide family
19planning services.”.
AB64-ASA1-AA8,12,20 2023. Page 925, line 14: after that line insert:
AB64-ASA1-AA8,12,21 21 Section 2218s. 625.02 (1) of the statutes is renumbered 625.02 (1m).
AB64-ASA1-AA8,2218t 22Section 2218t. 625.02 (1j) of the statutes is created to read:
AB64-ASA1-AA8,12,2323 625.02 (1j) “Health insurance" has the meaning given in s. 632.745 (12).
AB64-ASA1-AA8,2218u 24Section 2218u. 625.03 (1m) (intro.) of the statutes is amended to read:
AB64-ASA1-AA8,13,4
1625.03 (1m) (intro.) This Except as specifically provided otherwise in this
2chapter, this
chapter applies to all kinds and lines of direct insurance written on risks
3or operations in this state by any insurer authorized to do business in this state,
4except:
AB64-ASA1-AA8,2218v 5Section 2218v. 625.13 (1) of the statutes is amended to read:
AB64-ASA1-AA8,13,116 625.13 (1) Filing procedure. Except as provided in sub. (2) and s. 625.25 (2)
7(a)
, every authorized insurer and every rate service organization licensed under s.
8625.31 which has been designated by any insurer for the filing of rates under s.
9625.15 (2) shall file with the commissioner all rates and supplementary rate
10information and all changes and amendments thereof made by it for use in this state
11within 30 days after they become effective.
AB64-ASA1-AA8,2218w 12Section 2218w. 625.15 (2) of the statutes is amended to read:
AB64-ASA1-AA8,13,2013 625.15 (2) Rate filing. An insurer may discharge its obligation under s. 625.13
14(1) or 625.25 (2) (a) by giving notice to the commissioner that it uses rates and
15supplementary rate information prepared by a designated rate service organization,
16with such information about modifications thereof as is necessary fully to inform the
17commissioner. The insurer's rates or proposed rates and supplementary rate
18information shall be those filed from time to time by the rate service organization,
19including any amendments or proposed amendments thereto as filed, subject,
20however, to the modifications filed by the insurer.
AB64-ASA1-AA8,2218x 21Section 2218x. 625.21 (1) of the statutes is amended to read:
AB64-ASA1-AA8,14,822 625.21 (1) Rule instituting delayed effect. If the commissioner finds that
23competition is not an effective regulator of the rates charged or that a substantial
24number of companies are competing irresponsibly through the rates charged, or that
25there are widespread violations of this chapter, in any kind or line of insurance or

1subdivision thereof or in any rating class or rating territory, he or she may
2promulgate a rule requiring that in the kind or line of insurance or subdivision
3thereof or rating class or rating territory comprehended by the finding any
4subsequent changes in the rates or supplementary rate information be filed with the
5commissioner at least 15 days before they become effective. The commissioner may
6extend the waiting period for not to exceed 15 additional days by written notice to
7the filer before the first 15-day period expires. This subsection does not apply to
8health insurance, which is subject to s. 625.25 (2) (a).
AB64-ASA1-AA8,2218y 9Section 2218y. 625.22 (1) of the statutes is amended to read:
AB64-ASA1-AA8,14,1310 625.22 (1) Order in event of violation. If the commissioner finds after a
11hearing that a rate or proposed rate is not in compliance with s. 625.11, the
12commissioner shall order that its use be discontinued, or that it may not be used, for
13any policy issued or renewed after a date specified in the order.
AB64-ASA1-AA8,2218z 14Section 2218z. 625.22 (3) of the statutes is amended to read:
AB64-ASA1-AA8,14,1915 625.22 (3) Approval of substituted rate. Within Except for rates for health
16insurance, which is subject to s. 625.25 (2) (a), within
one year after the effective date
17of an order under sub. (1), no rate promulgated to replace a disapproved one may be
18used until it has been filed with the commissioner and not disapproved within 30
19days thereafter.
