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AB7,30
1Section 30. 633.01 (6) of the statutes is created to read:
AB7,19,22 633.01 (6) “Self-insured health plan" has the meaning given in s. 632.85 (1) (c).
AB7,31 3Section 31 . 633.04 (intro.) of the statutes is amended to read:
AB7,19,8 4633.04 Written agreement required. (intro.) An administrator may not
5administer a an employee benefit plan in the absence of a written agreement
6between the administrator and a principal. The administrator and principal shall
7each retain a copy of the written agreement for the duration of the agreement and
8for 5 years thereafter. The written agreement shall contain the following terms:
AB7,32 9Section 32 . 633.05 of the statutes is amended to read:
AB7,19,16 10633.05 Payment to administrator. If a principal is an insurer, payment to
11the administrator of a premium or charge by or on behalf of an insured employee is
12payment to the insurer, but payment of a return premium or claim by the insurer to
13the administrator is not payment to an insured employee until the payment is
14received by the insured employee. This section does not limit any right of the insurer
15against the administrator for failure to make payments to the insurer or an insured
16employee.
AB7,33 17Section 33 . 633.06 of the statutes is amended to read:
AB7,19,22 18633.06 Examination and inspection of books and records. (1) The
19commissioner may examine, audit or accept an audit of the books and records of an
20administrator or pharmacy benefit manager as provided for examination of licensees
21under s. 601.43 (1), (3), (4) and (5), to be conducted as provided in s. 601.44, and with
22costs to be paid as provided in s. 601.45.
AB7,20,2 23(2) A principal that uses an administrator may inspect the books and records
24of the administrator, subject to any restrictions set forth in ss. 146.81 to 146.835 and

1in the written agreement required under s. 633.04, for the purpose of enabling the
2principal to fulfill its contractual obligations to insureds insured employees.
AB7,34 3Section 34 . 633.07 of the statutes is amended to read:
AB7,20,6 4633.07 Approval of advertising. An administrator may not use any
5advertising for a an employee benefit plan underwritten by an insurer unless the
6insurer approves the advertising in advance.
AB7,35 7Section 35 . 633.09 (4) (b) 2. and 3. of the statutes are amended to read:
AB7,20,98 633.09 (4) (b) 2. To a an employee benefit plan policyholder for payment to a
9principal, the funds belonging to the principal.
AB7,20,1010 3. To an insured employee, the funds belonging to the insured employee.
AB7,36 11Section 36 . 633.11 of the statutes is amended to read:
AB7,20,17 12633.11 Claim adjustment compensation. If an administrator adjusts or
13settles claims under a an employee benefit plan, the commission, fees or charges
14that the principal pays the administrator may not be based on the employee benefit
15plan's loss experience. This section does not prohibit compensation based on the
16number or amount of premiums or charges collected, or the number or amount of
17claims paid or processed by the administrator.
AB7,37 18Section 37 . 633.12 (1) (intro.), (b) and (c) of the statutes are amended to read:
AB7,20,2319 633.12 (1) (intro.) An administrator shall prepare sufficient copies of a written
20notice approved in advance by the principal for distribution to all insureds insured
21employees
of the principal and either shall distribute the copies to the insureds
22insured employees or shall provide the copies to the principal for distribution to the
23insureds
insured employees. The written notice shall contain all of the following:
AB7,20,2524 (b) An explanation of the respective rights and responsibilities of the
25administrator, the principal and the insureds insured employees.
AB7,21,2
1(c) A statement of the extent to which the employee benefit plan is insured or
2self-insured, and an explanation of the terms “insured" and “self-insured".
AB7,38 3Section 38 . 633.13 (1) and (3) of the statutes are amended to read:
AB7,21,84 633.13 (1) General. Except as provided in sub. (2), a person may not perform,
5offer to perform or advertise any service as an administrator or a pharmacy benefit
6manager
unless the person has obtained a license under s. 633.14. A pharmacy
7benefit manager that also performs services as an administrator need only obtain an
8administrator license under s. 633.14.
AB7,21,13 9(3) Responsibilities of principal. A principal may not use the services of an
10administrator unless the administrator furnishes proof of licensure under s. 633.14
11or exemption under sub. (2). An insurer or a self-insured health plan may not use
12the services of a pharmacy benefit manager unless the pharmacy benefit manager
13furnishes proof of licensure under s. 633.14.
AB7,39 14Section 39 . 633.14 (2) (intro.) and (c) 1. and 3. and (3) of the statutes are
15amended to read:
AB7,21,1816 633.14 (2) (intro.) The commissioner shall issue a license to act as an
17administrator or pharmacy benefit manager to a corporation, limited liability
18company or partnership that does all of the following:
AB7,21,2219 (c) 1. That the corporation, limited liability company or partnership intends in
20good faith to act as an administrator or pharmacy benefit manager through
21individuals designated under subd. 3. in compliance with applicable laws of this
22state and rules and orders of the commissioner.
AB7,22,223 3. That for each employee benefit plan or prescription drug benefit to be
24administered, the corporation, limited liability company or partnership has
25designated or will designate an individual in the corporation, limited liability

