AB100-engrossed,2141,1310
632.895
(13) Breast reconstruction. (a) Every disability insurance policy,
11and every self-insured health plan of the state or a county, city, village, town or school
12district, that provides coverage of the surgical procedure known as a mastectomy
13shall provide coverage of breast reconstruction incident to a mastectomy.
AB100-engrossed,2141,1614
(b) The coverage required under par. (a) may be subject to any limitations,
15exclusions or cost-sharing provisions that apply generally under the disability
16insurance policy or self-insured health plan.
AB100-engrossed,2141,2419
632.896
(4) Preexisting conditions. Notwithstanding ss.
632.745 (2) 632.746 20and 632.76 (2) (a), a disability insurance policy that is subject to sub. (2) and that is
21in effect when a court makes a final order granting adoption or when the child is
22placed for adoption may not exclude or limit coverage of a disease or physical
23condition of the child on the ground that the disease or physical condition existed
24before coverage is required to begin under sub. (3).
AB100-engrossed,2142,5
1632.897
(10) (am) 2. Provide family coverage under the group policy or
2individual policy for the individual's child, if eligible for coverage, upon application
3by the individual, the child's other parent, the department of
health and family
4services workforce development or the county
designee child support agency under
5s. 59.53 (5).
AB100-engrossed, s. 4932d
7Section 4932d. Subchapter I (title) of chapter 635 [precedes 635.01] of the
8statutes is repealed.
AB100-engrossed,2142,16
10635.01 Scope. This
subchapter chapter applies to all group health insurance
11plans, policies or certificates, written on risks or operations in this state, providing
12coverage for employes of a small employer, or employes of a small employer and the
13employer, and to individual health insurance policies, written on risks or operations
14in this state, providing coverage for employes of a small employer, or employes of a
15small employer and the employer when 3 or more are sold to
or through a small
16employer.
AB100-engrossed,2142,18
18635.02 Definitions. (intro.) In this
subchapter chapter:
AB100-engrossed,2142,2121
635.02
(1p) "Bona fide association" has the meaning given in s. 632.745 (3).
AB100-engrossed,2142,2525
635.02
(3g) "Employer" has the meaning given in s. 632.745 (6).
AB100-engrossed,2143,32
635.02
(3k) "Group health benefit plan" has the meaning given in s. 632.745
3(9).
AB100-engrossed,2143,55
635.02
(3m) "Health benefit plan" has the meaning given in s. 632.745 (11).
AB100-engrossed,2143,77
635.02
(4t) "Network plan" has the meaning given in s. 632.745 (19).
AB100-engrossed,2143,159
635.02
(7) "Small employer" means, with respect to a calendar year and a plan
10year, an employer that employed an average of at least 2 but not more than 50
11employes on business days during the preceding calendar year, or that is reasonably
12expected to employ an average of at least 2 but not more than 50 employes on
13business days during the current calendar year if the employer was not in existence
14during the preceding calendar year, and that employs at least 2 employes on the first
15day of the plan year.
AB100-engrossed,2143,1717
635.02
(9) "Small group market" has the meaning given in s. 632.745 (26).
AB100-engrossed, s. 4932y
19Section 4932y. 635.11 of the statutes is renumbered 635.11 (1m), and 635.11
20(1m) (intro.), as renumbered, is amended to read:
AB100-engrossed,2143,2321
635.11
(1m) (intro.) Before the sale of a plan or policy subject to this
subchapter 22chapter, a small employer insurer shall disclose to a small employer all of the
23following:
AB100-engrossed,2144,2
1635.11
(1m) (e) As part of the small employer insurer's solicitation and sales
2materials, the availability of the information under par. (f).
AB100-engrossed,2144,54
635.11
(1m) (f) Upon the request of the small employer, the following
5information:
AB100-engrossed,2144,76
1. The provisions, if any, of the plan or policy relating to preexisting condition
7exclusions.
