SB218,54,1818 (b) Health benefit plans for individuals.
SB218, s. 63 19Section 63. 635.18 (2) of the statutes is amended to read:
SB218,54,2120 635.18 (2) (a) Except as provided in par. (b), a small employer an insurer or an
21intermediary may not, directly or indirectly, do any of the following:
SB218,54,2522 1. Discourage a small an employer or an individual from applying, or direct a
23small
an employer or an individual not to apply, for coverage with the small employer
24insurer because of the health status condition, claims experience, industry,
25occupation or geographic location area of the small employer or individual.
SB218,55,3
12. Encourage or direct a small an employer or an individual to seek coverage
2from another insurer because of the health status condition, claims experience,
3industry, occupation or geographic location area of the small employer or individual.
SB218,55,74 (b) Paragraph (a) does not prohibit a small employer an insurer or an
5intermediary from providing a small an employer or an individual with information
6about an established geographic service area or a restricted network provision of the
7small employer insurer.
SB218, s. 64 8Section 64. 635.18 (3) (a) of the statutes is amended to read:
SB218,55,149 635.18 (3) (a) Except as provided in par. (b), a small employer an insurer may
10not, directly or indirectly, enter into any contract, agreement or arrangement with
11an intermediary that provides for or results in compensation to an the intermediary
12for the sale of a health benefit plan that varies according to the health status
13condition, claims experience, industry, occupation or geographic location area of the
14small employer or, eligible employes, insured individual or dependents.
SB218, s. 65 15Section 65. 635.18 (3) (b) of the statutes is amended to read:
SB218,55,1916 635.18 (3) (b) Payment of compensation on the basis of percentage of premium
17is not a violation of par. (a) if the percentage does not vary based on the health status
18condition, claims experience, industry, occupation or geographic area of the small
19employer or, eligible employes, insured individual or dependents.
SB218, s. 66 20Section 66. 635.18 (3) (c) of the statutes is repealed.
SB218, s. 67 21Section 67. 635.18 (4) of the statutes is amended to read:
SB218,56,222 635.18 (4) A small employer An insurer may not terminate, fail to renew or
23limit its contract or agreement of representation with an intermediary for any reason
24related to the health status condition, claims experience, occupation or geographic

1location area of the small employers or, eligible employes , insured individuals or
2their dependents placed by the intermediary with the small employer insurer.
SB218, s. 68 3Section 68. 635.18 (5) of the statutes is amended to read:
SB218,56,74 635.18 (5) A small employer An insurer or an intermediary may not induce or
5otherwise encourage a small an employer to separate or otherwise exclude an
6employe from health coverage or benefits provided in connection with the employe's
7employment.
SB218, s. 69 8Section 69. 635.18 (6) of the statutes is amended to read:
SB218,56,119 635.18 (6) Denial by a small employer an insurer of an application for coverage
10from a small employer under a health benefit plan shall be in writing and shall state
11the reason or reasons for the denial.
SB218, s. 70 12Section 70. 635.18 (7) of the statutes is amended to read:
SB218,56,1713 635.18 (7) A 3rd-party administrator that enters into a contract, agreement
14or other arrangement with a small employer an insurer to provide administrative,
15marketing or other services related to the offering of health benefit plans to small
16employers or individuals in this state is subject to this subchapter chapter as if it
17were a small employer an insurer.
SB218, s. 71 18Section 71. 635.18 (8) of the statutes is amended to read:
SB218,56,2219 635.18 (8) The commissioner may by rule establish additional standards to
20provide for the fair marketing and broad availability of health benefit plans to small
21employers and individuals in this state, including requirements designed to prevent
22evasion of the purposes of this chapter
.
SB218, s. 72 23Section 72. Subchapter II of chapter 635 [precedes 635.20] of the statutes, as
24affected by 1995 Wisconsin Act 289, is repealed.
SB218, s. 73 25Section 73 . Nonstatutory provisions.
SB218,57,6
1(1) Risk adjustment committee. The commissioner of insurance shall appoint
2a committee on risk adjustment under section 15.04 (1) (c) of the statutes, consisting
3of 5 to 8 members, to advise the commissioner on, and to assist the commissioner in
4developing rules for, the group risk adjustment mechanism under section 635.06 (4)
5of the statutes, as created by this act. The commissioner shall appoint at least 5
6representatives of insurers to be members of the committee.
SB218,57,147 (2) Risk adjustment mechanism emergency rule-making authority. Using the
8procedure under section 227.24 of the statutes, the commissioner of insurance may
9promulgate rules under section 635.06 (4) (e) of the statutes, as created by this act,
10for the period before the effective date of the permanent rules promulgated under
11section 635.06 (4) (e) of the statutes, as created by this act, but not to exceed the
12period authorized under section 227.24 (1) (c) and (2) of the statutes.
13Notwithstanding section 227.24 (1) and (3) of the statutes, the commissioner is not
14required to make a finding of emergency.
SB218,57,1515 (3) Evaluation of market reforms.
SB218,57,2016 (a) The commissioner of insurance shall evaluate the effectiveness of the health
17insurance market reforms under chapter 635 of the statutes, as affected by this act,
18and under the federal Health Insurance Portability and Accountability Act of 1996,
19P.L. 104-191, including the effectiveness of the reforms with respect to all of the
20following:
SB218,57,22 211. Accessibility of health insurance coverage, including such accessibility for
22persons who reside in rural areas of the state.
SB218,57,23 232. Availability of health insurance coverage for uninsured persons.
SB218,57,24 243. Affordability of health insurance coverage.
SB218,58,4
1(b) The commissioner shall submit a report of the results of the evaluation and
2any recommendations to the legislature in the manner provided under section
313.172 (2) of the statutes no later than the first day of the 24th month beginning after
4publication.
SB218, s. 74 5Section 74 . Initial applicability.
SB218,58,66 (1) This act first applies to all of the following:
SB218,58,97 (a) Except as provided in paragraphs (b) and (c ), health benefit plans that are
8issued or renewed, and self-insured health plans that are established, extended,
9modified or renewed, on the effective date of this paragraph.
SB218,58,1210 (b) Health benefit plans covering employes who are affected by a collective
11bargaining agreement containing provisions inconsistent with this act that are
12issued or renewed on the earlier of the following:
SB218,58,13 131. The day on which the collective bargaining agreement expires.
SB218,58,15 142. The day on which the collective bargaining agreement is extended, modified
15or renewed.
SB218,58,1816 (c) Self-insured health plans covering employes who are affected by a collective
17bargaining agreement containing provisions inconsistent with this act that are
18established, extended, modified or renewed on the earlier of the following:
SB218,58,19 191. The day on which the collective bargaining agreement expires.
SB218,58,21 202. The day on which the collective bargaining agreement is extended, modified
21or renewed.
SB218, s. 75 22Section 75. Effective dates. This act takes effect on the first day of the 7th
23month beginning after publication, except as follows:
SB218,58,2424 (1) Section 73 (1 ) and (2) of this act takes effect on the day after publication.
SB218,59,5
1(2) The repeal of section 635.08 (1) (b) of the statutes takes effect on the 31st
2day after the day on which the commissioner of insurance certifies to the revisor of
3statutes under section 632.898 (7) of the statutes, as affected by this act, that section
4635.08 (1) (b) of the statutes, as created by this act, is not necessary for the purpose
5for which it was intended.
SB218,59,66 (End)
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