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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 1An Act to repeal 632.746 (1) (b), 632.746 (2) (c), (d) and (e), 632.746 (3) (a),
2632.746 (3) (d) 2. and 3., 632.746 (5) and 632.76 (2) (ac) 3.; to renumber 632.746
3(3) (d) 1.; to renumber and amend 632.746 (1) (a); to amend 40.51 (8), 40.51
4(8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 625.12 (1) (a), 625.12 (1) (e),
5625.12 (2), 625.15 (1), 628.34 (3) (a), 632.746 (2) (a), 632.746 (8) (a) (intro.),
6632.76 (2) (a) and (ac) 1. and 2., 632.795 (4) (a) and 632.897 (11) (a); and to
7create
609.847 and 632.728 of the statutes; relating to: prohibiting
8preexisting condition exclusion and setting rates or cost sharing based on
9preexisting 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 1Section 1. 40.51 (8) of the statutes is amended to read:
AB365-SSA1,2,62 40.51 (8) Every health care coverage plan offered by the state under sub. (6)
3shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.728, 632.746
4(1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853,
5632.855, 632.867, 632.87 (3) to (6), 632.885, 632.89, 632.895 (5m) and (8) to (17), and
6632.896.
AB365-SSA1,2 7Section 2. 40.51 (8m) of the statutes is amended to read:
AB365-SSA1,2,118 40.51 (8m) Every health care coverage plan offered by the group insurance
9board under sub. (7) shall comply with ss. 631.95, 632.728, 632.746 (1) to (8) and (10),
10632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.867,
11632.885, 632.89, and 632.895 (11) to (17).
AB365-SSA1,3 12Section 3. 66.0137 (4) of the statutes, as affected by 2017 Wisconsin Act 30,
13is amended to read:
AB365-SSA1,3,214 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
15a village provides health care benefits under its home rule power, or if a town
16provides health care benefits, to its officers and employees on a self-insured basis,
17the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
18632.728, 632.746 (1), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85,

1632.853, 632.855, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17),
2632.896, and 767.513 (4).
AB365-SSA1,4 3Section 4. 120.13 (2) (g) of the statutes, as affected by 2017 Wisconsin Act 30,
4is amended to read:
AB365-SSA1,3,85 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
649.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.728, 632.746 (1), 632.746 (10) (a) 2. and
7(b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4) to (6),
8632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).
AB365-SSA1,5 9Section 5. 185.983 (1) (intro.) of the statutes, as affected by 2017 Wisconsin
10Act 30
, is amended to read:
AB365-SSA1,3,1811 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
12cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
13646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
14601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
15631.95, 632.72 (2), 632.728, 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798,
16632.85, 632.853, 632.855, 632.867, 632.87 (2) to (6), 632.885, 632.89, 632.895 (5) and
17(8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645, and 646, but
18the sponsoring association shall:
AB365-SSA1,6 19Section 6. 609.847 of the statutes is created to read:
AB365-SSA1,3,22 20609.847 Preexisting condition discrimination prohibited. Limited
21service health organizations, preferred provider plans, and defined network plans
22are subject to s. 632.728.
AB365-SSA1,7 23Section 7. 625.12 (1) (a) of the statutes is amended to read:
AB365-SSA1,3,2524 625.12 (1) (a) Past and prospective loss and expense experience within and
25outside of this state, except as provided in s. 632.728.
AB365-SSA1,8
1Section 8. 625.12 (1) (e) of the statutes is amended to read:
AB365-SSA1,4,32 625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors,
3including the judgment of technical personnel.
AB365-SSA1,9 4Section 9. 625.12 (2) of the statutes is amended to read:
AB365-SSA1,4,135 625.12 (2) Classification. Risks Except as provided in s. 632.728, risks may
6be classified in any reasonable way for the establishment of rates and minimum
7premiums, except that no classifications may be based on race, color, creed or
8national origin, and classifications in automobile insurance may not be based on
9physical condition or developmental disability as defined in s. 51.01 (5). Subject to
10s. ss. 632.365 and 632.728, rates thus produced may be modified for individual risks
11in accordance with rating plans or schedules that establish reasonable standards for
12measuring probable variations in hazards, expenses, or both. Rates may also be
13modified for individual risks under s. 625.13 (2).
