AB512, s. 14 13Section 14. 609.71 of the statutes is created to read:
AB512,7,15 14609.71 Coverage of alcoholism and other diseases. Defined network
15plans are subject to s. 632.89.
AB512, s. 15 16Section 15. 632.89 (title) of the statutes is amended to read:
AB512,7,18 17632.89 (title) Required coverage of Coverage of mental disorders,
18alcoholism, and other diseases.
AB512, s. 16 19Section 16. 632.89 (1) (b) of the statutes is repealed and recreated to read:
AB512,7,2020 632.89 (1) (b) "Health benefit plan" has the meaning given in s. 632.745 (11).
AB512, s. 17 21Section 17. 632.89 (1) (em) of the statutes is repealed and recreated to read:.
AB512,7,2322 632.89 (1) (em) "Self-insured health plan" has the meaning given in s. 632.745
23(24).
AB512, s. 18 24Section 18. 632.89 (2) (title) of the statutes is amended to read:
AB512,7,2525 632.89 (2) (title) Required coverage for group plans.
AB512, s. 19
1Section 19. 632.89 (2) (a) 1. of the statutes is renumbered 632.89 (2) (a) and
2amended to read:
AB512,8,73 632.89 (2) (a) Conditions covered. A group or blanket disability insurance
4policy issued by an insurer
health benefit plan and a self-insured health plan shall
5provide coverage of nervous and mental disorders and alcoholism and other drug
6abuse problems if required by pars. (c) to (dm) and as provided in pars. (b) (c) to (e)
7(dm) and subs. (2p) and (3).
AB512, s. 20 8Section 20. 632.89 (2) (a) 2. of the statutes is repealed.
AB512, s. 21 9Section 21. 632.89 (2) (b) of the statutes is repealed.
AB512, s. 22 10Section 22. 632.89 (2) (c) 1. of the statutes is renumbered 632.89 (2) (c) and
11amended to read:
AB512,8,1612 632.89 (2) (c) Minimum coverage Coverage of inpatient hospital services. If a
13group or blanket disability insurance policy issued by an insurer health benefit plan
14or a self-insured health plan
provides coverage of any inpatient hospital treatment,
15the policy plan shall provide coverage for inpatient hospital services for the
16treatment of conditions under par. (a) 1. as provided in subd. 2.
AB512, s. 23 17Section 23. 632.89 (2) (c) 2. of the statutes is repealed.
AB512, s. 24 18Section 24. 632.89 (2) (d) 1. of the statutes is renumbered 632.89 (2) (d) and
19amended to read:
AB512,8,2420 632.89 (2) (d) Minimum coverage Coverage of outpatient services. If a group or
21blanket disability insurance policy issued by an insurer
health benefit plan or a
22self-insured health plan
provides coverage of any outpatient treatment, the policy
23plan shall provide coverage for outpatient services for the treatment of conditions
24under par. (a) 1. as provided in subd. 2.
AB512, s. 25 25Section 25. 632.89 (2) (d) 2. of the statutes is repealed.
AB512, s. 26
1Section 26. 632.89 (2) (dm) 1. of the statutes is renumbered 632.89 (2) (dm)
2and amended to read:
AB512,9,83 632.89 (2) (dm) Minimum coverage Coverage of transitional treatment
4arrangements.
If a group or blanket disability insurance policy issued by an insurer
5health benefit plan or a self-insured health plan provides coverage of any inpatient
6hospital treatment or any outpatient treatment, the policy plan shall provide
7coverage for transitional treatment arrangements for the treatment of conditions
8under par. (a) 1. as provided in subd. 2.
AB512, s. 27 9Section 27. 632.89 (2) (dm) 2. of the statutes is repealed.
AB512, s. 28 10Section 28. 632.89 (2) (e) of the statutes is renumbered 632.89 (5) (b) and
11amended to read:
AB512,9,1512 632.89 (5) (b) Exclusion Certain health care plans. This subsection section does
13not apply to a health care plan offered by a limited service health organization, as
14defined in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4),
15that is not a defined network plan, as defined in s. 609.01 (1b)
.
AB512, s. 29 16Section 29. 632.89 (2m) of the statutes is renumbered 632.89 (4m).
AB512, s. 30 17Section 30. 632.89 (2p) of the statutes is created to read:
AB512,9,2218 632.89 (2p) Additional required coverage of screenings. If a group health
19benefit plan, individual health benefit plan, or self-insured health plan that
20provides coverage for the treatment of nervous and mental disorders and alcoholism
21and other drug abuse problems would provide coverage of at least one annual
22physical examination, the plan shall provide coverage of all of the following:
AB512,9,2523 (a) For an individual who has coverage under the plan, at least one annual
24screening for nervous and mental disorders and alcoholism and other drug abuse
25problems to determine the individual's need for treatment.
