SB218, s. 17 14Section 17. 619.123 of the statutes is repealed.
SB218, s. 18 15Section 18. 625.12 (2) of the statutes is amended to read:
SB218,10,2416 625.12 (2) Classification. Risks Subject to s. 635.09, risks may be classified
17in any reasonable way for the establishment of rates and minimum premiums,
18except that no classifications may be based on race, color, creed or national origin,
19and classifications in automobile insurance may not be based on physical condition
20or developmental disability as defined in s. 51.01 (5). Subject to s. ss. 632.365 and
21635.09
, rates thus produced may be modified for individual risks in accordance with
22rating plans or schedules that establish reasonable standards for measuring
23probable variations in hazards, expenses, or both. Rates may also be modified for
24individual risks under s. 625.13 (2).
SB218, s. 19
1Section 19. 628.34 (3) (a) of the statutes, as affected by 1995 Wisconsin Act
2289
, is amended to read:
SB218,11,103 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by
4charging different premiums or by offering different terms of coverage except on the
5basis of classifications related to the nature and the degree of the risk covered or the
6expenses involved, subject to ss. 632.365 and 632.745 , 635.03, 635.05, 635.08 and
7635.09
. Rates are not unfairly discriminatory if they are averaged broadly among
8persons insured under a group, blanket or franchise policy, and terms are not
9unfairly discriminatory merely because they are more favorable than in a similar
10individual policy.
SB218, s. 20 11Section 20. 628.34 (3) (b) of the statutes, as affected by 1995 Wisconsin Act
12289
, is amended to read:
SB218,11,1913 628.34 (3) (b) No insurer may refuse to insure or refuse to continue to insure,
14or limit the amount, extent or kind of coverage available to an individual, or charge
15an individual a different rate for the same coverage because of a mental or physical
16disability except when the refusal, limitation or rate differential is based on either
17sound actuarial principles supported by reliable data or actual or reasonably
18anticipated experience, subject to ss. 632.745, 632.747, 632.749, 635.09 and 635.26
19635.03 to 635.09, 635.16 and 635.165.
SB218, s. 21 20Section 21. 628.36 (2) (b) 1. of the statutes is amended to read:
SB218,12,221 628.36 (2) (b) 1. Except for health maintenance organizations, preferred
22provider plans, and limited service health organizations and the small employer
23health insurance plan under subch. II of ch. 635
, no health care plan may prevent
24any person covered under the plan from choosing freely among providers who have

1agreed to participate in the plan and abide by its terms, except by requiring the
2person covered to select primary providers to be used when reasonably possible.
SB218, s. 22 3Section 22. 628.36 (2) (b) 3. of the statutes is amended to read:
SB218,12,84 628.36 (2) (b) 3. Except as provided in subd. 4., no provider may be denied the
5opportunity to participate in a health care plan, other than a health maintenance
6organization, a limited service health organization, or a preferred provider plan or
7the small employer health insurance plan under subch. II of ch. 635
, under the terms
8of the plan.
SB218, s. 23 9Section 23. 628.36 (2) (b) 5. of the statutes is amended to read:
SB218,12,1410 628.36 (2) (b) 5. Except for the small employer health insurance plan under
11subch. II of ch. 635 to the extent determined by the small employer insurance board
12under s. 635.23 (1) (b), all
All health care plans, including health maintenance
13organizations, limited service health organizations and preferred provider plans are
14subject to s. 632.87 (3).
SB218, s. 24 15Section 24. 631.01 (4) of the statutes is amended to read:
SB218,13,216 631.01 (4) Annuities and group policies for eleemosynary institutions. This
17chapter, and ch. 632 and the health insurance mandates under ch. 632 that apply to
18the plan under subch. II of ch. 635
do not apply to annuities or group policies that
19are provided on a basis as uniform nationally as state statutes permit to educational,
20scientific research, religious or charitable institutions organized without profit to
21any person, for the benefit of employes of such institutions. The commissioner may
22by order subject such contracts issued by a particular insurer to this chapter, or ch.
23632 or the health insurance mandates under ch. 632 that apply to the plan under
24subch. II of ch. 635
or any portion of those provisions upon a finding, after a hearing,

1that the interests of Wisconsin insureds or creditors or the public of this state so
2require.
