SB273,22,188 101.177 (1) (d) "State agency" means any office, department, agency,
9institution of higher education, association, society, or other body in state
10government created or authorized to be created by the constitution or any law, that
11is entitled to expend moneys appropriated by law, including the legislature and the
12courts, the Wisconsin Housing and Economic Development Authority, the Bradley
13Center Sports and Entertainment Corporation, the University of Wisconsin
14Hospitals and Clinics Authority, the Wisconsin Aerospace Authority, the Wisconsin
15Economic Development Corporation, and the Wisconsin Health and Educational
16Facilities Authority, but excluding the Health Insurance Risk-Sharing Plan
17Authority, the Badger Health Benefit Authority, and the Lower Fox River
18Remediation Authority.
SB273, s. 45 19Section 45. 230.03 (3) of the statutes, as affected by 2011 Wisconsin Act 10,
20is amended to read:
SB273,23,521 230.03 (3) "Agency" means any board, commission, committee, council, or
22department in state government or a unit thereof created by the constitution or
23statutes if such board, commission, committee, council, department, unit, or the
24head thereof, is authorized to appoint subordinate staff by the constitution or
25statute, except a legislative or judicial board, commission, committee, council,

1department, or unit thereof or an authority created under subch. II of ch. 114 or,
2subch. III of ch. 149, or subch. III of ch. 636 or under ch. 231, 232, 233, 234, 235, 237,
3238, or 279. "Agency" does not mean any local unit of government or body within one
4or more local units of government that is created by law or by action of one or more
5local units of government.
SB273, s. 46 6Section 46. 230.80 (4) of the statutes is amended to read:
SB273,23,147 230.80 (4) "Governmental unit" means any association, authority, board,
8commission, department, independent agency, institution, office, society, or other
9body in state government created or authorized to be created by the constitution or
10any law, including the legislature, the office of the governor, and the courts, but
11excluding the Health Insurance Risk-Sharing Plan Authority and the Badger
12Health Benefit Authority
. "Governmental unit" does not mean any political
13subdivision of the state or body within one or more political subdivisions that is
14created by law or by action of one or more political subdivisions.
SB273, s. 47 15Section 47. 230.90 (1) (c) of the statutes is amended to read:
SB273,23,2416 230.90 (1) (c) "Governmental unit" means any association, authority, board,
17commission, department, independent agency, institution, office, society or other
18body in state government created or authorized to be created by the constitution or
19any law, including the legislature, the office of the governor and the courts.
20"Governmental unit" does not mean the University of Wisconsin Hospitals and
21Clinics Authority, the Health Insurance Risk-Sharing Plan Authority, the Badger
22Health Benefit Authority,
or any political subdivision of the state or body within one
23or more political subdivisions which is created by law or by action of one or more
24political subdivisions.
SB273, s. 48 25Section 48. 635.18 (1) of the statutes is amended to read:
SB273,24,2
1635.18 (1) Every Any small employer insurer shall may actively market health
2benefit plan coverage to small employers in the state.
SB273, s. 49 3Section 49. Chapter 636 of the statutes is created to read:
SB273,24,54 chapter 636
5 health benefit plan exchange
SB273,24,76 subchapter I
7 general provisions
SB273,24,8 8636.01 Definitions. In this chapter:
SB273,24,9 9(1) "Authority" means the Badger Health Benefit Authority.
SB273,24,12 10(2) "Educated health care consumer" means an individual who is
11knowledgeable about the health care system and who has background or experience
12in making informed decisions regarding health, medical, and scientific matters.
SB273,24,16 13(3) "Federal act" means the federal Patient Protection and Affordable Care Act
14(P.L. 111-148), as amended by the federal Health Care and Education Reconciliation
15Act of 2010 (P.L. 111-152), and any amendments to, or regulations or guidance issued
16under, those acts.