1company or partnership to directly administer the employee benefit plan or
2prescription drug benefit
.
AB7,22,6 3(3) The commissioner shall promulgate rules establishing the specifications
4that a bond supplied by an administrator or pharmacy benefit manager under sub.
5(1) (b) or (2) (b) must satisfy to guarantee faithful performance of the administrator
6or pharmacy benefit manager.
AB7,40 7Section 40 . 633.15 (1) (a), (1m), and (2) (a) 1., 2. and 3. and (b) 1. of the statutes
8are amended to read:
AB7,22,119 633.15 (1) (a) Payment. An administrator or pharmacy benefit manager shall
10pay the annual renewal fee under s. 601.31 (1) (w) for each annual renewal of a
11license by the date specified by a schedule established under par. (b).
AB7,22,23 12(1m) Social security number, federal employer identification number or
13statement.
At an annual renewal, an administrator or pharmacy benefit manager
14shall provide his or her social security number, if the administrator is an individual
15unless he or she does not have a social security number, or its federal employer
16identification number, if the administrator or pharmacy benefit manager is a
17corporation, limited liability company or partnership, if the social security number
18or federal employer identification number was not previously provided on the
19application for the license or at a previous renewal of the license. If an administrator
20who is an individual does not have a social security number, the individual shall
21provide to the commissioner, at each annual renewal and on a form prescribed by the
22department of children and families, a statement made or subscribed under oath or
23affirmation that the administrator does not have a social security number.
AB7,23,6 24(2) (a) 1. If an administrator or pharmacy benefit manager fails to pay the
25annual renewal fee as provided under sub. (1) or fails to provide a social security

1number, federal employer identification number or statement made or subscribed
2under oath or affirmation as required under sub. (1m), the commissioner shall
3suspend the administrator's or pharmacy benefit manager's license effective the day
4following the last day when the annual renewal fee may be paid, if the commissioner
5has given the administrator or pharmacy benefit manager reasonable notice of when
6the fee must be paid to avoid suspension.
AB7,23,127 2. If, within 60 days from the effective date of suspension under subd. 1., an
8administrator or pharmacy benefit manager pays the annual renewal fee or provides
9the social security number, federal employer identification number or statement
10made or subscribed under oath or affirmation, or both if the suspension was based
11upon a failure to do both, the commissioner shall reinstate the administrator's or
12pharmacy benefit manager's
license effective as of the date of suspension.
AB7,23,1713 3. If payment is not made or the social security number, federal employer
14identification number or statement made or subscribed under oath or affirmation is
15not provided within 60 days from the effective date of suspension under subd. 1., the
16commissioner shall revoke the administrator's or pharmacy benefit manager's
17license.
AB7,23,2018 (b) 1. Except as provided in pars. (c) to (e), the commissioner may revoke,
19suspend or limit the license of an administrator or pharmacy benefit manager after
20a hearing if the commissioner makes any of the following findings:
AB7,23,2221 a. That the administrator or pharmacy benefit manager is unqualified to
22perform the responsibilities of an administrator or pharmacy benefit manager.
AB7,23,2423 b. That the administrator or pharmacy benefit manager has repeatedly or
24knowingly violated an applicable law, rule or order of the commissioner.
AB7,24,5
1c. That If the licensee is an administrator, that the administrator's methods or
2practices in administering a an employee benefit plan endanger the interests of
3insureds insured employees or the public, or that the financial resources of the
4administrator are inadequate to safeguard the interests of insureds insured
5employees
or the public.
AB7,41 6Section 41 . 633.15 (2) (b) 1. d. of the statutes is created to read:
AB7,24,117 633.15 (2) (b) 1. d. If the licensee is a pharmacy benefit manager, that the
8pharmacy benefit manager's methods or practices in administering a prescription
9drug benefit endanger the interests of enrollees or the public, or that the financial
10resources of the pharmacy benefit manager are inadequate to safeguard the
11interests of enrollees or the public.
AB7,42 12Section 42 . 633.15 (2) (b) 2. of the statutes is amended to read:
AB7,24,1613 633.15 (2) (b) 2. A person whose license has been revoked under subd. 1. may
14apply for a new license under s. 633.14 only after the expiration of 5 years from the
15date of the order revoking the administrator's or pharmacy benefit manager's
16license, unless the order specifies a lesser period.
AB7,43 17Section 43 . 633.15 (2) (f) of the statutes is created to read:
AB7,24,2118 633.15 (2) (f) The commissioner, after ordering a suspension or revocation
19under this subsection, may allow a pharmacy benefit manager to continue to provide
20services for the purpose of providing continuity of care in prescription drug benefits
21to existing enrollees.
AB7,44 22Section 44 . 633.16 of the statutes is amended to read:
AB7,24,25 23633.16 Regulation. Nothing in this chapter gives the commissioner the
24authority to impose requirements on a an employee benefit plan that is exempt from
25state law under 29 USC 1144 (b).
AB7,45
1Section 45. Nonstatutory provisions.
AB7,25,62 (1) Pharmacy benefit manager; compliance date. A pharmacy benefit manager
3that is not required to be licensed as an administrator is not required to be licensed
4under s. 633.14 and a pharmacy benefit manager is not required to comply with s.
5632.865 (3) to (7) until the effective date of this subsection, unless the commissioner
6of insurance specifies a later date on which registration or compliance is required.
AB7,46 7Section 46 . Initial applicability.
AB7,25,108 (1) For policies and plans containing provisions inconsistent with this act, this
9act first applies to policy or plan years beginning on the effective date of this
10subsection.
AB7,25,1111 (End)
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