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AB68-ASA2-AA2,412g 7Section 412g. 609.847 of the statutes is created to read:
AB68-ASA2-AA2,77,10 8609.847 Preexisting condition discrimination and certain benefit
9limits prohibited.
Limited service health organizations, preferred provider plans,
10and defined network plans are subject to s. 632.728.
AB68-ASA2-AA2,412h 11Section 412h. 625.12 (1) (a) of the statutes is amended to read:
AB68-ASA2-AA2,77,1312 625.12 (1) (a) Past and prospective loss and expense experience within and
13outside of this state, except as provided in s. 632.728.
AB68-ASA2-AA2,412i 14Section 412i. 625.12 (1) (e) of the statutes is amended to read:
AB68-ASA2-AA2,77,1615 625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors,
16including the judgment of technical personnel.
AB68-ASA2-AA2,412j 17Section 412j. 625.12 (2) of the statutes is amended to read:
AB68-ASA2-AA2,78,218 625.12 (2) Classification. Except as provided in s. ss. 632.728 and 632.729,
19risks may be classified in any reasonable way for the establishment of rates and
20minimum premiums, except that no classifications may be based on race, color, creed
21or national origin, and classifications in automobile insurance may not be based on
22physical condition or developmental disability as defined in s. 51.01 (5). Subject to
23ss. 632.365, 632.728, and 632.729, rates thus produced may be modified for
24individual risks in accordance with rating plans or schedules that establish

1reasonable standards for measuring probable variations in hazards, expenses, or
2both. Rates may also be modified for individual risks under s. 625.13 (2).
AB68-ASA2-AA2,412k 3Section 412k. 625.15 (1) of the statutes is amended to read:
AB68-ASA2-AA2,78,114 625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may
5itself establish rates and supplementary rate information for one or more market
6segments based on the factors in s. 625.12 and, if the rates are for motor vehicle
7liability insurance, subject to s. 632.365, or the insurer may use rates and
8supplementary rate information prepared by a rate service organization, with
9average expense factors determined by the rate service organization or with such
10modification for its own expense and loss experience as the credibility of that
11experience allows.
AB68-ASA2-AA2,412L 12Section 412L. 628.34 (3) (a) of the statutes is amended to read:
AB68-ASA2-AA2,78,2013 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by
14charging different premiums or by offering different terms of coverage except on the
15basis of classifications related to the nature and the degree of the risk covered or the
16expenses involved, subject to ss. 632.365, 632.729, 632.746 and, 632.748, and
17632.7496
. Rates are not unfairly discriminatory if they are averaged broadly among
18persons insured under a group, blanket or franchise policy, and terms are not
19unfairly discriminatory merely because they are more favorable than in a similar
20individual policy.
AB68-ASA2-AA2,412m 21Section 412m. 628.34 (3) (a) of the statutes, as affected by 2021 Wisconsin Act
22.... (this act), section 412L, is amended to read:
AB68-ASA2-AA2,79,523 628.34 (3) (a) No insurer may unfairly discriminate among policyholders by
24charging different premiums or by offering different terms of coverage except on the
25basis of classifications related to the nature and the degree of the risk covered or the

1expenses involved, subject to ss. 632.365, 632.728, 632.729, 632.746, 632.748, and
2632.7496. Rates are not unfairly discriminatory if they are averaged broadly among
3persons insured under a group, blanket or franchise policy, and terms are not
4unfairly discriminatory merely because they are more favorable than in a similar
5individual policy.
AB68-ASA2-AA2,412n 6Section 412n. 632.728 of the statutes is created to read:
AB68-ASA2-AA2,79,8 7632.728 Coverage of persons with preexisting conditions; guaranteed
8issue; benefit limits.
(1) Definitions. In this section:
AB68-ASA2-AA2,79,109 (a) “Cost sharing” includes deductibles, coinsurance, copayments, or similar
10charges.
AB68-ASA2-AA2,79,1111 (b) “Health benefit plan” has the meaning given in s. 632.745 (11).
