AB512: Bill Text

AB512, s. 14 Section 14. 609.71 of the statutes is created to read:

AB512,7,15 609.71 Coverage of alcoholism and other diseases. Defined network plans are subject to s. 632.89.

AB512, s. 15 Section 15. 632.89 (title) of the statutes is amended to read:

AB512,7,18 632.89 (title) Required coverage of Coverage of mental disorders, alcoholism, and other diseases.

AB512, s. 16 Section 16. 632.89 (1) (b) of the statutes is repealed and recreated to read:

AB512,7,20 632.89 (1) (b) "Health benefit plan" has the meaning given in s. 632.745 (11).

AB512, s. 17 Section 17. 632.89 (1) (em) of the statutes is repealed and recreated to read:.

AB512,7,23 632.89 (1) (em) "Self-insured health plan" has the meaning given in s. 632.745 (24).

AB512, s. 18 Section 18. 632.89 (2) (title) of the statutes is amended to read:

AB512,7,25 632.89 (2) (title) Required coverage for group plans.

AB512, s. 19 Section 19. 632.89 (2) (a) 1. of the statutes is renumbered 632.89 (2) (a) and amended to read:

AB512,8,7 632.89 (2) (a) Conditions covered. A group or blanket disability insurance policy issued by an insurer health benefit plan and a self-insured health plan shall provide coverage of nervous and mental disorders and alcoholism and other drug abuse problems if required by pars. (c) to (dm) and as provided in pars. (b) (c) to (e) (dm) and subs. (2p) and (3).

AB512, s. 20 Section 20. 632.89 (2) (a) 2. of the statutes is repealed.

AB512, s. 21 Section 21. 632.89 (2) (b) of the statutes is repealed.

AB512, s. 22 Section 22. 632.89 (2) (c) 1. of the statutes is renumbered 632.89 (2) (c) and amended to read:

AB512,8,16 632.89 (2) (c) Minimum coverage Coverage of inpatient hospital services. If a group or blanket disability insurance policy issued by an insurer health benefit plan or a self-insured health plan provides coverage of any inpatient hospital treatment, the policy plan shall provide coverage for inpatient hospital services for the treatment of conditions under par. (a) 1. as provided in subd. 2.

AB512, s. 23 Section 23. 632.89 (2) (c) 2. of the statutes is repealed.

AB512, s. 24 Section 24. 632.89 (2) (d) 1. of the statutes is renumbered 632.89 (2) (d) and amended to read:

AB512,8,24 632.89 (2) (d) Minimum coverage Coverage of outpatient services. If a group or blanket disability insurance policy issued by an insurer health benefit plan or a self-insured health plan provides coverage of any outpatient treatment, the policy plan shall provide coverage for outpatient services for the treatment of conditions under par. (a) 1. as provided in subd. 2.

AB512, s. 25 Section 25. 632.89 (2) (d) 2. of the statutes is repealed.

AB512, s. 26 Section 26. 632.89 (2) (dm) 1. of the statutes is renumbered 632.89 (2) (dm) and amended to read:

AB512,9,8 632.89 (2) (dm) Minimum coverage Coverage of transitional treatment arrangements. If a group or blanket disability insurance policy issued by an insurer health benefit plan or a self-insured health plan provides coverage of any inpatient hospital treatment or any outpatient treatment, the policy plan shall provide coverage for transitional treatment arrangements for the treatment of conditions under par. (a) 1. as provided in subd. 2.

AB512, s. 27 Section 27. 632.89 (2) (dm) 2. of the statutes is repealed.

AB512, s. 28 Section 28. 632.89 (2) (e) of the statutes is renumbered 632.89 (5) (b) and amended to read:

AB512,9,15 632.89 (5) (b) Exclusion Certain health care plans. This subsection section does not apply to 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).

AB512, s. 29 Section 29. 632.89 (2m) of the statutes is renumbered 632.89 (4m).

AB512, s. 30 Section 30. 632.89 (2p) of the statutes is created to read:

AB512,9,22 632.89 (2p) Additional required coverage of screenings. If a group health benefit plan, individual health benefit plan, or self-insured health plan that provides coverage for the treatment of nervous and mental disorders and alcoholism and other drug abuse problems would provide coverage of at least one annual physical examination, the plan shall provide coverage of all of the following:

AB512,9,25 (a) For an individual who has coverage under the plan, at least one annual screening for nervous and mental disorders and alcoholism and other drug abuse problems to determine the individual's need for treatment.

