DE3 SB1: Bill Text

SB1,17,13 (1) Coverage extension of the Health Insurance Risk-Sharing Plan; issuance of Medicare supplement and replacement policies.

SB1,17,14 (a) Definitions. In this subsection:

SB1,17,16 1. "Authority" means the Health Insurance Risk-Sharing Plan Authority under subchapter III of chapter 149 of the statutes.

SB1,17,17 2. "Commissioner" means the commissioner of insurance.

SB1,17,18 3. "Covered person" means a person who has coverage under the plan.

SB1,17,19 4. "Medicare" has the meaning given in section 149.10 (7) of the statutes.

SB1,17,21 5. "Medicare Advantage" has the meaning given in section INS 3.39 (3) (r), Wisconsin Administrative Code.

SB1,17,23 6. "Medicare replacement policy" has the meaning given in section 600.03 (28p) of the statutes.

SB1,17,25 7. "Medicare supplement policy" has the meaning given in section 600.03 (28r) of the statutes.

SB1,18,1 8. "Office" means the office of the commissioner of insurance.

SB1,18,3 9. "Plan" means the Health Insurance Risk-Sharing Plan under subchapter II of chapter 149 of the statutes.

SB1,18,7 (b) Extension of the plan and authority. Notwithstanding any statute, administrative rule, or provision of a policy or contract or of the plan to the contrary, the dissolution of the plan and the authority as provided in 2013 Wisconsin Act 20, section 9122 (1L), is modified as follows:

SB1,18,9 1. `Coverage provisions.' Notwithstanding 2013 Wisconsin Act 20, section 9122 (1L) (b) 1. b., all of the following apply:

SB1,18,22 a. A covered person whose coverage under the plan was in effect on December 1, 2013, who paid his or her December premium, and who, if eligible for Medicare, had not enrolled in Medicare Advantage during the federal open enrollment period in 2013 may elect to obtain a policy under the plan by making a timely payment of the January 2014 premium. The covered person must maintain the same policy benefits, including the same deductible amount, that were in effect on December 1, 2013. A new deductible period will commence on January 1, 2014. The premium for January 2014 must be paid no later than February 1, 2014. Thereafter, the covered person must pay premiums in accordance with the terms of the contract for coverage, which may not extend beyond 11:59 p.m. on March 31, 2014. Any medical claims that the covered person incurs after December 31, 2013, and before the plan receives the premium payment for January 2014 shall be held in abeyance and the plan shall not be responsible for payment until the premium payment is received.

SB1,19,5 b. If a covered person's coverage under the plan is funded under a contract with the federal department of health and human services, the covered person's coverage will end as provided in 2013 Wisconsin Act 20, section 9122 (1L) (b) 1. b., unless the federal department of health and human services issues a contract amendment that extends the contract and coverage to a date later than December 31, 2013, and the terms of the contract amendment are such that the federal government will be financially liable for all costs related to the operation of the contract that exceed member premium collections.

SB1,19,20 c. If the requirements under subdivision 1 . b. are satisfied, a covered person whose coverage is funded under a contract with the federal department of health and human services, whose coverage under the plan was in effect on December 1, 2013, who paid his or her December premium, and who had not enrolled in Medicare Advantage during the federal open enrollment period in 2013 may elect to obtain a policy under the plan by making a timely payment of the January 2014 premium. The covered person must maintain the same policy benefits, including the same deductible amount, that were in effect on December 1, 2013. A new deductible period will commence on January 1, 2014. The premium for January 2014 must be paid no later than February 1, 2014. Thereafter, the covered person must pay premiums in accordance with the terms of the contract for coverage, which may not extend beyond 11:59 p.m. on March 31, 2014. Any medical claims that the covered person incurs after December 31, 2013, and before the plan receives the premium payment for January 2014 shall be held in abeyance and the plan shall not be responsible for payment until the premium payment is received.

SB1,19,24 d. No later than February 1, 2014, the authority shall provide notice that coverage shall terminate on March 31, 2014, to all covered persons, all insurers and providers that are affected by the termination of the coverage, the office, the legislative audit bureau, and the insurers described in paragraph (c) 1 .

SB1,20,9 2. `Provider claims.' Providers of medical services and devices and prescription drugs to covered persons whose coverage is extended as provided in this paragraph must file claims for payment no later than June 1, 2014. Any claim filed after that date is not payable and may not be charged to the covered person who received the service, device, or drug. Except for copayments, coinsurance, or deductibles required under the plan, consistent with sections 149.14 (3) and 149.142 (2m) of the statutes, a provider may not bill a covered person who receives a covered service or article and shall accept as payment in full the payment rate determined under section 149.142 (1) of the statutes.

SB1,20,10 3. `Grievances and review.'

