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AB445,34,2121 f. Data on rating practices.
AB445,34,2322 g. Information on cost sharing and payments with respect to any
23out-of-network coverage.
AB445,34,2424 h. Information on enrollee and participant rights under title I of the federal act.
AB445,34,2525 i. Other information as determined appropriate by the secretary.
12. The information required in subd. 1. shall be provided in plain language, as
2that term is defined in section 1311 (e) (3) (B) of the federal act.
AB445,35,93 (c) Permit individuals to learn, in a timely manner upon the request of the
4individual, the amount of cost sharing, including deductibles, copayments, and
5coinsurance, under the individual's plan or coverage that the individual would be
6responsible for paying with respect to the furnishing of a specific item or service by
7a participating provider. At a minimum, this information shall be made available
8to the individual through an Internet site and through other means for individuals
9without access to the Internet.
AB445,35,14 10(4) The authority may not exempt any health carrier seeking certification of
11a health benefit plan as a qualified health plan, regardless of the type or size of the
12health carrier, from state licensure or solvency requirements and shall apply the
13criteria of this section in a manner that assures equitable treatment of all health
14carriers participating in the exchange under s. 636.25 (1).
AB445,35,18 15(5) (a) The provisions of this chapter that are applicable to qualified health
16plans shall also apply to the extent relevant to qualified dental plans, except as
17modified in accordance with pars. (b), (c), and (d) or by regulations adopted by the
AB445,35,2019 (b) The health carrier shall be licensed to offer dental coverage, but need not
20be licensed to offer other health benefits.
AB445,36,221 (c) The plan shall be limited to dental and oral health benefits, without
22substantially duplicating the benefits typically offered by health benefit plans
23without dental coverage, and shall include, at a minimum, the essential pediatric
24dental benefits prescribed by the secretary under section 1302 (b) (1) (J) of the federal

1act and such other dental benefits as the authority or the secretary may specify by
AB445,36,73 (d) Health carriers may jointly offer a comprehensive plan through the
4exchange under s. 636.25 (1) in which the dental benefits are provided by a health
5carrier through a qualified dental plan and the other benefits are provided by a
6health carrier through a qualified health plan, provided that the plans are priced
7separately and are also made available for purchase separately at the same price.
AB445,36,13 8636.43 Insurer requirements. (1) Any health carrier that is authorized to
9do business in this state in one or more lines of insurance that includes health
10insurance may offer health benefit plans through the exchange under s. 636.25 (1).
11After the exchange becomes operational, no health carrier may offer or issue a health
12benefit plan in this state to an individual or to a small employer except through the
AB445,36,16 14(2) For the purpose of determining premiums, a health carrier may pool
15together all individuals and employees who have coverage under all of the qualified
16health plans issued by the health carrier through the exchange under s. 636.25 (1).
AB445,36,20 17(3) A health carrier that offers qualified health plans through the exchange
18under s. 636.25 (1) shall establish a toll-free hotline for providing information to
19enrollees and other individuals and shall furnish such reasonable reports as the
20authority determines necessary for the administration of the exchange.
AB445,36,24 21(4) The authority may audit any health carrier that provides coverage under
22a qualified health plan through the exchange under s. 636.25 (1) for the purpose of
23ensuring that the health carrier is providing covered individuals with the benefits
24provided for under this subchapter in a manner that does all of the following:
AB445,36,2525 (a) Complies with the provisions of this chapter.
1(b) Promotes positive health outcomes.
AB445,37,22 (c) Advances value-based and evidence-based medical practices.
AB445,37,53 (d) Avoids unnecessary operating and capital costs arising from inappropriate
4utilization or inefficient delivery of health care services, unwarranted duplication of
5services and infrastructure, or creation of excess care delivery capacity.
AB445,37,66 (e) Holds down the growth of health care costs.
AB445,37,14 7636.44 Intermediaries. An insurance intermediary that enrolls a qualified
8individual in a qualified health plan through the exchange under s. 636.25 (1) shall
9be paid a commission by the health carrier offering the qualified health plan. An
10insurance intermediary that enrolls the employees of a qualified employer in one or
11more qualified health plans through the exchange shall be paid a commission by each
12health carrier offering a qualified health plan selected by an employee of the
13qualified employer. The authority shall determine the commission amounts that
14must be paid to intermediaries under this section.
AB445,37,19 15636.45 Funding; publication of costs. (1) For payment of administrative
16expenses, the authority may impose a surcharge on each health carrier offering
17qualified health plans through the exchange under s. 636.25 (1). The surcharge shall
18be based on the health carrier's total premium or flat dollar amount per enrollee
19collected through the exchange.
AB445,37,23 20(2) The authority shall publish the average costs of licensing, regulatory fees,
21and any other payments required by the authority, and the administrative costs of
22the authority, on an Internet site to educate consumers on such costs. This
23information shall include information on moneys lost to waste, fraud, and abuse.
AB445,38,2 24636.46 Rules; application form. (1) The commissioner may promulgate
25rules to implement the provisions of this chapter. Rules promulgated under this

1section may not conflict with or prevent the application of regulations promulgated
2by the secretary under the federal act.
AB445,38,4 3(2) The commissioner shall develop a standard application form for use in the
AB445,38,11 5636.48 Relation to other laws. Nothing in this chapter, and no action taken
6by the authority under this chapter, shall be construed to preempt or supersede the
7authority of the commissioner to regulate the business of insurance within this state.
8Except as expressly provided to the contrary in this chapter, all health carriers
9offering qualified health plans in this state shall comply fully with all applicable
10health insurance laws of this state and rules promulgated and orders issued by the
AB445,38,1312 Subchapter III
13 badger Health benefit authority
AB445,38,24 14636.70 Creation and organization of authority. (1) There is created a
15public body corporate and politic to be known as the “Badger Health Benefit
16Authority." The board of directors of the authority shall consist of the commissioner,
17or his or her designee; the secretary of employee trust funds, or his or her designee;
18the person who is appointed by the secretary of health services to be the director of
19the Medical Assistance program, or his or her designee; the executive director, or his
20or her designee, of the Wisconsin Collaborative for Healthcare Quality, if that
21organization exists; the executive director, or his or her designee, of the Wisconsin
22Health Information Organization, if that organization exists; and all of the following
23members, who shall be nominated by the governor and, with the advice and consent
24of the senate, appointed for 3-year terms except as provided in sub. (2):
AB445,38,2525 (a) A member in good standing of the American Academy of Actuaries.
1(b) A health economist.
AB445,39,22 (c) An employee benefits specialist.
AB445,39,33 (d) A representative of small employers.
AB445,39,44 (e) A representative of an organization that represents consumer interests.
AB445,39,55 (f) A representative of organized labor.
AB445,39,66 (g) An individual with experience in health care administration.
AB445,39,10 7(2) No member of the board appointed under sub. (1) (a) to (g) may be a health
8care provider, as defined in s. 146.81 (1) (a) to (hp); an employee of a health care
9provider, as defined in s. 146.81 (1) (i) to (p); an employee of an insurer that is
10authorized to do business in the state; or an insurance intermediary.
AB445,39,13 11(3) A vacancy on the board under sub. (1) shall be filled in the same manner
12as the original appointment to the board for the remainder of the unexpired term,
13if any.
AB445,39,17 14(4) A member of the board under sub. (1) shall receive no compensation for
15services under this chapter but shall be reimbursed for actual and necessary
16expenses, including travel expenses, incurred in the discharge of the member's
17duties under this chapter.
AB445,39,23 18(5) The commissioner or the commissioner's designee shall be the chairperson
19of the board under sub. (1). Seven members of the board constitute a quorum for the
20purpose of conducting the business and exercising the powers of the authority,
21notwithstanding the existence of any vacancy. The board may take action upon a vote
22of a majority of the members present, unless the bylaws of the authority require a
23larger number.
AB445,40,10 24(6) The board under sub. (1) shall appoint an executive director who shall not
25be a member of the board and who shall serve at the pleasure of the board. The

1executive director shall receive compensation commensurate with the duties of the
2office, as determined by the board. The executive director shall serve as secretary
3of the authority and shall keep a record of the proceedings of the authority and shall
4be custodian of all books, documents, and papers filed with the authority, the minute
5book or journal of the authority, and its official seal. The executive director or other
6person may cause copies to be made of all minutes and other records and documents
7of the authority and may give certificates under the official seal of the authority to
8the effect that such copies are true copies, and all persons dealing with the authority
9may rely upon such certificates. The executive director shall have all of the following
AB445,40,1211 (a) Supervising the administrative affairs and the general management and
12operation of the authority.
AB445,40,1413 (b) Planning, directing, coordinating, and executing administrative functions
14in conformity with the policies and directives of the board.
AB445,40,1515 (c) Employing professional and clerical staff, as necessary.
AB445,40,1716 (d) Reporting to the board on all operations under his or her control and
AB445,40,1918 (e) Preparing an annual budget and managing the administrative expenses of
19the authority.
