SB698, s. 17
19Section
17. 49.474 of the statutes is created to read:
SB698,9,25
2049.474 Eligibility for Wisconsin Health Care Plan. Notwithstanding ss.
2149.46, 49.465, 49.47, and 49.472, if a waiver under 2005 Wisconsin Act .... (this act),
22section 57 (2) (a
) 2., is granted and in effect, a person who is covered under the
23Wisconsin Health Care Plan under s. 634.10 (2) (a) is eligible for medical assistance
24only with respect to health care benefits not provided under the Wisconsin Health
25Care Plan.
SB698, s. 18
1Section
18. 49.665 (4) (e) of the statutes is created to read:
SB698,10,62
49.665
(4) (e) Notwithstanding pars. (a) to (ap), if a waiver under 2005
3Wisconsin Act .... (this act), section 57 (2) (a
) 2., is granted and in effect, a person who
4is covered under the Wisconsin Health Care Plan under s. 634.10 (2) (a) is eligible
5for health care coverage under this section only with respect to health care benefits
6not provided under the Wisconsin Health Care Plan.
SB698, s. 19
7Section
19. 49.68 (3) (d) 1. of the statutes is amended to read:
SB698,10,228
49.68
(3) (d) 1. No aid may be granted under this subsection
unless if the
9recipient has
no other form of aid available from the federal
medicare Medicare
10program, from private health, accident, sickness, medical,
and or hospital insurance
11coverage,
from the Wisconsin Health Care Plan under ch. 634, or from other health
12care coverage specified by rule under s. 49.687 (1m). If insufficient aid is available
13from other sources and if the recipient has paid an amount equal to the annual
14medicare Medicare deductible amount specified in subd. 2., the state shall pay the
15difference in cost to a qualified recipient. If at any time sufficient federal or private
16insurance aid or other health care coverage becomes available during the treatment
17period, state aid under this subsection shall be terminated or appropriately reduced.
18Any patient who is eligible for the federal
medicare
Medicare program shall register
19and pay the premium for
medicare Medicare medical insurance coverage where
20permitted, and shall pay an amount equal to the annual
medicare Medicare 21deductible amounts required under
42 USC 1395e and
1395L (b), prior to becoming
22eligible for state aid under this subsection.
SB698, s. 20
23Section
20. 49.683 (3) of the statutes is amended to read:
SB698,11,324
49.683
(3) No payment shall be made under this section for any portion of
25medical care costs that are payable under any state, federal, or other health care
1coverage program, including
the Wisconsin Health Care Plan under ch. 634 or a
2health care coverage program specified by rule under s. 49.687 (1m), or under any
3grant, contract, or other contractual arrangement.
SB698, s. 21
4Section
21. 49.685 (6) (b) of the statutes is amended to read:
SB698,11,125
49.685
(6) (b) Reimbursement shall not be made under this section for any
6blood products or supplies that are not purchased from or provided by a
7comprehensive hemophilia treatment center, or a source approved by the treatment
8center. Reimbursement shall not be made under this section for any portion of the
9costs of blood products or supplies that are payable under any other state, federal,
10or other health care coverage program, including
the Wisconsin Health Care Plan
11under ch. 634 or a health care coverage program specified by rule under s. 49.687
12(1m), or under any grant, contract, or other contractual arrangement.
SB698, s. 22
13Section
22. 59.52 (11) (c) of the statutes is amended to read:
SB698,12,214
59.52
(11) (c)
Employee insurance. Provide for individual or group
hospital,
15surgical and life insurance for county officers and employees and for payment of
16premiums for county officers and employees. A county
may elect to provide health
17care benefits not provided under the Wisconsin Health Care Plan under ch. 634 to
18its officers and employees and a county with at least 100 employees may elect to
19provide health care benefits
not provided under the Wisconsin Health Care Plan
20under ch. 634 on a self-insured basis to its officers and employees. A county and one
21or more cities, villages, towns, or other counties that together have at least 100
22employees may jointly provide health care benefits
not provided under the Wisconsin
23Health Care Plan under ch. 634 to their officers and employees on a self-insured
24basis. Counties that elect to provide health care benefits
not provided under the
25Wisconsin Health Care Plan under ch. 634 on a self-insured basis to their officers
1and employees shall be subject to the requirements set forth under s. 120.13 (2) (c)
2to (e) and (g).
SB698, s. 23
3Section
23. 60.23 (25) of the statutes is amended to read:
SB698,12,64
60.23
(25) Self-insured health plans. Provide health care benefits
not
5provided under the Wisconsin Health Care Plan under ch. 634 to its officers and
6employees on a self-insured basis, subject to s. 66.0137 (4).
