SB375,7,2
1632.89
(1) (er) "Self-insured health plan" has the meaning given in s. 632.745
2(24).
SB375, s. 17
3Section
17. 632.89 (2) (title) of the statutes is amended to read:
SB375,7,44
632.89
(2) (title)
Required coverage
for group plans.
SB375, s. 18
5Section
18. 632.89 (2) (a) 1. of the statutes is renumbered 632.89 (2) (a) and
6amended to read:
SB375,7,117
632.89
(2) (a)
Conditions covered. A group
or blanket disability insurance
8policy issued by an insurer health benefit plan and a self-insured health plan shall
9provide coverage of nervous and mental disorders and alcoholism and other drug
10abuse problems if required by
pars. (c) to (dm) and as provided in pars.
(b) (c) to
(e) 11(dm) and subs. (2p) and (3).
SB375, s. 19
12Section
19. 632.89 (2) (a) 2. of the statutes is repealed.
SB375, s. 20
13Section
20. 632.89 (2) (b) of the statutes is repealed.
SB375, s. 21
14Section
21. 632.89 (2) (c) 1. of the statutes is renumbered 632.89 (2) (c) and
15amended to read:
SB375,7,2016
632.89
(2) (c)
Minimum coverage Coverage of inpatient hospital services. If a
17group
or blanket disability insurance policy issued by an insurer health benefit plan
18or a self-insured health plan provides coverage of any inpatient hospital treatment,
19the
policy plan shall provide coverage for inpatient hospital services for the
20treatment of conditions under par. (a)
1. as provided in subd. 2.
SB375, s. 22
21Section
22. 632.89 (2) (c) 2. of the statutes is repealed.
SB375, s. 23
22Section
23. 632.89 (2) (d) 1. of the statutes is renumbered 632.89 (2) (d) and
23amended to read:
SB375,8,324
632.89
(2) (d)
Minimum coverage Coverage of outpatient services. If a group
or
25blanket disability insurance policy issued by an insurer health benefit plan or a
1self-insured health plan provides coverage of any outpatient treatment, the
policy 2plan shall provide coverage for outpatient services for the treatment of conditions
3under par. (a)
1. as provided in subd. 2.
SB375, s. 24
4Section
24. 632.89 (2) (d) 2. of the statutes is repealed.
SB375, s. 25
5Section
25. 632.89 (2) (dm) 1. of the statutes is renumbered 632.89 (2) (dm)
6and amended to read:
SB375,8,127
632.89
(2) (dm)
Minimum coverage Coverage of transitional treatment
8arrangements. If a group
or blanket disability insurance policy issued by an insurer 9health benefit plan or a self-insured health plan provides coverage of any inpatient
10hospital treatment or any outpatient treatment, the
policy plan shall provide
11coverage for transitional treatment arrangements for the treatment of conditions
12under par. (a)
1. as provided in subd. 2.
SB375, s. 26
13Section
26. 632.89 (2) (dm) 2. of the statutes is repealed.
SB375, s. 27
14Section
27. 632.89 (2) (e) of the statutes is renumbered 632.89 (5) (b) and
15amended to read:
SB375,8,1916
632.89
(5) (b)
Exclusion
Certain health care plans. This
subsection section does
17not apply to a health care plan offered by a limited service health organization, as
18defined in s. 609.01 (3)
, or by a preferred provider plan, as defined in s. 609.01 (4),
19that is not a defined network plan, as defined in s. 609.01 (1b).
SB375, s. 28
20Section
28. 632.89 (2m) of the statutes is renumbered 632.89 (4m).
SB375, s. 29
21Section
29. 632.89 (2p) of the statutes is created to read:
SB375,9,222
632.89
(2p) Additional required coverage of screenings. If a group health
23benefit plan, individual health benefit plan, or self-insured health plan that
24provides coverage for the treatment of nervous and mental disorders and alcoholism
1and other drug abuse problems would provide coverage of at least one annual
2physical examination, the plan shall provide coverage of all of the following:
SB375,9,53
(a) For an individual who has coverage under the plan, at least one annual
4screening for nervous and mental disorders and alcoholism and other drug abuse
5problems to determine the individual's need for treatment.
SB375,9,106
(b) For a female individual who has coverage under the plan, with respect to
7any pregnancy at least one screening during the pregnancy for prepartum
8depression and at least one screening within 6 months after a live birth, stillbirth,
9or miscarriage for postpartum depression to determine the individual's need for
10treatment.
SB375, s. 30
11Section
30. 632.89 (3) of the statutes is created to read:
SB375,9,1612
632.89
(3) Equal coverage requirement. (a)
Group plans. A group health
13benefit plan or a self-insured health plan that provides coverage for the treatment
14of nervous and mental disorders and alcoholism and other drug abuse problems shall
15provide the same coverage for that treatment that it provides for the treatment of
16physical conditions.
SB375,9,2017
(b)
Individual plans. If an individual health benefit plan provides coverage for
18the treatment of nervous or mental disorders or alcoholism or other drug abuse
19problems, the individual health benefit plan shall provide the same coverage for that
20treatment that it provides for the treatment of physical conditions.
SB375,9,2521
(c)
All coverage components. The requirements under this subsection apply to
22all coverage-related components, including rates; exclusions and limitations;
23deductibles; copayments; coinsurance; annual and lifetime payment limits;
24out-of-pocket limits; out-of-network charges; day, visit, or appointment limits;
25duration or frequency of coverage; and medical necessity definitions.
SB375, s. 31
1Section
31. 632.89 (3m) of the statutes is repealed.
SB375, s. 32
2Section
32. 632.89 (5) (title) of the statutes is amended to read:
SB375,10,33
632.89
(5) (title)
Medicare exclusion Exclusions.
SB375, s. 33
4Section
33. 632.89 (5) of the statutes is renumbered 632.89 (5) (a).
SB375, s. 34
5Section
34. 632.89 (5) (a) (title) of the statutes is created to read:
SB375,10,66
632.89
(5) (a) (title)
Medicare.
SB375, s. 35
7Section
35. 632.89 (6) of the statutes is repealed.
SB375, s. 36
8Section
36. 632.89 (7) of the statutes is repealed.
SB375,10,1010
(1) This act first applies to all of the following:
SB375,10,1311
(a) Except as provided in paragraphs (b) and (c
), health benefit plans that are
12issued or renewed, and self-insured governmental health plans that are established,
13extended, modified, or renewed, on the effective date of this paragraph.
SB375,10,1614
(b) Health benefit plans covering employees who are affected by a collective
15bargaining agreement containing provisions inconsistent with this act that are
16issued or renewed on the earlier of the following:
SB375,10,17
171. The day on which the collective bargaining agreement expires.
SB375,10,19
182. The day on which the collective bargaining agreement is extended, modified,
19or renewed.
SB375,10,2320
(c) Self-insured governmental health plans covering employees who are
21affected by a collective bargaining agreement containing provisions inconsistent
22with this act that are established, extended, modified, or renewed on the earlier of
23the following:
SB375,10,24
241. The day on which the collective bargaining agreement expires.
SB375,11,2
12. The day on which the collective bargaining agreement is extended, modified,
2or renewed.
SB375,11,54
(1)
This act takes effect on the first day of the 7th month beginning after
5publication.