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AB56,1026,1918 (b) Annual limits on the dollar value of benefits for an enrollee or a dependent
19of an enrollee under the plan.
AB56,1027,2 20(6) Short-term plans. This section and s. 632.76 apply to every short-term,
21limited-duration health insurance policy. In this subsection, “short-term,
22limited-duration health insurance policy” means health coverage that is provided
23under a contract with an insurer, has an expiration date specified in the contract that
24is less than 12 months after the original effective date of the contract, and, taking
25into account renewals or extensions, has a duration of no longer than 36 months in

1total. “Short-term, limited-duration health insurance policy” includes any
2short-term policy subject to s. 632.7495 (4).
AB56,2080 3Section 2080. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and
4amended to read:
AB56,1027,115 632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health
6benefit plan may, with respect to a participant or beneficiary under the plan, not
7impose a preexisting condition exclusion only if the exclusion relates to a condition,
8whether physical or mental, regardless of the cause of the condition, for which
9medical advice, diagnosis, care or treatment was recommended or received within
10the 6-month period ending on the participant's or beneficiary's enrollment date
11under the plan
on a participant or beneficiary under the plan.
AB56,2081 12Section 2081. 632.746 (1) (b) of the statutes is repealed.
AB56,2082 13Section 2082. 632.746 (2) (a) of the statutes is amended to read:
AB56,1027,1714 632.746 (2) (a) An insurer offering a group health benefit plan may not treat
15impose a preexisting condition exclusion based on genetic information as a
16preexisting condition under sub. (1) without a diagnosis of a condition related to the
17information
.
AB56,2083 18Section 2083. 632.746 (2) (c), (d) and (e) of the statutes are repealed.
AB56,2084 19Section 2084. 632.746 (3) (a) of the statutes is repealed.
AB56,2085 20Section 2085 . 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).
AB56,2086 21Section 2086 . 632.746 (3) (d) 2. and 3. of the statutes are repealed.
AB56,2087 22Section 2087 . 632.746 (5) of the statutes is repealed.
AB56,2088 23Section 2088. 632.746 (8) (a) (intro.) of the statutes is amended to read:
AB56,1028,224 632.746 (8) (a) (intro.) A health maintenance organization that offers a group
25health benefit plan and that does not impose any preexisting condition exclusion

1under sub. (1)
with respect to a particular coverage option may impose an affiliation
2period for that coverage option, but only if all of the following apply:
AB56,2089 3Section 2089 . 632.748 (2) of the statutes is amended to read:
AB56,1028,104 632.748 (2) An insurer offering a group health benefit plan may not require any
5individual, as a condition of enrollment or continued enrollment under the plan, to
6pay, on the basis of any health status-related factor with respect to the individual
7or a dependent of the individual, a premium or contribution or a deductible,
8copayment, or coinsurance amount
that is greater than the premium or contribution
9or deductible, copayment, or coinsurance amount respectively for a similarly
10situated individual enrolled under the plan.
AB56,2090 11Section 2090. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to
12read:
AB56,1028,2013 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
14from the date of issue of the policy may be reduced or denied on the ground that a
15disease or physical condition existed prior to the effective date of coverage, unless the
16condition was excluded from coverage by name or specific description by a provision
17effective on the date of loss. This paragraph does not apply to a group health benefit
18plan, as defined in s. 632.745 (9), which is subject to s. 632.746 , a disability insurance
19policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s.
20632.85 (1) (c)
.
AB56,1029,221 (ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability
22commencing after 12 months from the date of issue of under an individual disability
23insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the
24ground that a disease or physical condition existed prior to the effective date of

1coverage, unless the condition was excluded from coverage by name or specific
2description by a provision effective on the date of the loss
.
AB56,1029,93 2. Except as provided in subd. 3., an An individual disability insurance policy,
4as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495
5(4) and (5),
may not define a preexisting condition more restrictively than a condition
6that was present before the date of enrollment for the coverage, whether physical or
7mental, regardless of the cause of the condition, for which and regardless of whether
8medical advice, diagnosis, care, or treatment was recommended or received within
912 months before the effective date of coverage
.
AB56,2091 10Section 2091. 632.76 (2) (ac) 3. of the statutes is repealed.
AB56,2092 11Section 2092. 632.795 (4) (a) of the statutes is amended to read:
AB56,1029,2312 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the
13same policy form and for the same premium as it originally offered in the most recent
14enrollment period, subject only to the medical underwriting used in that enrollment
15period. Unless otherwise prescribed by rule, the insurer may apply deductibles,
16preexisting condition limitations, waiting periods , or other limits only to the extent
17that they would have been applicable had coverage been extended at the time of the
18most recent enrollment period and with credit for the satisfaction or partial
19satisfaction of similar provisions under the liquidated insurer's policy or plan. The
20insurer may exclude coverage of claims that are payable by a solvent insurer under
21insolvency coverage required by the commissioner or by the insurance regulator of
22another jurisdiction. Coverage shall be effective on the date that the liquidated
23insurer's coverage terminates.
AB56,2093 24Section 2093. 632.796 of the statutes is created to read:
AB56,1030,2
1632.796 Drug cost report. (1) Definition. In this section, “ disability
2insurance policy” has the meaning given in s. 632.895 (1) (a).
AB56,1030,8 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.
AB56,2094 9Section 2094. 632.865 (3) of the statutes is created to read:
AB56,1030,1210 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.
AB56,1030,1513 (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.
AB56,2095 16Section 2095. 632.866 of the statutes is created to read:
AB56,1030,17 17632.866 Prescription drug cost reporting. (1) Definitions. In this section:
AB56,1030,1918 (a) “Brand-name drug” means a prescription drug approved under 21 USC 355
19(b) or 42 USC 262.
AB56,1030,2120 (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.
AB56,1030,2222 (c) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB56,1030,2323 (d) “Generic drug” means a prescription drug approved under 21 USC 355 (j).
AB56,1031,3
1(e) “Manufacturer” has the meaning given in s. 450.01 (12). “Manufacturer”
2does not include an entity that is engaged only in the dispensing, as defined in s.
3450.01 (7), of a brand-name drug or a generic drug.
AB56,1031,74 (f) “Manufacturer-sponsored assistance program” means a program offered by
5a manufacturer or an intermediary under contract with a manufacturer through
6which a brand-name drug or a generic drug is provided to a patient at no charge or
7at a discount.
AB56,1031,118 (g) “Margin” means, for a covered hospital, the difference between the net cost
9of a brand-name drug or generic drug covered under the federal drug-pricing
10program under 42 USC 256b and the net payment by the covered hospital for that
11brand-name drug or generic drug.
AB56,1031,1312 (h) “Net payment” means the amount paid for a brand-name drug or generic
13drug after all discounts and rebates have been applied.
AB56,1031,1414 (i) “Pharmacy benefit manager” has the meaning given in s. 632.865 (1) (c).
AB56,1031,1815 (j) “Wholesale acquisition cost” means the most recently reported
16manufacturer list or catalog price for a brand-name drug or a generic drug available
17to wholesalers or direct purchasers in the United States, before application of
18discounts, rebates, or reductions in price.
AB56,1031,24 19(2) Price increase or introduction notice; justification report. (a) A
20manufacturer shall notify the commissioner if it is increasing the wholesale
21acquisition cost of a brand-name drug on the market in this state by more than 10
22percent or by more than $10,000 during any 12-month period or if it intends to
23introduce to market in this state a brand-name drug that has an annual wholesale
24acquisition cost of $30,000 or more.
AB56,1032,4
1(b) A manufacturer shall notify the commissioner if it is increasing the
2wholesale acquisition cost of a generic drug by more than 25 percent or by more than
3$300 during any 12-month period or if it intends to introduce to market a generic
4drug that has an annual wholesale acquisition cost of $3,000 or more.
AB56,1032,105 (c) The manufacturer shall provide the notice under par. (a) or (b) in writing
6at least 30 days before the planned effective date of the cost increase or drug
7introduction with a justification that includes all documents and research related to
8the manufacturer's selection of the cost increase or introduction price and a
9description of life cycle management, market competition and context, and
10estimated value or cost-effectiveness of the product.
