SB466: Bill Text

SB466,7,6 601.64 (4) Criminal penalty. Whoever intentionally violates or intentionally permits any person over whom he or she has authority to violate or intentionally aids any person in violating any insurance statute or rule of this state, s. 59.52 (11) (c), 66.0137 (4) or (4m), 120.13 (2) (b) to (g), or 149.13, or any effective order issued under s. 601.41 (4) is guilty of a Class I felony, unless a specific penalty is provided elsewhere in the statutes. Intent has the meaning expressed under s. 939.23.

SB466, s. 13 Section 13. 623.17 of the statutes is created to read:

SB466,7,12 623.17 Self-insured governmental health plans. (1) The commissioner shall promulgate rules regarding the level of reserves, compulsory surplus, and security surplus that must be maintained by a city, village, town, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan.

SB466,7,15 (2) The commissioner may order a city, village, town, county, or school district to adjust its reserves or surpluses if they do not bear an appropriate relation to its obligations with regard to a self-insured health plan.

SB466,7,17 (3) A city, village, town, county, or school district that provides a self-insured health plan shall do all of the following:

SB466,7,18 (a) Comply with rules promulgated and orders issued under this section.

SB466,7,20 (b) Report to the commissioner annually the levels of reserves and surpluses maintained with respect to a self-insured health plan.

SB466, s. 14 Section 14. 627.23 (2) of the statutes is amended to read:

SB466,8,5 627.23 (2) Power to cede reinsurance. Subject to s. 611.78, any authorized insurer or a city, town, village, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan, may cede to any insurer authorized to assume it under chs. 611 to 618 and sub. (1) any liability it has undertaken on risks lawfully written under its certificate of authority. It may also cede reinsurance to any authorized agency of the federal government or of this state. Subject to rules promulgated by the commissioner for calculation of its reserves and its surplus, and subject to sub. (3), an authorized insurer may also cede reinsurance to an unauthorized insurer.

SB466, s. 15 Section 15. 627.23 (6) of the statutes is created to read:

SB466,8,10 627.23 (6) Reinsurance of self-insured health plans. A city, town, village, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan, shall report annually to the commissioner the name of any reinsurer.

SB466, s. 16 Section 16. 631.90 (2) (intro.) of the statutes is amended to read:

SB466,8,14 631.90 (2) (intro.) With regard to policies or plans issued or renewed on and after July 20, 1985, an insurer or self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3., may not do any of the following:

SB466, s. 17 Section 17. 631.90 (2) (b) of the statutes is amended to read:

SB466,8,19 631.90 (2) (b) Condition the provision of insurance or plan coverage on whether an individual has obtained a test for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV or what the results of this test, if obtained by the individual, were.

SB466, s. 18 Section 18. 631.90 (2) (c) of the statutes is amended to read:

SB466,8,24 631.90 (2) (c) Consider in the determination of rates or any other aspect of insurance or plan coverage provided to an individual whether an individual has obtained a test for the presence of HIV, antigen or nonantigenic products of HIV or an antibody to HIV or what the results of this test, if obtained by the individual, were.

SB466, s. 19 Section 19. 631.93 (2) of the statutes is amended to read:

SB466,9,6 631.93 (2) Accident and health insurance. An accident or health insurance policy or self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3., may not contain exclusions or limitations, including deductibles or copayments, for coverage of the treatment of HIV infection or any illness or medical condition arising from or related to HIV infection, unless the exclusions or limitations apply generally to other illnesses or medical conditions covered by the policy or plan.

SB466, s. 20 Section 20. 631.95 (2m) of the statutes is created to read:

SB466,9,11 631.95 (2m) Prohibitions and exceptions for self-insured health plans. (a) In this subsection, "self-insured governmental body" means a city, town, village, county, or school district that provides a self-insured health plan, with respect to the health plan.

SB466,9,13 (b) Except as provided in par. (c), a self-insured governmental body may not do any of the following:

SB466,9,20 1. Refuse to provide or renew coverage to a health plan participant under the self-insured health plan on the basis that the health plan participant has been, or the self-insured governmental body has reason to believe that the health plan participant is, a victim of abuse or domestic abuse or that a member of the health plan participant's family has been, or the self-insured governmental body has reason to believe that a member of the health plan participant's family is, a victim of abuse or domestic abuse.

SB466,9,25 2. Use as a factor in the determination of employee contributions or any other aspect of coverage under the self-insured health plan, the knowledge or suspicion that a health plan participant has been or is a victim of abuse or domestic abuse or that a member of the health plan participant's family has been or is a victim of abuse or domestic abuse.