SB273,24,19 17(4) (a) Except as provided in pars. (b) to (e), "health benefit plan" means a policy,
18contract, certificate, or agreement offered or issued by a health carrier to provide,
19deliver, arrange for, pay for, or reimburse any of the costs of health care services.
SB273,24,2020 (b) "Health benefit plan" does not include any of the following:
SB273,24,2221 1. Coverage only for accident, or disability income insurance, or any
22combination of those.
SB273,24,2323 2. Coverage issued as a supplement to liability insurance.
SB273,24,2524 3. Liability insurance, including general liability insurance and automobile
25liability insurance.
SB273,25,1
14. Worker's compensation or similar insurance.
SB273,25,22 5. Automobile medical payment insurance.
SB273,25,33 6. Credit-only insurance.
SB273,25,44 7. Coverage for on-site medical clinics.
SB273,25,75 8. Other similar insurance coverage, specified in federal regulations issued
6under P.L. 104-191, under which benefits for health care services are secondary or
7incidental to other insurance benefits.
SB273,25,108 (c) "Health benefit plan" does not include any of the following benefits if they
9are provided under a separate policy, certificate, or contract of insurance or otherwise
10not an integral part of the plan:
SB273,25,1111 1. Limited scope dental or vision benefits.
SB273,25,1312 2. Benefits for long-term care, nursing home care, home health care,
13community-based care, or any combination of those.
SB273,25,1514 3. Other similar, limited benefits specified in federal regulations issued under
15P.L. 104-191.
SB273,25,2216 (d) "Health benefit plan" does not include any of the following benefits if the
17benefits are provided under a separate policy, certificate, or contract of insurance,
18there is no coordination between the provision of the benefits and any exclusion of
19benefits under any group health plan maintained by the same plan sponsor, and the
20benefits are paid with respect to an event without regard to whether benefits are
21provided with respect to such an event under any group health plan maintained by
22the same plan sponsor:
SB273,25,2323 1. Coverage only for a specified disease or illness.
SB273,25,2424 2. Hospital indemnity or other fixed indemnity insurance.
SB273,26,2
1(e) "Health benefit plan" does not include any of the following if offered as a
2separate policy, certificate, or contract of insurance:
SB273,26,43 1. Medicare supplemental health insurance as defined under section 1882 (g)
4(1) of the federal Social Security Act.
SB273,26,652. Coverage supplemental to the coverage provided under 10 USC ch. 55
6(Civilian Health and Medical Program of the Uniformed Services (CHAMPUS)).
SB273,26,87 3. Similar supplemental coverage provided to coverage under a group health
8plan.
SB273,26,15 9(5) "Health carrier" or "carrier" means an entity subject to the insurance laws
10and rules of this state, or subject to the jurisdiction of the commissioner, that
11contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse
12any of the costs of health care services, including a sickness and accident insurance
13company, a health maintenance organization, a nonprofit hospital and health service
14corporation, or any other entity providing a plan of health insurance, health benefits,
15or health services.
SB273,26,17 16(5m) "Minimum essential coverage" has the meaning given in 26 USC 5000A
17(f) (1).
SB273,26,19 18(6) "Qualified dental plan" means a limited scope dental plan that has been
19certified in accordance with s. 636.42 (5).
SB273,26,23 20(7) "Qualified employer" means a small employer that elects to make its
21full-time employees eligible for one or more qualified health plans offered through
22the SHOP Exchange and, at the option of the employer, some or all of its part-time
23employees, provided that the employer satisfies any of the following:
SB273,27,3
1(a) The employer has its principal place of business in this state and elects to
2provide coverage through the SHOP Exchange to all of its eligible employees,
3wherever employed.
SB273,27,54 (b) The employer elects to provide coverage through the SHOP Exchange to all
5of its eligible employees who are principally employed in this state.
SB273,27,8 6(8) "Qualified health plan" means a health benefit plan that has in effect a
7certification that the plan meets the criteria for certification described in section
81311 (c) of the federal act and s. 636.42.