AB512,10,5
1(b) For a female individual who has coverage under the plan, with respect to
2any pregnancy at least one screening during the pregnancy for prepartum
3depression and at least one screening within 6 months after a live birth, stillbirth,
4or miscarriage for postpartum depression to determine the individual's need for
5treatment.
AB512, s. 31 6Section 31. 632.89 (3) of the statutes is created to read:
AB512,10,227 632.89 (3) Limitations. For a group health benefit plan and a self-insured
8health plan that provide coverage of the treatment of nervous and mental disorders
9and alcoholism and other drug abuse problems, and for an individual health benefit
10plan that provides coverage of the treatment of nervous and mental disorders or
11alcoholism and other drug abuse problems, the exclusions and limitations;
12deductibles; copayments; coinsurance; annual and lifetime payment limitations;
13out-of-pocket limits; out-of-network charges; day, visit, or appointment limits;
14limitations regarding referrals to nonphysician providers and treatment programs;
15and duration or frequency of coverage limits under the plan may be no more
16restrictive for coverage of the treatment of nervous and mental disorders or
17alcoholism and other drug abuse problems than the most common or frequent type
18of treatment limitations applied to substantially all other coverage under the plan.
19The plan shall include in any overall deductible amount or annual or lifetime limit
20or out-of-pocket limit for the plan, expenses incurred for the treatment of nervous
21and mental disorders or alcoholism and other drug abuse problems and for the
22screening required under sub. (2p).
AB512, s. 32 23Section 32. 632.89 (3m) of the statutes is repealed.
AB512, s. 33 24Section 33. 632.89 (3p) of the statutes is created to read:
AB512,11,16
1632.89 (3p) Availability of plan information. A group health benefit plan and
2a self-insured health plan that provide coverage of the treatment of nervous and
3mental disorders and alcoholism and other drug abuse problems, and an individual
4health benefit plan that provides coverage of the treatment of nervous and mental
5disorders or alcoholism and other drug abuse problems, shall, upon request, make
6available to any current or potential insured, participant, beneficiary, or contracting
7provider the criteria for determining medical necessity under the plan with respect
8to that coverage. If a group health benefit plan or a self-insured health plan that
9provides coverage of the treatment of nervous and mental disorders and alcoholism
10and other drug abuse problems denies any particular insured, participant, or
11beneficiary coverage for services for that treatment, or if an individual health benefit
12plan that provides coverage of the treatment of nervous and mental disorders or
13alcoholism and other drug abuse problems denies any particular insured coverage
14for services for that treatment, the plan shall, upon request, make the reason for the
15denial available to the insured, participant, or beneficiary, in addition to complying
16with s. 632.857, if applicable.
AB512, s. 34 17Section 34. 632.89 (5) (title) of the statutes is repealed and recreated to read:
AB512,11,1818 632.89 (5) (title) Exclusions.
AB512, s. 35 19Section 35. 632.89 (5) of the statutes is renumbered 632.89 (5) (a).
AB512, s. 36 20Section 36. 632.89 (5) (a) (title) of the statutes is created to read:
AB512,11,2121 632.89 (5) (a) (title) Medicare.
AB512, s. 37 22Section 37. 632.89 (6) of the statutes is repealed.
AB512, s. 38 23Section 38. 632.89 (7) of the statutes is repealed.
AB512, s. 39 24Section 39. Initial applicability.
AB512,11,2525 (1) This act first applies to all of the following:
AB512,12,3
1(a) Except as provided in paragraphs (b) and (c), health benefit plans that are
2issued or renewed, and self-insured governmental health plans that are established,
3extended, modified, or renewed, on the effective date of this paragraph.
AB512,12,64 (b) Health benefit plans covering employees who are affected by a collective
5bargaining agreement containing provisions inconsistent with this act that are
6issued or renewed on the earlier of the following:
AB512,12,7 71. The day on which the collective bargaining agreement expires.
AB512,12,9 82. The day on which the collective bargaining agreement is extended, modified,
9or renewed.
AB512,12,1310 (c) Self-insured governmental health plans covering employees who are
11affected by a collective bargaining agreement containing provisions inconsistent
12with this act that are established, extended, modified, or renewed on the earlier of
13the following:
AB512,12,14 141. The day on which the collective bargaining agreement expires.
AB512,12,16 152. The day on which the collective bargaining agreement is extended, modified,
16or renewed.
AB512, s. 40 17Section 40. Effective date.
AB512,12,1918 (1) This act takes effect on the first day of the 7th month beginning after
19publication.
AB512,12,2020 (End)
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