AB394: Bill Text

AB394, s. 36 Section 36. 635.20 (intro.) of the statutes is amended to read:

AB394,31,4 635.20 Definitions. (intro.) In this subchapter chapter:

AB394, s. 37 Section 37. Subchapter II (title) of chapter 635 [precedes 635.20] of the statutes is repealed.

AB394, s. 38 Section 38. 635.20 (1c) of the statutes is repealed and recreated to read:

AB394,31,11 635.20 (1c) "Dependent" means a spouse, an unmarried child under the age of 19 years, an unmarried child who is a full-time student under the age of 21 years and who is financially dependent upon the parent, or an unmarried child of any age who is medically certified as disabled and who is dependent upon the parent.

AB394, s. 39 Section 39. 635.20 (1m) of the statutes is repealed and recreated to read:

AB394,31,20 635.20 (1m) "Eligible employe" means an employe who works on a full-time basis and has a normal work week of 30 or more hours. "Eligible employe" includes a sole proprietor, a business owner, including the owner of a farm business, a partner of a partnership, a member of a limited liability company and an independent contractor if the sole proprietor, business owner, partner, member or independent contractor is included as an employe under a health benefit plan of a small employer, but "eligible employe" does not include an employe who works on a part-time, temporary or substitute basis.

AB394, s. 40 Section 40. 635.20 (10) of the statutes is amended to read:

AB394,31,24 635.20 (10) "Plan" means the health insurance plan for individuals employed by small employers that is created under s. 635.21 and that consists of a policy under this subchapter chapter containing the basic benefits.

AB394, s. 41 Section 41. 635.20 (13) of the statutes is repealed and recreated to read:

AB394,32,9 635.20 (13) "Small employer insurer" means an insurer that is authorized to do business in this state, in one or more lines of insurance that includes health insurance, and that offers group health benefit plans covering eligible employes of one or more small employers in this state, or that sells 3 or more individual health benefit plans to a small employer, covering eligible employes of the small employer. "Small employer insurer" includes a health maintenance organization, as defined in s. 609.01 (2), a preferred provider plan, as defined in s. 609.01 (4), and an insurer operating as a cooperative association organized under ss. 185.981 to 185.985, but does not include a limited service health organization, as defined in s. 609.01 (3).

AB394, s. 42 Section 42. 635.25 (1) (a) (intro.) of the statutes is amended to read:

AB394,32,12 635.25 (1) (a) (intro.) To be eligible to participate in the plan by purchasing a policy under this subchapter chapter containing the basic benefits, an employer:

AB394, s. 43 Section 43. 635.25 (1) (b) of the statutes is amended to read:

AB394,32,17 635.25 (1) (b) Except as provided in ss. 645.43 and 646.35, an employer that purchases a policy under this subchapter chapter containing the basic benefits and that ceases to be eligible to participate in the plan during a policy period shall retain coverage under the plan to the end of the policy period.

AB394, s. 44 Section 44. 635.25 (1m) of the statutes is amended to read:

AB394,32,21 635.25 (1m) Notwithstanding sub. (1), an employer is not eligible to participate in the plan if all of the individuals to be covered under the plan may be covered by a single one policy providing individual single or family coverage.

AB394, s. 45 Section 45. 635.254 (1) of the statutes is amended to read:

AB394,33,2 635.254 (1) An employer that participates in the plan shall pay a premium contribution of not less than 50% of the premium rate on behalf of an eligible employe with individual single coverage and not less than 40% of the premium rate on behalf of an eligible employe with family coverage.

AB394, s. 46 Section 46. 635.254 (3) of the statutes is amended to read:

AB394,33,8 635.254 (3) For an eligible employe who obtains coverage under the health insurance risk-sharing plan under s. 619.12 (2) (e) 2., an employer under sub. (1) shall pay a premium contribution to the health insurance risk-sharing plan that is equal to the amount that the employer would pay on behalf of the employe for coverage under the plan under this subchapter chapter.

AB394, s. 47 Section 47. 635.26 (1s) of the statutes is repealed.

AB394, s. 48 Section 48. 635.28 of the statutes is amended to read:

AB394,33,14 635.28 Liability of state and plan board. Neither the state nor the plan board is liable for any obligation arising under the plan. Plan board members are immune from civil liability for acts or omissions while performing their duties under this subchapter chapter.

AB394, s. 49 Section 49. 635.29 of the statutes is amended to read:

AB394,33,18 635.29 (title) Applicability of health insurance mandates. The health insurance mandates apply to the plan under this subchapter chapter only to the extent determined by the plan board under s. 635.23 (1) (b).

AB394, s. 50 Section 50. 635.31 of the statutes is amended to read:

AB394,33,22 635.31 Chapters 600 to 655 applicable. Except as otherwise provided in this subchapter chapter, the plan shall comply with and be administered in compliance with chs. 600 to 655.

AB394, s. 51 Section 51. 646.35 (5) of the statutes is amended to read:

AB394,34,7 646.35 (5) Rate increases. The board may increase any rates or premiums on policies during continuation of coverage under sub. (2) (b) or (3) (b) to the extent the policies permit the insurer to increase the rates or premiums and subject to s. 632.746 and any rules promulgated under s. 632.7465. If the board determines that the rates or premiums on policies which do not permit an increase or the rates or premiums as increased to the extent permitted by the policies are inadequate under s. 625.11 (3), the board may offer the policyholders the option of terminating the coverage or continuing the coverage at adequate rates or premiums as determined by the board.

AB394, s. 52 Section 52 . Nonstatutory provisions.

AB394,34,12 (1)   Rules on risk adjustment mechanism. The commissioner of insurance shall submit proposed rules required under section 632.747 (4) (a) of the statutes, as created by this act, to the legislative council staff for review under section 227.15 (1) of the statutes no later than April 1, 1996.

AB394, s. 53 Section 53. Initial applicability.

AB394,34,21 (1)  The treatment of sections 15.735 (1), 185.981 (4t), 185.983 (1) (intro.) and (1g), 600.01 (2) (b), 601.424, 625.03 (6), 625.12 (2), 625.15 (1), 625.22 (1) and (4), 628.34 (3) (c), 628.36 (2) (b) 1., 3. and 5., 631.01 (4), 632.70, 632.745, 632.746, 632.7465, 632.747, 632.748, 632.749, 632.76 (2) (a), 632.896 (4), 632.897 (2) (d) and (9) (c), 635.20 (intro.), (1c), (1m), (10) and (13), 635.25 (1) (a) (intro.) and (b), 635.26 (1s), 635.28, 635.29, 635.31 and 646.35 (5), chapter 635 (title) and subchapter I and subchapter II (title) of chapter 635 of the statutes first applies to health benefit plans issued or renewed on October 1, 1996.

AB394, s. 54 Section 54. Effective date. This act takes effect on October 1, 1996, except as follows:

AB394,35,3 (1)  The treatment of sections 619.12 (1) (intro.), 632.727, 632.747 (4) and (5) and 632.83 of the statutes and Section 52 (1) of this act take effect on the day after publication.

AB394,35,4 (End)