AB1016: Bill Text

AB1016,2,15 15.165 (5) Private employer health care coverage board. (a) There is created in the department of employe trust funds a private employer health care coverage board consisting of the following members nominated by the governor, and with the advice and consent of the senate appointed, for 3-year terms:

AB1016,2,18 1. Three members who are employes who receive health care coverage under subch. XI of ch. 40, but at least one employe shall be employed by an employer who employs 25 or fewer employes.

AB1016,2,20 2. Three members who are employers that offer health care coverage under subch. XI of ch. 40, but at least one employer shall employ 25 or fewer employes.

AB1016,3,2 3. One member who is an actuary, but who is not an insurer or an employe of an insurer.

AB1016,3,3 (b) The actuary appointed under par. (a) shall be a nonvoting member.

AB1016, s. 4 Section 4. 40.02 (26) (intro.) of the statutes is amended to read:

AB1016,3,12 40.02 (26) (intro.) "Employe" means any person who receives earnings as payment for personal services rendered for the benefit of any employer including officers of the employer, except as provided in subch. XI. An employe is deemed to have separated from the service of an employer at the end of the day on which the employe last performed services for the employer, or, if later, the day on which the employe-employer relationship is terminated because of the expiration or termination of leave without pay, sick leave, vacation or other leave of absence. A person shall not be considered an employe if a person:

AB1016, s. 5 Section 5. 40.02 (28) of the statutes is amended to read:

AB1016,3,21 40.02 (28) "Employer" means the state, including each state agency, any county, city, village, town, school district, other governmental unit or instrumentality of 2 or more units of government now existing or hereafter created within the state and any federated public library system established under s. 43.19 whose territory lies within a single county with a population of 500,000 or more, except as provided under ss. 40.51 (7) and 40.61 (3) and subch. XI, or a local exposition district created under subch. II of ch. 229. Each employer shall be a separate legal jurisdiction for OASDHI purposes.

AB1016, s. 6 Section 6. 40.03 (2) (ig) of the statutes is amended to read:

AB1016,3,25 40.03 (2) (ig) Shall promulgate, with the approval of the group insurance board, all rules required for the administration of the group health, long-term care, income continuation or life insurance plans established under subchs. IV to VI and XI.

AB1016, s. 7 Section 7. 40.03 (6) (k) of the statutes is created to read:

AB1016,4,5 40.03 (6) (k) May, on behalf of any employer specified under subch. XI, negotiate a contract or contracts with one or more insurers authorized to transact insurance business in this state for the purpose of providing the health care coverage plans provided under subch. XI.

AB1016, s. 8 Section 8. Subchapter XI of chapter 40 [precedes 40.98] of the statutes is created to read:

AB1016,4,8 Chapter 40

AB1016,4,11 Subchapter XI Private employer health Care coverage

AB1016,4,12 40.98 Health care coverage. (1) In this subchapter:

AB1016,4,19 (a) "Community rate" means a uniform rate charged by an insurer that is determined in such a manner that all insured individuals with the same level of coverage and plan design in the same community, as that term is defined by the department by rule under sub. (5m), pay the same rate for that coverage without regard to claims experience, health condition, duration of coverage or such demographic, actuarially based characteristics as age, gender, occupation or geographic area within the insured individual's community.

AB1016,5,2 (am) "Employe" means any person who receives earnings as payment for personal services rendered for the benefit of any employer including officers of the employer. An employe is deemed to have separated from the service of an employer at the end of the day on which the employe last performed services for the employer, or, if later, the day on which the employe-employer relationship is terminated because of the expiration or termination of leave without pay, sick leave, vacation or other leave of absence. A person shall not be considered an employe if a person:

AB1016,5,4 1. Is employed under a contract involving the furnishing of more than personal services.

AB1016,5,7 2. Is customarily engaged in an independently established trade, business or profession providing the same type of services to more than one employer and whose services to an employer are not compensated for on a payroll of that employer.

AB1016,5,9 3. Is a patient or inmate of a hospital, home or institution and performs services in the hospital, home or institution.

AB1016,5,13 (b) "Employer" means any person doing business or operating an organization in this state other than the state, including each state agency, and any county, city, village, town, school district, other governmental unit or instrumentality of 2 or more units of government.

AB1016,5,16 (c) "Federal metropolitan statistical area" means an area defined by the federal office of management and budget under 44 USC 3504 (d) (3) as a metropolitan statistical area or a primary metropolitan statistical area.

AB1016,5,23 (2) (a) Subject to pars. (b) and (c), any employer may offer to all of its employes a health care coverage plan through a program offered by the group insurance board. The department may, by rule, establish eligibility standards or contribution requirements for such employes and employers and may, by rule, limit the category of employers allowed to be included in any program available under this subchapter. The department may not require an employer to contribute more than 50% of the cost of an employe's health care coverage offered under this subchapter.

