LRBs0258/1

TJD:ahe&emw

2017 - 2018 LEGISLATURE

SENATE SUBSTITUTE AMENDMENT 1, TO ASSEMBLY BILL 365

February 20, 2018 - Offered by Senator Erpenbach.

AB365-SSA1,1,9 An Act to repeal 632.746 (1) (b), 632.746 (2) (c), (d) and (e), 632.746 (3) (a), 632.746 (3) (d) 2. and 3., 632.746 (5) and 632.76 (2) (ac) 3.; to renumber 632.746 (3) (d) 1.; to renumber and amend 632.746 (1) (a); to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 625.12 (1) (a), 625.12 (1) (e), 625.12 (2), 625.15 (1), 628.34 (3) (a), 632.746 (2) (a), 632.746 (8) (a) (intro.), 632.76 (2) (a) and (ac) 1. and 2., 632.795 (4) (a) and 632.897 (11) (a); and to create 609.847 and 632.728 of the statutes; relating to: prohibiting preexisting condition exclusion and setting rates or cost sharing based on preexisting conditions.

Analysis by the Legislative Reference Bureau

This substitute amendment prohibits a group health benefit plan, including a self-insured governmental health plan, from imposing a preexisting condition exclusion. The substitute amendment also prohibits an individual health insurance policy, known in the substitute amendment as a disability insurance policy, from reducing or denying a claim or loss incurred or disability commencing under the policy on the ground that a disease or physical condition existed prior to the effective date of coverage. The substitute amendment also prohibits a group or individual health insurance policy or a self-insured governmental health plan from considering whether an individual, including a dependent, who would be covered under the plan has a preexisting condition for the purpose of setting any deductibles, copayments, or coinsurance under the policy or plan.

The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:

AB365-SSA1,1 Section 1. 40.51 (8) of the statutes is amended to read:

AB365-SSA1,2,6 40.51 (8) Every health care coverage plan offered by the state under sub. (6) shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.728, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.867, 632.87 (3) to (6), 632.885, 632.89, 632.895 (5m) and (8) to (17), and 632.896.

AB365-SSA1,2 Section 2. 40.51 (8m) of the statutes is amended to read:

AB365-SSA1,2,11 40.51 (8m) Every health care coverage plan offered by the group insurance board under sub. (7) shall comply with ss. 631.95, 632.728, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.867, 632.885, 632.89, and 632.895 (11) to (17).

AB365-SSA1,3 Section 3. 66.0137 (4) of the statutes, as affected by 2017 Wisconsin Act 30, is amended to read:

AB365-SSA1,3,2 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.728, 632.746 (1), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).

AB365-SSA1,4 Section 4. 120.13 (2) (g) of the statutes, as affected by 2017 Wisconsin Act 30, is amended to read:

AB365-SSA1,3,8 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.728, 632.746 (1), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).

AB365-SSA1,5 Section 5. 185.983 (1) (intro.) of the statutes, as affected by 2017 Wisconsin Act 30, is amended to read:

AB365-SSA1,3,18 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a cooperative association organized under s. 185.981 shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93, 631.95, 632.72 (2), 632.728, 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (2) to (6), 632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645, and 646, but the sponsoring association shall: