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AB68-ASA2-AA2,108,2120 22. Fluoride varnish for prevention of tooth decay for minors at the age of
21eruption of their primary teeth.
AB68-ASA2-AA2,108,2322 23. Fluoride supplements for prevention of tooth decay for minors 6 months of
23age or older who do not have fluoride in their water source.
AB68-ASA2-AA2,108,2424 24. Gonorrhea prophylaxis treatment for newborns.
AB68-ASA2-AA2,108,2525 25. Health history and physical exams for prenatal visits and for minors.
AB68-ASA2-AA2,109,2
126. Length and weight measurements for newborns and height and weight
2measurements for minors.
AB68-ASA2-AA2,109,43 27. Head circumference and weight-for-length measurements for newborns
4and minors who have not attained the age of 3 years.
AB68-ASA2-AA2,109,55 28. Body mass index for minors 2 years of age or older.
AB68-ASA2-AA2,109,76 29. Blood pressure measurements for minors 3 years of age or older and a blood
7pressure risk assessment at birth.
AB68-ASA2-AA2,109,98 30. Risk assessment and referral for oral health issues for minors who have
9attained the age of 6 months but have not attained the age of 7 years.
AB68-ASA2-AA2,109,1110 31. Blood screening for newborns and minors who have not attained the age of
112 months.
AB68-ASA2-AA2,109,1212 32. Screening for critical congenital health defects for newborns.
AB68-ASA2-AA2,109,1313 33. Lead screenings in accordance with sub. (10).
AB68-ASA2-AA2,109,1514 34. Metabolic and hemoglobin screening and screening for phenylketonuria,
15sickle cell anemia, and congenital hypothyroidism for minors including newborns.
AB68-ASA2-AA2,109,1716 35. Tuberculin skin test based on risk assessment for minors one month of age
17or older.
AB68-ASA2-AA2,109,1918 36. Tobacco counseling and cessation interventions for individuals who are 5
19years of age or older.
AB68-ASA2-AA2,109,2120 37. Vision and hearing screening and assessment for minors including
21newborns.
AB68-ASA2-AA2,109,2322 38. Sexually transmitted infection and human immunodeficiency virus
23counseling for sexually active minors.
AB68-ASA2-AA2,110,3
139. Risk assessment for sexually transmitted infection for minors who are 10
2years of age or older and screening for sexually transmitted infection for minors who
3are 16 years of age or older.
AB68-ASA2-AA2,110,44 40. Alcohol misuse screening and counseling for minors 11 years of age or older.
AB68-ASA2-AA2,110,65 41. Autism screening for minors who have attained the age of 18 months but
6have not attained the age of 25 months.
AB68-ASA2-AA2,110,77 42. Developmental screening and surveillance for minors including newborns.
AB68-ASA2-AA2,110,88 43. Psychosocial and behavioral assessment for minors including newborns.
AB68-ASA2-AA2,110,109 44. Alcohol misuse screening and counseling for pregnant adults and a risk
10assessment for all adults.
AB68-ASA2-AA2,110,1211 45. Fall prevention and counseling and preventive medication for fall
12prevention for community-dwelling adults 65 years of age or older.
AB68-ASA2-AA2,110,1313 46. Screening and counseling for intimate partner violence for adult women.
AB68-ASA2-AA2,110,1614 47. Well-woman visits for women who have attained the age of 18 years but
15have not attained the age of 65 years and well-woman visits for recommended
16preventive services, preconception care, and prenatal care.
AB68-ASA2-AA2,110,1817 48. Counseling on, consultations with a trained provider on, and equipment
18rental for breastfeeding for pregnant and lactating women.
AB68-ASA2-AA2,110,1919 49. Folic acid supplement for adult women with reproductive capacity.
AB68-ASA2-AA2,110,2020 50. Iron deficiency anemia screening for pregnant and lactating women.
AB68-ASA2-AA2,110,2221 51. Preeclampsia preventive medicine for pregnant adult women at high risk
22for preeclampsia.
AB68-ASA2-AA2,110,2423 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high
24risk for miscarriage, preeclampsia, or clotting disorders.
AB68-ASA2-AA2,110,2525 53. Screenings for hepatitis B and bacteriuria for pregnant women.
AB68-ASA2-AA2,111,2
154. Screening for gonorrhea for pregnant and sexually active females 24 years
2of age or younger and females older than 24 years of age who are at risk for infection.
AB68-ASA2-AA2,111,53 55. Screening for chlamydia for pregnant and sexually active females 24 years
4of age and younger and females older than 24 years of age who are at risk for
5infection.
AB68-ASA2-AA2,111,76 56. Screening for syphilis for pregnant women and adults who are at high risk
7for infection.
