40.95(2)
(2) The department is not required to administer any program that provides health insurance premium credits for the purchase of health insurance for a retired employee, or the retired employee's surviving insured dependents; for an eligible employee under
s. 40.02 (25) (b) 6e., or the eligible employee's surviving insured dependents; for an employee who is laid off, but who is not on a temporary, school year, seasonal, or sessional layoff, and his or her surviving insured dependents; and for the surviving insured dependents of an employee who dies while employed by the state, if the department determines that the program does not conform to the program approved by the joint committee on employment relations under
s. 230.12 (9).
40.95 History
History: 1995 a. 88,
89,
216;
2003 a. 33,
117,
326.
PRIVATE EMPLOYER HEALTH
CARE COVERAGE
Effective date note
NOTE: This subchapter is repealed eff. 1-1-10 by
1999 Wis. Act 9.
40.98
40.98
Health care coverage. 40.98(1)(ag)
(ag) "Abortion" means the use of an instrument, medicine, drug or other substance or device with intent to terminate the pregnancy of a woman known to be pregnant or for whom there is reason to believe that she may be pregnant and with intent other than to increase the probability of a live birth, to preserve the life or health of the infant after live birth or to remove a dead fetus.
40.98(1)(ar)
(ar) "Board" means the private employer health care coverage board.
40.98(1)(b)
(b) "Dependent" means a spouse, an unmarried child under the age of 19 years, an unmarried child who is a full-time student under the age of 21 years and who is financially dependent upon the parent, or an unmarried child of any age who is medically certified as disabled and who is dependent upon the parent.
40.98(1)(c)
(c) "Employee" means any person who receives earnings as payment for personal services rendered for the benefit of any employer including officers of the employer. An employee is considered to have separated from the service of an employer at the end of the day on which the employee last performed services for the employer, or, if later, the day on which the employee-employer relationship is terminated because of the expiration or termination of leave without pay, sick leave, vacation or other leave of absence. A person shall not be considered an employee if any of the following applies:
40.98(1)(c)1.
1. The person is employed under a contract involving the furnishing of more than personal services.
40.98(1)(c)2.
2. The person is customarily engaged in an independently established trade, business or profession providing the same type of services to more than one employer and the person's services to an employer are not compensated for on a payroll of that employer.
40.98(1)(c)3.
3. The person is a patient or inmate of a hospital, home or institution and performs services in the hospital, home or institution.
40.98(1)(d)
(d) "Employer" means any person doing business or operating an organization in this state and employing at least 2 eligible employees, except that for a person operating a farm business the person must employ at least one eligible employee. "Employer" does not include an employer as defined in
s. 40.02 (28).
40.98(1)(e)
(e) "Health care coverage program" means the health care coverage program established under
sub. (2) (a).
40.98(1)(g)
(g) "Nontherapeutic abortion" means an abortion that is not directly and medically necessary to prevent the death of the woman.
40.98(2)(a)1.1. The department shall design an actuarially sound health care coverage program for employers that includes more than one group health care coverage plan and that provides coverage beginning not later than January 1, 2001. The health care coverage program shall be known as the "Private Employer Health Care Purchasing Alliance". In designing the health care coverage program, the department shall consult with the office of the commissioner of insurance and may consult with the departments of commerce and health and family services. The health care coverage program may not be implemented until it is approved by the board.
40.98(2)(a)2.
2. The department shall solicit and accept bids and make every reasonable effort to enter into a contract for the administration of the health care coverage plans under the program, based on criteria established by the board. If the department has not entered into a contract for the administration of the health care coverage plans under the program for coverage to begin before January 1, 2001, the department shall submit a report to the cochairpersons of the joint committee on finance specifying the department's reasons for not entering into a contract. After submitting the report to the cochairpersons of the joint committee on finance, the department shall provide all administrative services necessary for the provision of the health care coverage plans under the program. During the period that the department is providing the administrative services, the department shall continue to make every reasonable effort to contract for the administration of the health care coverage plans under the program.
40.98(2)(a)3.
3. The department shall enter into contracts with insurers who are to provide health care coverage under the health care coverage program.
40.98(2)(a)4.
4. The department or the administrator selected under
subd. 2. shall solicit and accept bids and shall enter into a contract for marketing the health care coverage program.
40.98(2)(a)5.
5. The department or the administrator selected under
subd. 2. shall maintain a toll-free telephone number to provide information on the health care coverage program.
40.98(2)(b)
(b) Every health care coverage plan under the health care coverage program is subject to the provisions of
chs. 600 to
646 that apply to group health benefit plans, as defined in
s. 632.745 (9), to the same extent as any other group health benefit plan, as defined in
s. 632.745 (9).
40.98(2)(bm)
(bm) No health care coverage plan under the health care coverage program may provide coverage of a nontherapeutic abortion except by an optional rider or supplemental coverage provision that is offered and provided on an individual basis and for which an additional, separate premium or charge is paid by the individual to be covered under the rider or supplemental coverage provision. Only funds attributable to premiums or charges paid for coverage under the rider or supplemental coverage provision may be used for the payment of any claim, and related administrative expenses, that relates to a nontherapeutic abortion. Such funds may not be used for the payment of any claim or administrative expenses that relate to any other type of coverage provided by the insurer under the health care coverage plan. Nothing in this paragraph requires an insurer or an employer to offer or provide coverage of an abortion under a health care coverage plan under the health care coverage program.