AB56,1032,14 11(3) Net prices paid by pharmacy benefit managers. By March 1 annually, the
12manufacturer shall report to the commissioner the value of price concessions,
13expressed as a percentage of the wholesale acquisition cost, provided to each
14pharmacy benefit manager for each drug sold in this state.
AB56,1032,19 15(4) Rebates and price concessions. By March 1 annually, each pharmacy
16benefit manager shall report to the commissioner the amount received from
17manufacturers as drug rebates and the value of price concessions, expressed as a
18percentage of the wholesale acquisition cost, provided by manufacturers for each
19drug.
AB56,1032,24 20(5) Hospital margin spending. By March 1 annually, each covered hospital
21operating in this state shall report to the commissioner the per unit margin for each
22drug covered under the federal drug pricing program under 42 USC 256b dispensed
23in the previous year multiplied by the number of units dispensed at that margin and
24how the margin revenue was used.
AB56,1033,4
1(6) Manufacturer-sponsored assistance programs. By March 1 annually,
2each manufacturer shall provide the commissioner with a description of each
3manufacturer-sponsored patient assistance program in effect during the previous
4year that includes all of the following:
AB56,1033,55 (a) The terms of the programs.
AB56,1033,66 (b) The number of prescriptions provided to state residents under the program.
AB56,1033,87 (c) The total market value of assistance provided to residents of this state under
8the program.
AB56,1033,13 9(7) Certification and penalties for noncompliance. Each manufacturer and
10covered hospital that is required to report under this section shall certify each report
11as accurate under the penalty of perjury. A manufacturer or covered hospital that
12fails to submit a report required under this section is subject to a forfeiture of no more
13than $10,000 each day the report is overdue.
AB56,1033,17 14(8) Hearing and public reporting. (a) The commissioner shall publicly post
15manufacturer price justification documents and covered hospital documentation of
16how each hospital spends the margin revenue. The commissioner shall keep any
17trade secret or proprietary information confidential.
AB56,1033,2518 (b) The commissioner shall analyze data collected under this section and
19publish annually a report on emerging trends in prescription prices and price
20increases, and shall annually conduct a public hearing based on the analysis under
21this paragraph. The report under this paragraph shall include analysis of
22manufacturer prices and price increases, analysis of hospital-specific margins and
23how that revenue is spent or allocated on a hospital-specific basis, and analysis of
24how pharmacy benefit manager discounts and net costs compare to retail prices paid
25by patients.
AB56,1034,8
1(9) Allowing cost disclosure to insured. The commissioner shall ensure that
2every disability insurance policy that covers prescription drugs or biological products
3does not restrict a pharmacy or pharmacist that dispenses a prescription drug or
4biological product from informing and does not penalize a pharmacy or pharmacist
5for informing an insured under a policy of a difference between the negotiated price
6of, or copayment or coinsurance for, the drug or biological product under the policy
7and the price the insured would pay for the drug or biological product if the insured
8obtained the drug or biological product without using any health insurance coverage.
AB56,2096 9Section 2096 . 632.87 (4) of the statutes is amended to read:
AB56,1034,1410 632.87 (4) No policy, plan or contract may exclude coverage for diagnosis and
11treatment of a condition or complaint by a licensed dentist or dental therapist within
12the scope of the dentist's or dental therapist's license, if the policy, plan or contract
13covers diagnosis and treatment of the condition or complaint by another health care
14provider, as defined in s. 146.81 (1) (a) to (p).
AB56,2097 15Section 2097. 632.895 (8) (d) of the statutes is amended to read:
AB56,1034,2216 632.895 (8) (d) Coverage is required under this subsection despite whether the
17woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c), and
18(e), coverage under this subsection may only be subject to exclusions and limitations,
19including deductibles, copayments and restrictions on excessive charges, that are
20applied to other radiological examinations covered under the disability insurance
21policy. Coverage under this subsection may not be subject to any deductibles,
22copayments, or coinsurance.
