AB118,1,4 1An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g), 185.981 (4t),
2185.983 (1) (intro.), 632.895 (15) (a) and 632.895 (15) (c) 5.; and to create 111.91
3(2) (t), 609.74 and 632.885 of the statutes; relating to: coverage of dependents
4under health care plans.
Analysis by the Legislative Reference Bureau
Current law contains a number of provisions related to coverage of dependents
under health insurance policies. For example, a health insurer must cover a newly
born child of an insured from the moment of birth, but may discontinue coverage
after 60 days if the insured does not notify the insurer of the birth and pay any
additional premium within those 60 days. If a health insurer covers a child of an
insured, the health insurer must also cover any child of the insured's child until the
insured's child is 18 years old. If a health insurer covers dependents up to a certain
age, the health insurer may not terminate coverage of a dependent child who reaches
that age if, and while, the child is incapable of self-sustaining employment because
of mental retardation or physical handicap and is dependent on the insured for
support and maintenance. If a health insurer covers a person as a dependent because
the person is a full-time student, the health insurer must continue to cover that
person if he or she ceases to be a full-time student due to a medically necessary leave
of absence until the happening of one of a number of specified events, such as the
person's obtaining other health care coverage or reaching the age at which coverage
ends under the terms of the policy for a dependent who is covered because he or she
is a full-time student. Current law, however, does not require a health insurer to

cover a dependent of an insured up to any particular age or because a dependent is
a full-time student.
Under this bill, a health insurer must offer to cover any child of an insured if
the child is unmarried, is under 27 years old, and is not eligible for coverage under
a group health benefit plan that is provided by his or her employer and for which his
or her premium contribution is no greater than the premium amount for his or her
dependent coverage under his or her parent's health insurance plan. Additionally,
if the child is a full-time student but previously had his or her education interrupted
by service in the national guard or reserves, the health insurer must offer dependent
coverage for that child for as long as he or she is a full-time student, regardless of
age.
The insurer must provide the coverage if the insured requests it, and may
require that the insured provide annual written documentation that the dependent
child satisfies the criteria for coverage. The bill specifies that an insurer must
determine the premium for coverage of a dependent who is over 18 years of age on
the same basis as the premium is determined for a younger dependent. The coverage
requirement applies to all types of individual and group health insurance policies
and plans, including those offered by the state, and to self-insured health plans of
counties, cities, villages, towns, school districts, and the state.
The bill does not eliminate any of the other requirements that exist in current
law related to coverage of dependents.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB118, s. 1 1Section 1. 40.51 (8) of the statutes is amended to read:
AB118,2,52 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
3shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
4and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.87 (3) to
5(5) (6), 632.885, 632.895 (5m) and (8) to (15), and 632.896.
AB118, s. 2 6Section 2. 40.51 (8m) of the statutes is amended to read:
AB118,2,97 40.51 (8m) Every health care coverage plan offered by the group insurance
8board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,
9632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.885, and 632.895 (11) to (15).
AB118, s. 3 10Section 3. 66.0137 (4) of the statutes is amended to read:
AB118,3,6
166.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
2a village provides health care benefits under its home rule power, or if a town
3provides health care benefits, to its officers and employees on a self-insured basis,
4the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
5632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.87 (4), and
6(5), and (6), 632.885, 632.895 (9) to (15), 632.896, and 767.25 (4m) (d) 767.513 (4).
AB118, s. 4 7Section 4. 111.91 (2) (t) of the statutes is created to read:
AB118,3,88 111.91 (2) (t) The requirements related to dependent coverage under s. 632.885.
AB118, s. 5 9Section 5. 120.13 (2) (g) of the statutes is amended to read:
AB118,3,1310 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
1149.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
12632.85, 632.853, 632.855, 632.87 (4) and, (5), and (6), 632.885, 632.895 (9) to (15),
13632.896, and 767.25 (4m) (d) 767.513 (4).
AB118, s. 6 14Section 6. 185.981 (4t) of the statutes is amended to read:
AB118,3,1815 185.981 (4t) A sickness care plan operated by a cooperative association is
16subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85,
17632.853, 632.855, 632.87 (2m), (3), (4), and (5), and (6), 632.885, 632.895 (10) to (15),
18and 632.897 (10) and chs. 149 and 155.
AB118, s. 7 19Section 7. 185.983 (1) (intro.) of the statutes is amended to read:
AB118,4,220 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be
21exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
22601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93,
23631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853,
24632.855, 632.87 (2m), (3), (4), and (5), and (6), 632.885, 632.895 (5) and (9) to (15),

1632.896, and 632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring
2association shall:
AB118, s. 8 3Section 8. 609.74 of the statutes is created to read:
AB118,4,5 4609.74 Coverage of dependents. Limited service health organizations,
5preferred provider plans, and defined network plans are subject to s. 632.885.