AB1016,6,2 (b) An employer who participates in a program offered by the group insurance board under par. (a) shall offer health care coverage under that program to all of its employes who have a normal work week of 30 or more hours, but may offer that coverage to its employes who have a normal work week of fewer than 30 hours.

AB1016,6,5 (c) An employer who participates in a program offered by the group insurance board under par. (a) shall make any premium payments for the health care coverage of the employer's employes directly to the insurer providing the coverage.

AB1016,6,9 (3) The department shall make available to employers who participate in a health care coverage plan under sub. (2) information that describes any grievance procedure that may be available to any employe who receives health care coverage under sub. (2).

AB1016,6,13 (4) The private employer health care coverage board shall advise the group insurance board on health care issues affecting private employers and shall recommend to the group insurance board the design for a uniform benefit structure for the health care coverage plans under sub. (2).

AB1016,6,17 (5m) The department shall, by rule, define "community" for purposes of the definition of "community rate" under sub. (1) (a). The department may not define "community" as a geographical area that includes less than an entire federal metropolitan statistical area or an entire county, whichever is larger.

AB1016,6,20 (5r) (a) Except as provided in par. (b), an insurer who participates in a program under this subchapter shall charge a community rate for coverage under a health care coverage plan under this subchapter.

AB1016,6,22 (b) The department may, by rule, modify the community rate under par. (a) by taking into account any of the following factors:

AB1016,6,23 1. The insured's age.

AB1016,6,24 2. Whether the insured's coverage is single or a type of family coverage.

AB1016,6,25 3. The insured's gender.

AB1016,7,4 (c) If an insurer raises a community rate for a health care coverage plan, the insurer shall raise all community rates for that health care coverage plan and for all other health care coverage plans offered by the insurer under this subchapter by the same percentage.

AB1016,7,8 (6m) (a) The group insurance board shall solicit widely throughout the state bids from insurers, who provide health maintenance organization health care plans, preferred provider plans and standard plans, as defined in s. 609.01 (7), to offer the health care coverage plans under this subchapter.

AB1016,7,12 (b) Subject to par. (c), the group insurance board shall require that in every area of the state each health care coverage plan offered under this subchapter include at least 2 health maintenance organization health care plans, 2 preferred provider plans and a standard plan, as defined in s. 609.01 (7).

AB1016,7,17 (c) The department may, by rule, establish standards that permit the group insurance board to waive the requirements under par. (b) if the group insurance board determines that at least 2 health maintenance organization health care plans, 2 preferred provider plans or a standard plan, as defined in s. 609.01 (7), are not available in every area of the state.

AB1016,7,20 (6r) No rule may be promulgated under this subchapter unless the private employer health care coverage board, with at least 4 members voting in the majority, approves the rule.

AB1016, s. 9 Section 9. 628.36 (4) (b) 1. of the statutes is amended to read:

AB1016,7,23 628.36 (4) (b) 1. Assisting the department of employe trust funds in the development of health care plans under s. 40.51 (7) and subch. XI of ch. 40.

AB1016, s. 10 Section 10. 628.36 (4) (b) 2. of the statutes is amended to read:

AB1016,8,3 628.36 (4) (b) 2. Providing employers and their employes with information regarding the availability and nature of health care coverage that may be obtained under s. 40.51 (7) and subch. XI of ch. 40.

AB1016, s. 11 Section 11. 628.36 (4) (b) 3. of the statutes is amended to read:

AB1016,8,7 628.36 (4) (b) 3. Providing information to employers regarding how to proceed under s. 40.51 (7) and subch. XI of ch. 40 to obtain health care coverage for their employes.

AB1016, s. 12 Section 12. Nonstatutory provisions.

AB1016,8,13 (1) Private employer health care coverage board; initial membership. Notwithstanding the length of terms or qualifications specified for the members of the private employer health care coverage board under section 15.165 (5) of the statutes, as created by this act, the initial members shall be appointed for the following terms:

AB1016,8,15 (a) Two persons who are eligible to be employes specified under section 15.165 (5) (a) 1. of the statutes, as created by this act, for terms expiring on July 1, 1998.

AB1016,8,17 (b) Two persons who are eligible to be employers specified under section 15.165 (5) (a) 2. of the statutes, as created by this act, for terms expiring on July 1, 1999.

AB1016,8,22 (c) One person who is an actuary specified under section 15.165 (5) (a) 3. of the statutes, as created by this act, one person who is eligible to be an employer specified under section 15.165 (5) (a) 2. of the statutes, as created by this act, and one person who is eligible to be an employe specified under section 15.165 (5) (a) 1. of the statutes, as created by this act, for a term expiring on July 1, 2000.

AB1016,8,23 (End)