SB1,20,13 a. Any grievance by a covered person whose coverage is extended as provided in this paragraph must be in writing and received no later than July 1, 2014, or be barred.

SB1,20,17 b. A covered person whose coverage is extended as provided in this paragraph who submits a grievance after March 31, 2014, must request an independent review, if any, with respect to the grievance no later than August 1, 2014, or be barred from requesting an independent review with respect to the grievance.

SB1,20,18 4. `Payment of plan costs.'

SB1,20,22 a. To the extent possible, the authority shall pay plan costs incurred in 2013 and 2014 and all other costs associated with operating and dissolving the plan that are incurred before administrative responsibility for the dissolution of the plan is transferred to the office on February 28, 2014.

SB1,21,3 b. Notwithstanding 2013 Wisconsin Act 20, section 9122 (1L) (b) 4., the authority, before March 1, 2014, and the office, on and after March 1, 2014, shall pay plan costs in the manner provided in section 149.143 of the statutes, except that the authority or office may use all available surplus before imposing an assessment against insurers, as described in subdivision 4 . c. All provider claims shall be adjudicated by September 30, 2014.

SB1,21,8 c. The authority, before March 1, 2014, and the office, on and after March 1, 2014, but no later than July 1, 2014, shall determine whether an assessment of insurers under section 149.13 of the statutes is necessary to cover in full the plan's expenses related to operations, winding up operations, and dissolution of the plan. Any such assessment shall be based on the 2013 filed plan assessment form.

SB1,21,9 5. `Dissolution notice, claims, and updates.'

SB1,21,19 a. On behalf of the commissioner, the authority shall provide notice of the plan's dissolution to all persons known, or reasonably expected from the plan's records, to have claims against the plan, including all covered persons. Notwithstanding 2013 Wisconsin Act 20, section 9122 (1L) (b) 10. a., the notice shall be sent by 1st class mail to the last-known addresses no later than February 1, 2014. Notice to potential claimants of the plan shall require the claimants to file their claims, together with proofs of claims, by June 1, 2014. The notice shall be consistent with any relevant terms of the policies under the plan and contracts and with section 645.47 (1) (a) of the statutes. The notice shall serve as final notice consistent with section 645.47 (3) of the statutes.

SB1,22,4 b. Proofs of all claims must be filed with the office in the form provided by the office consistent with the proof of claim, as applicable, under section 645.62 of the statutes, on or before the last day for filing specified in the notice. For good cause shown, the office shall permit a claimant to make a late filing if the existence of the claim was not known to the claimant and the claimant files the claim within 30 days after learning of the claim, but not later than September 1, 2014. Any such late claim that would have been payable under the policy under the plan if it had been filed timely and that was not covered by a succeeding insurer shall be permitted unless the claimant had actual notice of the termination of the plan or the notice was mailed to the claimant by 1st class mail at least 10 days before the insured event occurred.

SB1,22,5 (c) Medicare supplement and replacement policy issuance.

SB1,22,9 1. In addition to the requirement under 2013 Wisconsin Act 20, section 9122 (1m), an insurer offering a Medicare supplement policy or a Medicare replacement policy in this state shall provide coverage under the policy to any individual who satisfies all of the following:

SB1,22,10 a. The individual is eligible for Medicare.

SB1,22,11 b. The individual had coverage under the plan.

SB1,22,12 c. The individual's coverage under the plan terminated on March 31, 2014.

SB1,22,14 d. The individual applies for coverage under the policy before 63 days after the date specified in subdivision 1 . c.

SB1,22,15 e. The individual pays the premium for the coverage under the policy.

SB1,22,18 2. An insurer under subdivision 1. may not deny coverage to any individual who satisfies the criteria under subdivision 1 . a. to e . on the basis of health status, receipt of health care, claims experience, or medical condition including disability.

SB1,22,21 3. In addition to any other notice requirements to insurers, no later than February 1, 2014, the authority shall provide notice to the insurers described in subdivision 1. of the requirements under this paragraph.

SB1,33 Section 33. Effective dates. This act takes effect on the day after publication, except as follows:

SB1,22,25 (1) Health Insurance Risk-Sharing Plan. The treatment of section 895.514 (2) and (3) (a) and (b) of the statutes takes effect on January 1, 2015.

SB1,23,2 (2) Medical Assistance eligibility. The treatment of sections 49.45 (23) (a) (by Section 2) and 49.471 (4) (a) 4. b. of the statutes takes effect on April 1, 2014.

SB1,23,4 (3) Reconciliation with 2011 Wisconsin Act 32. The treatment of section 49.45 (23) (a) (by Section 3 ) of the statutes takes effect on January 1, 2015.

SB1,23,5 (End)