AB365-SSA3,33,13 11656.10 Administration of plan. (1) Authority. The authority shall be
12responsible for the operation of the plan and, subject to ss. 656.43 (3) and 656.47, may
13enter into contracts for the plan's administration.
AB365-SSA3,33,16 14(2) Fund. (a) The authority shall pay the operating administrative expenses
15of the plan from the fund, which shall be outside the state treasury and which shall
16consist of all of the following:
AB365-SSA3,33,1717 1. Insurer assessments paid under s. 656.15.
AB365-SSA3,33,1818 2. Premiums paid by eligible persons.
AB365-SSA3,33,1919 3. Moneys received from the federal government as grants for high-risk pools.
AB365-SSA3,33,2020 4. The earnings resulting from investments under par. (b).
AB365-SSA3,33,2121 5. Any other moneys received by the authority.
AB365-SSA3,33,2322 (b) The authority controls assets of the fund, including investment of assets of
23the fund.
AB365-SSA3,33,2524 (c) Moneys in the fund may be expended only for the purposes specified in par.
25(a).
AB365-SSA3,34,5
1656.11 Rules relating to creditable coverage. The commissioner shall
2promulgate rules that specify how creditable coverage is to be aggregated for
3purposes of s. 656.12 (1) (c) 1. and that determine the creditable coverage to which
4s. 656.12 (1) (c) 2. and 4. applies. The rules shall comply with any applicable federal
5law regarding creditable coverage.
AB365-SSA3,34,8 6656.12 Eligibility determination. (1) Eligible persons. Except as provided
7in sub. (3) and subject to subs. (2) and (4), the authority shall certify as eligible a
8person who is a resident of this state and is any of the following:
AB365-SSA3,34,109(a) A person who is covered by the Medicare program under 42 USC 1395 et seq.
10because he or she is disabled under 42 USC 423.
AB365-SSA3,34,1211 (b) A person who submits evidence that he or she has a positive, validated HIV
12test result, as defined in s. 252.01 (8).
AB365-SSA3,34,1313 (c) A person for whom all of the following apply:
AB365-SSA3,34,1514 1. The aggregate of the individual's periods of creditable coverage is 18 months
15or more.
AB365-SSA3,34,1816 2. The individual's most recent period of creditable coverage was under a group
17health plan, governmental plan, federal governmental plan, church plan, or under
18any health insurance offered in connection with any of those plans.
AB365-SSA3,34,2219 3. The individual does not have creditable coverage and is not eligible for
20coverage under a group health plan; part A, B, or D of the Medicare program under
2142 USC 1395 et seq.; or a state plan under the Medicaid program under 42 USC 1396
22et seq.
AB365-SSA3,34,2523 4. The individual's most recent period of creditable coverage was not
24terminated for any reason related to fraud or intentional misrepresentation of
25material fact or a failure to pay premiums.
AB365-SSA3,35,3
15. If the individual was offered the option of continuation coverage under a
2federal continuation provision or similar state program, the individual elected the
3continuation coverage.
AB365-SSA3,35,44 6. The individual has exhausted any continuation coverage under subd. 5.
AB365-SSA3,35,85 (d) A person who receives and submits any of the following notices based wholly
6or partially on medical underwriting considerations within 9 months before making
7an application for coverage by the plan and issued by a person acting as an
8administrator, as defined in s. 633.01 (1):
AB365-SSA3,35,99 1. A notice of rejection of coverage from one or more insurers.
AB365-SSA3,35,1010 2. A notice of cancellation of coverage from one or more insurers.
AB365-SSA3,35,1411 3. A notice of reduction or limitation of coverage, including restrictive riders,
12from an insurer if the effect of the reduction or limitation is to substantially reduce
13coverage compared to the coverage available to a person considered a standard risk
14for the type of coverage provided by the plan.
AB365-SSA3,35,1715 4. A notice of increase in premium exceeding the premium then in effect for the
16insured person by 50 percent or more, unless the increase applies to substantially all
17of the insurer's health insurance policies then in effect.
AB365-SSA3,35,2018 5. A notice of premium for a policy not yet in effect from 2 or more insurers
19which exceeds the premium applicable to a person considered a standard risk by 50
20percent or more for the types of coverage provided by the plan.
AB365-SSA3,35,2521 (e) A person not otherwise eligible under this subsection who meets eligibility
22criteria set by the authority. The authority shall ensure that any expansion of
23eligibility is consistent with the purpose of the plan to provide health care coverage
24for those who are unable to obtain health insurance in the private market and does
25not endanger the solvency of the plan.
AB365-SSA3,36,6
1(2) Resident status. (a) For purposes of eligibility under sub. (1) (a), (b), (d),
2and (e), a resident is a person who has been legally domiciled in this state for a period
3of at least 3 months. Except for any of the following circumstances, legal domicile
4is established by living in this state and obtaining a Wisconsin motor vehicle
5operator's license, registering to vote in Wisconsin, or filing a Wisconsin income tax
6return:
AB365-SSA3,36,97 1. A child is legally domiciled in this state if the child lives in this state and if
8at least one of the child's parents or the child's guardian is legally domiciled in this
9state.