AB68-ASA2-AA2,79,1212 (c) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB68-ASA2-AA2,79,18 13(2) Guaranteed issue. (a) Every individual health benefit plan shall accept
14every individual in this state who, and every group health benefit plan shall accept
15every employer in this state that, applies for coverage, regardless of sexual
16orientation, gender identity, or whether or not any employee or individual has a
17preexisting condition. A health benefit plan may restrict enrollment in coverage
18described in this paragraph to open or special enrollment periods.
AB68-ASA2-AA2,79,2119 (b) The commissioner shall establish a statewide open enrollment period of no
20shorter than 30 days for every individual health benefit plan to allow individuals,
21including individuals who do not have coverage, to enroll in coverage.
AB68-ASA2-AA2,80,2 22(3) Prohibiting discrimination based on health status. (a) An individual
23health benefit plan or a self-insured health plan may not establish rules for the
24eligibility of any individual to enroll, or for the continued eligibility of any individual

1to remain enrolled, under the plan based on any of the following health
2status-related factors in relation to the individual or a dependent of the individual:
AB68-ASA2-AA2,80,33 1. Health status.
AB68-ASA2-AA2,80,44 2. Medical condition, including both physical and mental illnesses.
AB68-ASA2-AA2,80,55 3. Claims experience.
AB68-ASA2-AA2,80,66 4. Receipt of health care.
AB68-ASA2-AA2,80,77 5. Medical history.
AB68-ASA2-AA2,80,88 6. Genetic information.
AB68-ASA2-AA2,80,109 7. Evidence of insurability, including conditions arising out of acts of domestic
10violence.
AB68-ASA2-AA2,80,1111 8. Disability.
AB68-ASA2-AA2,80,1812 (b) An insurer offering an individual health benefit plan or a self-insured
13health plan may not require any individual, as a condition of enrollment or continued
14enrollment under the plan, to pay, on the basis of any health status-related factor
15under par. (a) with respect to the individual or a dependent of the individual, a
16premium or contribution or a deductible, copayment, or coinsurance amount that is
17greater than the premium or contribution or deductible, copayment, or coinsurance
18amount respectively for a similarly situated individual enrolled under the plan.
AB68-ASA2-AA2,80,2219 (c) Nothing in this subsection prevents an insurer offering an individual health
20benefit plan or a self-insured health plan from establishing premium discounts or
21rebates or modifying otherwise applicable cost sharing in return for adherence to
22programs of health promotion and disease prevention.
AB68-ASA2-AA2,80,25 23(4) Premium rate variation. A health benefit plan offered on the individual or
24small employer market or a self-insured health plan may vary premium rates for a
25specific plan based only on the following considerations:
AB68-ASA2-AA2,81,1
1(a) Whether the policy or plan covers an individual or a family.
AB68-ASA2-AA2,81,22 (b) Rating area in the state, as established by the commissioner.
AB68-ASA2-AA2,81,53 (c) Age, except that the rate may not vary by more than 3 to 1 for adults over
4the age groups and the age bands shall be consistent with recommendations of the
5National Association of Insurance Commissioners.
AB68-ASA2-AA2,81,66 (d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
AB68-ASA2-AA2,81,11 7(5) Statewide risk pool. An insurer offering a health benefit plan may not
8segregate enrollees into risk pools other than a single statewide risk pool for the
9individual market and a single statewide risk pool for the small employer market or
10a single statewide risk pool that combines the individual and small employer
11markets.
AB68-ASA2-AA2,81,13 12(6) Annual and lifetime limits. An individual or group health benefit plan or
13a self-insured health plan may not establish any of the following:
AB68-ASA2-AA2,81,1514 (a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent
15of an enrollee under the plan.
AB68-ASA2-AA2,81,1716 (b) Annual limits on the dollar value of benefits for an enrollee or a dependent
17of an enrollee under the plan.
AB68-ASA2-AA2,81,21 18(7) Cost sharing maximum. A health benefit plan offered on the individual or
19small employer market may not require an enrollee under the plan to pay more in
20cost sharing than the maximum amount calculated under 42 USC 18022 (c),
21including the annual indexing of the limits.
AB68-ASA2-AA2,81,24 22(8) Medical loss ratio. (a) In this subsection, “medical loss ratio” means the
23proportion, expressed as a percentage, of premium revenues spent by a health
24benefit plan on clinical services and quality improvement.
