SB218: Bill Text

SB218,54,18 (b) Health benefit plans for individuals.

SB218, s. 63 Section 63. 635.18 (2) of the statutes is amended to read:

SB218,54,21 635.18 (2) (a) Except as provided in par. (b), a small employer an insurer or an intermediary may not, directly or indirectly, do any of the following:

SB218,54,25 1. Discourage a small an employer or an individual from applying, or direct a small an employer or an individual not to apply, for coverage with the small employer insurer because of the health status condition, claims experience, industry, occupation or geographic location area of the small employer or individual.

SB218,55,3 2. Encourage or direct a small an employer or an individual to seek coverage from another insurer because of the health status condition, claims experience, industry, occupation or geographic location area of the small employer or individual.

SB218,55,7 (b) Paragraph (a) does not prohibit a small employer an insurer or an intermediary from providing a small an employer or an individual with information about an established geographic service area or a restricted network provision of the small employer insurer.

SB218, s. 64 Section 64. 635.18 (3) (a) of the statutes is amended to read:

SB218,55,14 635.18 (3) (a) Except as provided in par. (b), a small employer an insurer may not, directly or indirectly, enter into any contract, agreement or arrangement with an intermediary that provides for or results in compensation to an the intermediary for the sale of a health benefit plan that varies according to the health status condition, claims experience, industry, occupation or geographic location area of the small employer or, eligible employes, insured individual or dependents.

SB218, s. 65 Section 65. 635.18 (3) (b) of the statutes is amended to read:

SB218,55,19 635.18 (3) (b) Payment of compensation on the basis of percentage of premium is not a violation of par. (a) if the percentage does not vary based on the health status condition, claims experience, industry, occupation or geographic area of the small employer or, eligible employes, insured individual or dependents.

SB218, s. 66 Section 66. 635.18 (3) (c) of the statutes is repealed.

SB218, s. 67 Section 67. 635.18 (4) of the statutes is amended to read:

SB218,56,2 635.18 (4) A small employer An insurer may not terminate, fail to renew or limit its contract or agreement of representation with an intermediary for any reason related to the health status condition, claims experience, occupation or geographic location area of the small employers or, eligible employes , insured individuals or their dependents placed by the intermediary with the small employer insurer.

SB218, s. 68 Section 68. 635.18 (5) of the statutes is amended to read:

SB218,56,7 635.18 (5) A small employer An insurer or an intermediary may not induce or otherwise encourage a small an employer to separate or otherwise exclude an employe from health coverage or benefits provided in connection with the employe's employment.

SB218, s. 69 Section 69. 635.18 (6) of the statutes is amended to read:

SB218,56,11 635.18 (6) Denial by a small employer an insurer of an application for coverage from a small employer under a health benefit plan shall be in writing and shall state the reason or reasons for the denial.

SB218, s. 70 Section 70. 635.18 (7) of the statutes is amended to read:

SB218,56,17 635.18 (7) A 3rd-party administrator that enters into a contract, agreement or other arrangement with a small employer an insurer to provide administrative, marketing or other services related to the offering of health benefit plans to small employers or individuals in this state is subject to this subchapter chapter as if it were a small employer an insurer.

SB218, s. 71 Section 71. 635.18 (8) of the statutes is amended to read:

SB218,56,22 635.18 (8) The commissioner may by rule establish additional standards to provide for the fair marketing and broad availability of health benefit plans to small employers and individuals in this state, including requirements designed to prevent evasion of the purposes of this chapter.

SB218, s. 72 Section 72. Subchapter II of chapter 635 [precedes 635.20] of the statutes, as affected by 1995 Wisconsin Act 289, is repealed.

SB218, s. 73 Section 73 . Nonstatutory provisions.

SB218,57,6 (1) Risk adjustment committee. The commissioner of insurance shall appoint a committee on risk adjustment under section 15.04 (1) (c) of the statutes, consisting of 5 to 8 members, to advise the commissioner on, and to assist the commissioner in developing rules for, the group risk adjustment mechanism under section 635.06 (4) of the statutes, as created by this act. The commissioner shall appoint at least 5 representatives of insurers to be members of the committee.

SB218,57,14 (2) Risk adjustment mechanism emergency rule-making authority. Using the procedure under section 227.24 of the statutes, the commissioner of insurance may promulgate rules under section 635.06 (4) (e) of the statutes, as created by this act, for the period before the effective date of the permanent rules promulgated under section 635.06 (4) (e) of the statutes, as created by this act, but not to exceed the period authorized under section 227.24 (1) (c) and (2) of the statutes. Notwithstanding section 227.24 (1) and (3) of the statutes, the commissioner is not required to make a finding of emergency.

SB218,57,15 (3) Evaluation of market reforms.

SB218,57,20 (a) The commissioner of insurance shall evaluate the effectiveness of the health insurance market reforms under chapter 635 of the statutes, as affected by this act, and under the federal Health Insurance Portability and Accountability Act of 1996, P.L. 104-191, including the effectiveness of the reforms with respect to all of the following:

SB218,57,22 1. Accessibility of health insurance coverage, including such accessibility for persons who reside in rural areas of the state.

SB218,57,23 2. Availability of health insurance coverage for uninsured persons.

SB218,57,24 3. Affordability of health insurance coverage.

SB218,58,4 (b) The commissioner shall submit a report of the results of the evaluation and any recommendations to the legislature in the manner provided under section 13.172 (2) of the statutes no later than the first day of the 24th month beginning after publication.

SB218, s. 74 Section 74 . Initial applicability.

SB218,58,6 (1) This act first applies to all of the following:

SB218,58,9 (a) Except as provided in paragraphs (b) and (c ), health benefit plans that are issued or renewed, and self-insured health plans that are established, extended, modified or renewed, on the effective date of this paragraph.

SB218,58,12 (b) Health benefit plans covering employes who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are issued or renewed on the earlier of the following:

SB218,58,13 1. The day on which the collective bargaining agreement expires.

SB218,58,15 2. The day on which the collective bargaining agreement is extended, modified or renewed.

SB218,58,18 (c) Self-insured health plans covering employes who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are established, extended, modified or renewed on the earlier of the following:

SB218,58,19 1. The day on which the collective bargaining agreement expires.

SB218,58,21 2. The day on which the collective bargaining agreement is extended, modified or renewed.

SB218, s. 75 Section 75. Effective dates. This act takes effect on the first day of the 7th month beginning after publication, except as follows:

SB218,58,24 (1) Section 73 (1 ) and (2) of this act takes effect on the day after publication.

SB218,59,5 (2) The repeal of section 635.08 (1) (b) of the statutes takes effect on the 31st day after the day on which the commissioner of insurance certifies to the revisor of statutes under section 632.898 (7) of the statutes, as affected by this act, that section 635.08 (1) (b) of the statutes, as created by this act, is not necessary for the purpose for which it was intended.

SB218,59,6 (End)