AB100-engrossed,2144,98
2. The benefits and premiums available under all health insurance coverage
9offered by the small employer insurer for which the small employer is qualified.
AB100-engrossed,2144,1411
635.11
(2m) Information required to be disclosed under this section shall be
12provided in a manner that is understandable to a small employer and shall be
13sufficient to reasonably inform a small employer of the small employer's rights and
14obligations under the health insurance coverage.
AB100-engrossed,2144,1816
635.11
(3m) A small employer insurer is not required under this section to
17disclose information that is proprietary or trade secret information under applicable
18law.
AB100-engrossed,2144,2420
635.13
(1) Records. A small employer insurer shall maintain at its principal
21place of business complete and detailed records relating to its rating methods and
22practices and its renewal underwriting methods and practices, and shall make the
23records available to the commissioner
and the small employer insurance board upon
24request.
AB100-engrossed,2145,7
1635.18
(1) Every small employer insurer shall actively market health benefit
2plan coverage
, including basic health benefit plans, to small employers in the state.
3If a small employer insurer denies coverage to a small employer under a health
4benefit plan that is not a basic health benefit plan on the basis of the health status
5or claims experience of the small employer or its eligible employes or their
6dependents, the small employer insurer shall offer the small employer the
7opportunity to purchase a basic health benefit plan.
AB100-engrossed,2145,1410
635.18
(7) A 3rd-party administrator that enters into a contract, agreement
11or other arrangement with a small employer insurer to provide administrative,
12marketing or other services related to the offering of health benefit plans to small
13employers in this state is subject to this
subchapter
chapter as if it were a small
14employer insurer.
AB100-engrossed,2145,18
16635.19 Issuance of coverage in small group market. (1) (a) Except as
17provided in subs. (2) to (6), a small employer insurer that offers a group health benefit
18plan in the small group market shall do all of the following:
AB100-engrossed,2145,1919
1. Accept any small employer in the state that applies for such coverage.
AB100-engrossed,2145,2220
2. Accept for enrollment under such coverage any eligible individual who
21applies for enrollment during the period in which the individual first becomes
22eligible to enroll under the terms of the group health benefit plan.
AB100-engrossed,2145,2423
3. Place no restriction on an eligible individual under par. (b) that is
24inconsistent with s. 632.746 or 632.748.
AB100-engrossed,2146,3
1(b) For purposes of this section, whether an individual is an "eligible
2individual" in relation to a small employer shall be determined in accordance with
3all of the following:
AB100-engrossed,2146,54
1. The terms of the group health benefit plan under which the individual is
5applying for enrollment.
AB100-engrossed,2146,86
2. Rules of the small employer insurer offering the group health benefit plan
7under which the individual is applying for enrollment, which rules must apply
8uniformly in this state to small employers in the small group market.
AB100-engrossed,2146,109
3. All state laws that apply to small employer insurers and the small group
10market.
AB100-engrossed,2146,12
11(2) (a) A small employer insurer that offers a group health benefit plan in the
12small group market through a network plan may do any of the following:
AB100-engrossed,2146,1413
1. Limit the small employers that may apply for such coverage to those with
14eligible individuals who reside, live or work in the service area of the network plan.
AB100-engrossed,2146,1715
2. Within the service area of the network plan, deny such coverage to small
16employers if the small employer insurer demonstrates to the commissioner all of the
17following:
AB100-engrossed,2146,2018
a. That the insurer does not have the capacity to deliver services adequately
19to enrollees of any additional groups because of its obligations to existing group
20contract holders and enrollees.
AB100-engrossed,2146,2421
b. That the insurer is applying this subdivision uniformly to all small
22employers without regard to the claims experience of those small employers or their
23employes or employes' dependents or any other health status-related factor of those
24employes or their dependents.
AB100-engrossed,2147,3
1(b) A small employer insurer that denies coverage under par. (a) 2. in any
2service area may not offer coverage in the small group market in that service area
3for 180 days after the date on which the coverage was denied.