AB68-ASA2-AA2,82,2
1(b) A health benefit plan on the individual or small employer market shall have
2a medical loss ratio of at least 80 percent.
AB68-ASA2-AA2,82,43 (c) A group health benefit plan other than one described under par. (b) shall
4have a medical loss ratio of at least 85 percent.
AB68-ASA2-AA2,82,8 5(9) Actuarial values of plan tiers. Any health benefit plan offered on the
6individual or small employer market shall provide a level of coverage that is designed
7to provide benefits that are actuarially equivalent to at least 60 percent of the full
8actuarial value of the benefits provided under the plan.
AB68-ASA2-AA2,412p 9Section 412p. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and
10amended to read:
AB68-ASA2-AA2,82,1711 632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health
12benefit plan may, with respect to a participant or beneficiary under the plan, not
13impose a preexisting condition exclusion only if the exclusion relates to a condition,
14whether physical or mental, regardless of the cause of the condition, for which
15medical advice, diagnosis, care or treatment was recommended or received within
16the 6-month period ending on the participant's or beneficiary's enrollment date
17under the plan
on a participant or beneficiary under the plan.
AB68-ASA2-AA2,412q 18Section 412q. 632.746 (1) (b) of the statutes is repealed.
AB68-ASA2-AA2,412r 19Section 412r. 632.746 (2) (a) of the statutes is amended to read:
AB68-ASA2-AA2,82,2320 632.746 (2) (a) An insurer offering a group health benefit plan may not treat
21impose a preexisting condition exclusion based on genetic information as a
22preexisting condition under sub. (1) without a diagnosis of a condition related to the
23information
.
AB68-ASA2-AA2,412s 24Section 412s. 632.746 (2) (c), (d) and (e) of the statutes are repealed.
AB68-ASA2-AA2,412t 25Section 412t. 632.746 (3) (a) of the statutes is repealed.
AB68-ASA2-AA2,412u
1Section 412u. 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).
AB68-ASA2-AA2,412v 2Section 412v. 632.746 (3) (d) 2. and 3. of the statutes are repealed.
AB68-ASA2-AA2,412w 3Section 412w. 632.746 (5) of the statutes is repealed.
AB68-ASA2-AA2,412x 4Section 412x. 632.746 (8) (a) (intro.) of the statutes is amended to read:
AB68-ASA2-AA2,83,85 632.746 (8) (a) (intro.) A health maintenance organization that offers a group
6health benefit plan and that does not impose any preexisting condition exclusion
7under sub. (1)
with respect to a particular coverage option may impose an affiliation
8period for that coverage option, but only if all of the following apply:
AB68-ASA2-AA2,412y 9Section 412y. 632.748 (2) of the statutes is amended to read:
AB68-ASA2-AA2,83,1610 632.748 (2) An insurer offering a group health benefit plan may not require any
11individual, as a condition of enrollment or continued enrollment under the plan, to
12pay, on the basis of any health status-related factor with respect to the individual
13or a dependent of the individual, a premium or contribution or a deductible,
14copayment, or coinsurance amount
that is greater than the premium or contribution
15or deductible, copayment, or coinsurance amount respectively for a similarly
16situated individual enrolled under the plan.
AB68-ASA2-AA2,412yc 17Section 412yc. 632.7495 (4) (b) of the statutes is amended to read:
AB68-ASA2-AA2,83,1818 632.7495 (4) (b) The coverage has a term of not more than 12 3 months.
AB68-ASA2-AA2,412ye 19Section 412ye. 632.7495 (4) (c) of the statutes is amended to read:
AB68-ASA2-AA2,83,2420 632.7495 (4) (c) The coverage term aggregated with all consecutive periods of
21the insurer's coverage of the insured by individual health benefit plan coverage not
22required to be renewed under this subsection does not exceed 18 6 months. For
23purposes of this paragraph, coverage periods are consecutive if there are no more
24than 63 days between the coverage periods.
