185.96 History
History: 1985 a. 30 s.
42.
185.97
185.97
Title. This chapter may be cited as the "Wisconsin Cooperative Association Act".
185.97 History
History: 1985 a. 30 s.
42.
185.981
185.981
Cooperative sickness care. 185.981(1)
(1) Cooperative associations may be organized under this chapter without capital stock, exclusively to establish and operate in the state or in any county or counties therein a nonprofit plan or plans for sickness care, including hospital care, for their members and their dependents through contracts with physicians, medical societies, chiropractors, optometrists, dentists, dental societies, hospitals and others.
185.981(2)
(2) Such associations shall operate only on a cooperative nonprofit basis and for the purpose of establishing, maintaining and operating a voluntary nonprofit health, dental or vision care plan or plans or for constructing, operating and maintaining nonprofit hospitals or other facilities whereby sickness care, including hospital, dental or vision care, is provided at the expense of such association, its members or both, to such persons or groups of persons as shall become subscribers to such plan, under contracts which will entitle each such subscriber to definite medical, surgical, chiropractic, vision, dental or hospital care, appliances and supplies, by physicians and surgeons licensed and registered under
ch. 448, optometrists licensed under
ch. 449, chiropractors licensed under
ch. 446 and dentists licensed under
ch. 447 in their offices, in hospitals, in other facilities and in the home.
185.981(3)
(3) No cooperative association organized for the purposes provided in
ss. 185.981 to
185.983 shall be prevented from contracting with any hospital in this state for the rendition of such hospital care as is included within such a plan because such hospital participates in any other such plan, or in a plan organized and operated under
ss. 148.03 and
613.80. No hospital may discriminate against any physician and surgeon, chiropractor or dentist with respect to the use of such hospital's facilities by reason of his or her participation in a sickness care plan of a cooperative.
185.981(4)
(4) No contract by or on behalf of any such cooperative association shall provide for the payment of any cash, indemnity or other material benefit by that association to the subscriber or the subscriber's estate on account of death, illness or injury, nor be in any way related to the payment of any such benefit by any other agency, but any such association may stipulate in its plan that it will pay any nonparticipating physician and surgeon, optometrist, chiropractor, dentist or hospital outside of its normal territory for sickness or hospital care rendered any covered member or a member's covered dependent who is in need of the benefits of such plan when he or she is outside of the territory of such association in which the benefits of such plan are normally available. Any such plan may prescribe monetary limitations with respect to such extraterritorial benefits.
185.981(4t)
(4t) A sickness care plan operated by a cooperative association is subject to
ss. 252.14,
631.17,
631.89,
631.95,
632.72 (2),
632.745 to
632.749,
632.85,
632.853,
632.855,
632.87 (2m),
(3),
(4) and
(5),
632.895 (10) to
(14) and
632.897 (10) and
chs. 149 and
155.
185.981(5)
(5) Every such cooperative association is a charitable and benevolent corporation.
185.981(6)
(6) Every cooperative sickness care association organized under this section shall provide coverage for newborn infants as required under
s. 632.895 (5).
185.981(7)
(7) Notwithstanding
sub. (4) and
s. 185.982 (1), a sickness care plan that is operated by a cooperative association and that qualifies as a health maintenance organization, as defined in
s. 609.01 (2), is subject to
s. 609.655.
185.981(8)
(8) A sickness care plan operated by a cooperative association is subject to
s. 632.895 (8). Coverage of mammograms under
s. 632.895 (8) may be subject to any requirements that the sickness care plan imposes under
s. 609.05 (2) and
(3) on the coverage of other health care services obtained by members and their dependents.
185.981(9)
(9) Every cooperative sickness care association organized under this section that provides coverage for dependent children of members shall provide coverage for adopted children and children placed for adoption, as required under
s. 632.896. Coverage of health care services obtained by adopted children and children placed for adoption may be subject to any requirements that the sickness care plan imposes under
s. 609.05 (2) and
(3) on the coverage of health care services obtained by other members and their dependents.