AB64-ASA1-AA8,2219b 20Section 2219b. 625.23 of the statutes is amended to read:
AB64-ASA1-AA8,15,7 21625.23 Special restrictions on individual insurers. The commissioner
22may by order require that a particular insurer file any or all of its rates and
23supplementary rate information 15 days prior to their effective date, if and to the
24extent that he or she finds, after a hearing, that the protection of the interests of its
25insureds and the public in this state requires closer supervision of its rates because

1of the insurer's financial condition or rating practices. The commissioner may extend
2the waiting period for any filing for not to exceed 15 additional days by written notice
3to the insurer before the first 15-day period expires. A filing not disapproved before
4the expiration of the waiting period shall be deemed to meet the requirements of this
5chapter, subject to the possibility of subsequent disapproval under s. 625.22. This
6section does not apply to an insurer with respect to rates for health insurance, which
7is subject to s. 625.25 (2) (a).
AB64-ASA1-AA8,2219c 8Section 2219c. 625.25 of the statutes is created to read:
AB64-ASA1-AA8,15,9 9625.25 Rates for health insurance. (1) Definitions. In this section:
AB64-ASA1-AA8,15,1010 (a) “Group health benefit plan" has the meaning given in s. 632.745 (9).
AB64-ASA1-AA8,15,1111 (b) “Health benefit plan" has the meaning given in s. 632.745 (11).
AB64-ASA1-AA8,15,1212 (c) “Insurer" has the meaning given in s. 632.745 (15).
AB64-ASA1-AA8,15,1313 (d) “Large group market" has the meaning given in s. 632.745 (17).
AB64-ASA1-AA8,15,1414 (e) “Small group market" has the meaning given in s. 632.745 (26).
AB64-ASA1-AA8,16,6 15(2) Filing of rates; hearing. (a) Every insurer, and every rate service
16organization licensed under s. 625.31 that has been designated by any insurer for the
17filing of rates under s. 625.15 (2), shall file with the commissioner all proposed rates
18and supplementary rate information, and all proposed changes and amendments to
19rates and supplementary rate information, for use in this state for any health benefit
20plan offered by the insurer before the proposed rates or changes to rates become
21effective. An insurer may not use a proposed rate or change to a rate until it has been
22filed with and approved by the commissioner. Unless the commissioner holds a
23hearing on the proposed rate or change to a rate, a proposed rate or change to a rate
24is approved if the commissioner does not disapprove the proposed rate or change
25within 30 days after filing, or within a 30-day extension of that period ordered by the

1commissioner prior to the expiration of the first 30 days. The requirement under this
2paragraph applies with respect to rates and changes to rates for all health benefit
3plans, including individual health benefit plans, group health benefit plans offered
4in the small group market, and group health benefit plans offered in the large group
5market, that have not gone into effect by the effective date of this paragraph .... [LRB
6inserts date].
AB64-ASA1-AA8,16,97 (b) If any proposed change to a rate filed under par. (a) increases the existing
8rate by more than 10 percent of that rate, the commissioner shall hold a public
9hearing before approving or disapproving the proposed change to the rate.
AB64-ASA1-AA8,16,1210 (c) The commissioner may disapprove a proposed rate or change to a rate filed
11under par. (a) that the commissioner determines is not justified based on underlying
12medical costs.
AB64-ASA1-AA8,16,16 13(3) Publication of increases, negotiated rates. (a) The commissioner shall
14publish on the office's Internet site, in a format that is readily understandable by
15members of the public, all rate changes filed under sub. (2) (a) that increase an
16existing rate by any amount and that are approved.
AB64-ASA1-AA8,16,2117 (b) If the commissioner approves a rate increase after holding a hearing under
18sub. (2) (b) and the insurer justified the rate increase based on increased medical
19costs, the commissioner shall publish on the office's Internet site, in a format that is
20readily understandable by members of the public, the discounted payment rates the
21insurer has negotiated with each of the insurer's provider networks.
AB64-ASA1-AA8,16,25 22(4) Notice of rate increase to insureds. If the commissioner approves a rate
23increase filed under sub. (2) (a), the insurer shall provide notice of the rate increase
24to each insured under the health benefit plan at least 60 days before the rate increase
25goes into effect.”.
AB64-ASA1-AA8,17,1
124. Page 925, line 14: after that line insert:
AB64-ASA1-AA8,17,2 2 Section 2218u. 609.713 of the statutes is created to read:
AB64-ASA1-AA8,17,4 3609.713 Essential health benefits. Defined network plans and preferred
4provider plans are subject to s. 632.895 (14m).