40.98(2)(c)
(c) The health care coverage program established under
par. (a), or any health care coverage plan included in the program, may not be combined with any health care coverage plan under
subch. IV.
40.98(2)(d)
(d) All insurance rates for health care coverage under the program shall be made available to employers and employees in a manner determined by the board. Rates that apply to coverage for small employers, as defined in
s. 635.02 (7), shall be published at least annually, as required in
s. 635.12. The rates may be listed by county or by any other regional factor that the board considers appropriate. Annually, the board shall submit a report to the appropriate standing committees under
s. 13.172 (3) specifying the average insurance rate for health care coverage under the program by county or by any other regional factor the board considers appropriate.
40.98(2)(e)
(e) All plans under the health care coverage program shall have an enrollment period that is established by the board.
40.98(2)(f)1.1. If the department has selected an administrator under
par. (a) 2., the administrator shall charge employers who participate in the health care coverage program a fee to cover the cost of administrative services for the health care coverage program. The administrator shall reimburse the department for the expenses incurred by the department in designing, marketing and contracting for administrative services for the program. All moneys received by the department under this subdivision shall be credited to the appropriation account under
s. 20.515 (2) (g).
40.98(2)(f)2.
2. If the department has not selected an administrator under
par. (a) 2., the department shall charge employers who participate in the health care coverage program a fee to cover the costs incurred by the department in designing, marketing and providing administrative services for the health care coverage program. All moneys received by the department under this subdivision shall be credited to the appropriation account under
s. 20.515 (2) (g).
40.98(2)(g)
(g) The department may not sell any health care coverage under the health care coverage program to an employer or enroll any employee in the health care coverage program, but the department shall make information about the program available to employers on a statewide basis.
40.98(2)(h)
(h) The department may seek funding from any person for the payment of costs of designing, marketing, and contracting for or providing administrative services under the health care coverage program. Any moneys received by the department under this paragraph shall be credited to the appropriation account under
s. 20.515 (2) (g).
40.98(3)
(3) Any employer who participates in the health care coverage program shall do all of the following:
40.98(3)(a)
(a) Offer health care coverage under one or more plans to all of its eligible employees and, if permitted by any plan offered by an insurer under the health care coverage program, may offer health care coverage under such a plan to any of its other employees.
40.98(3)(b)
(b) Provide health care coverage under one or more plans to at least 50% of its eligible employees who do not otherwise receive health care coverage as a dependent under any other plan that is not offered by the employer or a percentage of such employees specified by the board, whichever percentage is greater.
40.98(3)(c)
(c) Pay for each eligible employee at least 50% of the lowest premium rate for single coverage that is available to the employer for that employee's coverage under the health care coverage program.
40.98(3)(d)
(d) Make premium payments for the health care coverage of its employees in the manner specified by the board.
40.98(4)
(4) Any employer that provides health care coverage for its employees under the program and that voluntarily terminates coverage under the program is not eligible to participate in the program for at least 3 years from the date that coverage is terminated.
40.98(5)(am)(am) Any insurer that offers a health care coverage plan under the health care coverage program shall provide coverage under the plan to any employer that applies for coverage, and to all of the employer's employees who elect coverage under the health care coverage plan, without regard to the health condition or claims experience of any individual who would be covered under the health care coverage plan if all of the following apply:
40.98(5)(am)1.
1. The employer agrees to pay the premium required for coverage under the health care coverage plan.
40.98(5)(am)2.
2. The employer agrees to comply with all provisions of the health care coverage plan that apply generally to a policyholder or an insured without regard to health condition or claims experience.
40.98(5)(bm)
(bm) Notwithstanding
par. (am), the department, in consultation with the board, may limit the requirement under
par. (am) to compliance with
s. 635.19.
40.98(6)(a)(a) Health care coverage under the health care coverage program may only be sold by insurance agents licensed under
ch. 628.
40.98(6)(b)
(b) An insurance agent may not sell any health care coverage under the health care coverage program on behalf of an insurer unless he or she is listed by the insurer under
s. 628.11.
40.98(6)(c)
(c) The board shall set, and may adjust as often as semiannually, the commission rate for the sale of a policy under the health care coverage program. The rate shall be based on the average commission rate that insurance agents are paid in the state for the sale of comparable health insurance policies at the time that the rate is set or adjusted.
40.98(6)(d)
(d) The board may establish training requirements that an insurance agent must satisfy, in addition to any requirements under
s. 628.04 (3), to sell health care coverage under the health care coverage program.
40.98(7)(a)(a) Annually, on or before December 31, the board shall submit a report to the appropriate standing committees under
s. 13.172 (3) and to the governor on the operation of the health care coverage program. The report shall specify the number of employers and employees participating in the health care coverage program, calculate the costs of the health care coverage program to employers and their employees and include recommendations for improving the health care coverage program.
40.98(7)(b)
(b) No later than January 1, 2008, the board shall submit a report to the appropriate standing committees under
s. 13.172 (3) and to the governor that offers recommendations as to whether the department should continue to be involved in the design, marketing and contracting for administrative services for the health care coverage program. If the board recommends that the department not be involved in the performance of these functions, the board shall submit proposed legislation eliminating the department's involvement in the performance of these functions to the appropriate standing committees under
s. 13.172 (3) at the time that the board submits its report.
Effective date note
NOTE: This section is repealed eff. 1-1-10 by
1999 Wis. Act 9.