AB118, s. 9 6Section 9. 632.885 of the statutes is created to read:
AB118,4,7 7632.885 Coverage of dependents. (1) Definitions. In this section:
AB118,4,88 (a) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
AB118,4,99 (b) "Insured" includes an enrollee.
AB118,4,1010 (c) "Self-insured health plan" has the meaning given in s. 632.745 (24).
AB118,4,15 11(2) Requirement to offer dependent coverage. (a) Subject to ss. 632.88 and
12632.895 (5), every insurer that issues a disability insurance policy, and every
13self-insured health plan, shall offer and, if so requested by an applicant or an
14insured, provide coverage for an adult child of the applicant or insured as a
15dependent of the applicant or insured if the child satisfies all of the following criteria:
AB118,4,1616 1. The child is over 17 but less than 27 years of age.
AB118,4,1717 2. The child is not married.
AB118,4,2118 3. The child is not eligible for coverage under a group health benefit plan, as
19defined in s. 632.745 (9), that is offered by the child's employer and for which the
20amount of the child's premium contribution is no greater than the premium amount
21for his or her coverage as a dependent under this section.
AB118,4,2322 (b) Notwithstanding par. (a) 1., the coverage requirement under this section
23applies to an adult child who satisfies all of the following criteria:
AB118,4,2424 1. The child is a full-time student, regardless of age.
AB118,4,2525 2. The child satisfies the criteria under par. (a) 2. and 3.
AB118,5,3
13. The child was called to federal active duty in the national guard or in a
2reserve component of the U.S. armed forces while the child was attending, on a
3full-time basis, an institution of higher education.
AB118,5,54 4. The child was under the age of 27 years when called to federal active duty
5under subd. 3.
AB118,5,9 6(3) Premium determination. An insurer or self-insured health plan shall
7determine the premium for coverage of a dependent who is over 18 years of age on
8the same basis as the premium is determined for coverage of a dependent who is 18
9years of age or younger.
AB118,5,13 10(4) Documentation of criteria satisfaction. An insurer or self-insured health
11plan may require that an applicant or insured seeking coverage of a dependent child
12provide written documentation, initially and annually thereafter, that the
13dependent child satisfies the criteria for coverage under this section.
AB118, s. 10 14Section 10. 632.895 (15) (a) of the statutes is amended to read:
AB118,5,2015 632.895 (15) (a) Subject to pars. (b) and (c), every disability insurance policy,
16and every self-insured health plan of the state or a county, city, town, village, or
17school district, that provides coverage for a person as a dependent of the insured
18because the person is a full-time student, including the coverage under s. 632.885
19(2) (b),
shall continue to provide dependent coverage for the person if, due to a
20medically necessary leave of absence, he or she ceases to be a full-time student.
AB118, s. 11 21Section 11. 632.895 (15) (c) 5. of the statutes is amended to read:
AB118,5,2522 632.895 (15) (c) 5. The Except for a person who has coverage as a dependent
23under s. 632.885 (2) (b), the
person reaches the age at which coverage as a dependent
24who is a full-time student would otherwise end under the terms and conditions of
25the policy or plan.
AB118, s. 12
1Section 12. Initial applicability.
AB118,6,22 (1) This act first applies to all of the following:
AB118,6,63 (a) Except as provided in paragraphs (b) and (c ), disability insurance policies
4that are issued or renewed, and governmental or school district self-insured health
5plans that are established, extended, modified, or renewed, on the effective date of
6this paragraph.
AB118,6,97 (b) Disability insurance policies covering employees who are affected by a
8collective bargaining agreement containing provisions inconsistent with this act
9that are issued or renewed on the earlier of the following:
AB118,6,10 101. The day on which the collective bargaining agreement expires.
AB118,6,12 112. The day on which the collective bargaining agreement is extended, modified,
12or renewed.
AB118,6,1613 (c) Governmental or school district self-insured health plans covering
14employees who are affected by a collective bargaining agreement containing
15provisions inconsistent with this act that are established, extended, modified, or
16renewed on the earlier of the following:
AB118,6,17 171. The day on which the collective bargaining agreement expires.
AB118,6,19 182. The day on which the collective bargaining agreement is extended, modified,
19or renewed.
AB118, s. 13 20Section 13. Effective date.
AB118,6,2221 (1) This act takes effect on the first day of the 7th month beginning after
22publication.
AB118,6,2323 (End)
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