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LRB-1150/1
TJD:ahe
2017 - 2018 LEGISLATURE
June 2, 2017 - Introduced by Representatives Riemer, Kolste, C. Taylor,
Anderson, Barca, Berceau, Billings, Bowen, Brostoff, Considine, Crowley,
Doyle, Fields, Genrich, Goyke, Hebl, Hesselbein, Hintz, Kessler, Mason,
Meyers, Milroy, Ohnstad, Pope, Sargent, Shankland, Sinicki, Spreitzer,
Stuck, Subeck, Vruwink, Wachs, Young, Zamarripa and Zepnick,
cosponsored by Senators Erpenbach, Johnson, Shilling, Bewley, Carpenter,
Hansen, Larson, Miller, Ringhand, Risser, L. Taylor, Vinehout and Wirch.
Referred to Committee on Insurance.
AB363,1,9 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 bill prohibits a group health benefit plan, including a self-insured
governmental health plan, from imposing a preexisting condition exclusion. The bill
also prohibits an individual health insurance policy, known in the bill 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 bill 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.
For further information see the state and local fiscal estimate, which will be
printed as an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB363,1 1Section 1. 40.51 (8) of the statutes is amended to read:
AB363,2,62 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.
AB363,2 7Section 2. 40.51 (8m) of the statutes is amended to read:
AB363,2,118 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).
AB363,3 12Section 3. 66.0137 (4) of the statutes is amended to read:
AB363,2,1913 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
14a village provides health care benefits under its home rule power, or if a town
15provides health care benefits, to its officers and employees on a self-insured basis,
16the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
17632.728, 632.746 (1), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85,
18632.853, 632.855, 632.867, 632.87 (4), (5), and (6), 632.885, 632.89, 632.895 (9) to
19(17), 632.896, and 767.513 (4).
AB363,4
1Section 4. 120.13 (2) (g) of the statutes is amended to read:
AB363,3,52 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
349.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.728, 632.746 (1), 632.746 (10) (a) 2. and
4(b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4), (5), and (6),
5632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).
AB363,5 6Section 5. 185.983 (1) (intro.) of the statutes is amended to read:
AB363,3,147 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
8cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
9646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
10601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
11631.95, 632.72 (2), 632.728, 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798,
12632.85, 632.853, 632.855, 632.867, 632.87 (2), (2m), (3), (4), (5), and (6), 632.885,
13632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630,
14635, 645, and 646, but the sponsoring association shall:
AB363,6 15Section 6. 609.847 of the statutes is created to read:
AB363,3,18 16609.847 Preexisting condition discrimination prohibited. Limited
17service health organizations, preferred provider plans, and defined network plans
18are subject to s. 632.728.
AB363,7 19Section 7. 625.12 (1) (a) of the statutes is amended to read:
AB363,3,2120 625.12 (1) (a) Past and prospective loss and expense experience within and
21outside of this state, except as provided in s. 632.728.
AB363,8 22Section 8. 625.12 (1) (e) of the statutes is amended to read:
AB363,3,2423 625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors,
24including the judgment of technical personnel.
AB363,9 25Section 9. 625.12 (2) of the statutes is amended to read:
AB363,4,9
1625.12 (2) Classification. Risks Except as provided in s. 632.728, risks may
2be classified in any reasonable way for the establishment of rates and minimum
3premiums, except that no classifications may be based on race, color, creed or
4national origin, and classifications in automobile insurance may not be based on
5physical condition or developmental disability as defined in s. 51.01 (5). Subject to
6s. ss. 632.365 and 632.728, rates thus produced may be modified for individual risks
7in accordance with rating plans or schedules that establish reasonable standards for
8measuring probable variations in hazards, expenses, or both. Rates may also be
9modified for individual risks under s. 625.13 (2).
AB363,10 10Section 10. 625.15 (1) of the statutes is amended to read:
AB363,4,1811 625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may
12itself establish rates and supplementary rate information for one or more market
13segments based on the factors in s. 625.12 and, if the rates are for motor vehicle
14liability insurance, subject to s. 632.365, or the insurer may use rates and
15supplementary rate information prepared by a rate service organization, with
16average expense factors determined by the rate service organization or with such
17modification for its own expense and loss experience as the credibility of that
18experience allows.
AB363,11 19Section 11. 628.34 (3) (a) of the statutes is amended to read:
AB363,5,220 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by
21charging different premiums or by offering different terms of coverage except on the
22basis of classifications related to the nature and the degree of the risk covered or the
23expenses involved, subject to ss. 632.365, 632.728, 632.746 and 632.748. Rates are
24not unfairly discriminatory if they are averaged broadly among persons insured

1under a group, blanket or franchise policy, and terms are not unfairly discriminatory
2merely because they are more favorable than in a similar individual policy.
AB363,12 3Section 12. 632.728 of the statutes is created to read:
AB363,5,5 4632.728 Premiums and cost-sharing discrimination prohibited for
5preexisiting conditions.
(1) Definition. In this section:
AB363,5,66 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB363,5,77 (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB363,5,13 8(2) Prohibition. For the purpose of setting rates or premiums for coverage
9under a group or individual disability insurance policy or a self-insured health plan
10and for the purpose of setting any deductibles, copayments, or coinsurance under a
11group or individual disability insurance policy or a self-insured health plan, the
12policy or plan may not consider whether an individual, including a dependent, who
13would be covered under the plan has a preexisting condition.
AB363,13 14Section 13. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and
15amended to read:
AB363,5,2216 632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health
17benefit plan may, with respect to a participant or beneficiary under the plan, not
18impose a preexisting condition exclusion only if the exclusion relates to a condition,
19whether physical or mental, regardless of the cause of the condition, for which
20medical advice, diagnosis, care or treatment was recommended or received within
21the 6-month period ending on the participant's or beneficiary's enrollment date
22under the plan
on a participant or beneficiary under the plan.
AB363,14 23Section 14. 632.746 (1) (b) of the statutes is repealed.
AB363,15 24Section 15. 632.746 (2) (a) of the statutes is amended to read:
AB363,6,3
1632.746 (2) (a) An insurer offering a group health benefit plan may not treat
2genetic information as a preexisting condition under sub. (1) without a diagnosis of
3a condition related to the information
.
AB363,16 4Section 16. 632.746 (2) (c), (d) and (e) of the statutes are repealed.
AB363,17 5Section 17. 632.746 (3) (a) of the statutes is repealed.
AB363,18 6Section 18. 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).
AB363,19 7Section 19. 632.746 (3) (d) 2. and 3. of the statutes are repealed.
AB363,20 8Section 20. 632.746 (5) of the statutes is repealed.
AB363,21 9Section 21. 632.746 (8) (a) (intro.) of the statutes is amended to read:
AB363,6,1310 632.746 (8) (a) (intro.) A health maintenance organization that offers a group
11health benefit plan and that does not impose any preexisting condition exclusion
12under sub. (1)
with respect to a particular coverage option may impose an affiliation
13period for that coverage option, but only if all of the following apply:
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