SB698, s. 24
7Section
24. 62.61 of the statutes is renumbered 62.61 (1) (intro.) and amended
8to read:
SB698,12,109
62.61
(1) (intro.) The common council of a 1st class city may, by ordinance or
10resolution,
provide do any of the following:
SB698,12,14
11(a) Provide for, including the payment of premiums of, general hospital,
12surgical and group insurance for
both active and retired city officers and city
13employees and their respective dependents in private companies
, or may, by
14ordinance or resolution, elect.
SB698,12,18
15(c) Elect to offer to all of its employees a health care coverage plan through a
16program offered by the group insurance board under ch. 40. Municipalities
which 17that elect to participate under s. 40.51 (7) are subject to the applicable sections of ch.
1840 instead of this section.
SB698,13,2
19(2) Contracts for insurance under this section may be entered into for active
20officers and employees separately from contracts for retired officers and employees.
21Appropriations may be made for the purpose of financing insurance under this
22section. Moneys accruing to a fund to finance insurance under this section, by
23investment or otherwise, may not be diverted for any other purpose than those for
24which the fund was set up or to defray management expenses of the fund or to
1partially pay premiums to reduce costs to the city or to persons covered by the
2insurance, or both.
SB698, s. 25
3Section
25. 62.61 (1) (b) of the statutes is created to read:
SB698,13,64
62.61
(1) (b) Subject to s. 634.40, provide for, including the payment of
5premiums of, group health insurance for active city officers and city employees and
6their respective dependents.
SB698,13,169
66.0137
(4) Self-insured health plans. If a city, including a 1st class city, or
10a village provides health care benefits
not provided under the Wisconsin Health Care
11Plan under ch. 634 under its home rule power, or if a town provides health care
12benefits
not provided under the Wisconsin Health Care Plan under ch. 634, to its
13officers and employees on a self-insured basis, the self-insured plan shall comply
14with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747
15(3), 632.85, 632.853, 632.855, 632.87 (4)
, (5), and (6), 632.895 (9) to (14), 632.896
, and
16767.25 (4m) (d).
SB698, s. 27
17Section
27. 66.0137 (4m) (b) of the statutes is amended to read:
SB698,13,2118
66.0137
(4m) (b) A political subdivision and one or more other political
19subdivisions, that together have at least 100 employees, may jointly provide health
20care benefits
not provided under the Wisconsin Health Care Plan under ch. 634 to
21their officers and employees on a
self insured self-insured basis.
SB698, s. 28
22Section
28. 66.0137 (5) of the statutes is amended to read:
SB698,14,723
66.0137
(5) Hospital, accident, and life insurance. The Subject to s. 634.40,
24the state or a local governmental unit may provide for the payment of premiums for
25hospital, surgical and other health and accident insurance and life insurance for
1employees and officers and their spouses and dependent children. A local
2governmental unit may also provide for the payment of premiums for hospital and
3surgical care for its retired employees. In addition, a local governmental unit may,
4by ordinance or resolution, elect to offer to all of its employees a health care coverage
5plan through a program offered by the group insurance board under ch. 40. A local
6governmental unit that elects to participate under s. 40.51 (7) is subject to the
7applicable sections of ch. 40 instead of this subsection.
SB698, s. 29
8Section
29. 109.075 (9) of the statutes is created to read:
SB698,14,119
109.075
(9) This section does not apply to an employer that ceases providing
10health care benefits to its employees because the employees are covered under the
11Wisconsin Health Care Plan under ch. 634.
SB698, s. 30
12Section
30. 111.70 (1) (dm) of the statutes is amended to read:
SB698,15,213
111.70
(1) (dm) "Economic issue" means salaries, overtime pay, sick leave,
14payments in lieu of sick leave usage, vacations, clothing allowances in excess of the
15actual cost of clothing, length-of-service credit, continuing education credit, shift
16premium pay, longevity pay, extra duty pay, performance bonuses, health insurance
17coverage of benefits not provided under the Wisconsin Health Care Plan under ch.
18634, life insurance, dental insurance, disability insurance, vision insurance,
19long-term care insurance, worker's compensation and unemployment insurance,
20social security benefits, vacation pay, holiday pay, lead worker pay, temporary
21assignment pay, retirement contributions, supplemental retirement benefits,
22severance or other separation pay, hazardous duty pay, certification or license
23payment, limitations on layoffs that create a new or increased financial liability on
24the employer and contracting or subcontracting of work that would otherwise be
1performed by municipal employees in the collective bargaining unit with which there
2is a labor dispute.
SB698, s. 31
3Section
31. 111.91 (2) (pm) of the statutes is created to read:
SB698,15,54
111.91
(2) (pm) Health care coverage of employees under the Wisconsin Health
5Care Plan under ch. 634.
SB698, s. 32
6Section
32. 120.12 (24) of the statutes is amended to read:
SB698,15,117
120.12
(24) Health care benefits. Prior to the selection
for school district
8professional employees, as defined in s. 111.70 (1) (ne), of any
provider of group
9health care benefits
provider for school district professional employees, as defined
10in s. 111.70 (1) (ne) not provided under the Wisconsin Health Care Plan under ch. 634,
11solicit sealed bids for the provision of such benefits.
SB698, s. 33
12Section
33. 120.13 (2) (b) of the statutes is amended to read:
SB698,15,1813
120.13
(2) (b) Provide health care benefits
not provided under the Wisconsin
14Health Care Plan under ch. 634 on a self-insured basis to the employees of the school
15district if the school district has at least 100 employees. In addition, any 2 or more
16school districts which together have at least 100 employees may jointly provide
17health care benefits
not provided under the Wisconsin Health Care Plan under ch.
18634 on a self-insured basis to employees of the school districts.
SB698,15,2421
120.13
(2) (g) Every self-insured plan under par. (b) shall comply with ss.
2249.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
23632.85, 632.853, 632.855, 632.87 (4)
, (5), and (6), 632.895 (9) to (14), 632.896
, and
24767.25 (4m) (d).
SB698, s. 35
25Section
35. 149.12 (2) (e) of the statutes is repealed and recreated to read:
SB698,16,3
1149.12
(2) (e) No person who is covered under the Wisconsin Health Care Plan
2under s. 634.10 (2) (a) is eligible for coverage under the plan established under this
3chapter.
SB698, s. 36
4Section
36. 227.01 (13) (nm) of the statutes is created to read:
SB698,16,65
227.01
(13) (nm) Relates to determining coverage under s. 634.10 (4) or setting
6premiums or assessments under s. 634.25.
SB698, s. 37
7Section
37. 254.11 (13) of the statutes is amended to read:
SB698,16,158
254.11
(13) "Third-party payer" means a disability insurance policy that is
9required to provide coverage for a blood lead test under s. 632.895 (10) (a); a health
10maintenance organization or preferred provider plan under ch. 609;
a health care
11coverage plan offered by the state under s. 40.51 (6); a self-insured health plan
12offered by a city or village under s. 66.0137 (4), a political subdivision under s.
1366.0137 (4m), a town under s. 60.23 (25), a county under s. 59.52 (11) (c), or a school
14district under s. 120.13 (2) (b); or a sickness care plan operated by a cooperative
15association under s. 185.981.
SB698, s. 38
16Section
38. 609.10 of the statutes is repealed.
SB698, s. 39
17Section
39. 609.20 (1m) (c) of the statutes is repealed.
SB698, s. 40
18Section
40. 609.20 (1m) (d) of the statutes is repealed.
SB698, s. 41
19Section
41. 628.36 (4) (a) (intro.) of the statutes is amended to read:
SB698,16,2320
628.36
(4) (a) (intro.) The commissioner shall provide information and
21assistance to
the department of employee trust funds, employers and their
22employees, providers of health care services
, and members of the public, as provided
23in par. (b), for the following purposes:
SB698, s. 42
24Section
42. 628.36 (4) (b) 1. of the statutes is repealed.
SB698, s. 43
25Section
43. 628.36 (4) (b) 2. of the statutes is repealed.
SB698, s. 44
1Section
44. 628.36 (4) (b) 3. of the statutes is repealed.
SB698, s. 45
2Section
45. 632.87 (5) of the statutes is amended to read:
SB698,17,103
632.87
(5) No insurer
or self-insured school district, city or village may, under
4a policy, plan
, or contract covering gynecological services or procedures, exclude or
5refuse to provide coverage for Papanicolaou tests, pelvic examinations
, or associated
6laboratory fees when the test or examination is performed by a licensed nurse
7practitioner, as defined in s. 632.895 (8) (a) 3., within the scope of the nurse
8practitioner's professional license, if the policy, plan
, or contract includes coverage
9for Papanicolaou tests, pelvic examinations
, or associated laboratory fees when the
10test or examination is performed by a physician.
SB698, s. 46
11Section
46. 632.895 (8) (f) 4. of the statutes is created to read:
SB698,17,1312
632.895
(8) (f) 4. A disability insurance policy providing only health care
13benefits not provided under the Wisconsin Health Care Plan under ch. 634.
SB698, s. 47
14Section
47. 632.895 (9) (d) 4. of the statutes is created to read:
SB698,17,1615
632.895
(9) (d) 4. A disability insurance policy providing only health care
16benefits not provided under the Wisconsin Health Care Plan under ch. 634.