185.981 History
History: 1971 c. 40 s.
93;
1971 c. 307 s.
118;
1975 c. 98;
1975 c. 223 s.
28;
1975 c. 224 s.
146;
1975 c. 421;
1981 c. 39 s.
22;
1981 c. 205;
1981 c. 391 s.
210;
1985 a. 29;
1985 a. 30 s.
42;
1987 a. 27 ss.
1917e,
3202 (47) (a);
1987 a. 312 s.
17;
1989 a. 121,
129,
200,
201,
336;
1991 a. 39,
123,
269;
1993 a. 27,
450,
481;
1995 a. 27,
118,
289;
1997 a. 27,
155,
237;
1999 a. 95,
115;
2003 a. 321.
185.982
185.982
Manner of practicing medicine, chiropractic and dentistry; payment; promotional expense. 185.982(1)
(1) No sickness care plan or contract issued thereunder by such cooperative association shall interfere with the manner or mode of the practice of medicine, optometry, chiropractic or dentistry, the relationship of physician, chiropractor, optometrist or dentist and patient, nor the responsibility of physician, chiropractor, optometrist or dentist to patient. A plan may require persons covered to utilize health care providers designated by the cooperative association. The cooperative association may provide health care services directly through providers who are employees of the cooperative association or through agreements with individual providers or groups of providers organized on a group practice or individual practice basis. In making such agreements, no plan may refuse to provide coverage for vision care services or procedures provided by an optometrist licensed under
ch. 449 within the scope of the practice of optometry, as defined in
s. 449.01 (1), if the plan provides coverage for the same services or procedures when provided by another health care provider.
185.982(2)
(2) Any cooperative association operating a voluntary sickness care plan under the provisions of this chapter may pay physicians and surgeons, optometrists, chiropractors or dentists on a salary, per person or fee-for-service basis to provide sickness care to members of such association. Every association shall contract only with its own members for the benefits of any plan which it operates, but any association which operates a hospital may make the facilities thereof available to nonmembers and to nonparticipating physicians, optometrists or dentists.
185.982(3)
(3) Promotional expenses of any such associations, including promotional expense for building or investment purposes, shall be limited to 5 per cent as provided in
s. 185.09.
185.982 History
History: 1981 c. 205;
1987 a. 27.
185.983
185.983
Requirements of plan. 185.983(1)
(1) Every such voluntary nonprofit sickness care plan shall be exempt from
chs. 600 to
646, with the exception of
ss. 601.04,
601.13,
601.31,
601.41,
601.42,
601.43,
601.44,
601.45,
611.67,
619.04,
628.34 (10),
631.17,
631.89,
631.93,
631.95,
632.72 (2),
632.745 to
632.749,
632.775,
632.79,
632.795,
632.85,
632.853,
632.855,
632.87 (2m),
(3),
(4) and
(5),
632.895 (5) and
(9) to
(14),
632.896 and
632.897 (10) and
chs. 609,
630,
635,
645 and
646, but the sponsoring association shall:
185.983(1)(a)
(a) File with the commissioner of insurance a declaration defining the organization and operation of the plan, all printed literature and specimen copies of all proposed contracts with persons covered and with participating physicians and hospitals, including all amendments thereto. The form of all such contracts and amendments shall be subject to approval by the commissioner of insurance but the commissioner may not withhold approval if the form of such contracts or changes therein comply with the provisions of
ss. 185.981 to
185.985.
185.983(1)(b)
(b) Provide for like rates, benefits, terms and conditions for all persons in the same class.
185.983(1)(c)
(c) Invest its funds only in property and securities approved for domestic life insurance companies.
185.983(1)(d)
(d) File with the commissioner of insurance, on such forms as may be prescribed by the commissioner, an annual report of its financial condition as of December 31 each year, on or before the last day of February following.
185.983(1)(e)
(e) Maintain sufficient reserves to discharge its obligations, having regard for the nature of its contracts and the area and number of persons covered.