SB218, s. 25 3Section 25. 632.70 of the statutes is repealed.
SB218, s. 26 4Section 26. 632.745 of the statutes, as affected by 1995 Wisconsin Acts 289 and
5453, is repealed.
SB218, s. 27 6Section 27. 632.747 (title) of the statutes, as created by 1995 Wisconsin Act
7289
, is renumbered 635.04 (title) and amended to read:
SB218,13,8 8635.04 (title) Guaranteed acceptance under group plans.
SB218, s. 28 9Section 28. 632.747 (1) of the statutes, as created by 1995 Wisconsin Act 289,
10is renumbered 635.04 (1), and 635.04 (1) (intro.), as renumbered, is amended to read:
SB218,13,1711 635.04 (1) Employe becomes eligible after commencement of coverage.
12(intro.) If Unless otherwise permitted by rule of the commissioner, if an insurer
13provides coverage under a group health benefit plan, the insurer shall provide
14coverage under the group health benefit plan to an eligible employe who becomes
15eligible for coverage after the commencement of the employer's coverage, and to the
16eligible employe's dependents, regardless of health condition or claims experience,
17if all of the following apply:
SB218, s. 29 18Section 29. 632.747 (2) of the statutes, as created by 1995 Wisconsin Act 289,
19is repealed.
SB218, s. 30 20Section 30. 632.747 (3) (intro.) of the statutes, as created by 1995 Wisconsin
21Act 289
, is renumbered 635.04 (2) (intro.).
SB218, s. 31 22Section 31. 632.747 (3) (a) of the statutes, as created by 1995 Wisconsin Act
23289
, is renumbered 635.04 (2) (a) and amended to read:
SB218,14,3
1635.04 (2) (a) The eligible employe was covered as a dependent under
2qualifying creditable coverage when he or she waived coverage under the
3self-insured health plan.
SB218, s. 32 4Section 32. 632.747 (3) (b) of the statutes, as created by 1995 Wisconsin Act
5289
, is renumbered 635.04 (2) (b) and amended to read:
SB218,14,116 635.04 (2) (b) The eligible employe's coverage under the qualifying creditable
7coverage has terminated or will terminate due to a divorce from the insured under
8the qualifying creditable coverage, the death of the insured under the qualifying
9creditable coverage, loss of employment by the insured under the qualifying
10creditable coverage or involuntary loss of coverage under the qualifying creditable
11coverage by the insured under the qualifying creditable coverage.
SB218, s. 33 12Section 33. 632.747 (3) (c) of the statutes, as created by 1995 Wisconsin Act
13289
, is renumbered 635.04 (2) (c) and amended to read:
SB218,14,1614 635.04 (2) (c) The eligible employe applies for coverage under the self-insured
15health plan not more than 30 days after termination of his or her coverage under the
16qualifying creditable coverage.
SB218, s. 34 17Section 34. 632.749 of the statutes, as created by 1997 Wisconsin Act 289, is
18repealed.
SB218, s. 35 19Section 35. 632.76 (2) (a) of the statutes, as affected by 1995 Wisconsin Act
20289
, is amended to read:
SB218,15,221 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
22from the date of issue of the policy may be reduced or denied on the ground that a
23disease or physical condition existed prior to the effective date of coverage, unless the
24condition was excluded from coverage by name or specific description by a provision
25effective on the date of loss. This paragraph does not apply to a group health benefit

1plan, as defined in s. 632.745 (1) (c) 635.02 (14), which is subject to s. 632.745 (2)
2635.03 or 635.08 (2).
SB218, s. 36 3Section 36. 632.896 (4) of the statutes, as affected by 1995 Wisconsin Act 289,
4is amended to read:
SB218,15,105 632.896 (4) Preexisting conditions. Notwithstanding ss. 632.745 (2) and
6632.76 (2) (a), 635.03 and 635.08 (2), a disability insurance policy that is subject to
7sub. (2) and that is in effect when a court makes a final order granting adoption or
8when the child is placed for adoption may not exclude or limit coverage of a disease
9or physical condition of the child on the ground that the disease or physical condition
10existed before coverage is required to begin under sub. (3).