AB100-engrossed,2147,7
4(3) (a) A small employer insurer that offers a group health benefit plan in the
5small group market may deny small employers coverage under such a plan in the
6small group market if the small employer insurer demonstrates to the commissioner
7all of the following:
AB100-engrossed,2147,98
1. That the insurer does not have the financial reserves necessary to
9underwrite additional coverage.
AB100-engrossed,2147,1410
2. That the insurer is applying this paragraph uniformly to all small employers
11in the small group market in the state in accordance with applicable state law and
12without regard to the claims experience of those small employers or their employes
13or employes' dependents or any other health status-related factor of those employes
14or their dependents.
AB100-engrossed,2147,1915
(b) A small employer insurer that denies coverage under par. (a) may not offer
16a group health benefit plan in the small group market in the state for 180 days after
17the date on which the coverage was denied or until the insurer demonstrates to the
18commissioner that the insurer has sufficient financial reserves to underwrite
19additional coverage, whichever is later.
AB100-engrossed,2147,22
20(4) Subsection (1) shall not be construed to preclude a small employer insurer
21from establishing, for the offering of a group health benefit plan in the small group
22market, any of the following:
AB100-engrossed,2147,2523
(a) Rules or requirements relating to the minimum level or amount of small
24employer contribution toward the premium for the enrollment of participants and
25beneficiaries.
AB100-engrossed,2148,3
1(b) Rules or requirements relating to the minimum number or percentage of
2participants or beneficiaries that must be enrolled in relation to a specified number
3or percentage of eligible individuals or employes of a small employer.
AB100-engrossed,2148,5
4(5) Subsection (1) does not apply to a group health benefit plan offered by a
5small employer insurer in the small group market if all of the following apply:
AB100-engrossed,2148,76
(a) The group health benefit plan is offered in the small group market only
7through one or more bona fide associations.
AB100-engrossed,2148,118
(b) The small employer insurer offering the group health benefit plan makes
9the coverage available to all members of a bona fide association regardless of any
10health status-related factors of the members or individuals eligible for coverage
11through the members.
AB100-engrossed,2148,1412
(c) The small employer insurer offering the group health benefit plan complies
13with any rules of the commissioner that are reasonably designed to prevent the use
14of an association for risk segmentation.
AB100-engrossed,2148,17
15(6) The commissioner may by rule permit an exception to sub. (1) with respect
16to a small employer for which coverage is nonrenewed or discontinued for a reason
17specified under s. 632.749 (2) (a) or (b).
AB100-engrossed,2148,2121
703.16
(6) (e) A lien under s. 292.31 (8) (i)
, 292.41 (6) (d) or 292.81.
AB100-engrossed,2149,223
706.11
(1) (intro.) Except as provided in sub. (4), when any of the following
24mortgages has been duly recorded, it shall have priority over all liens upon the
25mortgaged premises and the buildings and improvements thereon, except tax and
1special assessment liens filed after the recording of such mortgage and except liens
2under
s. ss. 292.31 (8) (i)
, 292.41 (6) (d) and 292.81:
AB100-engrossed,2149,124
706.13
(1) In addition to any criminal penalty or civil remedy provided by law,
5any person who submits for filing, entering in the judgment and lien docket or
6recording, any lien, claim of lien, lis pendens, writ of attachment
, financing
7statement or any other instrument relating to
a security interest in or the title
in to 8real or personal property,
knowing and who knows or should have known that the
9contents or any part of the contents
to be of the instrument are false,
a sham or
10frivolous, is liable in tort to any person interested in the property whose title is
11thereby impaired, for punitive damages of $1,000 plus any actual damages caused
12by the filing, entering or recording.
AB100-engrossed,2149,1414
707.37
(4) (d) A lien under s. 292.31 (8) (i)
, 144.77 292.41 (6) (d) or 292.81.
AB100-engrossed,2149,1716
753.06
(8) (e) Oconto county. The circuit has one branch.
Commencing August
171, 1998, the circuit has 2 branches.
