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LRBa2662/1
TJD:all
2017 - 2018 LEGISLATURE
SENATE AMENDMENT 2,
TO SENATE SUBSTITUTE AMENDMENT 2,
TO ASSEMBLY BILL 365
December 4, 2018 - Offered by Senators Erpenbach, Shilling, Schachtner, Wirch,
Miller, L. Taylor, Johnson, Vinehout, Carpenter, Larson, Frostman,
Ringhand, Risser, Hansen and Bewley.
AB365-SSA2-SA2,1,11 At the locations indicated, amend the substitute amendment as follows:
AB365-SSA2-SA2,1,6 21. Page 1, line 3: delete “coverage of individuals with preexisting conditions"
3and substitute “Medicaid expansion and eligibility for BadgerCare, lifetime and
4annual limits, preventive services, essential health benefits, guaranteed issue, and
5preexisting conditions under health insurance policies and plans and requiring the
6exercise of rule-making authority".
AB365-SSA2-SA2,1,8 72. Page 2, line 1: delete the material beginning with that line and ending with
8page 6, line 2, and substitute:
AB365-SSA2-SA2,1,9 9 Section 1. 40.51 (8) of the statutes is amended to read:
AB365-SSA2-SA2,2,210 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
11shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.728, 632.746
12(1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853,

1632.855, 632.867, 632.87 (3) to (6), 632.883, 632.885, 632.89, 632.895 (5m) and (8) to
2(17), and 632.896.
AB365-SSA2-SA2,2 3Section 2. 40.51 (8m) of the statutes is amended to read:
AB365-SSA2-SA2,2,74 40.51 (8m) Every health care coverage plan offered by the group insurance
5board under sub. (7) shall comply with ss. 631.95, 632.728, 632.746 (1) to (8) and (10),
6632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.867,
7632.883, 632.885, 632.89, and 632.895 (11) (8) and (10) to (17).
AB365-SSA2-SA2,3 8Section 3. 49.45 (23) (a) of the statutes is amended to read:
AB365-SSA2-SA2,2,169 49.45 (23) (a) The department shall request a waiver from the secretary of the
10federal department of health and human services to permit the department to
11conduct a demonstration project to provide health care coverage to adults who are
12under the age of 65, who have family incomes not to exceed 100 133 percent of the
13poverty line before application of the 5 percent income disregard under 42 CFR
14435.603 (d)
, except as provided in s. 49.471 (4g), and who are not otherwise eligible
15for medical assistance under this subchapter, the Badger Care health care program
16under s. 49.665, or Medicare under 42 USC 1395 et seq.
AB365-SSA2-SA2,4 17Section 4. 49.471 (1) (cr) of the statutes is created to read:
AB365-SSA2-SA2,2,1918 49.471 (1) (cr) “Enhanced federal medical assistance percentage" means a
19federal medical assistance percentage described under 42 USC 1396d (y) or (z).
AB365-SSA2-SA2,5 20Section 5. 49.471 (4) (a) 4. b. of the statutes is amended to read:
AB365-SSA2-SA2,2,2321 49.471 (4) (a) 4. b. The Except as provided in sub. (4g), the individual's family
22income does not exceed 100 133 percent of the poverty line before application of the
235 percent income disregard under 42 CFR 435.603 (d)
.
AB365-SSA2-SA2,6 24Section 6. 49.471 (4g) of the statutes is created to read:
AB365-SSA2-SA2,3,9
149.471 (4g) Medicaid expansion; federal medical assistance percentage. (a)
2For services provided to individuals described under sub. (4) (a) 4. and s. 49.45 (23),
3the department shall comply with all federal requirements to qualify for the highest
4available enhanced federal medical assistance percentage. The department shall
5submit any amendment to the state medical assistance plan, request for a waiver of
6federal Medicaid law, or other approval request required by the federal government
7to provide services to the individuals described under sub. (4) (a) 4. and s. 49.45 (23)
8and qualify for the highest available enhanced federal medical assistance
9percentage.
AB365-SSA2-SA2,3,2110 (b) If the department does not qualify for an enhanced federal medical
11assistance percentage, or if the enhanced federal medical assistance percentage
12obtained by the department is lower than printed in federal law as of July 1, 2013,
13for individuals eligible under sub. (4) (a) 4. or s. 49.45 (23), the department shall
14submit to the joint committee on finance a fiscal analysis comparing the cost to
15maintain coverage for adults who are not pregnant and not elderly with family
16incomes of up to 133 percent of the poverty line to the cost of limiting eligibility to
17those adults with family incomes of up to 100 percent of the poverty line. The
18department may reduce income eligibility for adults who are not pregnant and not
19elderly from family incomes of up to 133 percent of the poverty line to family incomes
20of up to 100 percent of the poverty line only if this reduction in income eligibility
21levels is approved by the joint committee on finance.
AB365-SSA2-SA2,7 22Section 7. 66.0137 (4) of the statutes, as affected by 2017 Wisconsin Act 30,
23is amended to read:
AB365-SSA2-SA2,4,524 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
25a village provides health care benefits under its home rule power, or if a town