SB218, s. 37 11Section 37. 632.898 (1) (b) of the statutes is repealed and recreated to read:
SB218,15,1512 632.898 (1) (b) "Dependent" means a spouse, an unmarried child under the age
13of 19 years, an unmarried child who is a full-time student under the age of 21 years
14and who is financially dependent upon the parent, or an unmarried child of any age
15who is medically certified as disabled and who is dependent upon the parent.
SB218, s. 38 16Section 38. 632.898 (7) of the statutes is amended to read:
SB218,16,517 632.898 (7) If the federal government enacts legislation providing for a federal
18income tax exemption for amounts deposited in an account established under this
19section and for any interest, dividends or other gain that accrues in the account if
20redeposited in the account, the commissioner shall conduct a study, to be completed
21within 4 years after the enactment of the federal legislation, of individuals and
22groups that had coverage under a high cost-share health plan and that terminated
23that coverage in order to enroll in a health benefit plan that was not a high cost-share
24health plan. If as a result of the study the commissioner determines that s. 632.745
25(1) (f) 2.
635.08 (1) (b) is not necessary for the purpose for which it was intended, the

1commissioner shall certify that determination to the revisor of statutes. Upon the
2certification, the revisor of statutes shall publish notice in the Wisconsin
3administrative register of the determination, the date of the certification and that
4after 30 days after the date of the certification s. 632.745 (1) (f) 2. 635.08 (1) (b) is not
5effective.
SB218, s. 39 6Section 39. Chapter 635 (title) of the statutes is amended to read:
SB218,16,77 CHAPTER 635
SB218,16,9 8SMALL EMPLOYER regulation
9of HEALTH INSURANCE
SB218, s. 40 10Section 40. Subchapter I (title) of chapter 635 [precedes 635.01] of the statutes
11is repealed.
SB218, s. 41 12Section 41. 635.01 of the statutes is repealed.
SB218, s. 42 13Section 42. 635.02 of the statutes, as affected by 1995 Wisconsin Act 289, is
14repealed and recreated to read:
SB218,16,15 15635.02 Definitions. In this chapter, unless otherwise specified:
SB218,16,18 16(1) "Affiliation period" means the period which, under the terms of health
17insurance coverage offered by a health maintenance organization, must expire
18before the health insurance coverage becomes effective.
SB218,16,21 19(2) "Base premium rate" means the lowest premium rate chargeable under a
20rating system to employers or individuals with similar case characteristics and the
21same or similar benefit design characteristics.
SB218,16,23 22(3) "Beneficiary" has the meaning given in section 3 (8) of the federal Employee
23Retirement Income Security Act of 1974.
SB218,17,3
1(4) "Benefit design characteristics" means covered services, cost sharing,
2utilization management, managed care networks and other features that
3differentiate plan or coverage designs.
SB218,17,5 4(5) "Bona fide association" means an association that satisfies all of the
5following:
SB218,17,66 (a) The association has been actively in existence for at least 5 years.
SB218,17,87 (b) The association has been formed and maintained in good faith for purposes
8other than obtaining insurance.
SB218,17,119 (c) The association does not condition membership in the association on any
10health status-related factor of an individual, including an employe of an employer
11or a dependent of an employe.
SB218,17,1412 (d) The association makes health insurance coverage offered through the
13association available to all members, regardless of any health status-related factor
14of those members or individuals eligible for coverage through a member.
SB218,17,1615 (e) The association does not make health insurance coverage offered through
16the association available other than in connection with a member of the association.
SB218,17,1917 (f) The association meets any additional requirements that are imposed by a
18rule of the commissioner designed to prevent the use of an association for risk
19segmentation.
SB218,17,21 20(6) "Case characteristics" means the age, gender, geographic location and
21tobacco use of the individuals covered under a health benefit plan.
SB218,17,23 22(7) (a) Except as provided in par. (b), "creditable coverage" means coverage
23under any of the following:
SB218,17,2424 1. A group health plan.
SB218,17,2525 2. Health insurance.
SB218,18,1
13. Part A or part B of title XVIII of the federal Social Security Act.
SB218,18,32 4. Title XIX of the federal Social Security Act, except for coverage consisting
3solely of benefits under section 1928 of that act.