SB273,27,10 9(9) "Qualified individual" means an individual, including a minor, who satisfies
10all of the following:
SB273,27,1211 (a) The individual is seeking to enroll in a qualified health plan offered to
12individuals through the exchange under subch. II.
SB273,27,1313 (b) The individual resides in this state.
SB273,27,1514 (c) At the time of enrollment, the individual is not incarcerated in a correctional
15facility, other than incarceration pending the disposition of charges.
SB273,27,1816 (d) The individual is, and is reasonably expected to be for the entire period for
17which enrollment is sought, a citizen or national of the United States or an alien
18lawfully present in the United States.
SB273,27,20 19(10) "Secretary" means the secretary of the federal department of health and
20human services.
SB273,27,22 21(11) "SHOP Exchange" means a small business health options program
22established under s. 636.30 (1) (q).
SB273,27,24 23(12) (a) "Small employer" means an employer that employed an average of not
24more than 100 employees during the preceding calendar year.
SB273,27,2525 (b) For purposes of this subsection, all of the following apply:
SB273,28,2
11. All persons treated as a single employer under section 414 (b), (c), (m), or (o)
2of the Internal Revenue Code shall be treated as a single employer.
SB273,28,43 2. An employer and any predecessor employer shall be treated as a single
4employer.
SB273,28,65 3. All employees shall be counted, including part-time employees and
6employees who are not eligible for coverage through the employer.
SB273,28,107 4. If an employer was not in existence during the entire preceding calendar
8year, the determination of whether that employer is a small employer shall be based
9on the average number of employees that it is reasonably expected that employer will
10employ on business days in the current calendar year.
SB273,28,1511 5. An employer that makes enrollment in qualified health plans available to
12its employees through the SHOP Exchange and that would cease to be a small
13employer by reason of an increase in the number of its employees shall continue to
14be treated as a small employer for purposes of this chapter as long as it continuously
15makes enrollment through the SHOP Exchange available to its employees.
SB273,28,1716 subchapter II
17 operation of exchange
SB273,28,21 18636.25 General matters. (1) The authority shall establish and operate a
19Wisconsin Health Benefit Exchange and shall make qualified health plans, with
20effective dates on or before January 1, 2014, available to qualified individuals and
21qualified employers.
SB273,28,23 22(2) (a) The authority may not make available any health benefit plan that is
23not a qualified health plan.
SB273,29,324 (b) The authority shall allow a health carrier to offer a plan that provides
25limited scope dental benefits meeting the requirements of section 9832 (c) (2) (A) of

1the Internal Revenue Code through the exchange, either separately or in conjunction
2with a qualified health plan, if the plan provides pediatric dental benefits meeting
3the requirements of section 1302 (b) (1) (J) of the federal act.
SB273,29,9 4(3) Neither the authority nor a carrier offering health benefit plans through
5the exchange may charge an individual a fee or penalty for termination of coverage
6if the individual enrolls in another type of minimum essential coverage because the
7individual has become newly eligible for that coverage or because the individual's
8employer-sponsored coverage has become affordable under the standards of section
936B (c) (2) (C) of the Internal Revenue Code.
SB273,29,14 10(4) The authority may enter into information-sharing agreements with federal
11and state agencies and entities operating exchanges in other states to carry out its
12responsibilities under this chapter, provided that such agreements include adequate
13protections with respect to the confidentiality of the information to be shared and
14comply with all state and federal laws and rules and regulations.
SB273,29,17 15636.30 Exchange duties and powers. (1) In addition to all other duties
16imposed under this chapter, the authority shall do all of the following relating to the
17exchange:
SB273,29,2118 (a) Implement procedures for the certification, recertification, and
19decertification, consistent with guidelines developed by the secretary under section
201311 (c) of the federal act and s. 636.42, of health benefit plans as qualified health
21plans.
SB273,29,2322 (b) Provide for the operation of a toll-free telephone hotline to respond to
23requests for assistance.
SB273,29,2524 (c) Provide for enrollment periods, as provided under section 1311 (c) (6) of the
25federal act.