185.983(1g)
(1g) A cooperative association that is a small employer insurer, as defined in
s. 635.02 (8), is subject to the health insurance mandates, as defined in
s. 601.423 (1), to the same extent as any other small employer insurer, as defined in
s. 635.02 (8).
185.983(1m)
(1m) In addition to
ss. 601.04,
601.31,
632.79 and
632.895 (5), the commissioner of insurance may by rule subject a medicare supplement policy as defined in
s. 600.03 (28r), a medicare replacement policy as defined in
s. 600.03 (28p) or a long-term care insurance policy as defined in
s. 600.03 (28g) sold by a voluntary nonprofit sickness care plan to other provisions of
chs. 600 to
646, except the commissioner may not subject a medicare supplement policy, a medicare replacement policy or a long-term care insurance policy to
s. 632.895 (8).
185.983(2)
(2) Every such plan shall make provision for a minimum of one physician and surgeon, or dentist to each 2,000 persons covered for medical or dental care and a minimum of 6 hospital beds for each 2,000 persons covered for hospital care.
185.983(3)(a)(a) A plan that provides coverage of pharmaceutical services when performed by one or more pharmacists who are designated by the cooperative association but who are not full-time salaried employees of the cooperative association shall provide an annual period of at least 30 days during which any pharmacist registered under
ch. 450 may elect to participate in the plan under its terms as a designated health care provider for at least one year.
185.983(3)(b)
(b) Except as provided in
par. (c),
par. (a) applies to plans on and after May 10, 1984.
185.983(3)(c)
(c) If compliance with the requirements of
par. (a) during the period specified in
par. (b) would impair any provision of a contract between a cooperative association and any other person, and if the contract provision was in existence prior to May 10, 1984, then immediately after the expiration of all such contract provisions the plan operated by the cooperative association shall comply with the requirements of
par. (a).
185.983 History
History: 1975 c. 98;
1975 c. 224 s.
146;
1975 c. 352;
1975 c. 422 s.
163;
1977 c. 339;
1979 c. 89;
1981 c. 20;
1981 c. 39 s.
22;
1981 c. 82;
1981 c. 391 s.
210;
1983 a. 189 s.
329 (25);
1983 a. 396;
1985 a. 29 ss.
2060d to
2060r,
3202 (30);
1987 a. 27,
325;
1989 a. 23,
31,
129,
200,
201,
336,
359;
1991 a. 39,
189,
250,
269,
315;
1993 a. 450,
481,
482;
1995 a. 289;
1997 a. 27,
155,
237;
1999 a. 95,
115;
2003 a. 321.
185.985
185.985
Inconsistent provisions of the statutes. Sickness care or hospital plans operated by cooperative associations organized under this chapter shall be operated exclusively under the provisions of
ss. 185.981 to
185.985. Other provisions of the statutes inconsistent with any of such provisions shall not be applicable to cooperative associations or sickness care plans operated by cooperative associations pursuant to this chapter.
185.985 History
History: 1985 a. 30 s.
42.
185.99
185.99
Health benefit purchasing cooperatives. 185.99(1)(a)
(a) "Commissioner" means the commissioner of insurance.
185.99(1)(c)
(c) "Person" means any corporation, limited liability company, partnership, cooperative, association, trade or labor organization, city, village, town, county, or self-employed individual.
185.99(2)(a)(a) Notwithstanding
s. 185.02, one health benefit purchasing cooperative may be organized under this chapter before January 1, 2008, in each of the 5 geographic areas designated under
sub. (6). Notwithstanding
s. 185.043, each health benefit purchasing cooperative may be formed by one or more persons.
185.99(2)(b)
(b) The purpose of a health benefit purchasing cooperative is to provide health care benefits for the individuals specified in
sub. (4) (a) 1. to
3., through a contract with an insurer authorized to do business in this state in one or more lines of insurance that includes health insurance.
185.99(2)(c)
(c) A health benefit purchasing cooperative shall be designed so that all of the following are accomplished:
185.99(2)(c)1.
