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AB1-ASA1,3,7
166.0137 (4) Self-insured health plans. If a city, including a 1st class city, or
2a village provides health care benefits under its home rule power, or if a town
3provides health care benefits, to its officers and employees on a self-insured basis,
4the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
5632.728, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855,
6632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513
7(4).
AB1-ASA1,4 8Section 4 . 120.13 (2) (g) of the statutes is amended to read:
AB1-ASA1,3,129 120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
1049.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.728, 632.746 (10) (a) 2. and (b) 2.,
11632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.867, 632.87 (4) to (6), 632.885,
12632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).
AB1-ASA1,5 13Section 5 . 185.983 (1) (intro.) of the statutes is amended to read:
AB1-ASA1,3,2114 185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
15cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
16646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
17601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
18631.95, 632.72 (2), 632.728, 632.745 to 632.749, 632.775, 632.79, 632.795, 632.798,
19632.85, 632.853, 632.855, 632.867, 632.87 (2) to (6), 632.885, 632.89, 632.895 (5) and
20(8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630, 635, 645, and 646, but
21the sponsoring association shall:
AB1-ASA1,6 22Section 6 . 609.847 of the statutes is created to read:
AB1-ASA1,3,25 23609.847 Preexisting condition discrimination prohibited; benefit
24limits.
Limited service health organizations, preferred provider plans, and defined
25network plans are subject to s. 632.728.
AB1-ASA1,7
1Section 7. 632.728 of the statutes is created to read:
AB1-ASA1,4,3 2632.728 Coverage of individuals with preexisting conditions; rating;
3benefit limits.
(1) Definitions. In this section:
AB1-ASA1,4,44 (a) “Health benefit plan” has the meaning given in s. 632.745 (11).
AB1-ASA1,4,95 (b) “Preexisting condition exclusion” means, with respect to coverage, a
6limitation or exclusion of benefits relating to a condition based on the fact that the
7condition was present before the date of enrollment for the coverage, whether or not
8any medical advice, diagnosis, care, or treatment was recommended or received
9before the date of enrollment for coverage.
AB1-ASA1,4,1010 (c) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB1-ASA1,4,1111 (d) “Small employer” has the meaning given in s. 635.02 (7).
AB1-ASA1,4,17 12(2) Access to coverage. Every individual health benefit plan shall accept
13every individual in this state who applies for coverage and every group health benefit
14plan shall accept every employer in this state that applies for coverage, regardless
15of whether any individual or employee has a preexisting condition. A health benefit
16plan may restrict enrollment in coverage described in this subsection to open or
17special enrollment periods under sub. (4).
AB1-ASA1,4,20 18(3) Premium rate variation. A health benefit plan offered on the individual or
19small employer market or a self-insured health plan may vary premium rates for a
20specific plan based only on the following considerations:
AB1-ASA1,4,2121 (a) Whether the plan covers an individual or a family.
AB1-ASA1,4,2222 (b) Rating area in the state, as established by the commissioner.
AB1-ASA1,4,2523 (c) Age, except that the rate may not vary by more than 3 to 1 for adults over
24the age groups and the age bands shall be consistent with recommendations of the
25National Association of Insurance Commissioners.
AB1-ASA1,5,1
1(d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
AB1-ASA1,5,5 2(4) Enrollment periods. (a) The commissioner shall ensure that every
3individual health benefit plan has open enrollment during a statewide open
4enrollment period of no longer than 45 days to allow individuals, including
5individuals who do not have coverage, to enroll in coverage.
AB1-ASA1,5,76 (b) Every health benefit plan shall provide special enrollment periods for
7qualifying events under 26 USC 9801 (f) and 29 USC 1163.
AB1-ASA1,5,10 8(5) Preexisting condition exclusion. An individual or group health benefit
9plan or a self-insured health plan may not impose a preexisting condition exclusion
10for any time on a participant or beneficiary under the plan.
AB1-ASA1,5,12 11(6) Annual and lifetime limits. An individual or group health benefit plan or
12a self-insured health plan may not establish any of the following:
AB1-ASA1,5,1413 (a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent
14of an enrollee under the plan.
AB1-ASA1,5,1615 (b) Annual limits on the dollar value of benefits for an enrollee or a dependent
16of an enrollee under the plan.
AB1-ASA1,5,24 17(7) Applicability. (a) This section applies only if provisions of the federal
18Patient Protection and Affordable Care Act, P.L. 111-148, as amended, under 42
19USC 300gg
to 300gg-4 and 300gg-11 are no longer enforceable or no longer preempt
20state law relating to individual or group health insurance policies. If this section
21applies, this section supersedes any conflicting provision of ss. 625.12 (1) or (2),
22625.15 (1), 628.34 (3), 632.746, 632.76, 632.795 (4) (a), 632.896 (4), or 632.897 (11) (a)
23or any other conflicting provision in chs. 600 to 655 to the extent this section conflicts
24with that provision.
AB1-ASA1,6,2
1(b) 1. A health benefit plan that is not required to comply with 42 USC 300gg-1
2as amended as of January 1, 2019, is not required to comply with sub. (2).
AB1-ASA1,6,432. A health benefit plan that is not required to comply with 42 USC 300gg as
4amended as of January 1, 2019, is not required to comply with sub. (3).
AB1-ASA1,6,653. A health benefit plan that is not required to comply with 42 USC 300gg-3
6as amended as of January 1, 2019, is not required to comply with sub. (5).
AB1-ASA1,6,974. A health benefit plan that is not required to comply with 42 USC 300gg-11
8(a) (1) (A) as amended as of January 1, 2019, is not required to comply with sub. (6)
9(a).
AB1-ASA1,6,12105. A health benefit plan that is not required to comply with 42 USC 300gg-11
11(a) (1) (B) as amended as of January 1, 2019, is not required to comply with sub. (6)
12(b).
AB1-ASA1,6,1313 (End)
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