AB64-ASA1-AA8,2218y 5Section 2218y. 632.895 (14m) of the statutes is created to read:
AB64-ASA1-AA8,17,76 632.895 (14m) Essential health benefits. (a) In this subsection,
7“self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB64-ASA1-AA8,17,108 (b) On a date specified by the commissioner, by rule, every disability insurance
9policy and every self-insured health plan shall provide coverage for essential health
10benefits as determined by the commissioner, by rule, subject to par. (c).
AB64-ASA1-AA8,17,1211 (c) In determining the essential health benefits for which coverage is required
12under par. (b), the commissioner shall do all of the following:
AB64-ASA1-AA8,17,1413 1. Include benefits, items, and services in, at least, all of the following
14categories:
AB64-ASA1-AA8,17,1515 a. Ambulatory patient services.
AB64-ASA1-AA8,17,1616 b. Emergency services.
AB64-ASA1-AA8,17,1717 c. Hospitalization.
AB64-ASA1-AA8,17,1818 d. Maternity and newborn care.
AB64-ASA1-AA8,17,2019 e. Mental health and substance use disorder services, including behavioral
20health treatment.
AB64-ASA1-AA8,17,2121 f. Prescription drugs.
AB64-ASA1-AA8,17,2222 g. Rehabilitative and habilitative services and devices.
AB64-ASA1-AA8,17,2323 h. Laboratory services.
AB64-ASA1-AA8,17,2424 i. Preventive and wellness services and chronic disease management.
AB64-ASA1-AA8,18,1
1j. Pediatric services, including oral and vision care.
AB64-ASA1-AA8,18,62 2. Conduct a survey of employer-sponsored coverage to determine benefits
3typically covered by employers and ensure that the scope of essential health benefits
4for which coverage is required under this subsection is equal to the scope of benefits
5covered under a typical disability insurance policy offered by an employer to its
6employees.
AB64-ASA1-AA8,18,87 3. Ensure that essential health benefits reflect a balance among the categories
8described in subd. 1. such that benefits are not unduly weighted toward one category.
AB64-ASA1-AA8,18,109 4. Ensure that essential health benefit coverage is provided with no or limited
10cost-sharing requirements.
AB64-ASA1-AA8,18,1411 5. Require that disability insurance policies and self-insured health plans do
12not make coverage decisions, determine reimbursement rates, establish incentive
13programs, or design benefits in ways that discriminate against individuals because
14of their age, disability, or expected length of life.
AB64-ASA1-AA8,18,1715 6. Establish essential health benefits in a way that takes account of the health
16care needs of diverse segments of the population, including women, children, persons
17with disabilities, and other groups.
AB64-ASA1-AA8,18,2118 7. Ensure that essential health benefits established under this subsection not
19be subject to a coverage denial based on an insured's or plan participant's age,
20expected length of life, present or predicted disability, degree of dependency on
21medical care, or quality of life.
AB64-ASA1-AA8,19,322 8. Require that disability insurance policies and self-insured health plans
23cover emergency department services that are essential health benefits without
24imposing any requirement to obtain prior authorization for those services and
25without limiting coverage for services provided by an emergency services provider

1that is not in the provider network of a policy or plan in a way that is more restrictive
2than requirements or limitations that apply to emergency services provided by a
3provider that is in the provider network of the policy or plan.
AB64-ASA1-AA8,19,84 9. Require a disability insurance policy or self-insured health plan to apply to
5emergency department services that are essential health benefits provided by an
6emergency department provider that is not in the provider network of the policy or
7plan the same copayment amount or coinsurance rate that applies if those services
8are provided by a provider that is in the provider network of the policy or plan.
AB64-ASA1-AA8,19,109 (d) The commissioner shall periodically update, by rule, the essential health
10benefits under this subsection to address any gaps in access to coverage.
AB64-ASA1-AA8,19,1511 (e) If an essential health benefit is also subject to mandated coverage elsewhere
12under this section and the coverage requirements are not identical, the disability
13insurance policy or self-insured health plan shall provide coverage under whichever
14subsection provides the insured or plan participant with more comprehensive
15coverage of the medical condition, item, or service.
AB64-ASA1-AA8,19,1916 (f) Nothing in this subsection or rules promulgated under this subsection
17prohibits a disability insurance policy or a self-insured health plan from providing
18benefits in excess of the essential health benefit coverage required under this
19subsection.”.
