AB920,1 1Section 1. 146.79 of the statutes is created to read:
AB920,2,62 146.79 Employer group self-funded health benefits project. (1)
3Definition. In this section, “eligible employee” means an employee who works on a
4permanent basis and has a normal work week of 30 or more hours and includes all
5of the following, if included as an employee under the health care benefit
6arrangement under this section:
AB920,2,77 (a) A sole proprietor.
AB920,2,88 (b) A business owner, including the owner of a farm business.
AB920,2,99 (c) A partner of a partnership.
AB920,2,1110(d) A member of a limited liability company or a corporation defined under 26
11USC 1361
(a) (1).
AB920,3,5
1(2) Employer groups; qualification. (a) Two or more employers that are
2members of the same chamber of commerce or industry-based association may form
3an employer group to establish and administer an employee health care benefit
4arrangement to jointly provide health care benefits on a self-funded basis to eligible
5employees of employers in the group and the dependents of those eligible employees.
AB920,3,126 (b) Employer groups that provide evidence to the commissioner of insurance
7that they have formed and are able to comply with the requirements of this section
8qualify to participate in the project under this section. When employer groups have
9qualified under this paragraph, the commissioner of insurance shall submit a notice
10to the legislative reference bureau for publication in the Wisconsin Administrative
11Register that lists the employer groups that have qualified and the date on which
12each group provided the necessary evidence of compliance.
AB920,3,14 13(3) Employer group duties and powers. (a) Each employer group qualified
14under sub. (2) (b) shall do all of the following:
AB920,3,1615 1. Determine all matters necessary for the administration and operation of its
16employee health care benefit arrangement.
AB920,3,1717 2. Designate an agent for service of process, notice, or demand.
AB920,3,1918 3. Define who is a dependent for purposes of coverage under its employee health
19care benefit arrangement.
AB920,3,2420 4. Employ or contract with an actuary to make recommendations, in
21accordance with generally accepted actuarial principles, as to the sufficient amount
22of funding for the employee health care benefit arrangement. The employer group
23satisfies the requirement under this subdivision if the employer group contracts with
24an insurer or a 3rd-party administrator that employs an actuary.
AB920,4,11
15. Determine, based on the actuary's recommendations under subd. 4., the
2amount that each employer that is participating in the employer group shall
3contribute to self-fund the employee health care benefit arrangement; to pay
4administrative expenses, including the actuary's compensation; and to purchase
5excess or stop-loss coverage, as described under sub. (5) (b). The contribution
6amount under this subdivision may vary by employer based on criteria developed by
7the employer group. An employer group may require employers in the employer
8group to contribute payments for establishing a surplus fund and may levy an
9assessment whenever the amount of any loss or expense that is due exceeds the
10assets of the employer group or the surplus fund amount established by the employer
11group is impaired.
AB920,4,1812 6. Establish a minimum participation period for an employer's participation in
13the employer group, which shall be the same length for each employer participating
14in the employer group and may not be less than 3 years. An employer group may
15specify circumstances under which a participating employer may discontinue
16participation in the employer group before the minimum participation period
17established under this subdivision ends without forfeiting all or a portion of the
18amount paid by the employer under sub. (4) (a) 2.
AB920,4,2019 7. Annually submit a report to the commissioner of insurance describing the
20stability of the employer group and the finances of the employer group.
AB920,5,221 (b) An employer group qualified under sub. (2) (b) may specify minimum
22participation requirements that an employer is required to satisfy to participate in
23the employer group. Except as provided under sub. (4) (b), an employer group
24qualified under sub. (2) (b) shall allow any employer that is a member of the same
25chamber of commerce or industry-based association as the other group members and

1that agrees to comply with the participation requirements specified under this
2paragraph to participate in the employer group.
AB920,5,93 (c) If an employer group qualified under sub. (2) (b) seeks to contract with a
43rd-party administrator to administer any part of the health care benefit
5arrangement, the employer group shall contract with a 3rd-party administrator that
6is registered to do business in this state. A contract between an employer group and
7a 3rd-party administrator that relates to the administration of the payment of
8claims shall specify terms for the resolution of claims upon termination of the
9contract with that 3rd-party administrator.
AB920,5,11 10(4) Employer requirements. (a) An employer group qualified under sub. (2)
11(b) shall require each of its participating employers to do all of the following:
AB920,5,1412 1. Offer a similar level of health care benefits to all of the employer's eligible
13employees and all of the eligible employee's dependents, as defined under sub. (3) (a)
143.
AB920,5,1915 2. Participate for at least the minimum participation period specified by the
16employer group under sub. (3) (a) 6. An employer group may require employers that
17desire to participate in the employer group to pay an amount that is forfeited to the
18employer group if the employer's participation terminates voluntarily or
19involuntarily before the employer's minimum participation period ends.
AB920,5,2320 (b) Subject to any policy created by the employer group regarding late
21payments, an employer group qualified under sub. (2) (b) shall terminate an
22employer's participation in the employer group if the employer fails to pay a
23contribution required by the employer group under sub. (3) (a) 5.
AB920,6,3
1(c) An employer group qualified under sub. (2) (b) shall hold an employer whose
2participation in the employer group terminates voluntarily or involuntarily
3responsible for all of the following:
AB920,6,54 1. Any contribution amounts required during the employer's period of
5participation.
AB920,6,86 2. The employer's proportionate share of the cost of any claims payable by the
7employer group that were incurred before the termination of the employer's
8participation.
AB920,6,12 9(5) Covered benefits; payment of claims. (a) An employer group may provide
10a choice of health care benefit plans but shall offer a similar level of health care
11benefits to all employees and dependents of each employer that participates in the
12employer group.
AB920,6,2013 (b) An employer group qualified under sub. (2) (b) shall pay no more than
14$50,000 in benefits on a self-funded basis incurred in a calendar year for each
15individual covered under its employee health care benefit arrangement, unless the
16employer group is financially capable of paying more than $50,000 in benefits per
17individual per calendar year as confirmed by an independent actuary. Each
18employer group shall obtain excess or stop-loss coverage through an insurer
19authorized to do business in this state in an amount that is sufficient to pay claims
20that exceed the amount that the employer group will pay on a self-funded basis.
AB920,6,2421 (c) If an employer group qualified under sub. (2) (b) ceases operating its
22employee health care benefit arrangement, the employer group is responsible for
23paying eligible claims incurred during the time in which the employee health benefit
24arrangement was operating.
AB920,7,6
1(6) Exemption from insurance regulation. Notwithstanding 29 USC 1144 (b)
2(6) (A), chs. 600 to 646 and any rules promulgated under chs. 600 to 646 do not apply
3to an employer group or an employee health care benefit arrangement under this
4section. An employer group may not be considered an insurer, and an employee
5health care benefit arrangement may not be considered an insurance contract, for
6any purpose under the statutes.
AB920,2 7Section 2. 600.01 (1) (b) 13. of the statutes is created to read:
AB920,7,98 600.01 (1) (b) 13. Any employer group or employee health care benefit
9arrangement under s. 146.79.
AB920,3 10Section 3. 601.415 (14) of the statutes is created to read:
AB920,7,1211 601.415 (14) Qualification of employer groups. The commissioner shall
12qualify employer groups as specified under s. 146.79 (2) (b).
AB920,7,1313 (End)
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