SB337,3,105 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
6a village provides health care benefits under its home rule power, or if a town
7provides health care benefits, to its officers and employees on a self-insured basis,
8the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
9632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.87
10(4), (5), and (6), 632.895 (9) to (14), 632.896, and 767.513 (4).
SB337, s. 4 11Section 4. 120.13 (2) (g) of the statutes is amended to read:
SB337,3,1512 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
1349.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
14632.798, 632.85, 632.853, 632.855, 632.87 (4), (5), and (6), 632.895 (9) to (14),
15632.896, and 767.513 (4).
SB337, s. 5 16Section 5. 146.903 of the statutes is created to read:
SB337,3,18 17146.903 Disclosures required of health care providers. (1) In this
18section:
SB337,3,1919 (a) "Ambulatory surgery center" has the meaning given in 42 CFR 416.2.
SB337,3,2220 (b) "Clinic" means a place, other than a residence, that is used primarily for the
21provision of nursing, medical, podiatric, dental, chiropractic, or optometric care and
22treatment.
SB337,3,2423 (c) "Diagnosis-related groups" means a classification of inpatient hospital
24discharges specified under 42 CFR 412.60.
SB337,4,2
1(d) "Health care provider" has the meaning given in s. 146.81 (1) and includes
2a clinic and an ambulatory surgery center.
SB337,4,43 (e) "Medical Assistance" means health care benefits provided under subch. IV
4of ch. 49.
SB337,4,85 (f) "Usual and customary charge" means the amount that a health care provider
6usually and customarily charges for a health care service, diagnostic test, or
7procedure, before any discount or contractual rate applicable to certain patients or
8payers is applied.
SB337,4,11 9(2) Except as provided in sub. (5), a health care provider or the health care
10provider's designee shall, upon request by and at no cost to a health care consumer,
11disclose to the consumer all of the following, under the following circumstances:
SB337,4,1512 (a) Within a reasonable period of time after the request, the usual and
13customary charges, assuming no medical complications, for an inpatient or
14outpatient health care service, diagnostic test, or procedure that is specified by the
15consumer and that is provided by the health care provider.
SB337,4,1716 (b) Immediately upon request, on the site of the health care provider, as a single
17document, all of the following:
SB337,4,2218 1. The usual and customary charge, assuming no medical complications, for
19each of the 50 health care services, diagnostic tests, or procedures, relevant to the
20treatment of particular presenting conditions, that the health care provider most
21frequently performs. The information under this subdivision shall be classified as
22follows:
SB337,4,2423 a. If provided concerning inpatient or outpatient services by a hospital, in the
24form of diagnosis-related groups.
SB337,5,4
1b. If provided by a physician, in the form of presenting conditions, including the
2total charges for codes under the Current Procedural Terminology of the American
3Medical Association that are most frequently performed as a result of the presenting
4conditions.
SB337,5,125 c. If provided by a health care provider other than a hospital or physician, in
6a grouping form similar to that under subd. 1. a. or b. Notwithstanding the
7requirement under subd. 1. (intro.) that 50 health care services, diagnostic tests, or
8procedures be disclosed, if the health care provider under this subd. 1. c. performs
9fewer than 50 health care services, diagnostic tests, or procedures on a regular basis,
10the health care provider shall indicate that fact and disclose those health care
11services, diagnostic tests, or procedures that the health care provider performs on a
12regular basis.
SB337,5,1613 2. If the health care provider is certified as a provider of Medical Assistance,
14the Medical Assistance payment rates, as specified on the Web site of the
15department, for the provider for the health care services, diagnostic tests, or
16procedures specified in subd. 1.
SB337,5,1817 3. The average allowable payment from private, 3rd party payers for the health
18care services, diagnostic tests, or procedures specified in subd. 1.
SB337,5,2019 4. The average of the charges and payment rates specified in subd. 1., 2., and
203. for each health care service, diagnostic test, or procedure specified in subd. 1.
SB337,5,23 21(3) Information on charges or payment rates that is provided to a health care
22consumer under sub. (2) shall be updated annually by the health care provider and
23may not be construed as a legally binding estimate of the cost to the consumer.
