Amendment ASA1-AB16

AB16-ASA1,4,13 3. "Physician" has the meaning given in s. 448.01 (5).

AB16-ASA1,4,15 4. "Self-insured health plan" means a self-insured health plan of the state or a county, city, village, town, or school district.

AB16-ASA1,4,17 5. "Treatment" means services, diagnoses, procedures, surgery, and therapy provided by a health care professional.

AB16-ASA1,4,20 (b) 1. Subject to par. (c) and except as provided in par. (d), every disability insurance policy and every self-insured health plan shall provide the following coverages:

AB16-ASA1,5,2 a. Coverage of the cost of hearing aids and cochlear implants that are prescribed by a physician, or by an audiologist licensed under subch. II of ch. 459, in accordance with accepted professional medical or audiological standards, for a child covered under the policy or plan who is under 18 years of age and who is certified as deaf or hearing impaired by a physician or by an audiologist licensed under subch. II of ch. 459.

AB16-ASA1,5,5 b. Coverage of the cost of treatment related to hearing aids and cochlear implants, including procedures for the implantation of cochlear devices, for a child specified in subd. 1. a.

AB16-ASA1,5,7 2. Coverage of the cost of hearing aids under this subsection is not required to exceed the cost of one hearing aid per ear per child more often than once every 3 years.

AB16-ASA1,5,11 3. The coverage required under this subsection may be subject to any cost-sharing provisions, limitations, or exclusions, other than a preexisting condition exclusion, that apply generally under the disability insurance policy or self-insured health plan.

AB16-ASA1,5,15 (c) 1. Notwithstanding par. (b) 3. and subject to subd. 2., an individual disability insurance policy may impose a preexisting condition exclusion that does not exceed one year with respect to the coverage required under this subsection for cochlear implants and related treatment.

AB16-ASA1,5,21 2. An individual disability insurance policy that imposes a preexisting condition exclusion as authorized under subd. 1. shall nevertheless cover the cost of cochlear implants and related treatment for a child during the preexisting condition exclusion period if time is of the essence for the child to receive cochlear implants and related treatment as a result of the occurrence during that period of any of the following conditions:

AB16-ASA1,5,22 a. Vestibular aqueduct syndrome.

AB16-ASA1,5,23 b. Viral infection.

AB16-ASA1,5,24 c. Ototoxicity.

AB16-ASA1,5,25 d. Autoimmune inner ear disease.

AB16-ASA1,6,2 e. Any other condition with respect to which a failure to intervene would likely negatively impact the child's outcome.

AB16-ASA1,6,3 (d) This subsection does not apply to any of the following:

AB16-ASA1,6,4 1. A disability insurance policy that covers only certain specified diseases.

AB16-ASA1,6,7 2. A health care plan offered by a limited service health organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b).

AB16-ASA1,6,8 3. A long-term care insurance policy.

AB16-ASA1,6,9 4. A medicare replacement policy or a medicare supplement policy.

AB16-ASA1, s. 10 Section 10. Initial applicability.

AB16-ASA1,6,11 (1) This act first applies to all of the following:

AB16-ASA1,6,14 (a) Except as provided in paragraphs (b) and (c ), disability insurance policies that are issued or renewed, and governmental self-insured health plans that are established, extended, modified, or renewed, on the effective date of this paragraph.

AB16-ASA1,6,17 (b) Disability insurance policies covering employees who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are issued or renewed on the earlier of the following:

AB16-ASA1,6,18 1. The day on which the collective bargaining agreement expires.

AB16-ASA1,6,20 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

AB16-ASA1,6,24 (c) Governmental self-insured health plans covering employees who are affected by a collective bargaining agreement containing provisions inconsistent with this act that are established, extended, modified, or renewed on the earlier of the following:

AB16-ASA1,6,25 1. The day on which the collective bargaining agreement expires.

AB16-ASA1,7,2 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

AB16-ASA1, s. 11 Section 11. Effective date.

AB16-ASA1,7,5 (1) This act takes effect on the first day of the 7th month beginning after publication.

AB16-ASA1,7,6 (End)