SB466: Bill Text

SB466,23,24 632.895 (11) (a) (intro.) Except as provided in par. (e), every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, that provides coverage of any diagnostic or surgical procedure involving a bone, joint, muscle or tissue shall provide coverage for diagnostic procedures and medically necessary surgical or nonsurgical treatment for the correction of temporomandibular disorders if all of the following apply:

SB466,24,4 (d) Notwithstanding par. (c) 1., an insurer or a self-insured health plan of the state or a county, city, village, town or school district may require that an insured obtain prior authorization for any medically necessary surgical or nonsurgical treatment for the correction of temporomandibular disorders.

SB466, s. 64 Section 64. 632.895 (12) (b) (intro.) of the statutes is amended to read:

SB466,24,11 632.895 (12) (b) (intro.) Except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, shall cover hospital or ambulatory surgery center charges incurred, and anesthetics provided, in conjunction with dental care that is provided to a covered individual in a hospital or ambulatory surgery center, if any of the following applies:

SB466, s. 65 Section 65. 632.895 (12) (c) of the statutes is amended to read:

SB466,24,15 632.895 (12) (c) The coverage required under this subsection may be subject to any limitations, exclusions or cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan.

SB466, s. 66 Section 66. 632.895 (13) (a) of the statutes is amended to read:

SB466,24,20 632.895 (13) (a) Every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, that provides coverage of the surgical procedure known as a mastectomy shall provide coverage of breast reconstruction of the affected tissue incident to a mastectomy.

SB466, s. 67 Section 67. 632.895 (14) (b) of the statutes is amended to read:

SB466,25,2 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, town, village or school district, that provides coverage for a dependent of the insured shall provide coverage of appropriate and necessary immunizations, from birth to the age of 6 years, for a dependent who is a child of the insured.

SB466, s. 68 Section 68. 632.895 (15) (a) of the statutes, as affected by 2009 Wisconsin Act 28, is amended to read:

SB466,25,10 632.895 (15) (a) Subject to pars. (b) and (c), every disability insurance policy, and every self-insured health plan of the state or a county, city, town, village, or school district, that provides coverage for a person as a dependent of the insured because the person is a full-time student, including the coverage under s. 632.885 (2) (b), shall continue to provide dependent coverage for the person if, due to a medically necessary leave of absence, he or she ceases to be a full-time student.

SB466, s. 69 Section 69. 632.895 (16) (a) 4. of the statutes, as created by 2009 Wisconsin Act 14, is repealed.

SB466, s. 70 Section 70. 632.895 (16) (c) 2. of the statutes, as created by 2009 Wisconsin Act 14, is amended to read:

SB466,25,17 632.895 (16) (c) 2. A disability insurance policy, or a self-insured health plan of the state or a county, city, town, village, or school district, that provides only limited-scope dental or vision benefits.

SB466, s. 71 Section 71. 632.895 (17) (b) (intro.) of the statutes, as created by 2009 Wisconsin Act 28, is amended to read:

SB466,25,24 632.895 (17) (b) (intro.) Every disability insurance policy, and every self-insured health plan of the state or of a county, city, town, village, or school district, that provides coverage of outpatient health care services, preventive treatments and services, or prescription drugs and devices shall provide coverage for all of the following:

SB466, s. 72 Section 72. 632.895 (17) (d) 2. of the statutes, as created by 2009 Wisconsin Act 28, is amended to read:

SB466,26,5 632.895 (17) (d) 2. A disability insurance policy, or a self-insured health plan of the state or a county, city, town, village, or school district, that provides only limited-scope dental or vision benefits.

SB466, s. 73 Section 73. 632.896 (1) (bg) of the statutes is created to read:

SB466,26,8 632.896 (1) (bg) "Insured" includes a person who participates in a self-insured health plan.

SB466, s. 74 Section 74. 632.896 (1) (bk) of the statutes is created to read:

SB466,26,12 632.896 (1) (bk) "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. 75 Section 75. 632.896 (1) (d) of the statutes is created to read:

SB466,26,15 632.896 (1) (d) "Self-insured health plan" has the meaning given in s. 632.85 (1) (c) 2. and 3.