AB68-ASA2-AA2,111,108 57. Human immunodeficiency virus screening for adults who have attained the
9age of 15 years but have not attained the age of 66 years and individuals at high risk
10of infection who are younger than 15 years of age or older than 65 years of age.
AB68-ASA2-AA2,111,1111 58. All contraceptives and services in accordance with sub. (17).
AB68-ASA2-AA2,111,1312 59. Any services not already specified under this paragraph having an A or B
13rating in current recommendations from the U.S. preventive services task force.
AB68-ASA2-AA2,111,1614 60. Any preventive services not already specified under this paragraph that are
15recommended by the federal health resources and services administration's Bright
16Futures project.
AB68-ASA2-AA2,111,1917 61. Any immunizations, not already specified under sub. (14), that are
18recommended and determined to be for routine use by the federal advisory
19committee on immunization practices.
AB68-ASA2-AA2,111,2220 (c) Subject to par. (d), no disability insurance policy and no self-insured health
21plan may subject the coverage of any of the preventive services under par. (b) to any
22deductibles, copayments, or coinsurance under the policy or plan.
AB68-ASA2-AA2,112,223 (d) 1. If an office visit and a preventive service specified under par. (b) are billed
24separately by the health care provider, the disability insurance policy or self-insured

1health plan may apply deductibles to and impose copayments or coinsurance on the
2office visit but not on the preventive service.
AB68-ASA2-AA2,112,53 2. If the primary reason for an office visit is not to obtain a preventive service,
4the disability insurance policy or self-insured health plan may apply deductibles to
5and impose copayments or coinsurance on the office visit.
AB68-ASA2-AA2,112,156 3. Except as otherwise provided in this subdivision, if a preventive service
7specified under par. (b) is provided by a health care provider that is outside the
8disability insurance policy's or self-insured health plan's network of providers, the
9policy or plan may apply deductibles to and impose copayments or coinsurance on the
10office visit and the preventive service. If a preventive service specified under par. (b)
11is provided by a health care provider that is outside the disability insurance policy's
12or self-insured health plan's network of providers because there is no available
13health care provider in the policy's or plan's network of providers that provides the
14preventive service, the policy or plan may not apply deductibles to or impose
15copayments or coinsurance on the preventive service.
AB68-ASA2-AA2,112,2016 4. If multiple well-woman visits described under par. (b) 47. are required to
17fulfill all necessary preventive services and are in accordance with clinical
18recommendations, the disability insurance policy or self-insured health plan may
19not apply a deductible to or impose a copayment or coinsurance on any of those
20well-woman visits.
AB68-ASA2-AA2,412zn 21Section 412zn. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:
AB68-ASA2-AA2,112,2222 632.895 (14) (a) 1. i. Hepatitis A and B.
AB68-ASA2-AA2,112,2323 j. Varicella and herpes zoster.
AB68-ASA2-AA2,412zp 24Section 412zp. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:
AB68-ASA2-AA2,112,2525 632.895 (14) (a) 1. k. Human papillomavirus.
AB68-ASA2-AA2,113,1
1L. Meningococcal meningitis.
AB68-ASA2-AA2,113,22 m. Pneumococcal pneumonia.
AB68-ASA2-AA2,113,33 n. Influenza.
AB68-ASA2-AA2,113,44 o. Rotavirus.
AB68-ASA2-AA2,412zq 5Section 412zq. 632.895 (14) (b) of the statutes is amended to read:
AB68-ASA2-AA2,113,116 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy,
7and every self-insured health plan of the state or a county, city, town, village, or
8school district, that provides coverage for a dependent of the insured shall provide
9coverage of appropriate and necessary immunizations, from birth to the age of 6
10years,
for an insured or plan participant, including a dependent who is a child of the
11insured or plan participant.
AB68-ASA2-AA2,412zr 12Section 412zr. 632.895 (14) (c) of the statutes is amended to read:
AB68-ASA2-AA2,113,1713 632.895 (14) (c) The coverage required under par. (b) may not be subject to any
14deductibles, copayments, or coinsurance under the policy or plan. This paragraph
15applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to
16appropriate and necessary immunizations provided by providers participating, as
17defined in s. 609.01 (3m), in the plan.
AB68-ASA2-AA2,412zs 18Section 412zs. 632.895 (14) (d) 3. of the statutes is amended to read:
AB68-ASA2-AA2,113,2119 632.895 (14) (d) 3. A health care plan offered by a limited service health
20organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined
21in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b)
.
AB68-ASA2-AA2,412zt 22Section 412zt. 632.895 (14m) of the statutes is created to read:
AB68-ASA2-AA2,113,2423 632.895 (14m) Essential health benefits. (a) In this subsection,
24“self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB68-ASA2-AA2,114,4
1(b) On a date specified by the commissioner, by rule, every disability insurance
2policy, except as provided in par. (g), and every self-insured health plan shall provide
3coverage for essential health benefits as determined by the commissioner, by rule,
4subject to par. (c).