1provides health care benefits, to its officers and employees on a self-insured basis,
2the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
3632.728, 632.746 (1) and (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853,
4632.855, 632.867, 632.87 (4) to (6), 632.883, 632.885, 632.89, 632.895 (9) (8) to (17),
5632.896, and 767.513 (4).
AB365-SSA2-SA2,8 6Section 8. 120.13 (2) (g) of the statutes, as affected by 2017 Wisconsin Act 30,
7is amended to read:
AB365-SSA2-SA2,4,118 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
949.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.728, 632.746 (1) and (10) (a) 2. and (b)
102., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4) to (6), 632.883,
11632.885, 632.89, 632.895 (9) (8) to (17), 632.896, and 767.513 (4).
AB365-SSA2-SA2,9 12Section 9. 185.983 (1) (intro.) of the statutes is amended to read:
AB365-SSA2-SA2,4,2013 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
14cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
15646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
16601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
17631.95, 632.72 (2), 632.728, 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798,
18632.85, 632.853, 632.855, 632.867, 632.87 (2) to (6), 632.883, 632.885, 632.89,
19632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645,
20and 646, but the sponsoring association shall:
AB365-SSA2-SA2,10 21Section 10. 609.713 of the statutes is created to read:
AB365-SSA2-SA2,4,23 22609.713 Essential health benefits. Defined network plans and preferred
23provider plans are subject to s. 632.895 (14m).
AB365-SSA2-SA2,11 24Section 11. 609.845 of the statutes is created to read:
AB365-SSA2-SA2,5,2
1609.845 Lifetime and annual limits. Limited service health organizations,
2preferred provider plans, and defined network plans are subject to s. 632.883.
AB365-SSA2-SA2,12 3Section 12. 609.847 of the statutes is created to read:
AB365-SSA2-SA2,5,6 4609.847 Preexisting condition discrimination prohibited. Limited
5service health organizations, preferred provider plans, and defined network plans
6are subject to s. 632.728.
AB365-SSA2-SA2,13 7Section 13. 609.896 of the statutes is created to read:
AB365-SSA2-SA2,5,9 8609.896 Preventive services. Defined network plans and preferred provider
9plans are subject to s. 632.895 (13m).
AB365-SSA2-SA2,14 10Section 14. 625.12 (1) (a) of the statutes is amended to read:
AB365-SSA2-SA2,5,1211 625.12 (1) (a) Past and prospective loss and expense experience within and
12outside of this state, except as provided in s. 632.728.
AB365-SSA2-SA2,15 13Section 15. 625.12 (1) (e) of the statutes is amended to read:
AB365-SSA2-SA2,5,1514 625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors,
15including the judgment of technical personnel.
AB365-SSA2-SA2,16 16Section 16. 625.12 (2) of the statutes is amended to read:
AB365-SSA2-SA2,5,2517 625.12 (2) Classification. Risks Except as provided in s. 632.728, risks may
18be classified in any reasonable way for the establishment of rates and minimum
19premiums, except that no classifications may be based on race, color, creed or
20national origin, and classifications in automobile insurance may not be based on
21physical condition or developmental disability as defined in s. 51.01 (5). Subject to
22s. ss. 632.365 and 632.728, rates thus produced may be modified for individual risks
23in accordance with rating plans or schedules that establish reasonable standards for
24measuring probable variations in hazards, expenses, or both. Rates may also be
25modified for individual risks under s. 625.13 (2).
AB365-SSA2-SA2,17
1Section 17. 625.15 (1) of the statutes is amended to read:
AB365-SSA2-SA2,6,92 625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may
3itself establish rates and supplementary rate information for one or more market
4segments based on the factors in s. 625.12 and, if the rates are for motor vehicle
5liability insurance, subject to s. 632.365, or the insurer may use rates and
6supplementary rate information prepared by a rate service organization, with
7average expense factors determined by the rate service organization or with such
8modification for its own expense and loss experience as the credibility of that
9experience allows.
AB365-SSA2-SA2,18 10Section 18. 628.34 (3) (a) of the statutes is amended to read:
AB365-SSA2-SA2,6,1711 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by
12charging different premiums or by offering different terms of coverage except on the
13basis of classifications related to the nature and the degree of the risk covered or the
14expenses involved, subject to ss. 632.365, 632.728, 632.746 and 632.748. Rates are
15not unfairly discriminatory if they are averaged broadly among persons insured
16under a group, blanket or franchise policy, and terms are not unfairly discriminatory
17merely because they are more favorable than in a similar individual policy.
AB365-SSA2-SA2,19 18Section 19. 632.728 of the statutes is created to read:
AB365-SSA2-SA2,6,20 19632.728 Coverage of persons with preexisting conditions; guaranteed
20issue.
(1) Definitions. In this section:
AB365-SSA2-SA2,6,2121 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB365-SSA2-SA2,6,2222 (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB365-SSA2-SA2,7,3 23(2) Guaranteed issue. Every individual disability insurance policy shall accept
24every individual and every group disability insurance policy shall accept every
25employer in this state that applies for coverage, regardless of whether or not any

1employee or individual has a preexisting condition. A disability insurance policy
2may restrict enrollment in coverage described in this subsection to open or special
3enrollment periods.
AB365-SSA2-SA2,7,10 4(3) Rate setting and cost-sharing discrimination prohibited. For the purpose
5of setting rates or premiums for coverage under a group or individual disability
6insurance policy or a self-insured health plan and for the purpose of setting any
7deductibles, copayments, or coinsurance under a group or individual disability
8insurance policy or a self-insured health plan, the policy or plan may not consider
9whether an individual, including a dependent, who would be covered under the plan
10has a preexisting condition.
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