SB466,24,4
1(d) Notwithstanding par. (c) 1., an insurer or a self-insured health plan of the
2state or a county, city, village, town or school district
may require that an insured
3obtain prior authorization for any medically necessary surgical or nonsurgical
4treatment for the correction of temporomandibular disorders.
SB466, s. 64 5Section 64. 632.895 (12) (b) (intro.) of the statutes is amended to read:
SB466,24,116 632.895 (12) (b) (intro.) Except as provided in par. (d), every disability
7insurance policy, and every self-insured health plan of the state or a county, city,
8village, town or school district,
shall cover hospital or ambulatory surgery center
9charges incurred, and anesthetics provided, in conjunction with dental care that is
10provided to a covered individual in a hospital or ambulatory surgery center, if any
11of the following applies:
SB466, s. 65 12Section 65. 632.895 (12) (c) of the statutes is amended to read:
SB466,24,1513 632.895 (12) (c) The coverage required under this subsection may be subject
14to any limitations, exclusions or cost-sharing provisions that apply generally under
15the disability insurance policy or self-insured health plan.
SB466, s. 66 16Section 66. 632.895 (13) (a) of the statutes is amended to read:
SB466,24,2017 632.895 (13) (a) Every disability insurance policy, and every self-insured
18health plan of the state or a county, city, village, town or school district, that provides
19coverage of the surgical procedure known as a mastectomy shall provide coverage of
20breast reconstruction of the affected tissue incident to a mastectomy.
SB466, s. 67 21Section 67. 632.895 (14) (b) of the statutes is amended to read:
SB466,25,222 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy,
23and every self-insured health plan of the state or a county, city, town, village or school
24district
, that provides coverage for a dependent of the insured shall provide coverage

1of appropriate and necessary immunizations, from birth to the age of 6 years, for a
2dependent who is a child of the insured.
SB466, s. 68 3Section 68. 632.895 (15) (a) of the statutes, as affected by 2009 Wisconsin Act
428
, is amended to read:
SB466,25,105 632.895 (15) (a) Subject to pars. (b) and (c), every disability insurance policy,
6and every self-insured health plan of the state or a county, city, town, village, or
7school district,
that provides coverage for a person as a dependent of the insured
8because the person is a full-time student, including the coverage under s. 632.885
9(2) (b), shall continue to provide dependent coverage for the person if, due to a
10medically necessary leave of absence, he or she ceases to be a full-time student.
SB466, s. 69 11Section 69. 632.895 (16) (a) 4. of the statutes, as created by 2009 Wisconsin
12Act 14
, is repealed.
SB466, s. 70 13Section 70. 632.895 (16) (c) 2. of the statutes, as created by 2009 Wisconsin
14Act 14
, is amended to read:
SB466,25,1715 632.895 (16) (c) 2. A disability insurance policy, or a self-insured health plan
16of the state or a county, city, town, village, or school district, that provides only
17limited-scope dental or vision benefits.
SB466, s. 71 18Section 71. 632.895 (17) (b) (intro.) of the statutes, as created by 2009
19Wisconsin Act 28
, is amended to read:
SB466,25,2420 632.895 (17) (b) (intro.) Every disability insurance policy, and every
21self-insured health plan of the state or of a county, city, town, village, or school
22district,
that provides coverage of outpatient health care services, preventive
23treatments and services, or prescription drugs and devices shall provide coverage for
24all of the following:
SB466, s. 72
1Section 72. 632.895 (17) (d) 2. of the statutes, as created by 2009 Wisconsin
2Act 28
, is amended to read:
SB466,26,53 632.895 (17) (d) 2. A disability insurance policy, or a self-insured health plan
4of the state or a county, city, town, village, or school district, that provides only
5limited-scope dental or vision benefits.
SB466, s. 73 6Section 73. 632.896 (1) (bg) of the statutes is created to read:
SB466,26,87 632.896 (1) (bg) "Insured" includes a person who participates in a self-insured
8health plan.
SB466, s. 74 9Section 74. 632.896 (1) (bk) of the statutes is created to read:
SB466,26,1210 632.896 (1) (bk) "Insurer" includes a city, town, village, county, or school district
11that provides a self-insured health plan, with respect to the self-insured health
12plan.
SB466, s. 75 13Section 75. 632.896 (1) (d) of the statutes is created to read:
SB466,26,1514 632.896 (1) (d) "Self-insured health plan" has the meaning given in s. 632.85
15(1) (c) 2. and 3.