AB512,10,5 (b) For a female individual who has coverage under the plan, with respect to any pregnancy at least one screening during the pregnancy for prepartum depression and at least one screening within 6 months after a live birth, stillbirth, or miscarriage for postpartum depression to determine the individual's need for treatment.

AB512, s. 31 Section 31. 632.89 (3) of the statutes is created to read:

AB512,10,22 632.89 (3) Limitations. For a group health benefit plan and a self-insured health plan that provide coverage of the treatment of nervous and mental disorders and alcoholism and other drug abuse problems, and for an individual health benefit plan that provides coverage of the treatment of nervous and mental disorders or alcoholism and other drug abuse problems, the exclusions and limitations; deductibles; copayments; coinsurance; annual and lifetime payment limitations; out-of-pocket limits; out-of-network charges; day, visit, or appointment limits; limitations regarding referrals to nonphysician providers and treatment programs; and duration or frequency of coverage limits under the plan may be no more restrictive for coverage of the treatment of nervous and mental disorders or alcoholism and other drug abuse problems than the most common or frequent type of treatment limitations applied to substantially all other coverage under the plan. The plan shall include in any overall deductible amount or annual or lifetime limit or out-of-pocket limit for the plan, expenses incurred for the treatment of nervous and mental disorders or alcoholism and other drug abuse problems and for the screening required under sub. (2p).

AB512, s. 32 Section 32. 632.89 (3m) of the statutes is repealed.

AB512, s. 33 Section 33. 632.89 (3p) of the statutes is created to read:

AB512,11,16 632.89 (3p) Availability of plan information. A group health benefit plan and a self-insured health plan that provide coverage of the treatment of nervous and mental disorders and alcoholism and other drug abuse problems, and an individual health benefit plan that provides coverage of the treatment of nervous and mental disorders or alcoholism and other drug abuse problems, shall, upon request, make available to any current or potential insured, participant, beneficiary, or contracting provider the criteria for determining medical necessity under the plan with respect to that coverage. If a group health benefit plan or a self-insured health plan that provides coverage of the treatment of nervous and mental disorders and alcoholism and other drug abuse problems denies any particular insured, participant, or beneficiary coverage for services for that treatment, or if an individual health benefit plan that provides coverage of the treatment of nervous and mental disorders or alcoholism and other drug abuse problems denies any particular insured coverage for services for that treatment, the plan shall, upon request, make the reason for the denial available to the insured, participant, or beneficiary, in addition to complying with s. 632.857, if applicable.

AB512, s. 34 Section 34. 632.89 (5) (title) of the statutes is repealed and recreated to read:

AB512,11,18 632.89 (5) (title) Exclusions.

AB512, s. 35 Section 35. 632.89 (5) of the statutes is renumbered 632.89 (5) (a).

AB512, s. 36 Section 36. 632.89 (5) (a) (title) of the statutes is created to read:

AB512,11,21 632.89 (5) (a) (title) Medicare.

AB512, s. 37 Section 37. 632.89 (6) of the statutes is repealed.

AB512, s. 38 Section 38. 632.89 (7) of the statutes is repealed.

AB512, s. 39 Section 39. Initial applicability.

AB512,11,25 (1) This act first applies to all of the following:

AB512,12,3 (a) Except as provided in paragraphs (b) and (c), health benefit plans that are issued or renewed, and self-insured governmental health plans that are established, extended, modified, or renewed, on the effective date of this paragraph.

AB512,12,6 (b) Health benefit plans 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:

AB512,12,7 1. The day on which the collective bargaining agreement expires.

AB512,12,9 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

AB512,12,13 (c) Self-insured governmental 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:

AB512,12,14 1. The day on which the collective bargaining agreement expires.

AB512,12,16 2. The day on which the collective bargaining agreement is extended, modified, or renewed.

AB512, s. 40 Section 40. Effective date.

AB512,12,19 (1) This act takes effect on the first day of the 7th month beginning after publication.

AB512,12,20 (End)