AB365-SSA1,10 14Section 10. 625.15 (1) of the statutes is amended to read:
AB365-SSA1,4,2215 625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may
16itself establish rates and supplementary rate information for one or more market
17segments based on the factors in s. 625.12 and, if the rates are for motor vehicle
18liability insurance, subject to s. 632.365, or the insurer may use rates and
19supplementary rate information prepared by a rate service organization, with
20average expense factors determined by the rate service organization or with such
21modification for its own expense and loss experience as the credibility of that
22experience allows.
AB365-SSA1,11 23Section 11. 628.34 (3) (a) of the statutes is amended to read:
AB365-SSA1,5,524 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by
25charging different premiums or by offering different terms of coverage except on the

1basis of classifications related to the nature and the degree of the risk covered or the
2expenses involved, subject to ss. 632.365, 632.728, 632.746 and 632.748. Rates are
3not unfairly discriminatory if they are averaged broadly among persons insured
4under a group, blanket or franchise policy, and terms are not unfairly discriminatory
5merely because they are more favorable than in a similar individual policy.
AB365-SSA1,12 6Section 12. 632.728 of the statutes is created to read:
AB365-SSA1,5,8 7632.728 Premiums and cost-sharing discrimination prohibited for
8preexisiting conditions.
(1) Definition. In this section:
AB365-SSA1,5,99 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB365-SSA1,5,1010 (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB365-SSA1,5,16 11(2) Prohibition. For the purpose of setting rates or premiums for coverage
12under a group or individual disability insurance policy or a self-insured health plan
13and for the purpose of setting any deductibles, copayments, or coinsurance under a
14group or individual disability insurance policy or a self-insured health plan, the
15policy or plan may not consider whether an individual, including a dependent, who
16would be covered under the plan has a preexisting condition.
AB365-SSA1,13 17Section 13. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and
18amended to read:
AB365-SSA1,5,2519 632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health
20benefit plan may, with respect to a participant or beneficiary under the plan, not
21impose a preexisting condition exclusion only if the exclusion relates to a condition,
22whether physical or mental, regardless of the cause of the condition, for which
23medical advice, diagnosis, care or treatment was recommended or received within
24the 6-month period ending on the participant's or beneficiary's enrollment date
25under the plan
on a participant or beneficiary under the plan.
AB365-SSA1,14
1Section 14. 632.746 (1) (b) of the statutes is repealed.
AB365-SSA1,15 2Section 15. 632.746 (2) (a) of the statutes is amended to read:
AB365-SSA1,6,53 632.746 (2) (a) An insurer offering a group health benefit plan may not treat
4genetic information as a preexisting condition under sub. (1) without a diagnosis of
5a condition related to the information
.
AB365-SSA1,16 6Section 16. 632.746 (2) (c), (d) and (e) of the statutes are repealed.
AB365-SSA1,17 7Section 17. 632.746 (3) (a) of the statutes is repealed.
AB365-SSA1,18 8Section 18 . 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).
AB365-SSA1,19 9Section 19 . 632.746 (3) (d) 2. and 3. of the statutes are repealed.
AB365-SSA1,20 10Section 20 . 632.746 (5) of the statutes is repealed.
AB365-SSA1,21 11Section 21. 632.746 (8) (a) (intro.) of the statutes is amended to read:
AB365-SSA1,6,1512 632.746 (8) (a) (intro.) A health maintenance organization that offers a group
13health benefit plan and that does not impose any preexisting condition exclusion
14under sub. (1)
with respect to a particular coverage option may impose an affiliation
15period for that coverage option, but only if all of the following apply:
AB365-SSA1,22 16Section 22. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to read:
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