AB873: Bill Text

AB873,5,14 1. The insurer and health care plan, as applicable, are subject to ss. 600.03, 610.70, 631.27 with respect to rules of law that are applicable to the insurer or health care plan, 631.28, 631.90, 631.93, 632.715, 632.745 to 632.7495, and 632.785, subchs. III and IV of ch. 628, subch. I of ch. 631, and chs. 601 and 618, and any rules promulgated under any of them.

AB873,5,18 2. If the insurer's domiciliary state does not require the insurer to establish and follow grievance and independent claims review procedures, the insurer and health care plan are subject to ss. 632.83 and 632.835 and any rules promulgated under them.

AB873,5,24 3. The insurer may not refuse to provide or pay for benefits under the health care plan for health care services provided by a licensed health care professional on the ground that the services were not rendered by a physician as defined in s. 990.01 (28), unless the health care plan clearly excludes services by such practitioners, but no health care plan under this section may exclude services in violation of s. 632.87 (2), (2m), (3), (4), or (5).

AB873,6,2 (b) An insurer under par. (a) is subject to assessment under ch. 149 and taxation under subch. III of ch. 76.

AB873,6,5 (3) Disclosures regarding plan differences. Each application form for, and each policy of, a health care plan under this section shall disclose, in plain language, all of the following:

AB873,6,7 (a) The differences between the health care plan under this section and a health care plan issued in compliance with chs. 600 to 646.

AB873,6,9 (b) What state's laws govern the issuance of and requirements under the health care plan offered under this section.

AB873,6,12 (4) Rules. The commissioner may promulgate rules for the administration of this section. The commissioner may not promulgate a rule that does any of the following:

AB873,6,15 (a) Requires a foreign insurer under this section to modify coverage or benefit requirements or to restrict rate increases in any way that exceeds the insurer's domiciliary state's laws or regulations.

AB873,6,17 (b) Expands the commissioner's authority over foreign insurers in a way that conflicts with this section.

AB873,6,19 (c) Conflicts with the purpose of exempting foreign insurers under this section from requirements under chs. 600 to 646.

AB873,7,7 (5) Exemptions for domestic insurers. A domestic insurer authorized to do business in this state in one or more lines of insurance that includes health insurance may apply for an exemption from the provisions under chs. 600 to 646, and any rules promulgated under those provisions, as determined by the commissioner, that would allow the insurer to offer health care plans that are comparable in plan design to health care plans offered by foreign insurers under this section. Upon an insurer's application, the commissioner shall make an order exempting the insurer from those provisions and rules that would allow the domestic insurer to offer a health care plan or plans that are comparable in design to health care plans offered by foreign insurers under this section. Any health care plan offered by a domestic insurer under an exemption under this subsection shall be subject to the requirements that apply to health care plans offered by foreign insurers under this section, including the disclosure requirements under sub. (3).

AB873, s. 9 Section 9. 618.36 (1) of the statutes is amended to read:

AB873,7,12 618.36 (1) Continuance of regulation. A Subject to s. 618.29 (2) (a), a nondomestic insurer authorized under this chapter is subject to regulation under the applicable provisions of chs. 600 to 646 until released from regulation under this section.

AB873, s. 10 Section 10. 625.03 (1m) (d) of the statutes is amended to read:

AB873,7,14 625.03 (1m) (d) Variable and fixed annuities; and

AB873, s. 11 Section 11. 625.03 (1m) (e) of the statutes is amended to read:

AB873,7,17 625.03 (1m) (e) Group and blanket accident and sickness insurance other than credit accident and sickness insurance.; and

AB873, s. 12 Section 12. 625.03 (1m) (f) of the statutes is created to read:

AB873,7,20 625.03 (1m) (f) Individual health care plans, as defined in s. 628.36 (2) (a) 1., offered by a foreign insurer under s. 618.29.

AB873, s. 13 Section 13. 631.01 (1) (a) of the statutes is amended to read:

AB873,7,22 631.01 (1) (a) As provided in ss. 600.01, 618.29, and 618.42;

AB873, s. 14 Section 14. 635.01 of the statutes is renumbered 635.01 (1) and amended to read:

AB873,8,7 635.01 (1) This Except as provided in sub. (2), this chapter applies to all group health insurance plans, policies, or certificates, written on risks or operations in this state, providing coverage for employees of a small employer, or employees of a small employer and the employer, and to individual health insurance policies, written on risks or operations in this state, providing coverage for employees of a small employer, or employees of a small employer and the employer when 3 or more are sold to or through a small employer.

AB873, s. 15 Section 15. 635.01 (2) of the statutes is created to read:

AB873,8,10 635.01 (2) This chapter does not apply to a group or individual health care plan, as defined in s. 628.36 (2) (a) 1., that is offered by a foreign insurer under s. 618.29.

AB873, s. 16 Section 16. 645.02 (3) of the statutes is amended to read:

AB873,8,13 645.02 (3) All Except as provided in s. 618.29 (2) (a) 1., all insurers who have insureds resident in this state.

AB873, s. 17 Section 17. 646.01 (1) (a) 2. m. of the statutes is created to read:

AB873,8,15 646.01 (1) (a) 2. m. Foreign insurers offering health care plans under s. 618.29.

AB873, s. 18 Section 18. 646.01 (1) (b) 19. of the statutes is created to read:

AB873,8,17 646.01 (1) (b) 19. Health care plans offered by foreign insurers under s. 618.29.

AB873, s. 19 Section 19. Initial applicability.

AB873,8,19 (1) This act first applies to all of the following:

AB873,8,23 (a) Foreign insurers that apply for a certificate of authority under section 618.11 of the statutes, as affected by this act, or that apply for a new certificate of authority under section 618.12 (4) of the statutes, on the effective date of this paragraph.

AB873,8,25 (b) Domestic insurers that apply for an exemption under section 618.29 (5) of the statutes, as created by this act, on the effective date of this paragraph.

AB873, s. 20 Section 20. Effective date.

AB873,9,2 (1) This act takes effect on July 1, 2009.

AB873,9,3 (End)