SB698, s. 48
17Section
48. 632.895 (10) (a) of the statutes is amended to read:
SB698,17,2518
632.895
(10) (a) Except as provided in par. (b), every disability insurance policy
19and every health care benefits plan provided on a self-insured basis by a county
20board under s. 59.52 (11), by a city or village under s. 66.0137 (4), by a political
21subdivision under s. 66.0137 (4m), by a town under s. 60.23 (25), or by a school district
22under s. 120.13 (2) shall provide coverage for blood lead tests for children under 6
23years of age, which shall be conducted in accordance with any recommended lead
24screening methods and intervals contained in any rules promulgated by the
25department of health and family services under s. 254.158.
SB698, s. 49
1Section
49. 632.895 (10) (b) 6. of the statutes is created to read:
SB698,18,32
632.895
(10) (b) 6. A disability insurance policy providing only health care
3benefits not provided under the Wisconsin Health Care Plan under ch. 634.
SB698, s. 50
4Section
50. 632.895 (11) (a) (intro.) of the statutes is amended to read:
SB698,18,105
632.895
(11) (a) (intro.) Except as provided in par. (e), every disability
6insurance policy
, and every self-insured health plan of the state or a county, city,
7village, town or school district, that provides coverage of any diagnostic or surgical
8procedure involving a bone, joint, muscle
, or tissue shall provide coverage for
9diagnostic procedures and medically necessary surgical or nonsurgical treatment for
10the correction of temporomandibular disorders if all of the following apply:
SB698, s. 51
11Section
51. 632.895 (11) (c) 1. of the statutes is amended to read:
SB698,18,1412
632.895
(11) (c) 1. The coverage required under this subsection may be subject
13to any limitations, exclusions
, or cost-sharing provisions that apply generally under
14the disability insurance policy
or self-insured health plan.
SB698, s. 52
15Section
52. 632.895 (11) (d) of the statutes is amended to read:
SB698,18,1916
632.895
(11) (d) Notwithstanding par. (c) 1., an insurer
or a self-insured health
17plan of the state or a county, city, village, town or school district may require that an
18insured obtain prior authorization for any medically necessary surgical or
19nonsurgical treatment for the correction of temporomandibular disorders.
SB698, s. 53
20Section
53. 632.895 (11) (e) 3. of the statutes is created to read:
SB698,18,2221
632.895
(11) (e) 3. A disability insurance policy providing only health care
22benefits not provided under the Wisconsin Health Care Plan under ch. 634.
SB698, s. 54
23Section
54. 632.895 (14) (b) of the statutes is amended to read:
SB698,19,324
632.895
(14) (b) Except as provided in par. (d), every disability insurance policy
,
25and every self-insured health plan of the state or a county, city, town, village or school
1district, that provides coverage for a dependent of the insured shall provide coverage
2of appropriate and necessary immunizations, from birth to the age of 6 years, for a
3dependent who is a child of the insured.
SB698, s. 55
4Section
55. 632.895 (14) (d) 7. of the statutes is created to read:
SB698,19,65
632.895
(14) (d) 7. A disability insurance policy providing only health care
6benefits not provided under the Wisconsin Health Care Plan under ch. 634.
SB698, s. 56
7Section
56. Chapter 634 of the statutes is created to read:
SB698,19,99
Wisconsin Health Care Plan
SB698,19,10
10634.01 Definitions. In this chapter:
SB698,19,11
11(1) "Board" means the Wisconsin health care plan board.
SB698,19,12
12(2) "Dependent" means any of the following:
SB698,19,1313
(a) A spouse.
SB698,19,1614
(b) An unmarried child under the age of 19 years, including a stepchild of the
15current marriage if the stepchild is dependent on the stepparent for support and
16maintenance.
SB698,19,1917
(c) An unmarried child over the age of 18 years and under the age of 21 years,
18including a stepchild of the current marriage, if the child or stepchild is a full-time
19student and is financially dependent on the parent or stepparent.
SB698,19,2220
(d) An unmarried child of any age, including a stepchild of the current
21marriage, if the child or stepchild is medically certified as disabled and is dependent
22on the parent or stepparent.
SB698,19,23
23(3) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
SB698,19,24
24(4) "Distributor" has the meaning given in s. 450.01 (9).
SB698,20,4
1(5) "Employee" means an individual who is employed in this state by an
2employer, regardless of whether the individual is a resident. "Employee" does not
3include a self-employed individual, regardless of whether the self-employed
4individual has other employees.
SB698,20,9
5(6) "Employer" means any person engaged in any activity, enterprise, or
6business employing one or more individuals within this state. "Employer" includes
7the state and its political subdivisions and charitable, nonprofit, or tax-exempt
8organizations or institutions. "Employer" does not include a self-employed
9individual who has no other employees.