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 of insurance with persons covered and with participating physicians, hospitals, and other providers, 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 the contracts or changes in the contracts 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), that is sold by a cooperative health care association organized under
s. 185.981 to other provisions of
chs. 600 to
646, except that 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 voluntary nonprofit health care plan operated by a cooperative association organized under
s. 185.981 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;
2005 a. 194;
2007 a. 36;
2009 a. 14,
28,
146,
165,
218,
346;
2011 a. 260;
2013 a. 186.
185.985
185.985
Inconsistent provisions of the statutes. Health 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 that are inconsistent with any of those provisions shall not be applicable to cooperative associations or health care plans operated by cooperative associations under this chapter.
185.985 History
History: 1985 a. 30 s.
42;
2009 a. 165.
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, health benefit purchasing cooperatives may be organized under this chapter in each of the geographic areas designated under
sub. (6). Notwithstanding
s. 185.043, a 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., under a single group health care policy or plan through a contract between the health benefit purchasing cooperative and 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 receive their health care benefits under the group health care policy or plan negotiated under
sub. (4) (a).
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 and shall be offered in a single group health care policy or plan. The insurer must offer coverage under the group health care policy or plan 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 health benefit purchasing cooperative and an insurer shall be for a term of 3 years. Upon enrollment in the insurer's group health care policy or 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(4)(c)
(c) An insurer that contracts under this section with a health benefit purchasing cooperative that provides health care benefits for more than 50 individuals who are members or employees of one or more members is not a small employer insurer, as defined in
s. 635.02 (8), with respect to the contract between the insurer and the health benefit purchasing cooperative.
185.99(5)
(5) 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 Cooperative Network, the commissioner shall designate, by order, the 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.