AB68-ASA2-AA2,412yg 25Section 412yg. 632.7496 of the statutes is created to read:
AB68-ASA2-AA2,84,3
1632.7496 Coverage requirements for short-term plans. (1) Definition.
2In this section, “short-term, limited duration plan” means an individual health
3benefit plan described in s. 632.7495 (4) that an insurer is not required to renew.
AB68-ASA2-AA2,84,6 4(2) Guaranteed issue. Every short-term, limited duration plan shall accept
5every individual in this state who applies for coverage whether or not any individual
6has a preexisting condition.
AB68-ASA2-AA2,84,11 7(3) Prohibiting discrimination based on health status. (a) A short-term,
8limited duration plan may not establish rules for the eligibility of any individual to
9enroll, or for the continued eligibility of any individual to remain enrolled, under the
10plan based on any of the following health status-related factors in relation to the
11individual or a dependent of the individual:
AB68-ASA2-AA2,84,1212 1. Health status.
AB68-ASA2-AA2,84,1313 2. Medical condition, including both physical and mental illnesses.
AB68-ASA2-AA2,84,1414 3. Claims experience.
AB68-ASA2-AA2,84,1515 4. Receipt of health care.
AB68-ASA2-AA2,84,1616 5. Medical history.
AB68-ASA2-AA2,84,1717 6. Genetic information.
AB68-ASA2-AA2,84,1918 7. Evidence of insurability, including conditions arising out of acts of domestic
19violence.
AB68-ASA2-AA2,84,2020 8. Disability.
AB68-ASA2-AA2,85,221 (b) A short-term, limited duration plan may not require any individual, as a
22condition of enrollment or continued enrollment under the plan, to pay, on the basis
23of any health status-related factor under par. (a) with respect to the individual or a
24dependent of the individual, a premium or contribution or a deductible, copayment,
25or coinsurance amount that is greater than the premium or contribution or

1deductible, copayment, or coinsurance amount respectively for a similarly situated
2individual enrolled under the plan.
AB68-ASA2-AA2,85,4 3(4) Premium rate variation. A short-term, limited duration plan may vary
4premium rates for a specific plan based only on the following considerations:
AB68-ASA2-AA2,85,55 (a) Whether the policy or plan covers an individual or a family.
AB68-ASA2-AA2,85,66 (b) Rating area in the state, as established by the commissioner.
AB68-ASA2-AA2,85,97 (c) Age, except that the rate may not vary by more than 3 to 1 for adults over
8the age groups and the age bands shall be consistent with recommendations of the
9National Association of Insurance Commissioners.
AB68-ASA2-AA2,85,1010 (d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
AB68-ASA2-AA2,85,12 11(5) Annual and lifetime limits. A short-term, limited duration plan may not
12establish any of the following:
AB68-ASA2-AA2,85,1413 (a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent
14of an enrollee under the plan.
AB68-ASA2-AA2,85,1615 (b) Limits on the dollar value of benefits for an enrollee or a dependent of an
16enrollee under the plan for the initial or cumulative duration of the plan.
AB68-ASA2-AA2,412yj 17Section 412yj. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to
18read:
AB68-ASA2-AA2,86,219 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
20from the date of issue of the policy may be reduced or denied on the ground that a
21disease or physical condition existed prior to the effective date of coverage, unless the
22condition was excluded from coverage by name or specific description by a provision
23effective on the date of loss. This paragraph does not apply to a group health benefit
24plan, as defined in s. 632.745 (9), which is subject to s. 632.746 , a disability insurance

1policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s.
2632.85 (1) (c)
.
AB68-ASA2-AA2,86,83 (ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability
4commencing after 12 months from the date of issue of under an individual disability
5insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the
6ground that a disease or physical condition existed prior to the effective date of
7coverage, unless the condition was excluded from coverage by name or specific
8description by a provision effective on the date of the loss
.
AB68-ASA2-AA2,86,159 2. Except as provided in subd. 3., an An individual disability insurance policy,
10as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495
11(4) and (5), may not define a preexisting condition more restrictively than a condition
12that was present before the date of enrollment for the coverage, whether physical or
13mental, regardless of the cause of the condition, for which and regardless of whether
14medical advice, diagnosis, care, or treatment was recommended or received within
1512 months before the effective date of coverage
.
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