AB500: Bill Text

AB500,30,24 (a) The insured's age.

AB500,30,25 (b) The insured's gender.

AB500,31,1 (c) The insured's geographic area.

AB500,31,2 (d) The insured's tobacco use.

AB500,31,4 (e) Whether the insured's coverage is single coverage or a type of family coverage.

AB500,31,7 (3) For each of the following factors, the rate bands prescribed by the commissioner by rule may not restrict the ratio of the highest variance to the lowest variance to a ratio that is less than the ratio shown after each factor:

AB500,31,8 (a) For age, a ratio of 2.5.

AB500,31,9 (b) For gender, a ratio of 1.2.

AB500,31,10 (c) For geographic area, a ratio of 1.2.

AB500,31,17 (4) Notwithstanding subs. (1) and (2), the commissioner may promulgate rules that permit an insurer to vary from the community rate required under sub. (1) and modified under sub. (2) within restrictions provided in the rules. The restrictions provided in the rules shall be reasonably designed to provide for an orderly transition to the community rates required under sub. (1) and modified under sub. (2) by no later than the first day of the 24th month beginning after the date on which the department of health and social services makes a certification under s. 49.44 (5).

AB500,31,20 (5) An employer may pay any portion or all of the premium, or the premium less a subsidy under s. 637.27, on behalf of an employe who is not a medical assistance recipient.

AB500,31,22 637.26 Abortion coverage. The basic plan may provide coverage for services related to the performance of an abortion only if any of the following applies:

AB500,32,5 (1) The abortion is directly and medically necessary to save the life of the woman or in a case of sexual assault or incest, provided that prior thereto the physician signs a certification which so states, and provided that, in the case of sexual assault or incest the crime has been reported to the law enforcement authorities. The certification shall be affixed to the claim form or invoice when submitted to an insurer for payment, and shall specify and attest to the direct medical necessity of such abortion upon the best clinical judgment of the physician or attest to his or her belief that sexual assault or incest has occurred.

AB500,32,12 (2) The physician performing the abortion determines that, due to a medical condition existing prior to the abortion, the abortion is directly and medically necessary to prevent grave, long-lasting physical health damage to the woman, provided that prior thereto the physician signs a certification which so states. The certification shall be affixed to the claim form or invoice when submitted to an insurer for payment, and shall specify and attest to the direct medical necessity of such abortion upon the best clinical judgment of the physician.

AB500,32,19 637.27 Premium subsidies. (1) The commissioner shall establish and administer a program to subsidize, from the appropriations under s. 20.145 (9) (c) and (i), the premium cost for coverage under the basic plan for an individual other than a medical assistance recipient or for an employe whose employer provides coverage for the employe under the basic plan, if the individual or employe had a family income in the preceding year that was less than 200% of the poverty line for a family the size of the individual's or employe's family.

AB500,33,4 (2) Except as provided in rules promulgated under sub. (3) (d) to (f), for an individual or employe who is eligible for a subsidy under sub. (1) and whose family income in the preceding year did not exceed 100% of the poverty line for a family the size of the individual's or employe's family, the subsidy amount shall be 100% of the cost of coverage under the basic plan. Except as provided in rules promulgated under sub. (3) (d) to (f), for all other individuals or employes who are eligible for a subsidy under sub. (1), the subsidy amount shall be reduced from 100% of the cost of coverage by one percentage point for every percentage point that the individual's or employe's family income in the preceding year exceeded 100% of the poverty line for a family the size of the individual's or employe's family.

AB500,33,5 (3) The commissioner shall promulgate rules that do all of the following:

AB500,33,6 (a) Define family income for purposes of this section.

AB500,33,9 (b) Specify how an individual, employe or employer may provide satisfactory evidence of family income to the insurer providing coverage under the basic plan for the individual or employe.

AB500,33,12 (c) Establish procedures for paying subsidies to insurers for the cost of coverage under the basic plan for individuals or employes eligible for a subsidy under this section.

AB500,33,14 (d) Establish asset-based eligibility criteria for premium subsidies under this section.

AB500,33,17 (e) Limit an individual's eligibility for premium subsidies under this section for specified periods, if the individual transfers assets or income for less than fair market within a specified period prior to applying for a premium subsidy under this section.

AB500,33,19 (f) Provide for reducing or eliminating premium subsidies under this section for violations of this chapter or of rules promulgated under this chapter.

AB500,33,22 (g) Provide for the recovery of premium subsidies paid under this section, if the family income of a recipient of a premium subsidy increases above the level at which the recipient is eligible for a premium subsidy under this section.

AB500,33,23 637.30 Commissioner duties. The commissioner shall do all of the following:

AB500,33,25 (1) Enter into contracts with insurers selected under s. 637.10 to provide coverage under the basic plan.

AB500,34,6 (2) After reasonable notice and opportunity for hearing, recover premium subsidies paid under s. 637.27 that are improperly or erroneously paid, by offsetting or adjusting amounts owed to the insurer under this chapter, by crediting against an insurer's future claims for premium subsidies or by requiring the insurer to make direct payment to the commissioner. Any moneys received under this subsection shall be credited to the appropriation under s. 20.145 (9) (i).

AB500,34,13 (3) Review the statutory provisions governing the provision of coverage under the basic plan to medical assistance recipients and, if the commissioner determines that remedial legislation is required, submit proposed remedial legislation to the appropriate standing committees of the legislature under s. 13.172 (3), no later than the first day of the first floorperiod ending before the first day of the 12th month beginning after the date on which the department makes a certification under s. 49.44 (5).

AB500, s. 66 Section 66. Initial applicability.

AB500,34,19 (1)  Basic plan premium subsidies. The treatment of sections 20.145 (9) (c) and (i) and 637.27 of the statutes first applies to subsidies for premiums for coverage under the basic plan that commences on the first day of the 12th month beginning after the date on which the department of health and social services makes a certification under section 49.44 (5) of the statutes, as created by this act.

AB500,34,20 (End)