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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.
AB56,1037,99 28. Body mass index for minors 2 years of age or older.
AB56,1037,1110 29. Blood pressure measurements for minors 3 years of age or older and a blood
11pressure risk assessment at birth.
AB56,1037,1312 30. Risk assessment and referral for oral health issues for minors who have
13attained the age of 6 months but have not attained the age of 7 years.
AB56,1037,1514 31. Blood screening for newborns and minors who have not attained the age of
152 months.
AB56,1037,1616 32. Screening for critical congenital health defects for newborns.
AB56,1037,1717 33. Lead screenings in accordance with sub. (10).
AB56,1037,1918 34. Metabolic and hemoglobin screening and screening for phenylketonuria,
19sickle cell anemia, and congenital hypothyroidism for minors including newborns.
AB56,1037,2120 35. Tuberculin skin test based on risk assessment for minors one month of age
21or older.
AB56,1037,2322 36. Tobacco counseling and cessation interventions for individuals who are 5
23years of age or older.
AB56,1037,2524 37. Vision and hearing screening and assessment for minors including
25newborns.
AB56,1038,2
138. Sexually transmitted infection and human immunodeficiency virus
2counseling for sexually active minors.
AB56,1038,53 39. Risk assessment for sexually transmitted infection for minors who are 10
4years of age or older and screening for sexually transmitted infection for minors who
5are 16 years of age or older.
AB56,1038,66 40. Alcohol misuse screening and counseling for minors 11 years of age or older.
AB56,1038,87 41. Autism screening for minors who have attained the age of 18 months but
8have not attained the age of 25 months.
AB56,1038,99 42. Developmental screening and surveillance for minors including newborns.
AB56,1038,1010 43. Psychosocial and behavioral assessment for minors including newborns.
AB56,1038,1211 44. Alcohol misuse screening and counseling for pregnant adults and a risk
12assessment for all adults.
AB56,1038,1413 45. Fall prevention and counseling and preventive medication for fall
14prevention for community-dwelling adults 65 years of age or older.
AB56,1038,1515 46. Screening and counseling for intimate partner violence for adult women.
AB56,1038,1816 47. Well-woman visits for women who have attained the age of 18 years but
17have not attained the age of 65 years and well-woman visits for recommended
18preventive services, preconception care, and prenatal care.
AB56,1038,2019 48. Counseling on, consultations with a trained provider on, and equipment
20rental for breastfeeding for pregnant and lactating women.
AB56,1038,2121 49. Folic acid supplement for adult women with reproductive capacity.
AB56,1038,2222 50. Iron deficiency anemia screening for pregnant and lactating women.
AB56,1038,2423 51. Preeclampsia preventive medicine for pregnant adult women at high risk
24for preeclampsia.
AB56,1039,2
152. Low-dose aspirin after 12 weeks of gestation for pregnant women at high
2risk for miscarriage, preeclampsia, or clotting disorders.
AB56,1039,33 53. Screenings for hepatitis B and bacteriuria for pregnant women.
AB56,1039,54 54. Screening for gonorrhea for pregnant and sexually active females 24 years
5of age or younger and females older than 24 years of age who are at risk for infection.
AB56,1039,86 55. Screening for chlamydia for pregnant and sexually active females 24 years
7of age and younger and females older than 24 years of age who are at risk for
8infection.
AB56,1039,109 56. Screening for syphilis for pregnant women and adults who are at high risk
10for infection.
AB56,1039,1311 57. Human immunodeficiency virus screening for adults who have attained the
12age of 15 years but have not attained the age of 66 years and individuals at high risk
13of infection who are younger than 15 years of age or older than 65 years of age.
AB56,1039,1414 58. All contraceptives and services in accordance with sub. (17).
AB56,1039,1615 59. Any services not already specified under this paragraph having an A or B
16rating in current recommendations from the U.S. preventive services task force.
AB56,1039,1917 60. Any preventive services not already specified under this paragraph that are
18recommended by the federal health resources and services administration's Bright
19Futures project.
