AB100-ASA1,1826,9 149.17 (4) Cost containment provisions established by the commissioner department by rule, including managed care requirements.

AB100-ASA1, s. 3469 Section 3469. 619.175 of the statutes is renumbered 149.175 and amended to read:

AB100-ASA1,1826,16 149.175 Waiver or exemption from provisions prohibited. Except as provided in s. 619.13 (1) (a) 149.13 (1), the commissioner department may not waive, or authorize the board to waive, any of the requirements of this subchapter chapter or exempt, or authorize the board to exempt, an individual or a class of individuals from any of the requirements of this subchapter chapter.

AB100-ASA1, s. 3470 Section 3470. 619.18 of the statutes is renumbered 149.18 and amended to read:

AB100-ASA1,1826,21 149.18 Chapters 600 to 645 applicable. Except as otherwise provided in this subchapter chapter, the plan shall comply and be administered in compliance with chs. 600 to 645.

AB100-ASA1, s. 3471 Section 3471. 631.36 (7) (a) 2. of the statutes is amended to read:

AB100-ASA1,1827,2 631.36 (7) (a) 2. Unless the notice contains adequate instructions to the policyholder for applying for insurance through a risk-sharing plan under subch. I of ch. 619, if a risk-sharing plan exists under subch. I of ch. 619 for the kind of coverage being canceled or nonrenewed, except as provided in par. (b).

AB100-ASA1, s. 3472 Section 3472. 632.745 (1) (d) of the statutes, as created by 1995 Wisconsin Act 289, is amended to read:

AB100-ASA1,1827,13 632.745 (1) (d) "Health benefit plan" means any hospital or medical policy or certificate. "Health benefit plan" does not include accident-only, credit accident or health, dental, vision, medicare supplement, medicare replacement, long-term care, disability income or short-term insurance, coverage issued as a supplement to liability insurance, worker's compensation or similar insurance, automobile medical payment insurance, individual conversion policies, specified disease policies, hospital indemnity policies, as defined in s. 632.895 (1) (c), policies or certificates issued under the health insurance risk-sharing plan or an alternative plan under subch. II of ch. 619 149 or other insurance exempted by rule of the commissioner.

AB100-ASA1, s. 4929c Section 4929c. 632.745 (1) (f) 2. of the statutes, as created by 1995 Wisconsin Act 453, is amended to read:

AB100-ASA1,1827,22 632.745 (1) (f) 2. Notwithstanding subd. 1. b. and c., "qualifying coverage" does not include a high cost-share health plan, as defined in s. 632.898 (1) (c), 1995 stats., that is linked to a medical savings account, as described in s. 632.898, 1995 stats., if the employer that provides the individual's new coverage offers its eligible employes a choice of health benefit plan options that includes a high cost-share health plan, as defined in s. 632.898 (1) (c), 1995 stats., and the individual's new coverage is not a high cost-share health plan.

AB100-ASA1, s. 3473 Section 3473. 632.785 (1) (intro.) of the statutes is amended to read:

AB100-ASA1,1828,5 632.785 (1) (intro.) If an insurer issues one or more of the following or takes any other action based wholly or partially on medical underwriting considerations which is likely to render any person eligible under s. 619.12 149.12 for coverage under subch. II of ch. 619 149, the insurer shall notify all persons affected of the existence of the mandatory health insurance risk-sharing plan under subch. II of ch. 619 149, as well as the eligibility requirements and method of applying for coverage under the plan:

AB100-ASA1, s. 4930d Section 4930d. 632.89 (2) (a) 2. of the statutes is amended to read:

AB100-ASA1,1828,10 632.89 (2) (a) 2. Except as provided in pars. (b) to (e), coverage of conditions under subd. 1. by a policy may not be subject to exclusions or limitations, including deductibles, that are not generally applicable to other conditions covered under the policy.

AB100-ASA1, s. 4930f Section 4930f. 632.89 (2) (c) 2. a. of the statutes is amended to read:

AB100-ASA1,1828,12 632.89 (2) (c) 2. a. The expenses of the first 30 days as an inpatient in a hospital.

AB100-ASA1, s. 4930h Section 4930h. 632.89 (2) (c) 2. b. of the statutes is amended to read:

AB100-ASA1,1828,17 632.89 (2) (c) 2. b. The first $7,000 Seven thousand dollars minus a copayment of up to 10% for inpatient hospital services or, if the coverage is provided by a health maintenance organization, as defined in s. 609.01 (2), the first $6,300 or the equivalent benefits measured in services rendered.

AB100-ASA1, s. 4930pm Section 4930pm. 632.89 (2) (d) 2. of the statutes is amended to read:

AB100-ASA1,1828,23 632.89 (2) (d) 2. Except as provided in par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than the first $2,000 $7,000 minus a copayment of up to 10% for outpatient services or, if the coverage is provided by a health maintenance organization, as defined in s. 609.01 (2), the first $1,800 $6,300 or the equivalent benefits measured in services rendered.

AB100-ASA1, s. 4930rm Section 4930rm. 632.89 (2) (dm) 2. of the statutes is amended to read:

AB100-ASA1,1829,5 632.89 (2) (dm) 2. Except as provided in par. (b), a policy under subd. 1. shall provide coverage in every policy year for not less than the first $3,000 $7,000 minus a copayment of up to 10% for transitional treatment arrangements or, if the coverage is provided by a health maintenance organization, as defined in s. 609.01 (2), the first $2,700 $6,300 or the equivalent benefits measured in services rendered.

AB100-ASA1, s. 4930t Section 4930t. 632.895 (11) of the statutes is created to read:

AB100-ASA1,1829,14 632.895 (11) Procedures involving a bone, joint, muscle or tissue and intraoral splint therapy devices. (a) Every disability insurance policy, and every self-insured health plan of the state or a county, city, village, town or school district, that provides coverage of any diagnostic or surgical procedure involving a bone, joint, muscle or tissue shall provide coverage for diagnostic and surgical procedures involving a bone, joint, muscle or tissue of the face, neck, head or skeletal structure, and for prescribed intraoral splint therapy devices, for the treatment of a condition, if all of the following apply:

AB100-ASA1,1829,16 1. The condition is caused by congenital, developmental or acquired deformity, disease or injury.

AB100-ASA1,1829,19 2. Under the accepted standards of the profession of the health care provider rendering the service, the procedure or device is reasonable and appropriate for the diagnosis or treatment of the condition.

AB100-ASA1,1829,21 3. The purpose of the procedure or device is to control or eliminate infection, pain, disease or facial disfigurement or to restore functional swallowing or chewing.

AB100-ASA1,1829,24 (b) The coverage required under this subsection may be subject to any limitations, exclusions or cost-sharing provisions that apply generally under the disability insurance policy or self-insured health plan.