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AB56-SA2,63,1111 253.07 (1) (a) 3. Pregnancy termination.
AB56-SA2,1936w 12Section 1936w. 253.07 (1) (b) 3. of the statutes is created to read:
AB56-SA2,63,1313 253.07 (1) (b) 3. Pregnancy termination.
AB56-SA2,1937w 14Section 1937w. 253.07 (5) (b) (intro.) of the statutes is renumbered 253.07 (5)
15(b) and amended to read:
AB56-SA2,63,1916 253.07 (5) (b) Subject to par. (c), a A public entity that receives women's health
17funds under this section may provide some or all of the funds to other public or
18private entities provided that the recipient of the funds does not do any of the
19following:
.
AB56-SA2,1938w 20Section 1938w. 253.07 (5) (b) 1. to 3. of the statutes are repealed.
AB56-SA2,1939w 21Section 1939w. 253.07 (5) (c) of the statutes is repealed.
AB56-SA2,1940w 22Section 1940w. 253.075 of the statutes is repealed.”.
AB56-SA2,63,23 23101. Page 446, line 1: delete lines 1 to 2 and substitute:
AB56-SA2,64,2
1“254.151 (2m) Award grants for residential lead hazard abatement, residential
2lead hazard reduction, and lead abatement worker training.”.
AB56-SA2,64,4 3102. Page 448, line 25: delete the material beginning with that line and
4ending with page 449, line 2, and substitute:
AB56-SA2,64,5 5 Section 1950m. 255.06 (2) (i) of the statutes is amended to read:
AB56-SA2,64,76 255.06 (2) (i) Multiple sclerosis services. Allocate and expend at least up to
7$60,000 as reimbursement for the provision of multiple sclerosis services to women.”.
AB56-SA2,64,8 8103. Page 454, line 2: after that line insert:
AB56-SA2,64,9 9 Section 2069f. 601.83 (1) (a) of the statutes is amended to read:
AB56-SA2,64,2210 601.83 (1) (a) The commissioner shall administer a state-based reinsurance
11program known as the healthcare stability plan in accordance with the specific terms
12and conditions approved by the federal department of health and human services
13dated July 29, 2018. Before December 31, 2023, the commissioner may not request
14from the federal department of health and human services a modification,
15suspension, withdrawal, or termination of the waiver under 42 USC 18052 under
16which the healthcare stability plan under this subchapter operates unless
17legislation has been enacted specifically directing the modification, suspension,
18withdrawal, or termination. Before December 31, 2023, the commissioner may
19request renewal, without substantive change, of the waiver under 42 USC 18052
20under which the health care stability plan operates in accordance with s. 20.940 (4)
21unless legislation has been enacted that is contrary to such a renewal request. The
22commissioner shall comply with applicable timing in and requirements of s. 20.940.
”.
AB56-SA2,2070i 23Section 2070i. 609.713 of the statutes is created to read:
AB56-SA2,65,2
1609.713 Essential health benefits; preventive services. Defined network
2plans and preferred provider plans are subject to s. 632.895 (13m) and (14m).
AB56-SA2,2071i 3Section 2071i. 609.847 of the statutes is created to read:
AB56-SA2,65,6 4609.847 Preexisting condition discrimination and certain benefit
5limits prohibited.
Limited service health organizations, preferred provider plans,
6and defined network plans are subject to s. 632.728.
AB56-SA2,2072i 7Section 2072i. 625.12 (1) (a) of the statutes is amended to read:
AB56-SA2,65,98 625.12 (1) (a) Past and prospective loss and expense experience within and
9outside of this state, except as provided in s. 632.728.
AB56-SA2,2073i 10Section 2073i. 625.12 (1) (e) of the statutes is amended to read:
AB56-SA2,65,1211 625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors,
12including the judgment of technical personnel.
AB56-SA2,2074i 13Section 2074i. 625.12 (2) of the statutes is amended to read:
AB56-SA2,65,2214 625.12 (2) Classification. Risks Except as provided in s. 632.728, risks may
15be classified in any reasonable way for the establishment of rates and minimum
16premiums, except that no classifications may be based on race, color, creed or
17national origin, and classifications in automobile insurance may not be based on
18physical condition or developmental disability as defined in s. 51.01 (5). Subject to
19s. ss. 632.365 and 632.728, rates thus produced may be modified for individual risks
20in accordance with rating plans or schedules that establish reasonable standards for
21measuring probable variations in hazards, expenses, or both. Rates may also be
22modified for individual risks under s. 625.13 (2).
AB56-SA2,2075i 23Section 2075i. 625.15 (1) of the statutes is amended to read:
AB56-SA2,66,624 625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may
25itself establish rates and supplementary rate information for one or more market

1segments based on the factors in s. 625.12 and, if the rates are for motor vehicle
2liability insurance, subject to s. 632.365, or the insurer may use rates and
3supplementary rate information prepared by a rate service organization, with
4average expense factors determined by the rate service organization or with such
5modification for its own expense and loss experience as the credibility of that
6experience allows.
AB56-SA2,2076i 7Section 2076i. 628.34 (3) (a) of the statutes is amended to read:
AB56-SA2,66,148 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by
9charging different premiums or by offering different terms of coverage except on the
10basis of classifications related to the nature and the degree of the risk covered or the
11expenses involved, subject to ss. 632.365, 632.728, 632.746 and 632.748. Rates are
12not unfairly discriminatory if they are averaged broadly among persons insured
13under a group, blanket or franchise policy, and terms are not unfairly discriminatory
14merely because they are more favorable than in a similar individual policy.”.
AB56-SA2,66,15 15104. Page 454, line 12: after that line insert:
AB56-SA2,66,16 16 Section 2079i. 632.728 of the statutes is created to read:
AB56-SA2,66,18 17632.728 Coverage of persons with preexisting conditions; guaranteed
18issue; benefit limits.
(1) Definitions. In this section:
AB56-SA2,66,1919 (a) “Health benefit plan” has the meaning given in s. 632.745 (11).
AB56-SA2,66,2020 (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB56-SA2,67,2 21(2) Guaranteed issue. (a) Every individual health benefit plan shall accept
22every individual in this state who, and every group health benefit plan shall accept
23every employer in this state that, applies for coverage, regardless of sexual
24orientation, gender identity, or whether or not any employee or individual has a

1preexisting condition. A health benefit plan may restrict enrollment in coverage
2described in this paragraph to open or special enrollment periods.
AB56-SA2,67,53 (b) The commissioner shall establish a statewide open enrollment period of no
4shorter than 30 days for every individual health benefit plan to allow individuals,
5including individuals who do not have coverage, to enroll in coverage.
AB56-SA2,67,10 6(3) 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:
AB56-SA2,67,1111 1. Health status.
AB56-SA2,67,1212 2. Medical condition, including both physical and mental illnesses.
AB56-SA2,67,1313 3. Claims experience.
AB56-SA2,67,1414 4. Receipt of health care.
AB56-SA2,67,1515 5. Medical history.
AB56-SA2,67,1616 6. Genetic information.
AB56-SA2,67,1817 7. Evidence of insurability, including conditions arising out of acts of domestic
18violence.
AB56-SA2,67,1919 8. Disability.
AB56-SA2,68,220 (b) An insurer offering an individual health benefit plan or a self-insured
21health plan may not require any individual, as a condition of enrollment or continued
22enrollment under the plan, to pay, on the basis of any health status-related factor
23under par. (a) with respect to the individual or a dependent of the individual, a
24premium or contribution or a deductible, copayment, or coinsurance amount that is

1greater than the premium or contribution or deductible, copayment, or coinsurance
2amount respectively for a similarly situated individual enrolled under the plan.
AB56-SA2,68,63 (c) Nothing in this subsection prevents an insurer offering an individual health
4benefit plan or a self-insured health plan from establishing premium discounts or
5rebates or modifying otherwise applicable cost sharing in return for adherence to
6programs of health promotion and disease prevention.
AB56-SA2,68,9 7(4) Premium rate variation. A health benefit plan offered on the individual or
8small employer market or a self-insured health plan may vary premium rates for a
9specific plan based only on the following considerations:
AB56-SA2,68,1010 (a) Whether the policy or plan covers an individual or a family.
AB56-SA2,68,1111 (b) Rating area in the state, as established by the commissioner.
AB56-SA2,68,1412 (c) Age, except that the rate may not vary by more than 3 to 1 for adults over
13the age groups and the age bands shall be consistent with recommendations of the
14National Association of Insurance Commissioners.
AB56-SA2,68,1515 (d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
AB56-SA2,68,17 16(5) Annual and lifetime limits. An individual or group health benefit plan or
17a self-insured health plan may not establish any of the following:
AB56-SA2,68,1918 (a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent
19of an enrollee under the plan.
AB56-SA2,68,2120 (b) Annual limits on the dollar value of benefits for an enrollee or a dependent
21of an enrollee under the plan.
AB56-SA2,69,4 22(6) Short-term plans. This section and s. 632.76 apply to every short-term,
23limited-duration health insurance policy. In this subsection, “short-term,
24limited-duration health insurance policy” means health coverage that is provided
25under a contract with an insurer, has an expiration date specified in the contract that

1is less than 12 months after the original effective date of the contract, and, taking
2into account renewals or extensions, has a duration of no longer than 36 months in
3total. “Short-term, limited-duration health insurance policy” includes any
4short-term policy subject to s. 632.7495 (4).
AB56-SA2,2080i 5Section 2080i. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and
6amended to read:
AB56-SA2,69,137 632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health
8benefit plan may, with respect to a participant or beneficiary under the plan, not
9impose a preexisting condition exclusion only if the exclusion relates to a condition,
10whether physical or mental, regardless of the cause of the condition, for which
11medical advice, diagnosis, care or treatment was recommended or received within
12the 6-month period ending on the participant's or beneficiary's enrollment date
13under the plan
on a participant or beneficiary under the plan.
AB56-SA2,2081i 14Section 2081i. 632.746 (1) (b) of the statutes is repealed.
AB56-SA2,2082i 15Section 2082i. 632.746 (2) (a) of the statutes is amended to read:
AB56-SA2,69,1916 632.746 (2) (a) An insurer offering a group health benefit plan may not treat
17impose a preexisting condition exclusion based on genetic information as a
18preexisting condition under sub. (1) without a diagnosis of a condition related to the
19information
.
AB56-SA2,2083i 20Section 2083i. 632.746 (2) (c), (d) and (e) of the statutes are repealed.
AB56-SA2,2084i 21Section 2084i. 632.746 (3) (a) of the statutes is repealed.
AB56-SA2,2085i 22Section 2085i. 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).
AB56-SA2,2086i 23Section 2086i. 632.746 (3) (d) 2. and 3. of the statutes are repealed.
AB56-SA2,2087i 24Section 2087i. 632.746 (5) of the statutes is repealed.
AB56-SA2,2088i 25Section 2088i. 632.746 (8) (a) (intro.) of the statutes is amended to read:
AB56-SA2,70,4
1632.746 (8) (a) (intro.) A health maintenance organization that offers a group
2health benefit plan and that does not impose any preexisting condition exclusion
3under sub. (1)
with respect to a particular coverage option may impose an affiliation
4period for that coverage option, but only if all of the following apply:
AB56-SA2,2089i 5Section 2089i. 632.748 (2) of the statutes is amended to read:
AB56-SA2,70,126 632.748 (2) An insurer offering a group health benefit plan may not require any
7individual, as a condition of enrollment or continued enrollment under the plan, to
8pay, on the basis of any health status-related factor with respect to the individual
9or a dependent of the individual, a premium or contribution or a deductible,
10copayment, or coinsurance amount
that is greater than the premium or contribution
11or deductible, copayment, or coinsurance amount respectively for a similarly
12situated individual enrolled under the plan.
AB56-SA2,2090i 13Section 2090i. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to
14read:
AB56-SA2,70,2215 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
16from the date of issue of the policy may be reduced or denied on the ground that a
17disease or physical condition existed prior to the effective date of coverage, unless the
18condition was excluded from coverage by name or specific description by a provision
19effective on the date of loss. This paragraph does not apply to a group health benefit
20plan, as defined in s. 632.745 (9), which is subject to s. 632.746 , a disability insurance
21policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s.
22632.85 (1) (c)
.
AB56-SA2,71,323 (ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability
24commencing after 12 months from the date of issue of under an individual disability
25insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the

1ground that a disease or physical condition existed prior to the effective date of
2coverage, unless the condition was excluded from coverage by name or specific
3description by a provision effective on the date of the loss
.
AB56-SA2,71,104 2. Except as provided in subd. 3., an An individual disability insurance policy,
5as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495
6(4) and (5),
may not define a preexisting condition more restrictively than a condition
7that was present before the date of enrollment for the coverage, whether physical or
8mental, regardless of the cause of the condition, for which and regardless of whether
9medical advice, diagnosis, care, or treatment was recommended or received within
1012 months before the effective date of coverage
.
AB56-SA2,2091i 11Section 2091i. 632.76 (2) (ac) 3. of the statutes is repealed.
AB56-SA2,2092i 12Section 2092i. 632.795 (4) (a) of the statutes is amended to read:
AB56-SA2,71,2413 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the
14same policy form and for the same premium as it originally offered in the most recent
15enrollment period, subject only to the medical underwriting used in that enrollment
16period. Unless otherwise prescribed by rule, the insurer may apply deductibles,
17preexisting condition limitations, waiting periods , or other limits only to the extent
18that they would have been applicable had coverage been extended at the time of the
19most recent enrollment period and with credit for the satisfaction or partial
20satisfaction of similar provisions under the liquidated insurer's policy or plan. The
21insurer may exclude coverage of claims that are payable by a solvent insurer under
22insolvency coverage required by the commissioner or by the insurance regulator of
23another jurisdiction. Coverage shall be effective on the date that the liquidated
24insurer's coverage terminates.
AB56-SA2,2093k 25Section 2093k. 632.796 of the statutes is created to read:
AB56-SA2,72,2
1632.796 Drug cost report. (1) Definition. In this section, “disability
2insurance policy” has the meaning given in s. 632.895 (1) (a).
AB56-SA2,72,8 3(2) Report required. Annually, at the time the insurer files its rate request
4with the commissioner, each insurer that offers a disability insurance policy that
5covers prescription drugs shall submit to the commissioner a report that identifies
6the 25 prescription drugs that are the highest cost to the insurer and the 25
7prescription drugs that have the highest cost increases over the 12 months before the
8submission of the report.
AB56-SA2,2094k 9Section 2094k. 632.865 (3) of the statutes is created to read:
AB56-SA2,72,1210 632.865 (3) Registration required. (a) No person may perform any activities
11of a pharmacy benefit manager in this state without first registering with the
12commissioner under this subsection.
AB56-SA2,72,1513 (b) The commissioner shall establish a registration procedure for pharmacy
14benefit managers. The commissioner may promulgate any rules necessary to
15implement the registration procedure under this paragraph.
AB56-SA2,2095k 16Section 2095k. 632.866 of the statutes is created to read:
AB56-SA2,72,17 17632.866 Prescription drug cost reporting. (1) Definitions. In this section:
AB56-SA2,72,1918 (a) “Brand-name drug” means a prescription drug approved under 21 USC 355
19(b) or 42 USC 262.
AB56-SA2,72,2120 (b) “Covered hospital” means an entity described in 42 USC 256b (a) (4) (L) to
21(N) that participates in the federal drug-pricing program under 42 USC 256b.
AB56-SA2,72,2222 (c) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
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