AB100, s. 4804
21Section
4804. 601.64 (4) of the statutes is amended to read:
AB100,1804,322
601.64
(4) Criminal penalty. Whoever intentionally violates or intentionally
23permits any person over whom he or she has authority to violate or intentionally aids
24any person in violating any insurance statute or rule of this state
, s. 149.13 or
25149.135 or any effective order issued under s. 601.41 (4) may, unless a specific penalty
1is provided elsewhere in the statutes, be fined not more than $10,000 if a corporation
2or if a natural person be fined not more than $5,000 or imprisoned for not to exceed
33 years or both. Intent has the meaning expressed under s. 939.23.
AB100, s. 4805
4Section
4805. 611.11 (4) (title) of the statutes is amended to read:
AB100,1804,55
611.11
(4) (title)
Municipalities Local governmental units.
AB100, s. 4806
6Section
4806. 611.11 (4) (a) of the statutes is amended to read:
AB100,1804,87
611.11
(4) (a) In this subsection,
"municipality" "local governmental unit" has
8the meaning given in s. 345.05 (1)
(c) (bg).
AB100, s. 4807
9Section
4807. 611.11 (4) (b) (intro.) of the statutes is amended to read:
AB100,1804,1310
611.11
(4) (b) (intro.) Any number of
municipalities local governmental units 11or associations of
municipalities local governmental units or both may organize a
12municipal insurance mutual under s. 611.13, subject to s. 611.23, to provide any of
13the following for its members:
AB100, s. 4808
14Section
4808. 613.03 (3) of the statutes is amended to read:
AB100,1804,1915
613.03
(3) Applicability of insurance laws. Except as otherwise specifically
16provided, service insurance corporations organized or operating under this chapter
17are subject to
subch. II of ch. 619 and ss. 610.01, 610.11, 610.21, 610.23 and 610.24
18and chs. 600, 601, 609, 617, 620, 623, 625, 627, 628, 631, 632, 635 and 645 and to no
19other insurance laws.
AB100, s. 4809
20Section
4809. 613.03 (4) of the statutes is created to read:
AB100,1804,2221
613.03
(4) Mandatory health insurance risk-sharing plan. Service insurance
22corporations organized or operating under this chapter are subject to ch. 149.
AB100, s. 4810
23Section
4810. 614.05 (1) of the statutes is amended to read:
AB100,1804,2524
614.05
(1) Chapters 611 and 619. No section of ch. 611 or
subch. I of ch. 619
25applies to fraternals unless it is specifically made applicable by this chapter.
AB100, s. 4811
1Section
4811. Subchapter I of chapter 619 [precedes 619.001] of the statutes
2is renumbered chapter 619 [precedes 619.001].
AB100, s. 4812
3Section
4812. Subchapter I (title) of chapter 619 [precedes 619.01] of the
4statutes is repealed.
AB100, s. 4813
5Section
4813. Subchapter II (title) of chapter 619 [precedes 619.10] of the
6statutes is repealed.
AB100, s. 4814
7Section
4814. 619.10 (intro.) of the statutes is renumbered 149.10 (intro.) and
8amended to read:
AB100,1805,9
9149.10 Definitions. (intro.) In this
subchapter chapter:
AB100, s. 4815
10Section
4815. 619.10 (1) of the statutes is repealed.
AB100, s. 4816
11Section
4816. 619.10 (1m) of the statutes is repealed.
AB100, s. 4817
12Section
4817. 619.10 (2) of the statutes is renumbered 149.10 (2) and amended
13to read:
AB100,1805,1514
149.10
(2) "Board" means the board of governors established under s.
619.15 15149.15.
AB100, s. 4818
16Section
4818. 619.10 (3) of the statutes is renumbered 149.10 (3) and amended
17to read:
AB100,1805,2018
149.10
(3) "Eligible person" means a resident of this state who qualifies under
19s.
619.12 149.12 whether or not the person is legally responsible for the payment of
20medical expenses incurred on the person's behalf.
AB100, s. 4819
21Section
4819. 619.10 (3m) and (4) of the statutes are renumbered 149.10 (3m)
22and (4).
AB100, s. 4820
23Section
4820. 619.10 (4m) of the statutes is renumbered 149.10 (4m).
AB100, s. 4821
24Section
4821. 619.10 (5) of the statutes is renumbered 149.10 (5) and amended
25to read:
AB100,1806,12
1149.10
(5) "Insurer" means any person or association of persons, including a
2health maintenance organization, limited service health organization or preferred
3provider plan offering or insuring health services on a prepaid basis, including, but
4not limited to, policies of health insurance issued by a currently licensed insurer,
as
5defined in s. 600.03 (27), nonprofit hospital or medical service plans under ch. 613,
6cooperative medical service plans under s. 185.981, or other entity whose primary
7function is to provide diagnostic, therapeutic or preventive services to a defined
8population in return for a premium paid on a periodic basis. "Insurer" includes any
9person providing health services coverage for individuals on a self-insurance basis
10without the intervention of other entities, as well as any person providing health
11insurance coverage under a medical reimbursement plan to persons. "Insurer" does
12not include a plan under ch. 613 which offers only dental care.
AB100, s. 4822
13Section
4822. 619.10 (6) and (7) of the statutes are renumbered 149.10 (6) and
14(7).
AB100, s. 4823
15Section
4823. 619.10 (8) of the statutes is renumbered 149.10 (8) and amended
16to read:
AB100,1806,1817
149.10
(8) "Plan" means the health care insurance plan established
and
18administered under this
subchapter chapter.
AB100, s. 4824
19Section
4824. 619.10 (9) of the statutes is renumbered 149.10 (9) and amended
20to read:
AB100,1807,521
149.10
(9) "Resident" means a person who
has been is legally domiciled in this
22state
for a period of at least 30 days. For purposes of this
subchapter chapter, legal
23domicile is established by living in this state and obtaining a Wisconsin motor vehicle
24operator's license, registering to vote in Wisconsin or filing a Wisconsin income tax
25return. A child is legally domiciled in this state if the child lives in this state and if
1at least one of the child's parents or the child's guardian is legally domiciled in this
2state. A person with a developmental disability or another disability which prevents
3the person from obtaining a Wisconsin motor vehicle operator's license, registering
4to vote in Wisconsin, or filing a Wisconsin income tax return, is legally domiciled in
5this state by living in this state
for 30 days.
AB100, s. 4825
6Section
4825. 619.11 of the statutes is renumbered 149.11 and amended to
7read:
AB100,1807,11
8149.11 (title) Establishment
Operation of plan. The
commissioner 9department shall promulgate rules
establishing for the operation of a plan of health
10insurance coverage for an eligible person which satisfies the requirements of this
11chapter.
AB100, s. 4826
12Section
4826. 619.12 (title) of the statutes is renumbered 149.12 (title).
AB100, s. 4827
13Section
4827. 619.12 (1) of the statutes is renumbered 149.12 (1), and 149.12
14(1) (intro.), as renumbered, is amended to read:
AB100,1807,2115
149.12
(1) (intro.) Except as provided in subs. (1m) and (2), the board or
16administering carrier plan administrator shall certify as eligible a person who is
17covered by medicare because he or she is disabled under
42 USC 423, a person who
18submits evidence that he or she has tested positive for the presence of HIV, antigen
19or nonantigenic products of HIV or an antibody to HIV, and any person who receives
20and submits any of the following based wholly or partially on medical underwriting
21considerations within 9 months prior to making application for coverage by the plan:
AB100, s. 4828
22Section
4828. 619.12 (1m) (intro) and (a) of the statutes are consolidated,
23renumbered 149.12 (1m) and amended to read:
AB100,1808,224
149.12
(1m) The board or
administering carrier plan administrator may not
25certify a person as eligible under circumstances requiring notice under sub. (1) (a)
1to (d) if the required notices were issued by
one of the following: (a) An an insurance
2intermediary who is not acting as an administrator, as defined in s. 633.01.
AB100, s. 4829
3Section
4829. 619.12 (1m) (b) of the statutes is repealed.
AB100, s. 4830
4Section
4830. 619.12 (2) of the statutes is renumbered 149.12 (2), and 149.12
5(2) (b) 1. and (e) 2. c., as renumbered, are amended to read:
AB100,1808,96
149.12
(2) (b) 1. Except as provided in subd. 2., no person who is covered under
7the plan and
who voluntarily terminates the coverage under the plan
, is again
8eligible for coverage unless 12 months have elapsed since the person's latest
9voluntary termination of coverage under the plan.