SB466,10,7 3. Exclude or limit coverage of, or deny a claim for, health care services or items related to the treatment of injury or disease resulting from abuse or domestic abuse on the basis that a health plan participant has been, or the self-insured governmental body has reason to believe that a health plan participant is, a victim of abuse or domestic abuse or that a member of the health plan participant's family has been, or the self-insured governmental body has reason to believe that a member of the health plan participant's family is, a victim of abuse or domestic abuse.

SB466,10,13 (c) In establishing any employee contribution amounts for a self-insured health plan, a self-insured governmental body may inquire about a person's existing medical condition and, based on the opinion of a qualified actuary, as defined in s. 623.06 (1c), use information related to a person's existing medical condition, regardless of whether that condition is or may have been caused by abuse or domestic abuse.

SB466, s. 21 Section 21. 631.95 (4) of the statutes is amended to read:

SB466,10,19 631.95 (4) Immunity for insurers. An insurer or a city, town, village, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan, is immune from any civil or criminal liability for any action taken under sub. (2m) (c) or (3) or for the death of, or injury to, an insured or health plan participant that results from abuse or domestic abuse.

SB466, s. 22 Section 22. 631.95 (5) (a) of the statutes is renumbered 631.95 (5) (ar).

SB466, s. 23 Section 23. 631.95 (5) (ag) of the statutes is created to read:

SB466,10,22 631.95 (5) (ag) In this subsection, unless the context requires otherwise:

SB466,10,24 1. "Insurance" includes a self-insured health plan of a city, town, village, county, or school district.

SB466,11,2 2. "Insured" includes a person who participates in a self-insured health plan provided by a city, town, village, county, or school district.

SB466,11,4 3. "Insurer" includes a city, town, village, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan.

SB466, s. 24 Section 24. 631.95 (5) (c) (intro.) of the statutes is amended to read:

SB466,11,9 631.95 (5) (c) (intro.) Paragraphs (a) (ar) and (b) do not apply if the use, disclosure or transfer of the information is made with the consent of the individual to whom the information relates or if the use, disclosure or transfer satisfies any of the following:

SB466, s. 25 Section 25. 632.726 (2) of the statutes is amended to read:

SB466,11,17 632.726 (2) If an insurer or a city, town, village, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan, changes a current procedural terminology code that was submitted by a health care provider on a health insurance claim form, the insurer or city, town, village, county, or school district shall include on the explanation of benefits form the reason for the change to the current procedural terminology code and shall cite on the explanation of benefits form the source for the change.

SB466, s. 26 Section 26. 632.745 (intro.) of the statutes is amended to read:

SB466,11,21 632.745 Coverage requirements for group and individual health benefit plans; definitions. (intro.) In this section and ss. 632.746 to 632.7495, unless the context requires otherwise:

SB466, s. 27 Section 27. 632.745 (9) of the statutes is renumbered 632.745 (9) (intro.) and amended to read:

SB466,11,24 632.745 (9) (intro.) "Group health benefit plan" means a any of the following:

SB466,12,3 (a) A health benefit plan that is issued by an insurer to or through an employer on behalf of a group consisting of at least 2 employees or a group including at least 2 eligible employees. The term includes individual

SB466,12,5 (b) Individual health benefit plans covering eligible employees when 3 or more are sold to or through an employer.

SB466, s. 28 Section 28. 632.745 (9) (c) of the statutes is created to read:

SB466,12,7 632.745 (9) (c) A self-insured health plan under sub. (24) (b) and (c).

SB466, s. 29 Section 29. 632.745 (15) of the statutes is amended to read:

SB466,12,17 632.745 (15) "Insurer" means an insurer that is authorized to do business in this state, in one or more lines of insurance that includes health insurance, and that offers health benefit plans covering individuals in this state or eligible employees of one or more employers in this state. The term includes a health maintenance organization, a preferred provider plan, as defined in s. 609.01 (4), an insurer operating as a cooperative association organized under ss. 185.981 to 185.985, a city, town, village, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan, and a limited service health organization, as defined in s. 609.01 (3).

SB466, s. 30 Section 30. 632.745 (24) of the statutes is renumbered 632.745 (24) (intro.) and amended to read:

SB466,12,21 632.745 (24) "Self-insured health plan" means a self-insured health plan of the any of the following:

SB466,12,22 (a) The state or a .

SB466,12,23 (b) A county, city, village, or town or.

SB466,12,24 (c) A school district.