1. The members become better informed about health care trends and cost increases.
185.99(2)(c)2.
2. All members purchase their health care benefits from the same insurer.
185.99(2)(c)3.
3. The members are actively engaged in designing health care benefit options that are offered by the insurer and that meet the needs of their community.
185.99(2)(c)4.
4. The health insurance risk of all of the members is pooled.
185.99(2)(c)5.
5. The members actively participate in health improvement decisions for their community.
185.99(2m)
(2m) Temporary board of directors. Notwithstanding
s. 185.05 (1) (m), the articles of a health benefit purchasing cooperative shall set forth the name and address of at least one incorporator who will act as the temporary board.
185.99(3)(a)(a) Notwithstanding
s. 185.11 (1), each health benefit purchasing cooperative shall be organized on a membership basis with no capital stock.
185.99(3)(b)
(b) Subject to
par. (c), any person that does business in, is located in, has a principal office in, or resides in the geographic area in which a health benefit purchasing cooperative is organized, that meets the membership criteria established by the health benefit purchasing cooperative in its bylaws, and that pays the membership fee may be a member of the health benefit purchasing cooperative.
185.99(3)(c)
(c) A health benefit cooperative may limit membership of self-employed individuals through its membership criteria, but such criteria must be applied in the same manner to all self-employed individuals.
185.99(3)(d)
(d) Each health benefit purchasing cooperative shall file its membership criteria, as well as any amendments to the criteria, with the commissioner.
185.99(4)(a)(a) The health care benefits offered by a health benefit purchasing cooperative shall be negotiated between the health benefit purchasing cooperative and the insurer. The insurer must offer coverage to all of the following:
185.99(4)(a)1.
1. An individual who is a member, officer, or eligible employee of a member of the health benefit purchasing cooperative.
185.99(4)(a)2.
2. A self-employed individual who is a member of the health benefit purchasing cooperative.
185.99(4)(a)3.
3. A dependent of an individual under
subd. 1. or
2. who receives coverage.
185.99(4)(b)
(b) The contract between the members of a health benefit purchasing cooperative and an insurer shall be for a term of 3 years. Upon enrollment in the insurer's health benefit plan, each member shall pay to the health benefit purchasing cooperative an amount determined by the health benefit purchasing cooperative that is not less than the member's applicable premium for the 36th month of coverage under the contract. If a member withdraws from the health benefit purchasing cooperative before the end of the contract term, the health benefit purchasing cooperative may retain, as a penalty, an amount specified by the health benefit purchasing cooperative that is not less than the premium that the member paid for the 36th month of coverage.
185.99(5)
(5) Additional required reports. Each health benefit purchasing cooperative shall submit to the legislature under
s. 13.172 (2) and to the commissioner all of the following:
185.99(5)(a)
(a) Annually, no later than September 30, a report on the progress of the health benefit purchasing arrangement described in this section and, to the extent possible, any significant findings in the criteria under
par. (b) 1. to
3.
185.99(5)(b)
(b) Within one year after the end of the term of the contract under
sub. (4) (b), a final report that details significant findings from the project and that includes, at a minimum, to the extent available, information on all of the following:
185.99(5)(b)1.
1. The extent to which the health benefit purchasing arrangement had an impact on the number of uninsured in the geographic area in which it operated.
185.99(5)(b)2.
2. The effect on health care coverage premiums for groups in the geographic area in which the health benefit purchasing arrangement operated, including groups other than the health benefit purchasing cooperative.
185.99(5)(b)3.
3. The degree to which health care consumers were involved in the development and implementation of the health benefit purchasing arrangement.
185.99(6)
(6) Designation of geographic areas. After consultation with the Wisconsin Federation of Cooperatives, the commissioner shall designate, by order, the 5 geographic areas of the state in which health benefit purchasing cooperatives may be organized. A geographic area may overlap with one or more other geographic areas.
185.99 History
History: 2003 a. 101.
