120.13 (2) (g) of the statutes is amended to read:
(g) Every self-insured plan under par. (b) shall comply with ss. 16
49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 17
632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4), (5), and (6), 632.885, 632.89, 18
632.895 (9) (8)
to (17), 632.896, and 767.513 (4).
609.896 of the statutes is created to read:
20609.896 Preventive services.
Defined network plans and preferred provider 21
plans are subject to s. 632.895 (13m).
632.895 (8) (d) of the statutes is amended to read:
(d) Coverage is required under this subsection despite whether the 24
woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c),
(e), coverage under this subsection may only be subject to exclusions and limitations,
including deductibles, copayments and
restrictions on excessive charges, that are 2
applied to other radiological examinations covered under the disability insurance 3
policy. Coverage under this subsection may not be subject to any deductibles,
4copayments, or coinsurance.
632.895 (13m) of the statutes is created to read:
632.895 (13m) Preventive services.
(a) In this section, “self-insured health 7
plan” has the meaning given in s. 632.85 (1) (c).
(b) Every disability insurance policy and every self-insured health plan shall 9
provide coverage for all of the following preventive services:
1. Mammography in accordance with sub. (8).
2. Genetic breast cancer screening and counseling and preventive medication 12
for adult women at high risk for breast cancer.
3. Papanicolaou test for cancer screening for women 21 years of age or older 14
with an intact cervix.
4. Human papillomavirus testing for women who have attained the age of 30 16
years but have not attained the age of 66 years.
5. Colorectal cancer screening in accordance with sub. (16m).
6. Annual tomography for lung cancer screening for adults who have attained 19
the age of 55 years but have not attained the age of 80 years and who have health 20
histories demonstrating a risk for lung cancer.
7. Skin cancer screening for individuals who have attained the age of 10 years 22
but have not attained the age of 22 years.
8. Counseling for skin cancer prevention for adults who have attained the age 24
of 18 years but have not attained the age of 25 years.
9. Abdominal aortic aneurysm screening for men who have attained the age of 2
65 years but have not attained the age of 75 years and who have ever smoked.
10. Hypertension screening for adults and blood pressure testing for adults, for 4
children under the age of 3 years who are at high risk for hypertension, and for 5
children 3 years of age or older.
11. Lipid disorder screening for minors 2 years of age or older, high risk women 7
20 years of age or older, men age 20 years of age or older at high risk for lipid 8
disorders, and all men 35 years of age or older.
12. Aspirin therapy for cardiovascular health for adults who have attained the 10
age of 55 years but have not attained the age of 80 years and for men who have 11
attained the age of 45 years but have not attained the age of 55 years.
13. Behavioral counseling for cardiovascular health for adults who are 13
overweight or obese and who have risk factors for cardiovascular disease.
14. Type II diabetes screening for adults with elevated blood pressure.
15. Depression screening for minors 11 years of age or older and for adults when 16
follow-up supports are available.
16. Hepatitis B screening for minors at high risk for infection and adults at high 18
risk for infection.
17. Hepatitis C screening for adults at high risk for infection and one time 20
hepatitis C screening for adults born in 1945 to 1965.
18. Obesity screening and management for all minors and adults with a body 22
mass index indicating obesity, counseling and behavioral interventions for obese 23
minors who are 6 years of age or older, and referral for intervention for obesity for 24
adults with a body mass index of 30 kilograms per square meter or higher.
19. Osteoporosis screening for all women 65 years of age or older and for women 2
at high risk for osteoporosis under the age of 65 years.
20. Immunizations in accordance with sub. (14).
21. Anemia screening for individuals 6 months of age or older and iron 5
supplements for individuals at high risk for anemia and who have attained the age 6
of 6 months but have not attained the age of 12 months.
22. Fluoride varnish for prevention of tooth decay for minors at the age of 8
eruption of their primary teeth.
23. Fluoride supplements for prevention of tooth decay for minors 6 months of 10
age or older who do not have fluoride in their water source.
24. Gonorrhea prophylaxis treatment for newborns.
25. Health history and physical exams for prenatal visits and for minors.
26. Length and weight measurements for newborns and height and weight 14
measurements for minors.
27. Head circumference and weight for length measurements for newborns and 16
minors who have not attained the age of 3 years.
28. Body mass index for minors 2 years of age or older.
29. Blood pressure measurements for minors 3 years of age or older and a blood 19
pressure risk assessment at birth.
30. Risk assessment and referral for oral health issues for minors who have 21
attained the age of 6 months but have not attained the age of 7 years.
31. Blood screening for newborns and minors who have not attained age 2 23
32. Screening for critical congenital health defect for newborns.
33. Lead screenings in accordance with sub. (10).
34. Metabolic and hemoglobin screening and screening for phenylketonuria, 2
sickle cell anemia, and congenital hypothyroidism for minors including newborns.
35. Tuberculin skin test based on risk assessment for minors one month of age 4
36. Tobacco counseling and cessation interventions for individuals who are 5 6
years of age or older.