SB466, s. 31 Section 31. 632.83 (1) of the statutes is renumbered 632.83 (1) (intro.) and amended to read:

SB466,13,3 632.83 (1) In this section, "health :

SB466,13,8 (a) "Health benefit plan" has the meaning given in s. 632.745 (11), except that "health benefit plan" includes the coverage specified in s. 632.745 (11) (b) 10. and includes a self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3., and a policy, certificate or contract under s. 632.745 (11) (b) 9. that provides only limited-scope dental or vision benefits.

SB466, s. 32 Section 32. 632.83 (1) (b) of the statutes is created to read:

SB466,13,11 632.83 (1) (b) "Insured" includes a person who participates in a self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3.

SB466, s. 33 Section 33. 632.83 (1) (c) of the statutes is created to read:

SB466,13,15 632.83 (1) (c) "Insurer" includes a city, town, village, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan.

SB466, s. 34 Section 34. 632.835 (1) (c) of the statutes is amended to read:

SB466,13,19 632.835 (1) (c) "Health benefit plan" has the meaning given in s. 632.745 (11), except that "health benefit plan" includes the coverage specified in s. 632.745 (11) (b) 10. and a self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3.

SB466, s. 35 Section 35. 632.835 (1) (cg) of the statutes is created to read:

SB466,13,22 632.835 (1) (cg) "Insured" includes a person who participates in a self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3.

SB466, s. 36 Section 36. 632.835 (1) (ck) of the statutes is created to read:

SB466,14,3 632.835 (1) (ck) "Insurer" includes a city, town, village, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan.

SB466, s. 37 Section 37. 632.845 (2) of the statutes, as created by 2009 Wisconsin Act 28, is amended to read:

SB466,14,10 632.845 (2) An A self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3. or an insurer that provides coverage under a health care plan may not refuse to cover health care services that are provided to an insured under the plan and for which there is coverage under the plan on the basis that there may be coverage for the services under a liability insurance policy.

SB466, s. 38 Section 38. 632.85 (1) (c) of the statutes is renumbered 632.85 (1) (c) (intro.) and amended to read:

SB466,14,14 632.85 (1) (c) "Self-insured health plan" means a self-insured health plan of the any of the following:

SB466,14,15 1. The state or a .

SB466,14,16 2. A county, city, village, or town or.

SB466,14,17 3. A school district.

SB466, s. 39 Section 39. 632.857 of the statutes is amended to read:

SB466,15,2 632.857 Explanation required for restriction or termination of coverage. If an insurer or a self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3., restricts or terminates an insured's or a health plan participant's coverage for the treatment of a condition or complaint and, as a result, the insured or health plan participant becomes liable for payment for all of his or her treatment for the condition or complaint, the insurer or self-insured health plan shall provide on the explanation of benefits form a detailed explanation of the clinical rationale and of the basis in the policy, plan, or contract or in applicable law for the insurer's or self-insured health plan's restriction or termination of coverage.

SB466, s. 40 Section 40. 632.86 (2) (intro.) of the statutes is amended to read:

SB466,15,7 632.86 (2) No group or blanket disability insurance policy or self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3., that provides coverage of prescribed drugs or devices through a pharmaceutical mail order plan may do any of the following:

SB466, s. 41 Section 41. 632.87 (1) of the statutes is renumbered 632.87 (1r).

SB466, s. 42 Section 42. 632.87 (1g) of the statutes is created to read:

SB466,15,10 632.87 (1g) In this section, unless the context requires otherwise:

SB466,15,12 (a) "Insured" includes a person who participates in a self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3.

SB466,15,14 (b) "Insurer" includes a city, town, village, county, or school district that provides a self-insured health plan, with respect to that self-insured health plan.

SB466,15,16 (c) "Plan" includes a self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3.

SB466, s. 43 Section 43. 632.875 (1) (bg) of the statutes is created to read:

SB466,15,20 632.875 (1) (bg) "Insurer" includes a city, town, village, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan.

SB466, s. 44 Section 44. 632.875 (1) (cg) of the statutes is created to read:

SB466,15,23 632.875 (1) (cg) "Plan" includes a self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3.

SB466, s. 45 Section 45. 632.88 (1) (intro.) of the statutes is amended to read:

SB466,16,7 632.88 (1) Termination of coverage. (intro.) Every hospital or medical expense insurance policy or contract or self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3., that provides that coverage of a dependent child of a person insured under the policy or covered under the plan shall terminate upon attainment of a limiting age for dependent children specified in the policy or plan shall also provide that the age limitation may not operate to terminate the coverage of a dependent child while the child is and continues to be both: