SB698: Bill Text

SB698, s. 10 Section 10. 40.51 (7) of the statutes is amended to read:

SB698,8,2 40.51 (7) Any employer, other than the state, may offer to all of its employees a health care coverage plan coverage for health care benefits not provided to the employees under the Wisconsin Health Care Plan under ch. 634 through a program offered by the group insurance board. Notwithstanding sub. (2) and ss. 40.05 (4) and 40.52 (1), the department may by rule establish different eligibility standards or contribution requirements for such employees and employers and may by rule limit the categories of employers, other than the state, which may be included as participating employers under this subchapter.

SB698, s. 11 Section 11. 40.51 (8) of the statutes, as affected by 2005 Wisconsin Act 194, is amended to read:

SB698,8,8 40.51 (8) Every health care coverage plan offered by the state under sub. (6) (a) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8) and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to (6), 632.895 (5m) and (8) to (14), and 632.896.

SB698, s. 12 Section 12. 40.51 (8m) of the statutes is amended to read:

SB698,8,13 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. subs. (6) (b) and (7) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8) and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, and 632.895 (11) to (14) 632.87 (3) to (6).

SB698, s. 13 Section 13. 40.52 (1) (intro.) of the statutes is amended to read:

SB698,8,18 40.52 (1) (intro.) The group insurance board shall establish by contract a standard health insurance plan in which all insured employees shall participate except as otherwise provided in this chapter. The Except as provided in sub. (1m), the standard plan shall provide:

SB698, s. 14 Section 14. 40.52 (1m) of the statutes is created to read:

SB698,8,22 40.52 (1m) The standard health insurance plan described under sub. (1) shall not provide employees any health care coverage that the employees receive under the Wisconsin Health Care Plan under ch. 634.

SB698, s. 15 Section 15. 40.52 (2) of the statutes is amended to read:

SB698,9,13 40.52 (2) Health insurance benefits under this subchapter shall be integrated, with exceptions determined appropriate by the group insurance board, with benefits under federal plans for hospital and health care for the aged and disabled and with benefits provided under the Wisconsin Health Care Plan under ch. 634. Exclusions and limitations with respect to benefits and different rates may be established for persons eligible under federal plans for hospital and health care for the aged and disabled in recognition of the utilization by persons within the age limits eligible under the federal program and for employees who receive benefits under the Wisconsin Health Care Plan under ch. 634. The plan may include special provisions for spouses and other dependents covered under a plan established under this subchapter where one spouse is eligible under federal plans for hospital and health care for the aged or under the Wisconsin Health Care Plan under ch. 634 but the others are not eligible because of age or other reasons. As part of the integration, the department may, out of premiums collected under s. 40.05 (4), pay premiums for the federal health insurance.

SB698, s. 16 Section 16. 49.473 (2) (c) of the statutes is amended to read:

SB698,9,18 49.473 (2) (c) The woman is not covered under the Wisconsin Health Care Plan under ch. 634 and is not eligible for any other health care coverage that qualifies as creditable coverage in 42 USC 300gg (c), excluding the coverage specified in 42 USC 300gg (c) (1) (F).

SB698, s. 17 Section 17. 49.474 of the statutes is created to read:

SB698,9,25 49.474 Eligibility for Wisconsin Health Care Plan. Notwithstanding ss. 49.46, 49.465, 49.47, and 49.472, if a waiver under 2005 Wisconsin Act .... (this act), section 57 (2) (a ) 2., is granted and in effect, a person who is covered under the Wisconsin Health Care Plan under s. 634.10 (2) (a) is eligible for medical assistance only with respect to health care benefits not provided under the Wisconsin Health Care Plan.

SB698, s. 18 Section 18. 49.665 (4) (e) of the statutes is created to read:

SB698,10,6 49.665 (4) (e) Notwithstanding pars. (a) to (ap), if a waiver under 2005 Wisconsin Act .... (this act), section 57 (2) (a ) 2., is granted and in effect, a person who is covered under the Wisconsin Health Care Plan under s. 634.10 (2) (a) is eligible for health care coverage under this section only with respect to health care benefits not provided under the Wisconsin Health Care Plan.

SB698, s. 19 Section 19. 49.68 (3) (d) 1. of the statutes is amended to read:

SB698,10,22 49.68 (3) (d) 1. No aid may be granted under this subsection unless if the recipient has no other form of aid available from the federal medicare Medicare program, from private health, accident, sickness, medical, and or hospital insurance coverage, from the Wisconsin Health Care Plan under ch. 634, or from other health care coverage specified by rule under s. 49.687 (1m). If insufficient aid is available from other sources and if the recipient has paid an amount equal to the annual medicare Medicare deductible amount specified in subd. 2., the state shall pay the difference in cost to a qualified recipient. If at any time sufficient federal or private insurance aid or other health care coverage becomes available during the treatment period, state aid under this subsection shall be terminated or appropriately reduced. Any patient who is eligible for the federal medicare Medicare program shall register and pay the premium for medicare Medicare medical insurance coverage where permitted, and shall pay an amount equal to the annual medicare Medicare deductible amounts required under 42 USC 1395e and 1395L (b), prior to becoming eligible for state aid under this subsection.

