April 22, 2005 - Introduced by Representatives Sheridan, Kaufert, Kreuser,
Ainsworth, Berceau, Boyle, Fields, Lehman, McCormick, Molepske, Pocan,
Richards, Seidel, Shilling, Sinicki, Staskunas, Turner, Van Akkeren and
Zepnick, cosponsored by Senators Hansen, Ellis, Breske, Carpenter and
Erpenbach. Referred to Committee on Insurance.
AB351,1,5
1An Act to renumber 149.10 (2t) (a), 149.10 (2t) (b), 149.10 (2t) (c), 149.10 (2t)
2(d) and 149.10 (2t) (e);
to renumber and amend 149.10 (2t) (f);
to amend
3149.10 (2t) (intro.) and 149.115; and
to create 149.10 (2t) (am) and 149.12 (3)
4(br) of the statutes;
relating to: eligibility of certain persons for the Health
5Insurance Risk-Sharing Plan.
Analysis by the Legislative Reference Bureau
The Health Insurance Risk-Sharing Plan (HIRSP) provides major medical
health insurance coverage for persons who are covered under Medicare because they
are disabled, persons who have tested positive for HIV, and persons who have been
refused coverage, or coverage at an affordable price, in the private health insurance
market because of their mental or physical health conditions. Also eligible for
coverage are persons (called "eligible individuals" in the statutes) who do not
currently have health insurance coverage, but who were covered under certain types
of health insurance coverage (called creditable coverage) for at least 18 months in the
past. HIRSP is funded by premiums paid by covered persons, insurer assessments,
and provider payment discounts, and administered by the Department of Health and
Family Services, a board of governors, and a plan administrator.
The federal Trade Adjustment Assistance Reform Act of 2002 (TAA) provides,
among other benefits that are employment related, a tax credit for up to 65 percent
of the amount of the premium paid by eligible persons for coverage under qualified
health insurance, including a state high-risk pool such as HIRSP. Eligible persons
are those who are eligible for TAA employment-related benefits because they have
lost their jobs or experienced reduced work hours and wages because of increased
imports (TAA eligible) and those who are at least 55 years of age and receiving
benefits from the Pension Benefit Guaranty Corporation (PBGC eligible).
Under this bill, a TAA-eligible person or a PBGC-eligible person who has
aggregate periods of creditable coverage of at least three months is eligible for
coverage under HIRSP. In conformity with the requirements under TAA, the bill
provides that a TAA-eligible person or a PBGC-eligible person who obtains coverage
under HIRSP: 1) receives the same benefits as other HIRSP enrollees; 2) pays the
same premium as other HIRSP enrollees; and 3) is not subject to any preexisting
condition exclusion, which also applies under current law to "eligible individuals"
with coverage under HIRSP, while other HIRSP enrollees are subject to a six-month
preexisting condition exclusion.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB351, s. 1
1Section
1. 149.10 (2t) (intro.) of the statutes is amended to read:
AB351,2,22
149.10
(2t) (intro.) "Eligible individual" means
an either of the following:
AB351,2,3
3(bm) An individual for whom all of the following apply:
AB351, s. 2
4Section
2. 149.10 (2t) (a) of the statutes is renumbered 149.10 (2t) (bm) 1.
AB351, s. 3
5Section
3. 149.10 (2t) (am) of the statutes is created to read:
AB351,2,76
149.10
(2t) (am) An eligible individual as defined in
26 USC 35 (c) for whom
7all of the following apply:
AB351,2,98
1. The aggregate of the individual's periods of creditable coverage is 3 months
9or more.
AB351,2,1010
2. The individual does not have other health care coverage.
AB351,2,1111
3. The individual is not confined in a prison, jail, or house of correction.
AB351, s. 4
12Section
4. 149.10 (2t) (b) of the statutes is renumbered 149.10 (2t) (bm) 2.
AB351, s. 5
13Section
5. 149.10 (2t) (c) of the statutes is renumbered 149.10 (2t) (bm) 3.
AB351, s. 6
14Section
6. 149.10 (2t) (d) of the statutes is renumbered 149.10 (2t) (bm) 4.
AB351, s. 7
15Section
7. 149.10 (2t) (e) of the statutes is renumbered 149.10 (2t) (bm) 5.
AB351, s. 8
1Section
8. 149.10 (2t) (f) of the statutes is renumbered 149.10 (2t) (bm) 6. and
2amended to read:
AB351,3,43
149.10
(2t) (bm) 6. The individual has exhausted any continuation coverage
4under
par. (e) subd. 5.
AB351, s. 9
5Section
9. 149.115 of the statutes is amended to read:
AB351,3,10
6149.115 Rules relating to creditable coverage. The commissioner, in
7consultation with the department, shall promulgate rules that specify how
8creditable coverage is to be aggregated for purposes of s. 149.10 (2t)
(a) (am) 1. and
9(bm) 1. and that determine the creditable coverage to which s. 149.10 (2t)
(b) and (d) 10(bm) 2. and 4. applies. The rules shall comply with section 2701 (c) of P.L.
104-191.
AB351, s. 10
11Section
10. 149.12 (3) (br) of the statutes is created to read:
AB351,3,1412
149.12
(3) (br) Persons receiving a federal or state income tax credit for
13premium payments are not ineligible for coverage under the plan by reason of such
14tax credits.