SB218,18,44 5. Chapter 55 of title 10 of the United States Code.
SB218,18,65 6. A medical care program of the federal Indian health service or of an
6American Indian tribal organization.
SB218,18,77 7. A state health benefits risk pool.
SB218,18,88 8. A health plan offered under chapter 89 of title 5 of the United States Code.
SB218,18,109 9. A public health plan, as defined in regulations issued by the federal
10department of health and human services.
SB218,18,1211 10. A health coverage plan under section 5 (e) of the federal Peace Corps Act,
1222 USC 2504 (e).
SB218,18,1413 (b) "Creditable coverage" does not include coverage consisting solely of
14coverage of excepted benefits, as defined in section 2791 (c) of P.L. 104-191.
SB218,18,21 15(8) (a) Except as provided in par. (b), "eligible employe" means an employe who
16works on a permanent basis and has a normal work week of 30 or more hours. The
17term includes a sole proprietor, a business owner, including the owner of a farm
18business, a partner of a partnership and a member of a limited liability company if
19the sole proprietor, business owner, partner or member is included as an employe
20under a health benefit plan of an employer, but the term does not include an employe
21who works on a temporary or substitute basis.
SB218,18,2422 (b) For purposes of a group health benefit plan, or a self-insured health plan,
23that is offered by the state under s. 40.51 (6) or by the group insurance board under
24s. 40.51 (7), "eligible employe" has the meaning given in s. 40.02 (25).
SB218,18,25 25(9) (a) "Employer" means any of the following:
SB218,19,3
11. An individual, firm, corporation, partnership, limited liability company or
2association that is actively engaged in a business enterprise in this state, including
3a farm business.
SB218,19,44 2. A municipality, as defined in s. 16.70 (8).
SB218,19,55 3. The state.
SB218,19,66 (b) For purposes of this definition, all of the following apply:
SB218,19,87 1. All persons treated as a single employer under subsection (b), (c), (m) or (o)
8of section 414 of the Internal Revenue Code of 1986 shall be treated as one employer.
SB218,19,99 2. "Employer" includes any predecessor of an employer.
SB218,19,13 10(10) "Enrollment date" means, with respect to an individual covered under a
11group health plan, self-insured health plan or health insurance, the date of
12enrollment of the individual under the plan or insurance or, if earlier, the first day
13of the waiting period for such enrollment.
SB218,19,14 14(11) "Federal continuation provision" means any of the following:
SB218,19,1615(a) Section 4980B of the Internal Revenue Code of 1986, except for section
164980B (f) (1) of that code insofar as it relates to pediatric vaccines.
SB218,19,1817 (b) Part 6 of subtitle B of title I of the federal Employee Retirement Income
18Security Act of 1974, except for section 609 of that act.
SB218,19,1919(c) Title XXII of P.L. 104-191.
SB218,19,24 20(12) "Group health benefit plan" means a health benefit plan that is issued by
21an insurer to or through an employer on behalf of a group consisting of at least 2
22employes or a group including at least 2 eligible employes. The term includes
23individual health benefit plans covering eligible employes when 3 or more are sold
24to or through an employer.
SB218,19,25 25(13) "Group health plan" means any of the following:
SB218,20,5
1(a) An employe welfare plan, as defined in section 3 (1) of the federal Employee
2Retirement Security Act of 1974, to the extent that the employe welfare plan provides
3medical care, including items and services paid for as medical care, to employes or
4to their dependents, as defined under the terms of the employe welfare plan, directly
5or through insurance, reimbursement or otherwise.
SB218,20,116 (b) Any program that would not otherwise be an employe welfare benefit plan
7and that is established or maintained by a partnership, to the extent that the
8program provides medical care, including items and services paid for as medical care,
9to present or former partners of the partnership or to their dependents, as defined
10under the terms of the program, directly or through insurance, reimbursement or
11otherwise.
SB218,20,13 12(14) (a) Except as provided in par. (b), "health benefit plan" means any hospital
13or medical policy or certificate.
SB218,20,1414 (b) "Health benefit plan" does not include any of the following:
Loading...
Loading...