AB100-engrossed,2099,23
20(2) (a) Except as specified by the board, the terms of coverage under s. 619.14,
21including deductible reductions under s. 619.14 (5) (a), do not apply to the coverage
22offered under this section. Premium reductions under s. 619.165 do not apply to the
23coverage offered under this section.
AB100-engrossed,2100,224
(b) The schedule of premiums for coverage under this section shall be
25promulgated by rule by the commissioner. The rates for coverage under this section
1shall be set such that they differ from the rates for coverage under s. 619.14 by the
2same percentage as the percentage difference between the following:
AB100-engrossed,2100,53
1. The rate that a standard risk would be charged under an individual policy
4providing substantially the same coverage and deductibles as provided under s.
5619.14.
AB100-engrossed,2100,86
2. The rate that a standard risk would be charged under an individual policy
7providing substantially the same coverage and deductibles as the coverage offered
8under this section.
AB100-engrossed, s. 4860d
9Section 4860d. 619.146 of the statutes, as created by 1997 Wisconsin Act ....
10(this act), is renumbered 149.146, and 149.146 (1) (a) and (b) and (2) (a) and (b)
11(intro.) and 1., as renumbered, are amended to read:
AB100-engrossed,2100,1512
149.146
(1) (a) Beginning on January 1, 1998, in addition to the coverage
13required under s.
619.14 149.14, the plan shall offer to all eligible persons a choice
14of coverage, as described in section 2744 (a) (1) (
C), P.L.
104-191. Any such choice
15of coverage shall be major medical expense coverage.
AB100-engrossed,2100,2416
(b) An eligible person may elect once each year, at the time and according to
17procedures established by the
board department, among the coverages offered under
18this section and s.
619.14 149.14. If an eligible person elects new coverage, any
19preexisting condition exclusion imposed under the new coverage is met to the extent
20that the eligible person has been previously and continuously covered under this
21subchapter chapter. No preexisting condition exclusion may be imposed on an
22eligible person who elects new coverage if the person was an eligible individual when
23first covered under this
subchapter chapter and the person remained continuously
24covered under this
subchapter chapter up to the time of electing the new coverage.
AB100-engrossed,2101,4
1(2) (a) Except as specified by the
board department, the terms of coverage
2under s.
619.14 149.14, including deductible reductions under s.
619.14 149.14 (5)
3(a), do not apply to the coverage offered under this section. Premium reductions
4under s.
619.165 149.165 do not apply to the coverage offered under this section.
AB100-engrossed,2101,95
(b) (intro.) The schedule of premiums for coverage under this section shall be
6promulgated by rule by the
commissioner department, as provided in s. 149.143. The
7rates for coverage under this section shall be set such that they differ from the rates
8for coverage under s.
619.14 149.14 by the same percentage as the percentage
9difference between the following:
AB100-engrossed,2101,1210
1. The rate that a standard risk would be charged under an individual policy
11providing substantially the same coverage and deductibles as provided under s.
12619.14 149.14.
AB100-engrossed,2102,816
149.15
(1) The plan shall
operate subject to the supervision and approval of a
17have a board
of governors consisting of representatives of 2 participating insurers
18which are nonprofit corporations,
representatives of 2 other participating insurers,
193 health care provider representatives, including one representative of the State
20Medical Society of Wisconsin, one representative of the Wisconsin Health and
21Hospital Association and one representative of an integrated multidisciplinary
22health system, and 3 public members,
including one representative of small
23businesses in the state, appointed by the
commissioner secretary for staggered
243-year terms. In addition, the commissioner
, or a designated representative from
25the office of the commissioner
, and the secretary, or a designated representative from
1the department, shall be
a member members of the board. The public members shall
2not be professionally affiliated with the practice of medicine, a hospital or an insurer.
3At least 2 of the public members shall be individuals reasonably expected to qualify
4for coverage under the plan or the parent or spouse of such an individual. The
5commissioner secretary or the
commissioner's secretary's representative shall be the
6chairperson of the board. Board members, except the commissioner or the
7commissioner's representative
and the secretary or the secretary's representative,
8shall be compensated at the rate of $50 per diem plus actual and necessary expenses.
AB100-engrossed,2102,1611
149.15
(2) Annually, the board shall make a report to the
members of the plan
12and to the chief clerk of each house of the legislature, for distribution to the 13appropriate standing committees under s. 13.172 (3)
,
and to the members of the plan 14summarizing the activities of the plan in the preceding calendar year. The annual
15report shall define the cost burden imposed by the plan on all policyholders in this
16state.