AB64-ASA1-AA8,19,20 2025. Page 925, line 14: after that line insert:
AB64-ASA1-AA8,19,21 21 Section 2218t. 609.847 of the statutes is created to read:
AB64-ASA1-AA8,19,24 22609.847 Preexisting condition discrimination prohibited. Limited
23service health organizations, preferred provider plans, and defined network plans
24are subject to s. 632.728.
AB64-ASA1-AA8,2218w
1Section 2218w. 625.12 (1) (a) of the statutes is amended to read:
AB64-ASA1-AA8,20,32 625.12 (1) (a) Past and prospective loss and expense experience within and
3outside of this state, except as provided in s. 632.728.
AB64-ASA1-AA8,2218y 4Section 2218y. 625.12 (1) (e) of the statutes is amended to read:
AB64-ASA1-AA8,20,65 625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors,
6including the judgment of technical personnel.
AB64-ASA1-AA8,2219b 7Section 2219b. 625.12 (2) of the statutes is amended to read:
AB64-ASA1-AA8,20,168 625.12 (2) Classification. Risks Except as provided in s. 632.728, risks may
9be classified in any reasonable way for the establishment of rates and minimum
10premiums, except that no classifications may be based on race, color, creed or
11national origin, and classifications in automobile insurance may not be based on
12physical condition or developmental disability as defined in s. 51.01 (5). Subject to
13s. ss. 632.365 and 632.728, rates thus produced may be modified for individual risks
14in accordance with rating plans or schedules that establish reasonable standards for
15measuring probable variations in hazards, expenses, or both. Rates may also be
16modified for individual risks under s. 625.13 (2).
AB64-ASA1-AA8,2219d 17Section 2219d. 625.15 (1) of the statutes is amended to read:
AB64-ASA1-AA8,20,2518 625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may
19itself establish rates and supplementary rate information for one or more market
20segments based on the factors in s. 625.12 and, if the rates are for motor vehicle
21liability insurance, subject to s. 632.365, or the insurer may use rates and
22supplementary rate information prepared by a rate service organization, with
23average expense factors determined by the rate service organization or with such
24modification for its own expense and loss experience as the credibility of that
25experience allows.
AB64-ASA1-AA8,2219f
1Section 2219f. 628.34 (3) (a) of the statutes is amended to read:
AB64-ASA1-AA8,21,82 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by
3charging different premiums or by offering different terms of coverage except on the
4basis of classifications related to the nature and the degree of the risk covered or the
5expenses involved, subject to ss. 632.365, 632.728, 632.746 and 632.748. Rates are
6not unfairly discriminatory if they are averaged broadly among persons insured
7under a group, blanket or franchise policy, and terms are not unfairly discriminatory
8merely because they are more favorable than in a similar individual policy.
AB64-ASA1-AA8,2219h 9Section 2219h. 632.728 of the statutes is created to read:
AB64-ASA1-AA8,21,11 10632.728 Premiums and cost-sharing discrimination prohibited for
11preexisiting conditions.
(1) Definition. In this section:
AB64-ASA1-AA8,21,1212 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB64-ASA1-AA8,21,1313 (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB64-ASA1-AA8,21,19 14(2) Prohibition. For the purpose of setting rates or premiums for coverage
15under a group or individual disability insurance policy or a self-insured health plan
16and for the purpose of setting any deductibles, copayments, or coinsurance under a
17group or individual disability insurance policy or a self-insured health plan, the
18policy or plan may not consider whether an individual, including a dependent, who
19would be covered under the plan has a preexisting condition.
AB64-ASA1-AA8,2219j 20Section 2219j. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and
21amended to read:
AB64-ASA1-AA8,22,322 632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health
23benefit plan may, with respect to a participant or beneficiary under the plan, not
24impose a preexisting condition exclusion only if the exclusion relates to a condition,
25whether physical or mental, regardless of the cause of the condition, for which

1medical advice, diagnosis, care or treatment was recommended or received within
2the 6-month period ending on the participant's or beneficiary's enrollment date
3under the plan
on a participant or beneficiary under the plan.
AB64-ASA1-AA8,2219n 4Section 2219n. 632.746 (1) (b) of the statutes is repealed.
AB64-ASA1-AA8,2219p 5Section 2219p. 632.746 (2) (a) of the statutes is amended to read:
AB64-ASA1-AA8,22,86 632.746 (2) (a) An insurer offering a group health benefit plan may not treat
7genetic information as a preexisting condition under sub. (1) without a diagnosis of
8a condition related to the information
.
Loading...
Loading...