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
.
AB64-ASA1-AA8,2219r 9Section 2219r. 632.746 (2) (c), (d) and (e) of the statutes are repealed.
AB64-ASA1-AA8,2219t 10Section 2219t. 632.746 (3) (a) of the statutes is repealed.
AB64-ASA1-AA8,2219v 11Section 2219v. 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).
AB64-ASA1-AA8,2219x 12Section 2219x. 632.746 (3) (d) 2. and 3. of the statutes are repealed.
AB64-ASA1-AA8,2219z 13Section 2219z. 632.746 (5) of the statutes is repealed.
AB64-ASA1-AA8,2220b 14Section 2220b. 632.746 (8) (a) (intro.) of the statutes is amended to read:
AB64-ASA1-AA8,22,1815 632.746 (8) (a) (intro.) A health maintenance organization that offers a group
16health benefit plan and that does not impose any preexisting condition exclusion
17under sub. (1)
with respect to a particular coverage option may impose an affiliation
18period for that coverage option, but only if all of the following apply:
AB64-ASA1-AA8,2220d 19Section 2220d. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended
20to read:
AB64-ASA1-AA8,23,321 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
22from the date of issue of the policy may be reduced or denied on the ground that a
23disease or physical condition existed prior to the effective date of coverage, unless the
24condition was excluded from coverage by name or specific description by a provision
25effective on the date of loss. This paragraph does not apply to a group health benefit

1plan, as defined in s. 632.745 (9), which is subject to s. 632.746, a disability insurance
2policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s.
3632.85 (1) (c)
.
AB64-ASA1-AA8,23,94 (ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability
5commencing after 12 months from the date of issue of under an individual disability
6insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the
7ground that a disease or physical condition existed prior to the effective date of
8coverage, unless the condition was excluded from coverage by name or specific
9description by a provision effective on the date of the loss
.
AB64-ASA1-AA8,23,1510 2. Except as provided in subd. 3., an An individual disability insurance policy,
11as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495
12(4) and (5),
may not define a preexisting condition more restrictively than a condition,
13whether physical or mental, regardless of the cause of the condition, for which
14medical advice, diagnosis, care, or treatment was recommended or received within
1512 months before the effective date of coverage
.
AB64-ASA1-AA8,2220f 16Section 2220f. 632.76 (2) (ac) 3. of the statutes is repealed.
AB64-ASA1-AA8,1 17Section 1. 632.795 (4) (a) of the statutes is amended to read:
AB64-ASA1-AA8,24,418 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the
19same policy form and for the same premium as it originally offered in the most recent
20enrollment period, subject only to the medical underwriting used in that enrollment
21period. Unless otherwise prescribed by rule, the insurer may apply deductibles,
22preexisting condition limitations, waiting periods , or other limits only to the extent
23that they would have been applicable had coverage been extended at the time of the
24most recent enrollment period and with credit for the satisfaction or partial
25satisfaction of similar provisions under the liquidated insurer's policy or plan. The

1insurer may exclude coverage of claims that are payable by a solvent insurer under
2insolvency coverage required by the commissioner or by the insurance regulator of
3another jurisdiction. Coverage shall be effective on the date that the liquidated
4insurer's coverage terminates.
AB64-ASA1-AA8,2220h 5Section 2220h. 632.897 (11) (a) of the statutes is amended to read:
AB64-ASA1-AA8,24,146 632.897 (11) (a) Notwithstanding subs. (2) to (10), the commissioner may
7promulgate rules establishing standards requiring insurers to provide continuation
8of coverage for any individual covered at any time under a group policy who is a
9terminated insured or an eligible individual under any federal program that
10provides for a federal premium subsidy for individuals covered under continuation
11of coverage under a group policy, including rules governing election or extension of
12election periods, notice, rates, premiums, premium payment, application of
13preexisting condition exclusions,
election of alternative coverage, and status as an
14eligible individual, as defined in s. 149.10 (2t), 2011 stats.”.
AB64-ASA1-AA8,24,15 1526. Page 925, line 14: after that line insert:
AB64-ASA1-AA8,24,16 16 Section 2218t. 609.896 of the statutes is created to read:
AB64-ASA1-AA8,24,18 17609.896 Preventive services. Defined network plans and preferred provider
18plans are subject to s. 632.895 (13m).
AB64-ASA1-AA8,2218w 19Section 2218w. 632.895 (8) (d) of the statutes is amended to read:
AB64-ASA1-AA8,25,220 632.895 (8) (d) Coverage is required under this subsection despite whether the
21woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c), and
22(e), coverage under this subsection may only be subject to exclusions and limitations,
23including deductibles, copayments and restrictions on excessive charges, that are
24applied to other radiological examinations covered under the disability insurance

1policy. Coverage under this subsection may not be subject to any deductibles,
2copayments, or coinsurance.
AB64-ASA1-AA8,2219b 3Section 2219b. 632.895 (13m) of the statutes is created to read:
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