AB56,2098 23Section 2098. 632.895 (13m) of the statutes is created to read:
AB56,1034,2524 632.895 (13m) Preventive services. (a) In this section, “self-insured health
25plan” has the meaning given in s. 632.85 (1) (c).
AB56,1035,3
1(b) Every disability insurance policy, except any disability insurance policy that
2is described in s. 632.745 (11) (b) 1. to 12., and every self-insured health plan shall
3provide coverage for all of the following preventive services:
AB56,1035,44 1. Mammography in accordance with sub. (8).
AB56,1035,65 2. Genetic breast cancer screening and counseling and preventive medication
6for adult women at high risk for breast cancer.
AB56,1035,87 3. Papanicolaou test for cancer screening for women 21 years of age or older
8with an intact cervix.
AB56,1035,109 4. Human papillomavirus testing for women who have attained the age of 30
10years but have not attained the age of 66 years.
AB56,1035,1111 5. Colorectal cancer screening in accordance with sub. (16m).
AB56,1035,1412 6. Annual tomography for lung cancer screening for adults who have attained
13the age of 55 years but have not attained the age of 80 years and who have health
14histories demonstrating a risk for lung cancer.
AB56,1035,1615 7. Skin cancer screening for individuals who have attained the age of 10 years
16but have not attained the age of 22 years.
AB56,1035,1817 8. Counseling for skin cancer prevention for adults who have attained the age
18of 18 years but have not attained the age of 25 years.
AB56,1035,2019 9. Abdominal aortic aneurysm screening for men who have attained the age of
2065 years but have not attained the age of 75 years and who have ever smoked.
AB56,1035,2321 10. Hypertension screening for adults and blood pressure testing for adults, for
22children under the age of 3 years who are at high risk for hypertension, and for
23children 3 years of age or older.
AB56,1035,2524 11. Lipid disorder screening for minors 2 years of age or older, adults 20 years
25of age or older at high risk for lipid disorders, and all men 35 years of age or older.
AB56,1036,3
112. Aspirin therapy for cardiovascular health for adults who have attained the
2age of 55 years but have not attained the age of 80 years and for men who have
3attained the age of 45 years but have not attained the age of 55 years.
AB56,1036,54 13. Behavioral counseling for cardiovascular health for adults who are
5overweight or obese and who have risk factors for cardiovascular disease.
AB56,1036,66 14. Type II diabetes screening for adults with elevated blood pressure.
AB56,1036,87 15. Depression screening for minors 11 years of age or older and for adults when
8follow-up supports are available.
AB56,1036,109 16. Hepatitis B screening for minors at high risk for infection and adults at high
10risk for infection.
AB56,1036,1211 17. Hepatitis C screening for adults at high risk for infection and one-time
12hepatitis C screening for adults born in any year from 1945 to 1965.
AB56,1036,1613 18. Obesity screening and management for all minors and adults with a body
14mass index indicating obesity, counseling and behavioral interventions for obese
15minors who are 6 years of age or older, and referral for intervention for obesity for
16adults with a body mass index of 30 kilograms per square meter or higher.
AB56,1036,1817 19. Osteoporosis screening for all women 65 years of age or older and for women
18at high risk for osteoporosis under the age of 65 years.
AB56,1036,1919 20. Immunizations in accordance with sub. (14).
AB56,1036,2220 21. Anemia screening for individuals 6 months of age or older and iron
21supplements for individuals at high risk for anemia and who have attained the age
22of 6 months but have not attained the age of 12 months.
AB56,1036,2423 22. Fluoride varnish for prevention of tooth decay for minors at the age of
24eruption of their primary teeth.
AB56,1037,2
123. Fluoride supplements for prevention of tooth decay for minors 6 months of
2age or older who do not have fluoride in their water source.
AB56,1037,33 24. Gonorrhea prophylaxis treatment for newborns.
AB56,1037,44 25. Health history and physical exams for prenatal visits and for minors.
AB56,1037,65 26. Length and weight measurements for newborns and height and weight
6measurements for minors.
AB56,1037,87 27. Head circumference and weight-for-length measurements for newborns
8and minors who have not attained the age of 3 years.
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