LRB-3086/2
TJD:bjk&jld:ph
2009 - 2010 LEGISLATURE
January 25, 2010 - Introduced by Senators Jauch, Sullivan, Carpenter,
Erpenbach, Taylor
and Schultz, cosponsored by Representatives Pasch,
Grigsby, Roys, Zepnick, Berceau, Dexter, Young
and Hubler. Referred to
Committee on Health, Health Insurance, Privacy, Property Tax Relief, and
Revenue.
SB483,1,5 1An Act to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g), 185.981 (4t)
2and 185.983 (1) (intro.); and to create 609.72 and 632.865 of the statutes;
3relating to: prohibiting health insurance policies and self-insured health
4plans from excluding coverage for injuries based on the use of alcohol or
5controlled substances.
Analysis by the Legislative Reference Bureau
This bill prohibits health insurance policies and governmental self-insured
health plans that cover medical expenses incurred as a result of an injury from using
an insured's alcohol consumption or use of a controlled substance as a basis to deny
or exclude coverage. The health insurance policy or governmental self-insured
health plan may subject the coverage of these injuries to any cost-sharing provisions,
limitations, or other exclusions that apply generally under the policy or plan.
The prohibition against denying coverage applies to individual and group
health insurance policies, including limited service health organizations, preferred
provider plans, defined network plans, and cooperative sickness care associations;
to health care plans, including a self-insured plan, offered by the state to its
employees; and to self-insured health plans of a city, town, village, county, or school
district.

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:
SB483, s. 1 1Section 1. 40.51 (8) of the statutes, as affected by 2009 Wisconsin Act 28, is
2amended to read:
SB483,2,63 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
4shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.746 (1) to (8)
5and (10), 632.747, 632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.865,
6632.87 (3) to (6), 632.885, 632.895 (5m) and (8) to (17), and 632.896.
SB483, s. 2 7Section 2. 40.51 (8m) of the statutes, as affected by 2009 Wisconsin Act 28, is
8amended to read:
SB483,2,129 40.51 (8m) Every health care coverage plan offered by the group insurance
10board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,
11632.748, 632.83, 632.835, 632.85, 632.853, 632.855, 632.865, 632.885, and 632.895
12(11) to (17).
SB483, s. 3 13Section 3. 66.0137 (4) of the statutes, as affected by 2009 Wisconsin Act 28,
14is amended to read:
SB483,2,2015 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
16a village provides health care benefits under its home rule power, or if a town
17provides health care benefits, to its officers and employees on a self-insured basis,
18the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
19632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.85, 632.853, 632.855, 632.865, 632.87
20(4), (5), and (6), 632.885, 632.895 (9) to (17), 632.896, and 767.513 (4).
SB483, s. 4
1Section 4. 120.13 (2) (g) of the statutes, as affected by 2009 Wisconsin Act 28,
2is amended to read:
SB483,3,63 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
449.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
5632.85, 632.853, 632.855, 632.865, 632.87 (4), (5), and (6), 632.885, 632.895 (9) to
6(17), 632.896, and 767.513 (4).
SB483, s. 5 7Section 5. 185.981 (4t) of the statutes, as affected by 2009 Wisconsin Act 28,
8is amended to read:
SB483,3,129 185.981 (4t) A sickness care plan operated by a cooperative association is
10subject to ss. 252.14, 631.17, 631.89, 631.95, 632.72 (2), 632.745 to 632.749, 632.85,
11632.853, 632.855, 632.865, 632.87 (2m), (3), (4), (5), and (6), 632.885, 632.895 (10) to
12(17), and 632.897 (10) and chs. 149 and 155.
SB483, s. 6 13Section 6. 185.983 (1) (intro.) of the statutes, as affected by 2009 Wisconsin
14Act 28
, is amended to read:
SB483,3,2115 185.983 (1) (intro.) Every such voluntary nonprofit sickness care plan shall be
16exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41,
17601.42, 601.43, 601.44, 601.45, 611.67, 619.04, 628.34 (10), 631.17, 631.89, 631.93,
18631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853,
19632.855, 632.865, 632.87 (2m), (3), (4), (5), and (6), 632.885, 632.895 (5) and (9) to (17),
20632.896, and 632.897 (10) and chs. 609, 630, 635, 645, and 646, but the sponsoring
21association shall:
SB483, s. 7 22Section 7. 609.72 of the statutes is created to read:
SB483,3,25 23609.72 Exclusion for injuries based on alcohol or controlled substance
24use prohibited.
Limited service health organizations, preferred provider plans,
25and defined network plans are subject to s. 632.865.
SB483, s. 8
1Section 8. 632.865 of the statutes is created to read:
SB483,4,3 2632.865 Exclusion for injuries based on alcohol or controlled
3substance use prohibited.
(1) In this section:
SB483,4,44 (a) "Controlled substance" has the meaning given in s. 961.01 (4).
SB483,4,55 (b) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
SB483,4,66 (c) "Self-insured health plan" has the meaning given in s. 632.85 (1) (c).
SB483,4,11 7(2) No disability insurance policy or self-insured health plan that provides
8coverage for emergency or nonemergency medical, hospital, or surgical expenses
9incurred as a result of an injury may use as a basis for denying or excluding coverage
10for those expenses any alcohol consumption by the insured or use of a controlled
11substance by the insured.
SB483,4,14 12(3) The coverage that may not be denied or excluded under sub. (2) may be
13subject to any cost-sharing provisions, limitations, or other exclusions that apply
14generally under the disability insurance policy or self-insured health plan.
SB483, s. 9 15Section 9. Initial applicability.
SB483,4,1616 (1) This act first applies to all of the following:
SB483,4,1917 (a) Except as provided in paragraphs (b) and (c), disability insurance policies
18that are issued or renewed, and governmental self-insured health plans that are
19established, extended, modified, or renewed, on the effective date of this paragraph.
SB483,4,2220 (b) Disability insurance policies covering employees who are affected by a
21collective bargaining agreement containing provisions inconsistent with this act
22that are issued or renewed on the earlier of the following:
SB483,4,23 231. The day on which the collective bargaining agreement expires.
SB483,4,25 242. The day on which the collective bargaining agreement is extended, modified,
25or renewed.
SB483,5,4
1(c) Governmental self-insured health plans covering employees who are
2affected by a collective bargaining agreement containing provisions inconsistent
3with this act that are established, extended, modified, or renewed on the earlier of
4the following:
SB483,5,5 51. The day on which the collective bargaining agreement expires.
SB483,5,7 62. The day on which the collective bargaining agreement is extended, modified,
7or renewed.
SB483, s. 10 8Section 10. Effective date.
SB483,5,109 (1) This act takes effect on the first day of the 7th month beginning after
10publication.
SB483,5,1111 (End)
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