AB100-engrossed, s. 4864
17Section
4864. 619.15 (3) (intro.) of the statutes is renumbered 149.15 (3)
18(intro.) and amended to read:
AB100-engrossed,2102,1919
149.15
(3) (intro.) The board shall
do all of the following:
AB100-engrossed, s. 4867c
22Section 4867c. 619.15 (3) (c) of the statutes is renumbered 149.15 (3) (c) and
23amended to read:
AB100-engrossed,2103,524
149.15
(3) (c) Collect assessments from all insurers to provide for claims paid
25under the plan and for administrative expenses incurred or estimated to be incurred
1during the period for which the assessment is made. The level of payments shall be
2established
by the board as provided under s. 149.143. Assessment of the insurers
3shall occur at the end of each calendar year or other fiscal year end established by
4the board. Assessments are due and payable within 30 days of receipt by the insurer
5of the assessment notice.
AB100-engrossed,2103,149
149.15
(3) (e) Establish for payment of covered expenses, a payment rate that
10is 10% less than the charges approved by the
administering carrier plan
11administrator for reimbursement of covered expenses under s.
619.14 149.14 (3).
A
12provider of a covered service or article may not bill an eligible person who receives
13the service or article for any amount by which the charge is reduced under this
14paragraph.
AB100-engrossed,2103,1716
619.15
(3) (f) In consultation with the office and the department of health and
17family services, establish a choice of coverage under s. 619.146.
AB100-engrossed, s. 4869m
18Section 4869m. 619.15 (3) (f) of the statutes, as created by 1997 Wisconsin Act
19.... (this act), is repealed.
AB100-engrossed, s. 4870
20Section
4870. 619.15 (4) (intro.) of the statutes is renumbered 149.15 (4)
21(intro.) and amended to read:
AB100-engrossed,2103,2222
149.15
(4) (intro.) The board may
do any of the following:
AB100-engrossed,2104,65
149.15
(5) The
commissioner department may, by rule, establish additional
6powers and duties of the board.
AB100-engrossed,2104,109
149.15
(6) If any provision of this
subchapter chapter conflicts with s. 625.11
10or 625.12, this
subchapter chapter prevails.
AB100-engrossed, s. 4882
15Section
4882. 619.16 (3) (a) of the statutes is renumbered 149.16 (3) (a) and
16amended to read:
AB100-engrossed,2104,1817
149.16
(3) (a) The
administering carrier plan administrator shall perform all
18eligibility and administrative claims payment functions relating to the plan.
AB100-engrossed, s. 4883
19Section
4883. 619.16 (3) (b) of the statutes is renumbered 149.16 (3) (b) and
20amended to read:
AB100-engrossed,2104,2321
149.16
(3) (b) The
administering carrier plan administrator shall establish a
22premium billing procedure for collection of premiums from insured persons. Billings
23shall be made on a periodic basis as determined by the
board department.
AB100-engrossed, s. 4884c
24Section 4884c. 619.16 (3) (c) of the statutes is renumbered 149.16 (3) (c), and
25149.16 (3) (c) (intro.), as renumbered, is amended to read:
AB100-engrossed,2105,3
1149.16
(3) (c) (intro.) The
administering carrier plan administrator shall
2perform all necessary functions to assure timely payment of benefits to covered
3persons under the plan, including:
AB100-engrossed, s. 4886
5Section
4886. 619.16 (3) (e) of the statutes is renumbered 149.16 (3) (e) and
6amended to read:
AB100-engrossed,2105,147
149.16
(3) (e) The
administering carrier plan administrator, under the
8direction of the department, shall pay claims expenses from the premium payments
9received from or on behalf of covered persons under the plan. If the
administering
10carrier's plan administrator's payments for claims expenses exceed
the portion of
11premiums allocated by the board for payment of claims expenses
premium
12payments, the board
shall forward to the department, and the department shall
13provide to the
carrier plan administrator, additional funds for payment of claims
14expenses.
AB100-engrossed, s. 4890
18Section
4890. 619.165 (1) (a) of the statutes is renumbered 149.165 (1) and
19amended to read:
AB100-engrossed,2105,2320
149.165
(1) The board Except as provided in s. 149.146 (2) (a), the department 21shall reduce the premiums established
by the commissioner under s.
619.11 149.11 22in conformity with ss.
619.14 (5) 149.143 and
619.17 149.17, for the eligible persons
23and in the manner set forth in
pars. (b) to (d) subs. (2) and (3).
AB100-engrossed, s. 4891
24Section
4891. 619.165 (1) (b) of the statutes is renumbered 149.165 (2), and
25149.165 (2) (intro.), as renumbered, is amended to read:
AB100-engrossed,2106,5
1149.165
(2) (intro.) If the household income, as defined in s. 71.52 (5) and as
2determined under
par. (d) sub. (3), of an eligible person is equal to or greater than
3the first amount and less than the 2nd amount listed in any of the following, the
4board department shall reduce the premium for the eligible person
, as established
5by the commissioner, to the rate shown after the amounts:
AB100-engrossed, s. 4891c
6Section 4891c. 619.165 (1) (d) of the statutes is renumbered 619.165 (1) (d) 1.