AB445,40,2120 (f) Undertaking any activities necessary to implement the powers and duties
21set forth in this chapter.
AB445,40,23 22636.72 Authority duties. In addition to all other duties imposed under this
23chapter, the authority shall do all of the following:
AB445,40,24 24(1) Establish its annual budget and monitor its fiscal management.
1(2) No later than 2 years after an exchange under subch. II begins operation,
2and annually thereafter, submit a report to the legislature under s. 13.172 (2) and
3to the governor on the operation of any exchange under subch. II, including a review
4of all of the following:
AB445,41,55 (a) Progress toward the goals of the exchange.
AB445,41,66 (b) The operations and administration of the exchange.
AB445,41,87 (c) The types of health insurance plans available to eligible individuals and
8groups and the percentage of the total exchange enrollees served by each plan.
AB445,41,119 (d) Surveys and reports on the insurers' experiences with different plans,
10including aggregated data on enrollees, claims, statistics, complaint data, and
11enrollee satisfaction data.
AB445,41,1312 (e) Significant observations regarding utilization and adoption of the
AB445,41,15 14(3) Annually submit to the governor and the legislative audit bureau a
15statement of its activities and financial condition.
AB445,41,17 16(4) Approve the use of any trademarks, seals, or logos by participating insurers
17and small employers.
AB445,41,19 18(5) Comply with the requirements of s. 16.413 as if the authority is a state
AB445,41,23 20636.74 Authority powers. The authority has all of the powers necessary or
21convenient to carry out its duties under this chapter, except that it may not acquire
22or hold title to real estate or issue bonds. In addition, the authority may do any of
23the following:
AB445,41,25 24(1) Adopt bylaws and policies and procedures for the regulation of its affairs
25and the conduct of its business.
1(2) Have a seal and alter the seal at pleasure, have perpetual existence, and
2maintain an office.
AB445,42,3 3(3) Hire employees, define their duties, and fix their rate of compensation.
AB445,42,5 4(4) Delegate by resolution to one or more of its members any powers and duties
5that it considers proper.
AB445,42,6 6(5) Incur debt.
AB445,42,10 7(6) Appoint any technical or professional advisory committee that the
8authority finds necessary to assist the authority in exercising its duties and powers.
9If the authority appoints a committee, the authority shall define the duties of the
10committee and provide reimbursement for the expenses of the committee.
AB445,42,12 11(7) Accept gifts, grants, loans, or other contributions from private or public
AB445,42,13 13(8) Procure liability insurance.
AB445,42,14 14(9) Sue and be sued in its own name and plead and be impleaded.
AB445,42,17 15(10) Execute contracts and other instruments, including contracts for
16professional or technical services required for the authority or the operation of an
17exchange under subch. II.
AB445,42,22 18636.76 Contracting for professional services. (1) Whenever contracting
19for professional services, the authority shall solicit competitive sealed bids or
20competitive sealed proposals, whichever is appropriate. Each request for
21competitive sealed proposals shall state the relative importance of price and other
22evaluation factors.
AB445,43,5 23(2) (a) When the estimated cost exceeds $25,000, the authority may invite
24competitive sealed bids or proposals by publishing a class 2 notice under ch. 985 or
25by posting notice on the Internet at a site determined or approved by the authority.

1The notice shall describe the contractual services to be purchased, the intent to make
2the procurement by solicitation of bids or proposals, any requirement for surety, and
3the date the bids or proposals will be opened, which shall be at least 7 days after the
4date of the last insertion of the notice or at least 7 days after the date of posting on
5the Internet.
AB445,43,86 (b) When the estimated cost is $25,000 or less, the authority may award the
7contract in accordance with simplified procedures established by the authority for
8such transactions.
AB445,43,129 (c) For purposes of clarification, the authority may discuss the requirements
10of the proposed contract with any person who submits a bid or proposal and shall
11permit any offerer to revise his or her bid or proposal to ensure its responsiveness to
12those requirements.
AB445,43,20 13(3) (a) The authority shall determine which bids or proposals are reasonably
14likely to be awarded the contract and shall provide each offerer of such a bid or
15proposal a fair and equal opportunity to discuss the bid or proposal. The authority
16may negotiate with each offerer in order to obtain terms that are advantageous to
17the authority. Prior to the award of the contract, any offerer may revise his or her
18bid or proposal. The authority shall keep a written record of all meetings,
19conferences, oral presentations, discussions, negotiations, and evaluations of bids or
20proposals under this section.
AB445,43,2321 (b) In opening, discussing, and negotiating bids or proposals, the authority may
22not disclose any information that would reveal the terms of a competing bid or
AB445,44,4 24(4) (a) After receiving each offerer's best and final offer, the authority shall
25determine which proposal is most advantageous and shall award the contract to the

1person who offered it. The authority's determination shall be based only on price and
2the other evaluation factors specified in the request for bids or proposals. The
3authority shall state in writing the reason for the award and shall place the
4statement in the contract file.
AB445,44,65 (b) Following the award of the contract, the authority shall prepare a register
6of all bids or proposals.
AB445,44,16 7636.78 Political activities. (1) No employee of the authority may directly
8or indirectly solicit or receive subscriptions or contributions for any partisan political
9party or any political purpose while engaged in his or her official duties as an
10employee. No employee of the authority may engage in any form of political activity
11calculated to favor or improve the chances of any political party or any person seeking
12or attempting to hold partisan political office while engaged in his or her official
13duties as an employee or engage in any political activity while not engaged in his or
14her official duties as an employee to such an extent that the person's efficiency during
15working hours will be impaired or that he or she will be tardy or absent from work.
16Any violation of this section is adequate grounds for dismissal.
AB445,44,20 17(2) If an employee of the authority declares an intention to run for partisan
18political office, the employee shall be placed on a leave of absence for the duration
19of the election campaign and if elected shall no longer be employed by the authority
20on assuming the duties and responsibilities of such office.
AB445,44,22 21(3) An employee of the authority may be granted, by the executive director, a
22leave of absence to participate in partisan political campaigning.
AB445,44,25 23(4) Persons on leave of absence under sub. (2) or (3) shall not be subject to the
24restrictions of sub. (1), except as they apply to the solicitation of assistance,
25subscription, or support from any other employee in the authority.
1636.80 Financial disclosure. (1) In this section, “individual required to file"
2means a person who is a member of the board of the authority or the executive
3director of the authority.
AB445,45,8 4(2) Each individual who in January of any year is an individual required to file
5shall file with the ethics commission no later than April 30 of that year a statement
6of economic interests meeting each of the requirements of s. 19.44 (1). The
7information contained on the statement shall be current as of December 31 of the
8preceding year.
AB445,45,15 9(3) An individual required to file shall file with the ethics commission a
10statement of economic interests meeting each of the requirements of s. 19.44 (1) no
11later than 21 days following the date he or she assumes a position on the board or
12the position of executive director if the individual required to file has not previously
13filed a statement of economic interests with the ethics commission during that year.
14The information on the statement shall be current as per the date he or she assumes
15the position.
AB445,45,24 16(4) If an individual required to file fails to make a timely filing, the ethics
17commission shall promptly provide notice of the delinquency to the secretary of
18administration, and to the executive director of the authority, or the chairperson of
19the board if the executive director's filing is untimely. Upon such notification, both
20the secretary of administration and the executive director, or chairperson, shall
21withhold all payments for compensation, reimbursement of expenses, and other
22obligations to the individual until the ethics commission notifies those to whom
23notice of the delinquency was provided that the individual has complied with this
1(5) On its own motion or at the request of any individual required to file a
2statement of economic interests, the ethics commission may extend the time for filing
3or waive any filing requirement if the ethics commission determines that the literal
4application of the filing requirements of this subchapter would work an
5unreasonable hardship on that individual or that the extension of the time for filing
6or waiver is in the public interest. The ethics commission shall set forth in writing
7as a matter of public record its reason for the extension or waiver.
AB445,46,14 8(6) (a) Any person who violates this section may be required to forfeit not more
9than $500 for each violation. If the court determines that the accused has realized
10economic gain as a result of the violation, the court may, in addition, order the
11accused to forfeit the amount gained as a result of the violation. The attorney
12general, when so requested by the ethics commission, shall institute proceedings to
13recover any forfeiture incurred under this subsection that is not paid by the person
14against whom it is assessed.
AB445,46,1715 (b) Any person who intentionally violates this section shall be fined not less
16than $100 nor more than $5,000 or imprisoned not more than one year in the county
17jail or both.
AB445,46,21 18636.82 Conflict of interest prohibited; exception. (1) Except in
19accordance with the ethics commission's advice under s. 19.46 (2) and except as
20otherwise provided in sub. (2), a member of the board under s. 636.70 (1) and the
21executive director of the authority may not do any of the following:
AB445,46,2522 (a) Take any official action substantially affecting a matter in which the board
23member or executive director, a member of his or her immediate family, or an
24organization with which the board member or director is associated has a substantial
25financial interest.