AB100,1808,1410
(e) 2. c. The board finds that the person is eligible for coverage under the plan
11after a review process, determined by the
commissioner
department by rule under
12s.
619.123 149.123, that evaluates and approves the certification by the physician
13that the person has a severe and chronic or long-lasting physical or mental illness
14or disability.
AB100, s. 4831
15Section
4831. 619.12 (3) of the statutes is renumbered 149.12 (3), and 149.12
16(3) (c), as renumbered, is amended to read:
AB100,1808,2017
149.12
(3) (c) The
commissioner, in consultation with the board, department 18may promulgate rules specifying other deductible or coinsurance amounts that, if
19paid or reimbursed for persons, will not make the persons ineligible for coverage
20under the plan.
AB100, s. 4832
21Section
4832. 619.123 of the statutes is renumbered 149.123 and amended to
22read:
AB100,1809,2
23149.123 Rules for review of physician certification. The
commissioner 24department shall promulgate rules that establish the procedure to be used by the
25board under s.
619.12 149.12 (2) (e) 2. c. The rules shall provide for an insurer that
1would be affected by the decision of the board to participate in the review process to
2contest or support the physician's certification.
AB100, s. 4833
3Section
4833. 619.125 of the statutes is renumbered 149.125 and amended to
4read:
AB100,1809,7
5149.125 Health insurance risk-sharing plan fund. There is created a
6health insurance risk-sharing plan fund, under the management of the
board 7department, to fund administrative expenses.
AB100, s. 4834
8Section
4834. 619.13 (title) of the statutes is renumbered 149.13 (title).
AB100, s. 4835
9Section
4835. 619.13 (1) (a) of the statutes is renumbered 149.13 (1) (a) and
10amended to read:
AB100,1809,1511
149.13
(1) (a) Every insurer shall participate in the cost of administering the
12plan, except the commissioner may by rule exempt as a class those insurers whose
13share as determined under par. (b) would be so minimal as to not exceed the
14estimated cost of levying the assessment.
The commissioner shall advise the
15department of the insurers participating in the cost of administering the plan.
AB100, s. 4836
16Section
4836. 619.13 (1) (b) of the statutes is renumbered 149.13 (1) (b) and
17amended to read:
AB100,1809,2418
149.13
(1) (b)
Except as provided by a rule promulgated under s. 619.145 (4),
19every Every participating insurer shall share in the operating, administrative and
20subsidy expenses of the plan in proportion to the ratio of the insurer's total health
21care coverage revenue for residents of this state during the preceding calendar year
22to the aggregate health care coverage revenue of all participating insurers for
23residents of this state during the preceding calendar year, as determined by the
24commissioner.
AB100, s. 4837
25Section
4837. 619.13 (1) (c) of the statutes is repealed.
AB100, s. 4838
1Section
4838. 619.13 (1) (d) of the statutes is renumbered 149.13 (1) (d), and
2149.13 (1) (d) 2., as renumbered, is amended to read:
AB100,1810,93
149.13
(1) (d) 2. If the
department or the commissioner finds that the
4commissioner's authority to require insurers to report under chs. 600 to 646 and 655
5is not adequate to permit the
department, the commissioner or the board to carry out
6the
department's, commissioner's or
the board's responsibilities under this
7subchapter chapter, the commissioner
may shall promulgate rules requiring
8insurers to report the information necessary for the
department, commissioner and
9the board to make the determinations required under this
subchapter chapter.
AB100, s. 4839
10Section
4839. 619.13 (2) of the statutes is renumbered 149.13 (2).
AB100, s. 4840
11Section
4840. 619.135 (title) of the statutes is renumbered 149.135 (title).
AB100, s. 4841
12Section
4841. 619.135 (1) (a) of the statutes is renumbered 149.135 (1) (a) and
13amended to read:
AB100,1810,2114
149.135
(1) (a) Whenever a person becomes eligible for and obtains coverage
15under the plan as a result of receiving a notice under s.