7and amended to read:
AB100-engrossed,2106,108
619.165
(1) (d) 1.
The Subject to subd. 2., the board shall establish and
9implement the method for determining the household income of an eligible person
10under par. (b).
AB100-engrossed, s. 4891r
11Section 4891r. 619.165 (1) (d) of the statutes, as affected by 1997 Wisconsin
12Act .... (this act), is renumbered 149.165 (3), and 149.165 (3) (a) and (b) (intro.), as
13renumbered, are amended to read:
AB100-engrossed,2106,1614
149.165
(3) (a) Subject to
subd. 2., the board par. (b), the department shall
15establish and implement the method for determining the household income of an
16eligible person under
par. (b) sub. (2).
AB100-engrossed,2106,2017
(b) (intro.) In determining household income under
par. (b), the board sub. (2),
18the department shall consider information submitted by an eligible person on a
19completed federal profit or loss from farming form, schedule F, if all of the following
20apply:
AB100-engrossed,2106,2422
619.165
(1) (d) 2. In determining household income under par. (b), the board
23shall consider information submitted by an eligible person on a completed federal
24profit or loss from farming form, schedule F, if all of the following apply:
AB100-engrossed,2106,2525
a. The person is a farmer, as defined in s. 102.04 (3).
AB100-engrossed,2107,2
1b. The person was not eligible to claim the homestead credit under subch. VIII
2of ch. 71 in the preceding taxable year.
AB100-engrossed,2107,96
149.165
(4) The
commissioner shall forward to the board moneys received
7under s. 20.145 (7) (a) and (g) in an amount sufficient to department shall reimburse
8the plan for premium reductions under sub.
(1) (2) and deductible reductions under
9s.
619.14 149.14 (5) (a)
with moneys from the appropriation under s. 20.435 (5) (ah).
AB100-engrossed,2107,1514
149.17
(1) Subject to
s. 619.14 (5) (a) ss. 149.143 and 149.146 (2) (b), a rating
15plan calculated in accordance with generally accepted actuarial principles.
AB100-engrossed,2107,1918
149.17
(2) A schedule of premiums, deductibles and coinsurance payments
19which complies with all requirements of this
subchapter chapter.
AB100-engrossed,2107,2423
149.17
(4) Cost containment provisions established by the
commissioner 24department by rule
, including managed care requirements.
AB100-engrossed,2108,7
3149.175 Waiver or exemption from provisions prohibited. Except as
4provided in s.
619.13 (1) (a) 149.13 (1), the
commissioner department may not waive,
5or authorize the board to waive, any of the requirements of this
subchapter chapter 6or exempt, or authorize the board to exempt, an individual or a class of individuals
7from any of the requirements of this
subchapter chapter.
AB100-engrossed,2108,12
10149.18 Chapters 600 to 645 applicable. Except as otherwise provided in this
11subchapter chapter, the plan shall comply and be administered in compliance with
12chs. 600 to 645.
AB100-engrossed,2108,2115
628.34
(3) (a) No insurer may unfairly discriminate among policyholders by
16charging different premiums or by offering different terms of coverage except on the
17basis of classifications related to the nature and the degree of the risk covered or the
18expenses involved, subject to ss. 632.365
and, 632.745
and 632.748. Rates are not
19unfairly discriminatory if they are averaged broadly among persons insured under
20a group, blanket or franchise policy, and terms are not unfairly discriminatory
21merely because they are more favorable than in a similar individual policy.
AB100-engrossed,2109,524
628.34
(3) (b) No insurer may refuse to insure or refuse to continue to insure,
25or limit the amount, extent or kind of coverage available to an individual, or charge
1an individual a different rate for the same coverage because of a mental or physical
2disability except when the refusal, limitation or rate differential is based on either
3sound actuarial principles supported by reliable data or actual or reasonably
4anticipated experience, subject to ss.
632.745, 632.747, 632.749, 635.09 and 635.26 5632.746 to 632.7495.
AB100-engrossed,2109,127
628.36
(2) (b) 1. Except for health maintenance organizations, preferred
8provider plans
, and limited service health organizations
and the small employer
9health insurance plan under subch. II of ch. 635, no health care plan may prevent
10any person covered under the plan from choosing freely among providers who have
11agreed to participate in the plan and abide by its terms, except by requiring the
12person covered to select primary providers to be used when reasonably possible.