SB466, s. 76 Section 76. 632.896 (2) of the statutes is amended to read:

SB466,26,23 632.896 (2) Adopted or placed for adoption. Every disability insurance policy that is issued or renewed on or after March 1, 1991, and every self-insured health plan, that provides coverage for dependent children of the insured, as defined in the disability insurance policy or self-insured health plan, shall cover adopted children of the insured and children placed for adoption with the insured, on the same terms and conditions, including exclusions, limitations, deductibles and copayments, as other dependent children, except as provided in subs. (3) to (6).

SB466, s. 77 Section 77. 632.896 (3) (a) 2. of the statutes is amended to read:

SB466,27,3 632.896 (3) (a) 2. Subdivision 1. does not require coverage to begin before coverage is available under the disability insurance policy or self-insured health plan for other dependent children.

SB466, s. 78 Section 78. 632.896 (4) of the statutes is amended to read:

SB466,27,10 632.896 (4) Preexisting conditions. Notwithstanding ss. 632.746 and 632.76 (2) (a), a disability insurance policy or self-insured health plan, that is subject to sub. (2) and that is in effect when a court makes a final order granting adoption or when the child is placed for adoption may not exclude or limit coverage of a disease or physical condition of the child on the ground that the disease or physical condition existed before coverage is required to begin under sub. (3).

SB466, s. 79 Section 79. 632.896 (6) of the statutes is amended to read:

SB466,27,21 632.896 (6) Notice to insurer. The disability insurance policy or self-insured health plan may require the insured to notify the insurer that a child is adopted or placed for adoption and to pay the insurer any premium or fees required to provide coverage for the child, within 60 days after coverage is required to begin under sub. (3). If the insured fails to give notice or make payment within 60 days as required by the disability insurance policy or self-insured health plan in accordance with this subsection, the disability insurance policy or self-insured health plan shall treat the adopted child or child placed for adoption no less favorably than it treats other dependents, other than newborn children, who seek coverage at a time other than when the dependent was first eligible to apply for coverage.

SB466, s. 80 Section 80. 635.02 (3k) of the statutes is amended to read:

SB466,27,24 635.02 (3k) "Group health benefit plan" has the meaning given in s. 632.745 (9) (a) and (b).

SB466, s. 81 Section 81. 645.02 (8) of the statutes is created to read:

SB466,28,2 645.02 (8) 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. 82 Section 82. 646.01 (1) (a) 3. of the statutes is created to read:

SB466,28,5 646.01 (1) (a) 3. 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. 83 Section 83. 646.01 (1) (b) 9. of the statutes is amended to read:

SB466,28,11 646.01 (1) (b) 9. Any Except for a self-insured health plan of a city, town, village, county, or school district, any self-funded, self-insured, or partially or wholly uninsured plan of an employer or other person to provide life insurance, annuity, or disability benefits to its employees or members to the extent that the plan is self-funded, self-insured, or uninsured.

SB466, s. 84 Section 84. 646.03 (2q) of the statutes is created to read:

SB466,28,15 646.03 (2q) "Insurer" includes a city, village, town, county, or school district that provides a self-insured health plan, with respect to the self-insured health plan.

SB466, s. 85 Section 85. Initial applicability.

SB466,28,17 (1) This act first applies to the following:

SB466,28,20 (a) Except as provided in paragraph (b), self-insured governmental health plans provided by that are established, extended, modified, or renewed on the effective date of this paragraph.

SB466,28,24 (b) Self-insured governmental health plans covering employees who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are established, extended, modified, or renewed on the earlier of the following:

SB466,28,25 1. The day on which the collective bargaining agreement expires.

SB466,29,2 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

SB466, s. 86 Section 86. Effective date.

SB466,29,5 (1) This act takes effect on the first day of the 7th month beginning after publication.

SB466,29,6 (End)