SB698, s. 20 Section 20. 49.683 (3) of the statutes is amended to read:

SB698,11,3 49.683 (3) No payment shall be made under this section for any portion of medical care costs that are payable under any state, federal, or other health care coverage program, including the Wisconsin Health Care Plan under ch. 634 or a health care coverage program specified by rule under s. 49.687 (1m), or under any grant, contract, or other contractual arrangement.

SB698, s. 21 Section 21. 49.685 (6) (b) of the statutes is amended to read:

SB698,11,12 49.685 (6) (b) Reimbursement shall not be made under this section for any blood products or supplies that are not purchased from or provided by a comprehensive hemophilia treatment center, or a source approved by the treatment center. Reimbursement shall not be made under this section for any portion of the costs of blood products or supplies that are payable under any other state, federal, or other health care coverage program, including the Wisconsin Health Care Plan under ch. 634 or a health care coverage program specified by rule under s. 49.687 (1m), or under any grant, contract, or other contractual arrangement.

SB698, s. 22 Section 22. 59.52 (11) (c) of the statutes is amended to read:

SB698,12,2 59.52 (11) (c) Employee insurance. Provide for individual or group hospital, surgical and life insurance for county officers and employees and for payment of premiums for county officers and employees. A county may elect to provide health care benefits not provided under the Wisconsin Health Care Plan under ch. 634 to its officers and employees and a county with at least 100 employees may elect to provide health care benefits not provided under the Wisconsin Health Care Plan under ch. 634 on a self-insured basis to its officers and employees. A county and one or more cities, villages, towns, or other counties that together have at least 100 employees may jointly provide health care benefits not provided under the Wisconsin Health Care Plan under ch. 634 to their officers and employees on a self-insured basis. Counties that elect to provide health care benefits not provided under the Wisconsin Health Care Plan under ch. 634 on a self-insured basis to their officers and employees shall be subject to the requirements set forth under s. 120.13 (2) (c) to (e) and (g).

SB698, s. 23 Section 23. 60.23 (25) of the statutes is amended to read:

SB698,12,6 60.23 (25) Self-insured health plans. Provide health care benefits not provided under the Wisconsin Health Care Plan under ch. 634 to its officers and employees on a self-insured basis, subject to s. 66.0137 (4).

SB698, s. 24 Section 24. 62.61 of the statutes is renumbered 62.61 (1) (intro.) and amended to read:

SB698,12,10 62.61 (1) (intro.) The common council of a 1st class city may, by ordinance or resolution, provide do any of the following:

SB698,12,14 (a) Provide for, including the payment of premiums of, general hospital, surgical and group insurance for both active and retired city officers and city employees and their respective dependents in private companies, or may, by ordinance or resolution, elect.

SB698,12,18 (c) Elect to offer to all of its employees a health care coverage plan through a program offered by the group insurance board under ch. 40. Municipalities which that elect to participate under s. 40.51 (7) are subject to the applicable sections of ch. 40 instead of this section.

SB698,13,2 (2) Contracts for insurance under this section may be entered into for active officers and employees separately from contracts for retired officers and employees. Appropriations may be made for the purpose of financing insurance under this section. Moneys accruing to a fund to finance insurance under this section, by investment or otherwise, may not be diverted for any other purpose than those for which the fund was set up or to defray management expenses of the fund or to partially pay premiums to reduce costs to the city or to persons covered by the insurance, or both.

SB698, s. 25 Section 25. 62.61 (1) (b) of the statutes is created to read:

SB698,13,6 62.61 (1) (b) Subject to s. 634.40, provide for, including the payment of premiums of, group health insurance for active city officers and city employees and their respective dependents.

SB698, s. 26 Section 26. 66.0137 (4) of the statutes, as affected by 2005 Wisconsin Act 194, is amended to read:

SB698,13,16 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits not provided under the Wisconsin Health Care Plan under ch. 634 under its home rule power, or if a town provides health care benefits not provided under the Wisconsin Health Care Plan under ch. 634, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.895 (9) to (14), 632.896, and 767.25 (4m) (d).

SB698, s. 27 Section 27. 66.0137 (4m) (b) of the statutes is amended to read:

SB698,13,21 66.0137 (4m) (b) A political subdivision and one or more other political subdivisions, that together have at least 100 employees, may jointly provide health care benefits not provided under the Wisconsin Health Care Plan under ch. 634 to their officers and employees on a self insured self-insured basis.

SB698, s. 28 Section 28. 66.0137 (5) of the statutes is amended to read:

SB698,14,7 66.0137 (5) Hospital, accident, and life insurance. The Subject to s. 634.40, the state or a local governmental unit may provide for the payment of premiums for hospital, surgical and other health and accident insurance and life insurance for employees and officers and their spouses and dependent children. A local governmental unit may also provide for the payment of premiums for hospital and surgical care for its retired employees. In addition, a local governmental unit may, by ordinance or resolution, elect to offer to all of its employees a health care coverage plan through a program offered by the group insurance board under ch. 40. A local governmental unit that elects to participate under s. 40.51 (7) is subject to the applicable sections of ch. 40 instead of this subsection.

SB698, s. 29 Section 29. 109.075 (9) of the statutes is created to read:

SB698,14,11 109.075 (9) This section does not apply to an employer that ceases providing health care benefits to its employees because the employees are covered under the Wisconsin Health Care Plan under ch. 634.

SB698, s. 30 Section 30. 111.70 (1) (dm) of the statutes is amended to read:

SB698,15,2 111.70 (1) (dm) "Economic issue" means salaries, overtime pay, sick leave, payments in lieu of sick leave usage, vacations, clothing allowances in excess of the actual cost of clothing, length-of-service credit, continuing education credit, shift premium pay, longevity pay, extra duty pay, performance bonuses, health insurance coverage of benefits not provided under the Wisconsin Health Care Plan under ch. 634, life insurance, dental insurance, disability insurance, vision insurance, long-term care insurance, worker's compensation and unemployment insurance, social security benefits, vacation pay, holiday pay, lead worker pay, temporary assignment pay, retirement contributions, supplemental retirement benefits, severance or other separation pay, hazardous duty pay, certification or license payment, limitations on layoffs that create a new or increased financial liability on the employer and contracting or subcontracting of work that would otherwise be performed by municipal employees in the collective bargaining unit with which there is a labor dispute.

SB698, s. 31 Section 31. 111.91 (2) (pm) of the statutes is created to read:

SB698,15,5 111.91 (2) (pm) Health care coverage of employees under the Wisconsin Health Care Plan under ch. 634.

SB698, s. 32 Section 32. 120.12 (24) of the statutes is amended to read:

SB698,15,11 120.12 (24) Health care benefits. Prior to the selection for school district professional employees, as defined in s. 111.70 (1) (ne), of any provider of group health care benefits provider for school district professional employees, as defined in s. 111.70 (1) (ne) not provided under the Wisconsin Health Care Plan under ch. 634, solicit sealed bids for the provision of such benefits.

SB698, s. 33 Section 33. 120.13 (2) (b) of the statutes is amended to read:

SB698,15,18 120.13 (2) (b) Provide health care benefits not provided under the Wisconsin Health Care Plan under ch. 634 on a self-insured basis to the employees of the school district if the school district has at least 100 employees. In addition, any 2 or more school districts which together have at least 100 employees may jointly provide health care benefits not provided under the Wisconsin Health Care Plan under ch. 634 on a self-insured basis to employees of the school districts.

SB698, s. 34 Section 34. 120.13 (2) (g) of the statutes, as affected by 2005 Wisconsin Act 194, is amended to read:

SB698,15,24 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.895 (9) to (14), 632.896, and 767.25 (4m) (d).

SB698, s. 35 Section 35. 149.12 (2) (e) of the statutes is repealed and recreated to read:

SB698,16,3 149.12 (2) (e) No person who is covered under the Wisconsin Health Care Plan under s. 634.10 (2) (a) is eligible for coverage under the plan established under this chapter.

SB698, s. 36 Section 36. 227.01 (13) (nm) of the statutes is created to read:

SB698,16,6 227.01 (13) (nm) Relates to determining coverage under s. 634.10 (4) or setting premiums or assessments under s. 634.25.

SB698, s. 37 Section 37. 254.11 (13) of the statutes is amended to read:

SB698,16,15 254.11 (13) "Third-party payer" means a disability insurance policy that is required to provide coverage for a blood lead test under s. 632.895 (10) (a); a health maintenance organization or preferred provider plan under ch. 609; a health care coverage plan offered by the state under s. 40.51 (6); a self-insured health plan offered by a city or village under s. 66.0137 (4), a political subdivision under s. 66.0137 (4m), a town under s. 60.23 (25), a county under s. 59.52 (11) (c), or a school district under s. 120.13 (2) (b); or a sickness care plan operated by a cooperative association under s. 185.981.

SB698, s. 38 Section 38. 609.10 of the statutes is repealed.

SB698, s. 39 Section 39. 609.20 (1m) (c) of the statutes is repealed.

SB698, s. 40 Section 40. 609.20 (1m) (d) of the statutes is repealed.

SB698, s. 41 Section 41. 628.36 (4) (a) (intro.) of the statutes is amended to read:

SB698,16,23 628.36 (4) (a) (intro.) The commissioner shall provide information and assistance to the department of employee trust funds, employers and their employees, providers of health care services, and members of the public, as provided in par. (b), for the following purposes:

SB698, s. 42 Section 42. 628.36 (4) (b) 1. of the statutes is repealed.

SB698, s. 43 Section 43. 628.36 (4) (b) 2. of the statutes is repealed.

SB698, s. 44 Section 44. 628.36 (4) (b) 3. of the statutes is repealed.

SB698, s. 45 Section 45. 632.87 (5) of the statutes is amended to read:

SB698,17,10 632.87 (5) No insurer or self-insured school district, city or village may, under a policy, plan, or contract covering gynecological services or procedures, exclude or refuse to provide coverage for Papanicolaou tests, pelvic examinations , or associated laboratory fees when the test or examination is performed by a licensed nurse practitioner, as defined in s. 632.895 (8) (a) 3., within the scope of the nurse practitioner's professional license, if the policy, plan, or contract includes coverage for Papanicolaou tests, pelvic examinations, or associated laboratory fees when the test or examination is performed by a physician.

SB698, s. 46 Section 46. 632.895 (8) (f) 4. of the statutes is created to read:

SB698,17,13 632.895 (8) (f) 4. A disability insurance policy providing only health care benefits not provided under the Wisconsin Health Care Plan under ch. 634.

SB698, s. 47 Section 47. 632.895 (9) (d) 4. of the statutes is created to read:

SB698,17,16 632.895 (9) (d) 4. A disability insurance policy providing only health care benefits not provided under the Wisconsin Health Care Plan under ch. 634.

SB698, s. 48 Section 48. 632.895 (10) (a) of the statutes is amended to read:

SB698,17,25 632.895 (10) (a) Except as provided in par. (b), every disability insurance policy and every health care benefits plan provided on a self-insured basis by a county board under s. 59.52 (11), by a city or village under s. 66.0137 (4), by a political subdivision under s. 66.0137 (4m), by a town under s. 60.23 (25), or by a school district under s. 120.13 (2) shall provide coverage for blood lead tests for children under 6 years of age, which shall be conducted in accordance with any recommended lead screening methods and intervals contained in any rules promulgated by the department of health and family services under s. 254.158.

SB698, s. 49 Section 49. 632.895 (10) (b) 6. of the statutes is created to read:

SB698,18,3 632.895 (10) (b) 6. A disability insurance policy providing only health care benefits not provided under the Wisconsin Health Care Plan under ch. 634.

SB698, s. 50 Section 50. 632.895 (11) (a) (intro.) of the statutes is amended to read:

SB698,18,10 632.895 (11) (a) (intro.) Except as provided in par. (e), every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, that provides coverage of any diagnostic or surgical procedure involving a bone, joint, muscle, or tissue shall provide coverage for diagnostic procedures and medically necessary surgical or nonsurgical treatment for the correction of temporomandibular disorders if all of the following apply:

SB698, s. 51 Section 51. 632.895 (11) (c) 1. of the statutes is amended to read:

SB698,18,14 632.895 (11) (c) 1. The coverage required under this subsection may be subject to any limitations, exclusions, or cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan.

SB698, s. 52 Section 52. 632.895 (11) (d) of the statutes is amended to read:

SB698,18,19 632.895 (11) (d) Notwithstanding par. (c) 1., an insurer or a self-insured health plan of the state or a county, city, village, town or school district may require that an insured obtain prior authorization for any medically necessary surgical or nonsurgical treatment for the correction of temporomandibular disorders.

SB698, s. 53 Section 53. 632.895 (11) (e) 3. of the statutes is created to read:

SB698,18,22 632.895 (11) (e) 3. A disability insurance policy providing only health care benefits not provided under the Wisconsin Health Care Plan under ch. 634.

SB698, s. 54 Section 54. 632.895 (14) (b) of the statutes is amended to read:

SB698,19,3 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, town, village or school district, that provides coverage for a dependent of the insured shall provide coverage of appropriate and necessary immunizations, from birth to the age of 6 years, for a dependent who is a child of the insured.

SB698, s. 55 Section 55. 632.895 (14) (d) 7. of the statutes is created to read:

SB698,19,6 632.895 (14) (d) 7. A disability insurance policy providing only health care benefits not provided under the Wisconsin Health Care Plan under ch. 634.