SB337,6,5 24(4) Except as provided in sub. (5), a health care provider shall prominently
25display, in the area of the health care provider's practice or facility that is most

1commonly frequented by health care consumers, a statement informing the
2consumers that they have the right to request charge or payment rate information
3for health care services, diagnostic tests, or procedures from the health care provider
4or, under s. 632.798, all of the following from their insurers or self-insured health
5plans:
SB337,6,86 (a) A good faith estimate of the reimbursement that the insurer or self-insured
7health plan would expect to pay a specified provider for a specified health care
8service.
SB337,6,109 (b) A good faith estimate of the insured's total out-of-pocket cost for the
10specified health care service provided by the specified provider.
SB337,6,11 11(5) This section does not apply to any of the following:
SB337,6,1312 (a) A health care provider that practices individually and not in association
13with another health care provider.
SB337,6,1514 (b) Health care providers that are an association of 3 or fewer individual health
15care providers.
SB337, s. 6 16Section 6. 185.981 (4t) of the statutes is amended to read:
SB337,6,2017 185.981 (4t) A sickness care plan operated by a cooperative association is
18subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.798,
19632.85, 632.853, 632.855, 632.87 (2m), (3), (4), (5), and (6), 632.895 (10) to (14), and
20632.897 (10) and chs. 149 and 155.
SB337, s. 7 21Section 7. 185.983 (1) (intro.) of the statutes is amended to read:
SB337,7,322 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be
23exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
24601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93,
25631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798, 632.85,

1632.853, 632.855, 632.87 (2m), (3), (4), (5), and (6), 632.895 (5) and (9) to (14), 632.896,
2and 632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring association
3shall:
SB337, s. 8 4Section 8. 609.71 of the statutes is created to read:
SB337,7,6 5609.71 Disclosure of payments. Limited service health organizations,
6preferred provider plans, and defined network plans are subject to s. 632.798.
SB337, s. 9 7Section 9. 632.798 of the statutes is created to read:
SB337,7,8 8632.798 Disclosure of payments. (1) Definitions. In this section:
SB337,7,99 (a) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
SB337,7,1110 (b) "Insured" includes an enrollee under a self-insured health plan and a
11representative or designee of an insured or enrollee.
SB337,7,1312 (c) "Self-insured health plan" means a self-insured health plan of the state or
13a county, city, village, town, or school district.
SB337,7,18 14(2) Provide information. (a) A self-insured health plan or an insurer that
15provides coverage under a disability insurance policy shall, at the request of an
16insured, provide to the insured a good faith estimate of the reimbursement that the
17insurer or self-insured health plan would expect to pay a specified provider for a
18specified health care service.
SB337,7,2219 (b) If requested by the insured, the insurer or self-insured health plan under
20par. (a) shall also provide to the insured a good faith estimate of the insured's total
21out-of-pocket cost for the specified health care service provided by the specified
22provider.
SB337,7,2423 (c) An estimate provided by an insurer or self-insured health plan under this
24section is not a legally binding estimate of the reimbursement or out-of-pocket cost.
SB337,8,2
1(d) An insurer or self-insured health plan may not charge an insured for
2providing the information under this section.
SB337, s. 10 3Section 10. Initial applicability.
SB337,8,114 (1) Disclosure of payments and out-of-pocket costs. If a disability insurance
5policy or a governmental self-insured health plan that is in effect on the effective
6date of this subsection contains a provision that is inconsistent with the treatment
7of section 40.51 (8) or (8m), 66.0137 (4), 120.13 (2) (g), 185.981 (4t), 185.983 (1)
8(intro.), 609.71, or 632.798 of the statutes, the treatment of section 40.51 (8) or (8m),
966.0137 (4), 120.13 (2) (g), 185.981 (4t), 185.983 (1) (intro.), 609.71, or 632.798 of the
10statutes first applies to that disability insurance policy or governmental self-insured
11health plan on the date on which it is modified, extended, or renewed.
SB337, s. 11 12Section 11. Effective date.
SB337,8,1413 (1) This act takes effect on the first day of the 7th month beginning after
14publication.
SB337,8,1515 (End)
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