AB68-ASA2-AA2,114,65 (c) In determining the essential health benefits for which coverage is required
6under par. (b), the commissioner shall do all of the following:
AB68-ASA2-AA2,114,87 1. Include benefits, items, and services in, at least, all of the following
8categories:
AB68-ASA2-AA2,114,99 a. Ambulatory patient services.
AB68-ASA2-AA2,114,1010 b. Emergency services.
AB68-ASA2-AA2,114,1111 c. Hospitalization.
AB68-ASA2-AA2,114,1212 d. Maternity and newborn care.
AB68-ASA2-AA2,114,1413 e. Mental health and substance use disorder services, including behavioral
14health treatment.
AB68-ASA2-AA2,114,1515 f. Prescription drugs.
AB68-ASA2-AA2,114,1616 g. Rehabilitative and habilitative services and devices.
AB68-ASA2-AA2,114,1717 h. Laboratory services.
AB68-ASA2-AA2,114,1818 i. Preventive and wellness services and chronic disease management.
AB68-ASA2-AA2,114,1919 j. Pediatric services, including oral and vision care.
AB68-ASA2-AA2,114,2420 2. Conduct a survey of employer-sponsored coverage to determine benefits
21typically covered by employers and ensure that the scope of essential health benefits
22for which coverage is required under this subsection is equal to the scope of benefits
23covered under a typical disability insurance policy offered by an employer to its
24employees.
AB68-ASA2-AA2,115,2
13. Ensure that essential health benefits reflect a balance among the categories
2described in subd. 1. such that benefits are not unduly weighted toward one category.
AB68-ASA2-AA2,115,43 4. Ensure that essential health benefit coverage is provided with no or limited
4cost-sharing requirements.
AB68-ASA2-AA2,115,85 5. Require that disability insurance policies and self-insured health plans do
6not make coverage decisions, determine reimbursement rates, establish incentive
7programs, or design benefits in ways that discriminate against individuals because
8of their age, disability, or expected length of life.
AB68-ASA2-AA2,115,119 6. Establish essential health benefits in a way that takes into account the
10health care needs of diverse segments of the population, including women, children,
11persons with disabilities, and other groups.
AB68-ASA2-AA2,115,1512 7. Ensure that essential health benefits established under this subsection are
13not subject to a coverage denial based on an insured's or plan participant's age,
14expected length of life, present or predicted disability, degree of dependency on
15medical care, or quality of life.
AB68-ASA2-AA2,115,2216 8. Require that disability insurance policies and self-insured health plans
17cover emergency department services that are essential health benefits without
18imposing any requirement to obtain prior authorization for those services and
19without limiting coverage for services provided by an emergency services provider
20that is not in the provider network of a policy or plan in a way that is more restrictive
21than requirements or limitations that apply to emergency services provided by a
22provider that is in the provider network of the policy or plan.
AB68-ASA2-AA2,116,223 9. Require a disability insurance policy or self-insured health plan to apply to
24emergency department services that are essential health benefits provided by an
25emergency department provider that is not in the provider network of the policy or

1plan the same copayment amount or coinsurance rate that applies if those services
2are provided by a provider that is in the provider network of the policy or plan.
AB68-ASA2-AA2,116,43 (d) The commissioner shall periodically update, by rule, the essential health
4benefits under this subsection to address any gaps in access to coverage.
AB68-ASA2-AA2,116,95 (e) If an essential health benefit is also subject to mandated coverage elsewhere
6under this section and the coverage requirements are not identical, the disability
7insurance policy or self-insured health plan shall provide coverage under whichever
8subsection provides the insured or plan participant with more comprehensive
9coverage of the medical condition, item, or service.
AB68-ASA2-AA2,116,1310 (f) Nothing in this subsection or rules promulgated under this subsection
11prohibits a disability insurance policy or a self-insured health plan from providing
12benefits in excess of the essential health benefit coverage required under this
13subsection.
AB68-ASA2-AA2,116,1514 (g) This subsection does not apply to any disability insurance policy that is
15described in s. 632.745 (11) (b) 1. to 12.
AB68-ASA2-AA2,412zu 16Section 412zu. 632.895 (16m) (b) of the statutes is amended to read:
AB68-ASA2-AA2,116,2117 632.895 (16m) (b) The coverage required under this subsection may be subject
18to any limitations, or exclusions, or cost-sharing provisions that apply generally
19under the disability insurance policy or self-insured health plan. The coverage
20required under this subsection may not be subject to any deductibles, copayments,
21or coinsurance.
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