SB466, s. 76 16Section 76. 632.896 (2) of the statutes is amended to read:
SB466,26,2317 632.896 (2) Adopted or placed for adoption. Every disability insurance policy
18that is issued or renewed on or after March 1, 1991, and every self-insured health
19plan,
that provides coverage for dependent children of the insured, as defined in the
20disability insurance policy or self-insured health plan, shall cover adopted children
21of the insured and children placed for adoption with the insured, on the same terms
22and conditions, including exclusions, limitations, deductibles and copayments, as
23other dependent children, except as provided in subs. (3) to (6).
SB466, s. 77 24Section 77. 632.896 (3) (a) 2. of the statutes is amended to read:
SB466,27,3
1632.896 (3) (a) 2. Subdivision 1. does not require coverage to begin before
2coverage is available under the disability insurance policy or self-insured health
3plan
for other dependent children.
SB466, s. 78 4Section 78. 632.896 (4) of the statutes is amended to read:
SB466,27,105 632.896 (4) Preexisting conditions. Notwithstanding ss. 632.746 and 632.76
6(2) (a), a disability insurance policy or self-insured health plan, that is subject to sub.
7(2) and that is in effect when a court makes a final order granting adoption or when
8the child is placed for adoption may not exclude or limit coverage of a disease or
9physical condition of the child on the ground that the disease or physical condition
10existed before coverage is required to begin under sub. (3).
SB466, s. 79 11Section 79. 632.896 (6) of the statutes is amended to read:
SB466,27,2112 632.896 (6) Notice to insurer. The disability insurance policy or self-insured
13health plan
may require the insured to notify the insurer that a child is adopted or
14placed for adoption and to pay the insurer any premium or fees required to provide
15coverage for the child, within 60 days after coverage is required to begin under sub.
16(3). If the insured fails to give notice or make payment within 60 days as required
17by the disability insurance policy or self-insured health plan in accordance with this
18subsection, the disability insurance policy or self-insured health plan shall treat the
19adopted child or child placed for adoption no less favorably than it treats other
20dependents, other than newborn children, who seek coverage at a time other than
21when the dependent was first eligible to apply for coverage.
SB466, s. 80 22Section 80. 635.02 (3k) of the statutes is amended to read:
SB466,27,2423 635.02 (3k) "Group health benefit plan" has the meaning given in s. 632.745
24(9) (a) and (b).
SB466, s. 81 25Section 81. 645.02 (8) of the statutes is created to read:
SB466,28,2
1645.02 (8) A city, town, village, county, or school district that provides a
2self-insured health plan, with respect to the self-insured health plan.
SB466, s. 82 3Section 82. 646.01 (1) (a) 3. of the statutes is created to read:
SB466,28,54 646.01 (1) (a) 3. A city, town, village, county, or school district that provides a
5self-insured health plan, with respect to the self-insured health plan.
SB466, s. 83 6Section 83. 646.01 (1) (b) 9. of the statutes is amended to read:
SB466,28,117 646.01 (1) (b) 9. Any Except for a self-insured health plan of a city, town,
8village, county, or school district, any
self-funded, self-insured, or partially or wholly
9uninsured plan of an employer or other person to provide life insurance, annuity, or
10disability benefits to its employees or members to the extent that the plan is
11self-funded, self-insured, or uninsured.
SB466, s. 84 12Section 84. 646.03 (2q) of the statutes is created to read:
SB466,28,1513 646.03 (2q) "Insurer" includes a city, village, town, county, or school district
14that provides a self-insured health plan, with respect to the self-insured health
15plan.
SB466, s. 85 16Section 85. Initial applicability.
SB466,28,1717 (1) This act first applies to the following:
SB466,28,2018 (a) Except as provided in paragraph (b), self-insured governmental health
19plans provided by that are established, extended, modified, or renewed on the
20effective date of this paragraph.
SB466,28,2421 (b) Self-insured governmental health plans covering employees who are
22affected by a collective bargaining agreement containing provisions inconsistent
23with this act that are established, extended, modified, or renewed on the earlier of
24the following:
SB466,28,25 251. The day on which the collective bargaining agreement expires.
SB466,29,2
12. The day on which the collective bargaining agreement is extended, modified,
2or renewed.
SB466, s. 86 3Section 86. Effective date.
SB466,29,54 (1) This act takes effect on the first day of the 7th month beginning after
5publication.
SB466,29,66 (End)
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