2019 - 2020 LEGISLATURE
ASSEMBLY AMENDMENT 1,
TO ASSEMBLY BILL 1
January 16, 2019 - Offered by Representative Petersen.
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3“(ae) “Cost sharing” means a deductible, coinsurance, or copayment.”.
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6“
(3m) Prohibiting discrimination based on health status. (a) An individual
7health benefit plan or a self-insured health plan may not establish rules for the
8eligibility of any individual to enroll, or for the continued eligibility of any individual
9to remain enrolled, under the plan based on any of the following health
10status-related factors in relation to the individual or a dependent of the individual:
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1. Health status.
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2. Medical condition, including both physical and mental illnesses.
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3. Claims experience.
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14. Receipt of health care.
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5. Medical history.
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6. Genetic information.
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7. Evidence of insurability, including conditions arising out of acts of domestic
5violence.
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8. Disability.
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(b) 1. An insurer offering an individual health benefit plan or a self-insured
8health plan may not require any individual, as a condition of enrollment or continued
9enrollment under the plan, to pay, on the basis of any health status-related factor
10under par. (a) in relation to the individual or a dependent of the individual, a
11premium or contribution or cost sharing that is greater than the premium or
12contribution or cost sharing for a similarly situated individual enrolled under the
13plan.
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2. An insurer offering a group health benefit plan may not require any
15individual, as a condition of enrollment or continued enrollment under the plan, to
16pay, on the basis of any health status-related factor under s. 632.748 (1) (a) 1. to 8.
17in relation to the individual or a dependent of the individual, cost sharing that is
18greater than the cost sharing for a similarly situated individual enrolled under the
19plan.
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(c) Nothing in this subsection prevents an insurer offering a health benefit plan
21or a self-insured health plan from establishing premium discounts or rebates or
22modifying otherwise applicable cost sharing in return for adherence to programs of
23health promotion and disease prevention.”.
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14. Page 5, line 12: after “
Applicability." insert “(a) An individual health
2benefit plan that is considered a grandfathered health plan under
42 USC 18011 as
3of January 1, 2019, or has transitional status as of January 1, 2019, granted by the
4federal department of health and human services and the commissioner is not
5required to comply with sub. (3m).