619.12 149.12 (1) (am), (b)
16or (c), the commissioner shall levy an assessment of $1,750 against the insurer that
17issued the notice, except that the commissioner may not levy an assessment if the
18notice of cancellation under s.
619.12 149.12 (1) (am) was issued on one of the
19permissible grounds under s. 631.36 (2) (a).
The commissioner shall notify the
20department if an assessment is not levied under this paragraph because a notice of
21cancellation was issued on permissible grounds.
AB100, s. 4842
22Section
4842. 619.135 (1) (b) of the statutes is renumbered 149.135 (1) (b).
AB100, s. 4843
23Section
4843. 619.135 (1) (c) of the statutes is renumbered 149.135 (1) (c) and
24amended to read:
AB100,1811,4
1149.135
(1) (c) If an assessment levied under par. (a) is not paid within the time
2prescribed, the commissioner shall impose a penalty against the insurer in an
3amount established by the commissioner by rule
, in consultation with the
4department.
AB100, s. 4844
5Section
4844. 619.135 (1) (d) of the statutes is renumbered 149.135 (1) (d) and
6amended to read:
AB100,1811,87
149.135
(1) (d) All assessments and penalties collected under this subsection
8shall be credited to the appropriation under s.
20.145 (7) (g) 20.435 (5) (hp).
AB100, s. 4845
9Section
4845. 619.135 (2) of the statutes is renumbered 149.135 (2) and
10amended to read:
AB100,1811,2111
149.135
(2) If the moneys under s.
20.145 (7) (a) and (g) 20.435 (5) (ah), (g) and
12(hp) are insufficient to reimburse the plan for premium reductions under s.
619.165 13149.165 and deductible reductions under s.
619.14 149.14 (5) (a), or the
commissioner 14department determines that the moneys under s.
20.145 (7) (a) and (g) 20.435 (5)
15(ah), (g) and (hp) will be insufficient to reimburse the plan for premium reductions
16under s.
619.165 149.165 and deductible reductions under s.
619.14 149.14 (5) (a),
17the
department shall notify the commissioner. In consultation with the department,
18the commissioner shall, by rule, increase the amount of the assessment under sub.
19(1) (a) or levy an assessment against every insurer, or a combination of both,
20sufficient to reimburse the plan for premium reductions under s.
619.165 149.165 21and deductible reductions under s.
619.14 149.14 (5) (a).
AB100, s. 4846
22Section
4846. 619.135 (3) of the statutes is renumbered 149.135 (3) and
23amended to read:
AB100,1812,524
149.135
(3) In addition to the assessments under subs. (1) (a) and (2),
in
25consultation with the department the commissioner may, by rule, establish an
1assessment to be levied against each insurer that issues a notice of rejection under
2s.
619.12 149.12 (1) (a) to a person who becomes eligible for and obtains coverage
3under the plan as a result of receiving the notice. Any assessments levied and
4collected under this subsection shall be credited to the appropriation under s.
20.145
5(7) (g) 20.435 (5) (hp).
AB100, s. 4847
6Section
4847. 619.14 (title) of the statutes is renumbered 149.14 (title).
AB100, s. 4848
7Section
4848. 619.14 (1) of the statutes is renumbered 149.14 (1), and 149.14
8(1) (b), as renumbered, is amended to read:
AB100,1812,139
149.14
(1) (b) If an individual terminates medical assistance coverage and
10applies for coverage under the plan within 45 days after the termination and is
11subsequently found to be eligible under s.
619.12
149.12, the effective date of
12coverage for the eligible person under the plan shall be the date of termination of
13medical assistance coverage.
AB100, s. 4849
14Section
4849. 619.14 (2) of the statutes is renumbered 149.14 (2).
AB100, s. 4850
15Section
4850. 619.14 (3) of the statutes is renumbered 149.14 (3), and 149.14
16(3) (intro.) and (c) 1. and 3., as renumbered, are amended to read:
AB100,1813,317
149.14
(3) Covered expenses. (intro.) Except as restricted by cost containment
18provisions under s.
619.17 149.17 (4)
and except as reduced by the board under s.
19619.15 (3) (e), covered expenses shall be the
usual and customary allowable charges
20paid under the medical assistance program under ss. 49.45 to 49.47 for the services
21provided by persons licensed under ch. 446
and certified under s. 49.45 (2) (a) 11.
22Except as restricted by cost containment provisions under s.
619.17 149.17 (4)
and
23except as reduced by the board under s. 619.15 (3) (e), covered expenses shall also be
24the
usual and customary allowable charges
paid under the medical assistance
25program under ss. 49.45 to 49.47 for the following services and articles
when if the
1service or article is prescribed by a physician
who is licensed under ch. 448 or in
2another state
and who is certified under s. 49.45 (2) (a) 11. and if the service or article
3is provided by a provider certified under s. 49.45 (2) (a) 11.:
AB100,1813,74
(c) 1. Inpatient treatment in a hospital
as defined in s. 632.89 (1) (c) or in a
5medical facility in another state approved by the board, licensed under s. 50.35 for
6up to 30 days' confinement per calendar year due to alcoholism or drug abuse and up
7to 60 days' confinement per calendar year for nervous and mental disorders.
AB100,1813,108
3. Subject to the limits under subd. 2. and to rules promulgated by the
9commissioner department, services for the chronically mentally ill in community
10support programs operated under s. 51.421.
AB100, s. 4851
11Section
4851. 619.14 (4) of the statutes is renumbered 149.14 (4), and 149.14
12(4) (d) and (m), as renumbered, are amended to read:
AB100,1813,1713
149.14
(4) (d) That part of any charge for services or articles rendered or
14prescribed by a physician, dentist or other health care personnel which exceeds the
15prevailing charge in the locality where the service is provided allowable charge paid
16under the medical assistance program under ss. 49.45 to 49.47 or any charge not
17medically necessary.
AB100,1813,1918
(m) Experimental treatment, as determined by the
board or its designee 19department.
AB100, s. 4852
20Section
4852. 619.14 (5) (title) of the statutes is renumbered 149.14 (5) (title).
AB100, s. 4853
21Section
4853. 619.14 (5) (a) of the statutes is renumbered 149.14 (5) (a) and
22amended to read:
AB100,1814,1723
149.14
(5) (a) The plan shall offer a deductible in combination with appropriate
24premiums determined under this
subchapter chapter for major medical expense
25coverage required under this section. For coverage offered to those persons eligible
1for medicare, the plan shall offer a deductible equal to the deductible charged by part
2A of title XVIII of the federal social security act, as amended. The deductible
3amounts for all other eligible persons shall be dependent upon household income as
4determined under s.
619.165 149.165. For eligible persons under s.
619.165 (1) (b)
51. 149.165 (2) (a), the deductible shall be $500. For eligible persons under s.
619.165
6(1) (b) 2. 149.165 (2) (b), the deductible shall be $600. For eligible persons under s.
7619.165 (1) (b) 3. 149.165 (2) (c), the deductible shall be $700. For eligible persons
8under s.
619.165 (1) (b) 4. 149.165 (2) (d), the deductible shall be $800. For all other
9eligible persons who are not eligible for medicare, the deductible shall be $1,000.
10With respect to all eligible persons, expenses used to satisfy the deductible during
11the last 90 days of a calendar year shall also be applied to satisfy the deductible for
12the following calendar year. The schedule of premiums shall be promulgated by rule
13by the
commissioner department. The
commissioner department shall set rates at
1460% of the operating and administrative costs of the plan
, except that a rate may not
15exceed 200% of the rate that a standard risk would be charged under an individual
16policy providing substantially the same coverage and deductibles as are provided
17under the plan.
AB100, s. 4854
18Section
4854. 619.14 (5) (b) of the statutes is renumbered 149.14 (5) (b) and
19amended to read:
AB100,1814,2420
149.14
(5) (b) Except as provided in par. (c), if the covered costs incurred by the
21eligible person exceed the deductible for major medical expense coverage in a
22calendar year, the plan shall pay at least 80% of
the allowable charges paid under
23the medical assistance program under ss. 49.45 to 49.47 for any additional covered
24costs incurred by the person during the calendar year.
AB100, s. 4855
1Section
4855. 619.14 (5) (c) of the statutes is renumbered 149.14 (5) (c) and
2amended to read: