SB220: Bill Text

LRB-2522/2

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1995 - 1996 LEGISLATURE

1995 Senate BILL 220

May 30, 1995 - Introduced by Senators Panzer, Buettner, Jauch, Andrea and Risser, cosponsored by Representatives Bock, Handrick, Skindrud, Robson, Baldus, Boyle, Grobschmidt, Gronemus, La Fave and Plombon. Referred to Committee on Insurance.

SB220,1,4 An Act to amend 40.51 (8), 60.23 (25), 66.184, 111.70 (1) (a), 120.13 (2) (g), 185.981 (4t), 185.983 (1) (intro.) and 632.89 (2) (a) 1.; and to create 40.52 (1) (c), 111.70 (4) (m), 111.91 (2) (k), 632.89 (6) and 632.895 (11) of the statutes; relating to: requiring insurance coverage of certain mental disorders.

Analysis by the Legislative Reference Bureau

Under current law, a group health insurance policy (called a "disability insurance policy" in the statutes) that provides coverage of any inpatient hospital services must provide coverage of inpatient hospital services for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems in the minimum amount of at least the first $7,000 minus a copayment of up to 10% or the first 30 days of inpatient services, whichever is less. If a group health insurance policy provides coverage of any outpatient hospital services, it must provide coverage of outpatient hospital services for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems in the minimum amount of at least the first $2,000 minus a copayment of up to 10%. If a group health insurance policy provides coverage of any inpatient or outpatient hospital services, it must provide coverage of transitional services for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems in the minimum amount of at least the first $3,000 minus a copayment of up to 10%. (Transitional services are services, specified by rule by the commissioner of insurance, that are provided in a less restrictive manner than inpatient services but in a more intensive manner than outpatient services.) If a group health insurance policy provides coverage for both inpatient and outpatient hospital services, the total coverage for all types of treatment for nervous and mental disorders and alcoholism and other drug abuse problems need not exceed $7,000 in a policy year.

This bill exempts certain severe mental disorders from the limitations of that law and requires group and individual health insurance policies, including those offered by the state, and self-insured health plans of the state, counties, cities, villages, towns and school districts to provide the same coverage of inpatient or outpatient hospital services or day treatment medical services for the treatment of those mental disorders as is provided under the policy or plan for the treatment of other conditions. No exclusions, limitations, copayments or deductibles may be applied to those mental disorders that are not generally applicable to other conditions. The 5 mental disorders to which the bill applies are schizophrenia, bipolar disorder, major depression, obsessive-compulsive disorder and panic disorder.

For further information see the state and local fiscal estimate, which will be printed as an appendix to this bill.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

SB220, s. 1 Section 1. 40.51 (8) of the statutes is amended to read:

SB220,2,4 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 632.72 (2), 632.87 (3) to (5), 632.895 (5m) and (8) to (10) (11) and 632.896.

SB220, s. 2 Section 2. 40.52 (1) (c) of the statutes is created to read:

SB220,2,6 40.52 (1) (c) The coverage required under s. 632.895 (11).

SB220, s. 3 Section 3. 60.23 (25) of the statutes is amended to read:

SB220,2,10 60.23 (25) Self-insured health plans. Provide health care benefits to its officers and employes on a self-insured basis if the self-insured plan complies with ss. 631.89, 631.90, 631.93 (2), 632.87 (4) and (5), 632.895 (9) and (11) and 632.896.

SB220, s. 4 Section 4. 66.184 of the statutes is amended to read:

SB220,3,2 66.184 Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employes on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.87 (4) and (5), 632.895 (9) and (10) to (11), 632.896, 767.25 (4m) (d) and 767.51 (3m) (d).

SB220, s. 5 Section 5. 111.70 (1) (a) of the statutes is amended to read:

SB220,3,24 111.70 (1) (a) "Collective bargaining" means the performance of the mutual obligation of a municipal employer, through its officers and agents, and the representatives of its employes, to meet and confer at reasonable times, in good faith, with the intention of reaching an agreement, or to resolve questions arising under such an agreement, with respect to wages, hours and conditions of employment, and with respect to a requirement of the municipal employer for a municipal employe to perform law enforcement and fire fighting services under s. 61.66, except as provided in sub. (4) (m) and s. 40.81 (3) and except that a municipal employer shall not meet and confer with respect to any proposal to diminish or abridge the rights guaranteed to municipal employes under ch. 164. The duty to bargain, however, does not compel either party to agree to a proposal or require the making of a concession. Collective bargaining includes the reduction of any agreement reached to a written and signed document. The employer shall not be required to bargain on subjects reserved to management and direction of the governmental unit except insofar as the manner of exercise of such functions affects the wages, hours and conditions of employment of the employes. In creating this subchapter the legislature recognizes that the public employer must exercise its powers and responsibilities to act for the government and good order of the municipality, its commercial benefit and the health, safety and welfare of the public to assure orderly operations and functions within its jurisdiction, subject to those rights secured to public employes by the constitutions of this state and of the United States and by this subchapter.

SB220, s. 6 Section 6. 111.70 (4) (m) of the statutes is created to read:

SB220,4,3 111.70 (4) (m) Health insurance coverage of certain mental disorders. The municipal employer is prohibited from bargaining collectively with respect to the provision of the health insurance coverage required under s. 632.895 (11).

SB220, s. 7 Section 7. 111.91 (2) (k) of the statutes is created to read:

SB220,4,6 111.91 (2) (k) The provision to employes of the health insurance coverage required under s. 632.895 (11).

SB220, s. 8 Section 8. 120.13 (2) (g) of the statutes is amended to read:

SB220,4,10 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.87 (4) and (5), 632.895 (9) and (10) to (11), 632.896, 767.25 (4m) (d) and 767.51 (3m) (d).

SB220, s. 9 Section 9. 185.981 (4t) of the statutes is amended to read:

SB220,4,14 185.981 (4t) A sickness care plan operated by a cooperative association is subject to ss. 252.14, 631.89, 632.72 (2), 632.87 (2m), (3), (4) and (5), 632.895 (10) and (11) and 632.897 (10) and ch. 155.

SB220, s. 10 Section 10. 185.983 (1) (intro.) of the statutes is amended to read:

SB220,4,21 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.89, 631.93, 632.72 (2), 632.775, 632.79, 632.795, 632.87 (2m), (3), (4) and (5), 632.895 (5), (9) and (10) and (9) to (11), 632.896 and 632.897 (10), subch. II of ch. 619 and chs. 609, 630, 635, 645 and 646, but the sponsoring association shall:

SB220, s. 11 Section 11. 632.89 (2) (a) 1. of the statutes is amended to read:

SB220,5,2 632.89 (2) (a) 1. A Except as provided in sub. (6), a group or blanket disability insurance policy issued by an insurer shall provide coverage of nervous and mental disorders and alcoholism and other drug abuse problems if required by and as provided in pars. (b) to (e).

SB220, s. 12 Section 12. 632.89 (6) of the statutes is created to read:

SB220,5,5 632.89 (6) Certain severe mental disorders. This section does not apply to coverage of the mental disorders listed in s. 632.895 (11) (b).

SB220, s. 13 Section 13. 632.895 (11) of the statutes is created to read:

SB220,5,12 632.895 (11) Coverage of certain severe mental disorders. (a) 1. Every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, that provides coverage of inpatient hospital services shall provide coverage of the usual and customary charges for the in-hospital medical treatment, including medication, of any disorder listed in par. (b).

SB220,5,17 2. Every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, that provides coverage of outpatient hospital services shall provide coverage of the usual and customary charges for the out-of-hospital medical treatment, including medication, of any disorder listed in par. (b).

SB220,5,22 3. Every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, that provides coverage of medical services provided by a day treatment program shall provide coverage of the usual and customary charges for medical services provided by a day treatment program, including medication, for the treatment of any disorder listed in par. (b).

SB220,5,24 (b) A disability insurance policy or a self-insured health plan under par. (a) shall provide the coverage required under par. (a) for all of the following disorders:

SB220,5,25 1. Schizophrenia.

SB220,6,1 2. Bipolar disorder.

SB220,6,2 3. Major depression with or without psychotic features.

SB220,6,3 4. Panic disorder.

SB220,6,4 5. Obsessive-compulsive disorder.

SB220,6,8 (c) The coverage under par. (a) may not be subject to exclusions, limitations, copayments or deductibles that are not generally applicable to other conditions for which there is coverage under the policy or plan for inpatient or outpatient hospital services or medical services provided by a day treatment program.

SB220,6,9 (d) This subsection does not apply to any of the following:

SB220,6,10 1. A disability insurance policy that covers only certain specified diseases.