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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, 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.
AB364,1,6 1An Act to amend 40.51 (8m), 66.0137 (4), 120.13 (2) (g), 632.895 (8) (d), 632.895
2(14) (a) 1. i. and j., 632.895 (14) (b), 632.895 (14) (c), 632.895 (14) (d) 3., 632.895
3(16m) (b), 632.895 (17) (b) 2. and 632.895 (17) (c); and to create 609.896,
4632.895 (13m) and 632.895 (14) (a) 1. k. to o. of the statutes; relating to:
5requiring coverage and prohibiting cost sharing for preventive services under
6health insurance policies and plans.
Analysis by the Legislative Reference Bureau
This bill requires health insurance policies, known in the bill as disability
insurance policies, and governmental self-insured health plans to cover certain
preventive services and to provide coverage without subjecting that coverage to
deductibles, copayments, or coinsurance. The preventive services for which coverage
is required are specified in the bill. The bill also specifies certain instances when
cost-sharing amounts may be charged for an office visit associated with a preventive
service.
This proposal may contain a health insurance mandate requiring a social and
financial impact report under s. 601.423, stats.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB364,1
1Section 1. 40.51 (8m) of the statutes is amended to read:
AB364,2,52 40.51 (8m) Every health care coverage plan offered by the group insurance
3board under sub. (7) shall comply with ss. 631.95, 632.746 (1) to (8) and (10), 632.747,
4632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 632.867, 632.885,
5632.89, and 632.895 (11) (8) and (10) to (17).
AB364,2 6Section 2. 66.0137 (4) of the statutes is amended to read:
AB364,2,137 66.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
8a village provides health care benefits under its home rule power, or if a town
9provides health care benefits, to its officers and employees on a self-insured basis,
10the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
11632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867,
12632.87 (4), (5), and (6), 632.885, 632.89, 632.895 (9) (8) to (17), 632.896, and 767.513
13(4).
AB364,3 14Section 3. 120.13 (2) (g) of the statutes is amended to read:
AB364,2,1815 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
1649.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.746 (10) (a) 2. and (b) 2., 632.747 (3),
17632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4), (5), and (6), 632.885, 632.89,
18632.895 (9) (8) to (17), 632.896, and 767.513 (4).
AB364,4 19Section 4. 609.896 of the statutes is created to read:
AB364,2,21 20609.896 Preventive services. Defined network plans and preferred provider
21plans are subject to s. 632.895 (13m).
AB364,5 22Section 5. 632.895 (8) (d) of the statutes is amended to read:
AB364,3,423 632.895 (8) (d) Coverage is required under this subsection despite whether the
24woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c), and
25(e), coverage under this subsection may only be subject to exclusions and limitations,

1including deductibles, copayments and restrictions on excessive charges, that are
2applied to other radiological examinations covered under the disability insurance
3policy. Coverage under this subsection may not be subject to any deductibles,
4copayments, or coinsurance.
AB364,6 5Section 6. 632.895 (13m) of the statutes is created to read:
AB364,3,76 632.895 (13m) Preventive services. (a) In this section, “self-insured health
7plan” has the meaning given in s. 632.85 (1) (c).
AB364,3,98 (b) Every disability insurance policy and every self-insured health plan shall
9provide coverage for all of the following preventive services:
AB364,3,1010 1. Mammography in accordance with sub. (8).
AB364,3,1211 2. Genetic breast cancer screening and counseling and preventive medication
12for adult women at high risk for breast cancer.
AB364,3,1413 3. Papanicolaou test for cancer screening for women 21 years of age or older
14with an intact cervix.
AB364,3,1615 4. Human papillomavirus testing for women who have attained the age of 30
16years but have not attained the age of 66 years.
AB364,3,1717 5. Colorectal cancer screening in accordance with sub. (16m).
AB364,3,2018 6. Annual tomography for lung cancer screening for adults who have attained
19the age of 55 years but have not attained the age of 80 years and who have health
20histories demonstrating a risk for lung cancer.
AB364,3,2221 7. Skin cancer screening for individuals who have attained the age of 10 years
22but have not attained the age of 22 years.
AB364,3,2423 8. Counseling for skin cancer prevention for adults who have attained the age
24of 18 years but have not attained the age of 25 years.
AB364,4,2
19. Abdominal aortic aneurysm screening for men who have attained the age of
265 years but have not attained the age of 75 years and who have ever smoked.
AB364,4,53 10. Hypertension screening for adults and blood pressure testing for adults, for
4children under the age of 3 years who are at high risk for hypertension, and for
5children 3 years of age or older.
AB364,4,86 11. Lipid disorder screening for minors 2 years of age or older, high risk women
720 years of age or older, men age 20 years of age or older at high risk for lipid
8disorders, and all men 35 years of age or older.
AB364,4,119 12. Aspirin therapy for cardiovascular health for adults who have attained the
10age of 55 years but have not attained the age of 80 years and for men who have
11attained the age of 45 years but have not attained the age of 55 years.
AB364,4,1312 13. Behavioral counseling for cardiovascular health for adults who are
13overweight or obese and who have risk factors for cardiovascular disease.
AB364,4,1414 14. Type II diabetes screening for adults with elevated blood pressure.
AB364,4,1615 15. Depression screening for minors 11 years of age or older and for adults when
16follow-up supports are available.
AB364,4,1817 16. Hepatitis B screening for minors at high risk for infection and adults at high
18risk for infection.
AB364,4,2019 17. Hepatitis C screening for adults at high risk for infection and one time
20hepatitis C screening for adults born in 1945 to 1965.
AB364,4,2421 18. Obesity screening and management for all minors and adults with a body
22mass index indicating obesity, counseling and behavioral interventions for obese
23minors who are 6 years of age or older, and referral for intervention for obesity for
24adults with a body mass index of 30 kilograms per square meter or higher.
AB364,5,2
119. Osteoporosis screening for all women 65 years of age or older and for women
2at high risk for osteoporosis under the age of 65 years.
AB364,5,33 20. Immunizations in accordance with sub. (14).
AB364,5,64 21. Anemia screening for individuals 6 months of age or older and iron
5supplements for individuals at high risk for anemia and who have attained the age
6of 6 months but have not attained the age of 12 months.
AB364,5,87 22. Fluoride varnish for prevention of tooth decay for minors at the age of
8eruption of their primary teeth.
AB364,5,109 23. Fluoride supplements for prevention of tooth decay for minors 6 months of
10age or older who do not have fluoride in their water source.
AB364,5,1111 24. Gonorrhea prophylaxis treatment for newborns.
AB364,5,1212 25. Health history and physical exams for prenatal visits and for minors.
AB364,5,1413 26. Length and weight measurements for newborns and height and weight
14measurements for minors.
AB364,5,1615 27. Head circumference and weight for length measurements for newborns and
16minors who have not attained the age of 3 years.
AB364,5,1717 28. Body mass index for minors 2 years of age or older.
AB364,5,1918 29. Blood pressure measurements for minors 3 years of age or older and a blood
19pressure risk assessment at birth.
AB364,5,2120 30. Risk assessment and referral for oral health issues for minors who have
21attained the age of 6 months but have not attained the age of 7 years.
AB364,5,2322 31. Blood screening for newborns and minors who have not attained age 2
23months.
AB364,5,2424 32. Screening for critical congenital health defect for newborns.
AB364,5,2525 33. Lead screenings in accordance with sub. (10).
AB364,6,2
134. Metabolic and hemoglobin screening and screening for phenylketonuria,
2sickle cell anemia, and congenital hypothyroidism for minors including newborns.
AB364,6,43 35. Tuberculin skin test based on risk assessment for minors one month of age
4or older.
AB364,6,65 36. Tobacco counseling and cessation interventions for individuals who are 5
6years of age or older.
AB364,6,87 37. Vision and hearing screening and assessment for minors including
8newborns.
AB364,6,109 38. Sexually transmitted infection and human immunodeficiency virus
10counseling for sexually active minors.
AB364,6,1311 39. Risk assessment for sexually transmitted infection for minors who are 10
12years of age or older and screening for sexually transmitted infection for minors who
13are 16 years of age or older.
AB364,6,1414 40. Alcohol misuse screening and counseling for minors 11 years of age or older.
AB364,6,1615 41. Autism screening for minors who have attained the age of 18 months but
16have not attained the age of 25 months.
AB364,6,1717 42. Developmental screening and surveillance for minors including newborns.
AB364,6,1818 43. Psychosocial and behavioral assessment for minors including newborns.
AB364,6,2019 44. Alcohol misuse screening and counseling for pregnant adults and a risk
20assessment for all adults.
AB364,6,2221 45. Fall prevention and counseling and preventive medication for fall
22prevention for community-dwelling adults 65 years of age or older.
AB364,6,2323 46. Screening and counseling for intimate partner violence for adult women.
AB364,7,3
147. Well-woman visits for women who have attained the age of 18 years but
2have not attained the age of 65 years and well-woman visits for recommended
3preventive services, preconception care, and prenatal care.
AB364,7,54 48. Counseling on, consultations with a trained provider on, and equipment
5rental for breastfeeding for pregnant and lactating women.
AB364,7,66 49. Folic acid supplement for adult women with reproductive capacity.
AB364,7,77 50. Iron deficiency anemia screening for pregnant and lactating women.
AB364,7,98 51. Preeclampsia preventive medicine for pregnant adult women at high risk
9for preeclampsia.
AB364,7,1110 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high
11risk for miscarriage, preeclampsia, or clotting disorders.
AB364,7,1212 53. Screenings for hepatitis B and bacteriuria for pregnant women.
AB364,7,1413 54. Screening for gonorrhea for pregnant and sexually active females 24 years
14of age or younger and females older than 24 years of age who are at risk for infection.
AB364,7,1715 55. Screening for chlamydia for pregnant and sexually active females 24 years
16of age and younger and females older than 24 years of age who are at risk for
17infection.
AB364,7,1918 56. Screening for syphilis for pregnant women and adults who are at high risk
19for infection.
AB364,7,2220 57. Human immunodeficiency virus screening for adults who have attained the
21age of 15 years but have not attained the age of 66 years and individuals at high risk
22of infection who are younger than 15 years of age or older than 65 years of age.
AB364,7,2323 58. All contraceptives and services in accordance with sub. (17).
AB364,7,2524 59. Any services not already specified under this paragraph having an A or B
25rating in current recommendations from the U.S. Preventive Services Task Force.
AB364,8,3
160. Any preventive services not already specified under this paragraph that are
2recommended by the federal health resources and services administration's Bright
3Futures project.
AB364,8,64 61. Any immunizations, not already specified under sub. (14), that are
5recommended and determined to be for routine use by the Advisory Committee on
6Immunization Practices.
AB364,8,97 (c) Subject to par. (d), no disability insurance policy and no self-insured health
8plan may subject the coverage of any of the preventive services under par. (b) to any
9deductibles, copayments, or coinsurance under the policy or plan.
AB364,8,1310 (d) 1. If an office visit and a preventive service specified under par. (b) are billed
11separately by the health care provider, the disability insurance policy or self-insured
12health plan may apply deductibles to and impose copayments or coinsurance on the
13office visit but not on the preventive service.
AB364,8,1614 2. If the primary reason for an office visit is not to obtain a preventive service,
15the disability insurance policy or self-insured health plan may apply deductibles to
16and impose copayments or coinsurance on the office visit.
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