AB56,1039,2220 61. Any immunizations, not already specified under sub. (14), that are
21recommended and determined to be for routine use by the federal advisory
22committee on immunization practices.
AB56,1039,2523 (c) Subject to par. (d), no disability insurance policy and no self-insured health
24plan may subject the coverage of any of the preventive services under par. (b) to any
25deductibles, copayments, or coinsurance under the policy or plan.
AB56,1040,4
1(d) 1. If an office visit and a preventive service specified under par. (b) are billed
2separately by the health care provider, the disability insurance policy or self-insured
3health plan may apply deductibles to and impose copayments or coinsurance on the
4office visit but not on the preventive service.
AB56,1040,75 2. If the primary reason for an office visit is not to obtain a preventive service,
6the disability insurance policy or self-insured health plan may apply deductibles to
7and impose copayments or coinsurance on the office visit.
AB56,1040,178 3. Except as otherwise provided in this subdivision, if a preventive service
9specified under par. (b) is provided by a health care provider that is outside the
10disability insurance policy's or self-insured health plan's network of providers, the
11policy or plan may apply deductibles to and impose copayments or coinsurance on the
12office visit and the preventive service. If a preventive service specified under par. (b)
13is provided by a health care provider that is outside the disability insurance policy's
14or self-insured health plan's network of providers because there is no available
15health care provider in the policy's or plan's network of providers that provides the
16preventive service, the policy or plan may not apply deductibles to or impose
17copayments or coinsurance on the preventive service.
AB56,1040,2218 4. If multiple well-woman visits described under par. (b) 47. are required to
19fulfill all necessary preventive services and are in accordance with clinical
20recommendations, the disability insurance policy or self-insured health plan may
21not apply a deductible to or impose a copayment or coinsurance on any of those
22well-woman visits.
AB56,2099 23Section 2099. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:
AB56,1040,2424 632.895 (14) (a) 1. i. Hepatitis A and B.
AB56,1040,2525 j. Varicella and herpes zoster.
AB56,2100
1Section 2100. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:
AB56,1041,22 632.895 (14) (a) 1. k. Human papillomavirus.
AB56,1041,33 L. Meningococcal meningitis.
AB56,1041,44 m. Pneumococcal pneumonia.
AB56,1041,55 n. Influenza.
AB56,1041,66 o. Rotavirus.
AB56,2101 7Section 2101. 632.895 (14) (b) of the statutes is amended to read:
AB56,1041,138 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy,
9and every self-insured health plan of the state or a county, city, town, village, or
10school district, that provides coverage for a dependent of the insured shall provide
11coverage of appropriate and necessary immunizations, from birth to the age of 6
12years,
for an insured or plan participant, including a dependent who is a child of the
13insured or plan participant.
AB56,2102 14Section 2102. 632.895 (14) (c) of the statutes is amended to read:
AB56,1041,1915 632.895 (14) (c) The coverage required under par. (b) may not be subject to any
16deductibles, copayments, or coinsurance under the policy or plan. This paragraph
17applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to
18appropriate and necessary immunizations provided by providers participating, as
19defined in s. 609.01 (3m), in the plan.
AB56,2103 20Section 2103. 632.895 (14) (d) 3. of the statutes is amended to read:
AB56,1041,2321 632.895 (14) (d) 3. A health care plan offered by a limited service health
22organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined
23in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b)
.
AB56,2104 24Section 2104. 632.895 (14m) of the statutes is created to read:
AB56,1042,2
1632.895 (14m) Essential health benefits. (a) In this subsection,
2“self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB56,1042,63 (b) On a date specified by the commissioner, by rule, every disability insurance
4policy, except as provided in par. (g), and every self-insured health plan shall provide
5coverage for essential health benefits as determined by the commissioner, by rule,
6subject to par. (c).
