SB157: Bill Text

SB157,6,20 632.89 (1) (er) "Self-insured health plan" has the meaning given in s. 632.745 (24).

SB157, s. 18 Section 18. 632.89 (2) (title) of the statutes is amended to read:

SB157,6,22 632.89 (2) (title) Required coverage for group plans.

SB157, s. 19 Section 19. 632.89 (2) (a) 1. of the statutes is renumbered 632.89 (2) (a) and amended to read:

SB157,7,5 632.89 (2) (a) Conditions covered. A group or blanket disability insurance policy issued by an insurer health benefit plan and a self-insured health plan shall provide coverage of nervous and mental disorders and alcoholism and other drug abuse problems if required by pars. (c) to (dm) and as provided in pars. (b) (c) to (e) (dm) and sub. (3).

SB157, s. 20 Section 20. 632.89 (2) (a) 2. of the statutes is repealed.

SB157, s. 21 Section 21. 632.89 (2) (b) of the statutes is repealed.

SB157, s. 22 Section 22. 632.89 (2) (c) 1. of the statutes is renumbered 632.89 (2) (c) and amended to read:

SB157,7,14 632.89 (2) (c) Minimum coverage Coverage of inpatient hospital services. If a group or blanket disability insurance policy issued by an insurer health benefit plan or a self-insured health plan provides coverage of any inpatient hospital treatment, the policy plan shall provide coverage for inpatient hospital services for the treatment of conditions under par. (a) 1. as provided in subd. 2.

SB157, s. 23 Section 23. 632.89 (2) (c) 2. of the statutes is repealed.

SB157, s. 24 Section 24. 632.89 (2) (d) 1. of the statutes is renumbered 632.89 (2) (d) and amended to read:

SB157,7,22 632.89 (2) (d) Minimum coverage Coverage of outpatient services. If a group or blanket disability insurance policy issued by an insurer health benefit plan or a self-insured health plan provides coverage of any outpatient treatment, the policy plan shall provide coverage for outpatient services for the treatment of conditions under par. (a) 1. as provided in subd. 2.

SB157, s. 25 Section 25. 632.89 (2) (d) 2. of the statutes is repealed.

SB157, s. 26 Section 26. 632.89 (2) (dm) 1. of the statutes is renumbered 632.89 (2) (dm) and amended to read:

SB157,8,6 632.89 (2) (dm) Minimum coverage Coverage of transitional treatment arrangements. If a group or blanket disability insurance policy issued by an insurer health benefit plan or a self-insured health plan provides coverage of any inpatient hospital treatment or any outpatient treatment, the policy plan shall provide coverage for transitional treatment arrangements for the treatment of conditions under par. (a) 1. as provided in subd. 2.

SB157, s. 27 Section 27. 632.89 (2) (dm) 2. of the statutes is repealed.

SB157, s. 28 Section 28. 632.89 (2) (e) of the statutes is renumbered 632.89 (5) (b) and amended to read:

SB157,8,13 632.89 (5) (b) Exclusion Certain health care plans. This subsection section does not apply to a health care plan offered by a limited service health organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not a managed care plan, as defined in s. 609.01 (3c).

SB157, s. 29 Section 29. 632.89 (2m) of the statutes is renumbered 632.89 (4m).

SB157, s. 30 Section 30. 632.89 (3) of the statutes is created to read:

SB157,8,20 632.89 (3) Equal coverage requirement. (a) Group plans. A group health benefit plan or a self-insured health plan that provides coverage for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems shall provide the same coverage for that treatment that it provides for the treatment of physical conditions.

SB157,8,24 (b) Individual plans. If an individual health benefit plan provides coverage for the treatment of nervous or mental disorders or alcoholism or other drug abuse problems, the individual health benefit plan shall provide the same coverage for that treatment that it provides for the treatment of physical conditions.

SB157,9,5 (c) All coverage components. The requirements under this subsection apply to all coverage-related components, including rates; exclusions and limitations; deductibles; copayments; coinsurance; annual and lifetime payment limits; out-of-pocket limits; out-of-network charges; day, visit, or appointment limits; duration or frequency of coverage; and medical necessity definitions.

SB157, s. 31 Section 31. 632.89 (3m) of the statutes is repealed.

SB157, s. 32 Section 32. 632.89 (5) (title) of the statutes is amended to read:

SB157,9,8 632.89 (5) (title) Medicare exclusion Exclusions.

SB157, s. 33 Section 33. 632.89 (5) of the statutes is renumbered 632.89 (5) (a).

SB157, s. 34 Section 34. 632.89 (5) (a) (title) of the statutes is created to read:

SB157,9,11 632.89 (5) (a) (title) Medicare.

SB157, s. 35 Section 35. Initial applicability.

SB157,9,13 (1) This act first applies to all of the following:

SB157,9,16 (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.

SB157,9,19 (b) Health benefit plans covering employees 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:

SB157,9,20 1. The day on which the collective bargaining agreement expires.

SB157,9,22 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

SB157,9,25 (c) Self-insured health plans covering employees 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:

SB157,10,1 1. The day on which the collective bargaining agreement expires.

SB157,10,3 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

SB157, s. 36 Section 36. Effective date.

SB157,10,6 (1) This act takes effect on the first day of the 6th month beginning after publication.

SB157,10,7 (End)