SB273,30,3
1(d) Maintain an Internet Web site through which enrollees and prospective
2enrollees of qualified health plans may obtain standardized comparative
3information on such plans.
SB273,30,84 (e) Assign a rating to each qualified health plan offered through the exchange
5in accordance with the criteria developed by the secretary under section 1311 (c) (3)
6of the federal act, and determine each qualified health plan's level of coverage in
7accordance with regulations issued by the secretary under section 1302 (d) (2) (A) of
8the federal act.
SB273,30,119 (f) Use a standardized format for presenting health benefit options in the
10exchange, including the use of the uniform outline of coverage established under
11section 2715 of the federal Public Health Service Act (42 USC 300gg-15).
SB273,30,1312 (g) Establish quality improvement standards for health benefit plans offered
13through the exchange.
SB273,30,1514 (h) Establish a system for enrolling eligible groups and individuals, using a
15standard application form developed by the commissioner under s. 636.46 (2).
SB273,30,1716 (i) Establish procedures for collecting premiums and remitting premium
17payments and providing enrollment information to health carriers.
SB273,30,2018 (j) Establish, in consultation with the commissioner, the method for
19determining the amount of the surcharge under s. 636.45 (1) and establish the
20procedure for imposing and collecting the surcharge.
SB273,30,2221 (k) Establish a plan for publicizing the exchange and the eligibility
22requirements and enrollment procedures.
SB273,30,2423 (L) Establish and operate a service center to provide information to small
24employers, individuals, enrollees, and insurance intermediaries about the exchange.
SB273,31,2
1(m) Establish a mechanism for regular communication and cooperation with
2insurance intermediaries.
SB273,31,43 (n) Establish an independent and binding appeals process for resolving
4disputes over eligibility and other determinations made by the authority.
SB273,31,95 (o) In accordance with section 1413 of the federal act, inform individuals of
6eligibility requirements for Medical Assistance under subch. IV of ch. 49 or any other
7applicable state or local public program and if, through screening of the application
8by the authority, the authority determines that any individual is eligible for any such
9program, assist that individual to enroll in that program.
SB273,31,1310 (p) Establish and make available by electronic means a calculator to determine
11the actual cost of coverage after application of any premium tax credit under section
1236B of the Internal Revenue Code and any cost-sharing reduction under section
131402 of the federal act.
SB273,31,1714 (q) Establish a SHOP Exchange through which qualified employers may access
15health care coverage for their employees and which shall enable any qualified
16employer to specify the level of coverage at which its employees may enroll in any
17qualified health plan offered through the SHOP Exchange.
SB273,31,2018 (r) Perform duties required of the authority by the secretary or the federal
19secretary of the treasury related to determining eligibility for premium tax credits,
20reduced cost-sharing, or individual responsibility requirement exemptions.
SB273,31,2421 (s) Select entities, which may include insurance intermediaries, that are
22qualified to serve as navigators in accordance with section 1311 (i) of the federal act
23and standards developed by the secretary, and award grants to enable navigators to
24do all of the following:
SB273,32,2
11. Conduct public education activities to raise awareness of the availability of
2qualified health plans.
SB273,32,63 2. Distribute fair and impartial information concerning enrollment in qualified
4health plans and concerning the availability of premium tax credits under section
536B of the Internal Revenue Code and cost-sharing reductions under section 1402
6of the federal act.
SB273,32,77 3. Facilitate enrollment in qualified health plans.
SB273,32,138 4. Provide referrals to any applicable office of health insurance consumer
9assistance or health insurance ombudsman established under section 2793 of the
10federal Public Health Service Act (42 USC 300gg-93), or to any other appropriate
11state agency or agencies, for any enrollee with a grievance, complaint, or question
12regarding their health benefit plan, coverage, or determination under that plan or
13coverage.
SB273,32,1514 5. Provide information in a manner that is culturally and linguistically
15appropriate to the needs of the population being served by the exchange.
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