AB56,1042,87 (c) In determining the essential health benefits for which coverage is required
8under par. (b), the commissioner shall do all of the following:
AB56,1042,109 1. Include benefits, items, and services in, at least, all of the following
10categories:
AB56,1042,1111 a. Ambulatory patient services.
AB56,1042,1212 b. Emergency services.
AB56,1042,1313 c. Hospitalization.
AB56,1042,1414 d. Maternity and newborn care.
AB56,1042,1615 e. Mental health and substance use disorder services, including behavioral
16health treatment.
AB56,1042,1717 f. Prescription drugs.
AB56,1042,1818 g. Rehabilitative and habilitative services and devices.
AB56,1042,1919 h. Laboratory services.
AB56,1042,2020 i. Preventive and wellness services and chronic disease management.
AB56,1042,2121 j. Pediatric services, including oral and vision care.
AB56,1043,222 2. Conduct a survey of employer-sponsored coverage to determine benefits
23typically covered by employers and ensure that the scope of essential health benefits
24for which coverage is required under this subsection is equal to the scope of benefits

1covered under a typical disability insurance policy offered by an employer to its
2employees.
AB56,1043,43 3. Ensure that essential health benefits reflect a balance among the categories
4described in subd. 1. such that benefits are not unduly weighted toward one category.
AB56,1043,65 4. Ensure that essential health benefit coverage is provided with no or limited
6cost-sharing requirements.
AB56,1043,107 5. Require that disability insurance policies and self-insured health plans do
8not make coverage decisions, determine reimbursement rates, establish incentive
9programs, or design benefits in ways that discriminate against individuals because
10of their age, disability, or expected length of life.
AB56,1043,1311 6. Establish essential health benefits in a way that takes into account the
12health care needs of diverse segments of the population, including women, children,
13persons with disabilities, and other groups.
AB56,1043,1714 7. Ensure that essential health benefits established under this subsection are
15not subject to a coverage denial based on an insured's or plan participant's age,
16expected length of life, present or predicted disability, degree of dependency on
17medical care, or quality of life.
AB56,1043,2418 8. Require that disability insurance policies and self-insured health plans
19cover emergency department services that are essential health benefits without
20imposing any requirement to obtain prior authorization for those services and
21without limiting coverage for services provided by an emergency services provider
22that is not in the provider network of a policy or plan in a way that is more restrictive
23than requirements or limitations that apply to emergency services provided by a
24provider that is in the provider network of the policy or plan.
AB56,1044,5
19. Require a disability insurance policy or self-insured health plan to apply to
2emergency department services that are essential health benefits provided by an
3emergency department provider that is not in the provider network of the policy or
4plan the same copayment amount or coinsurance rate that applies if those services
5are provided by a provider that is in the provider network of the policy or plan.
AB56,1044,76 (d) The commissioner shall periodically update, by rule, the essential health
7benefits under this subsection to address any gaps in access to coverage.
AB56,1044,128 (e) If an essential health benefit is also subject to mandated coverage elsewhere
9under this section and the coverage requirements are not identical, the disability
10insurance policy or self-insured health plan shall provide coverage under whichever
11subsection provides the insured or plan participant with more comprehensive
12coverage of the medical condition, item, or service.
AB56,1044,1613 (f) Nothing in this subsection or rules promulgated under this subsection
14prohibits a disability insurance policy or a self-insured health plan from providing
15benefits in excess of the essential health benefit coverage required under this
16subsection.
AB56,1044,1817 (g) This subsection does not apply to any disability insurance policy that is
18described in s. 632.745 (11) (b) 1. to 12.
AB56,2105 19Section 2105. 632.895 (16m) (b) of the statutes is amended to read:
AB56,1044,2420 632.895 (16m) (b) The coverage required under this subsection may be subject
21to any limitations, or exclusions, or cost-sharing provisions that apply generally
22under the disability insurance policy or self-insured health plan. The coverage
23required under this subsection may not be subject to any deductibles, copayments,
24or coinsurance.
AB56,2106 25Section 2106. 632.895 (17) (b) 2. of the statutes is amended to read:
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