37. Vision and hearing screening and assessment for minors including 8
38. Sexually transmitted infection and human immunodeficiency virus 10
counseling for sexually active minors.
39. Risk assessment for sexually transmitted infection for minors who are 10 12
years of age or older and screening for sexually transmitted infection for minors who 13
are 16 years of age or older.
40. Alcohol misuse screening and counseling for minors 11 years of age or older.
41. Autism screening for minors who have attained the age of 18 months but 16
have not attained the age of 25 months.
42. Developmental screening and surveillance for minors including newborns.
43. Psychosocial and behavioral assessment for minors including newborns.
44. Alcohol misuse screening and counseling for pregnant adults and a risk 20
assessment for all adults.
45. Fall prevention and counseling and preventive medication for fall 22
prevention for community-dwelling adults 65 years of age or older.
46. Screening and counseling for intimate partner violence for adult women.
47. Well-woman visits for women who have attained the age of 18 years but 2
have not attained the age of 65 years and well-woman visits for recommended 3
preventive services, preconception care, and prenatal care.
48. Counseling on, consultations with a trained provider on, and equipment 5
rental for breastfeeding for pregnant and lactating women.
49. Folic acid supplement for adult women with reproductive capacity.
50. Iron deficiency anemia screening for pregnant and lactating women.
51. Preeclampsia preventive medicine for pregnant adult women at high risk 9
52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high 11
risk for miscarriage, preeclampsia, or clotting disorders.
53. Screenings for hepatitis B and bacteriuria for pregnant women.
54. Screening for gonorrhea for pregnant and sexually active females 24 years 14
of age or younger and females older than 24 years of age who are at risk for infection.
55. Screening for chlamydia for pregnant and sexually active females 24 years 16
of age and younger and females older than 24 years of age who are at risk for 17
56. Screening for syphilis for pregnant women and adults who are at high risk 19
57. Human immunodeficiency virus screening for adults who have attained the 21
age of 15 years but have not attained the age of 66 years and individuals at high risk 22
of infection who are younger than 15 years of age or older than 65 years of age.
58. All contraceptives and services in accordance with sub. (17).
59. Any services not already specified under this paragraph having an A or B 25
rating in current recommendations from the U.S. Preventive Services Task Force.
60. Any preventive services not already specified under this paragraph that are 2
recommended by the federal health resources and services administration's Bright 3
61. Any immunizations, not already specified under sub. (14), that are 5
recommended and determined to be for routine use by the Advisory Committee on 6
(c) Subject to par. (d), no disability insurance policy and no self-insured health 8
plan may subject the coverage of any of the preventive services under par. (b) to any 9
deductibles, copayments, or coinsurance under the policy or plan.
(d) 1. If an office visit and a preventive service specified under par. (b) are billed 11
separately by the health care provider, the disability insurance policy or self-insured 12
health plan may apply deductibles to and impose copayments or coinsurance on the 13
office visit but not on the preventive service.
2. If the primary reason for an office visit is not to obtain a preventive service, 15
the disability insurance policy or self-insured health plan may apply deductibles to 16
and impose copayments or coinsurance on the office visit.
3. If a preventive service specified under par. (b) is provided by a health care 18
provider that is outside the disability insurance policy's or self-insured health plan's 19
network of providers, the policy or plan may apply deductibles to and impose 20
copayments or coinsurance on the office visit and the preventive service. If a 21
preventive service specified under par. (b) is provided by a health care provider that 22
is outside the disability insurance policy's or self-insured health plan's network of 23
providers because there is no available health care provider in the policy's or plan's 24
network of providers that provides the preventive service, the policy or plan may not 25
apply deductibles to or impose copayments or coinsurance on preventive service.
4. If multiple well-woman visits described under par. (b) 47. are required to 2
fulfill all necessary preventive services and are in accordance with clinical 3
recommendations, the disability insurance policy or self-insured health plan may 4
not apply a deductible or impose a copayment or coinsurance to any of those 5
632.895 (14) (a) 1. i. and j. of the statutes are amended to read:
(a) 1. i. Hepatitis A and
j. Varicella and herpes zoster
632.895 (14) (a) 1. k. to o. of the statutes are created to read:
(a) 1. k. Human papillomavirus.
L. Meningococcal meningitis.
m. Pneumococcal pneumonia.
632.895 (14) (b) of the statutes is amended to read:
(b) Except as provided in par. (d), every disability insurance policy, 17
and every self-insured health plan of the state or a county, city, town, village,
school district, that provides coverage for a dependent of the insured
shall provide 19
coverage of appropriate and necessary immunizations, from birth to the age of 6
for an insured or plan participant, including
a dependent who is a child
of the 21
insured or plan participant
632.895 (14) (c) of the statutes is amended to read:
(c) The coverage required under par. (b) may not be subject to any 24
deductibles, copayments, or coinsurance under the policy or plan.
25applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to
1appropriate and necessary immunizations provided by providers participating, as
2defined in s. 609.01 (3m), in the plan.
632.895 (14) (d) 3. of the statutes is amended to read: