AB50-ASA2-AA16,23,1212b. Ease in submitting insulin orders to manufacturers. AB50-ASA2-AA16,23,1313c. Timeliness of receiving insulin orders from manufacturers. AB50-ASA2-AA16,23,15143. The commissioner may contract with a nonprofit entity to develop and 15conduct the surveys under subds. 1. and 2. and to evaluate the survey results. AB50-ASA2-AA16,23,18164. No later than July 1, 2028, the commissioner shall submit to the governor 17and the chief clerk of each house of the legislature, for distribution to the legislature 18under s. 13.172 (2), a report on the results of the surveys under subds. 1. and 2. AB50-ASA2-AA16,23,2319(9) Penalty. A manufacturer that violates this section may be required to 20forfeit not more than $200,000 per month of violation, with the maximum forfeiture 21increasing to $400,000 per month if the manufacturer continues to be in violation 22after 6 months and increasing to $600,000 per month if the manufacturer continues 23to be in violation after one year.”. AB50-ASA2-AA16,24,53609.83 Coverage of drugs and devices. Limited service health 4organizations, preferred provider plans, and defined network plans are subject to 5ss. 632.853, 632.861, and 632.895 (6) (b), (16t), and (16v). AB50-ASA2-AA16,226Section 22. 632.895 (6) (title) of the statutes is amended to read: AB50-ASA2-AA16,24,87632.895 (6) (title) Equipment and supplies for treatment of diabetes; 8insulin. AB50-ASA2-AA16,239Section 23. 632.895 (6) of the statutes is renumbered 632.895 (6) (a) and 10amended to read: AB50-ASA2-AA16,24,2111632.895 (6) (a) Every disability insurance policy which that provides coverage 12of expenses incurred for treatment of diabetes shall provide coverage for expenses 13incurred by the installation and use of an insulin infusion pump, coverage for all 14other equipment and supplies, including insulin or any other prescription 15medication, used in the treatment of diabetes, and coverage of diabetic self-16management education programs. Coverage Except as provided in par. (b), 17coverage required under this subsection shall be subject to the same exclusions, 18limitations, deductibles, and coinsurance provisions of the policy as other covered 19expenses, except that insulin infusion pump coverage may be limited to the 20purchase of one pump per year and the insurer may require the insured to use a 21pump for 30 days before purchase. AB50-ASA2-AA16,24,2323632.895 (6) (b) 1. In this paragraph: AB50-ASA2-AA16,25,3
1a. “Cost sharing” means the total of any deductible, copayment, or 2coinsurance amounts imposed on a person covered under a disability insurance 3policy or self-insured health plan. AB50-ASA2-AA16,25,44b. “Self-insured health plan” has the meaning given in s. 632.85 (1) (c). AB50-ASA2-AA16,25,752. Every disability insurance policy and self-insured health plan that covers 6insulin and imposes cost sharing on prescription drugs may not impose cost sharing 7on insulin in an amount that exceeds $35 for a one-month supply of insulin. AB50-ASA2-AA16,25,1183. Nothing in this paragraph prohibits a disability insurance policy or self-9insured health plan from imposing cost sharing on insulin in an amount less than 10the amount specified under subd. 2. Nothing in this paragraph requires a disability 11insurance policy or self-insured health plan to impose any cost sharing on insulin. AB50-ASA2-AA16,25,1613(1) Cost-sharing cap on insulin. The treatment of ss. 609.83 and 632.895 14(6) (title), the renumbering and amendment of s. 632.895 (6), and the creation of s. 15632.895 (6) (b) take effect on the first day of the 4th month beginning after 16publication.”. AB50-ASA2-AA16,25,231940.51 (8) Every health care coverage plan offered by the state under sub. (6) 20shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.722, 21632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 22632.85, 632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (3) to (6), 632.885, 23632.89, 632.895 (5m) and (8) to (17), and 632.896. AB50-ASA2-AA16,26,5240.51 (8m) Every health care coverage plan offered by the group insurance 3board under sub. (7) shall comply with ss. 631.95, 632.722, 632.729, 632.746 (1) to 4(8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855, 5632.861, 632.862, 632.867, 632.885, 632.89, and 632.895 (11) to (17). AB50-ASA2-AA16,26,13766.0137 (4) Self-insured health plans. If a city, including a 1st class city, 8or a village provides health care benefits under its home rule power, or if a town 9provides health care benefits, to its officers and employees on a self-insured basis, 10the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2), 11632.722, 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 12632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (4) to (6), 632.885, 632.89, 13632.895 (9) to (17), 632.896, and 767.513 (4). AB50-ASA2-AA16,26,1815120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss. 1649.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.722, 632.729, 632.746 (10) (a) 2. and 17(b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.862, 632.867, 18632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4). AB50-ASA2-AA16,2919Section 29. 185.983 (1) (intro.) of the statutes is amended to read: AB50-ASA2-AA16,27,320185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a 21cooperative association organized under s. 185.981 shall be exempt from chs. 600 to 22646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 23601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93, 24631.95, 632.72 (2), 632.722, 632.729, 632.745 to 632.749, 632.775, 632.79, 632.795,
1632.798, 632.85, 632.853, 632.855, 632.861, 632.862, 632.867, 632.87 (2) to (6), 2632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 3620, 630, 635, 645, and 646, but the sponsoring association shall: AB50-ASA2-AA16,27,85609.83 Coverage of drugs and devices; application of payments. 6Limited service health organizations, preferred provider plans, and defined 7network plans are subject to ss. 632.853, 632.861, 632.862, and 632.895 (16t) and 8(16v). AB50-ASA2-AA16,27,1110632.862 Application of prescription drug payments. (1) Definitions. 11In this section: AB50-ASA2-AA16,27,1212(a) “Brand name” has the meaning given in s. 450.12 (1) (a). AB50-ASA2-AA16,27,1313(b) “Brand name drug” means any of the following: AB50-ASA2-AA16,27,15141. A prescription drug that contains a brand name and that has no generic 15equivalent. AB50-ASA2-AA16,27,20162. A prescription drug that contains a brand name and has a generic 17equivalent but for which the enrollee has received prior authorization from the 18insurer offering the disability insurance policy or self-insured health plan or 19authorization from a physician to obtain the prescription drug under the disability 20insurance policy or self-insured health plan. AB50-ASA2-AA16,27,2121(c) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a). AB50-ASA2-AA16,27,2222(d) “Prescription drug” has the meaning given in s. 450.01 (20). AB50-ASA2-AA16,28,2
1(e) “Self-insured health plan” means a self-insured health plan of the state or 2a county, city, village, town, or school district. AB50-ASA2-AA16,28,83(2) Application of discounts. A disability insurance policy that offers a 4prescription drug benefit or a self-insured health plan shall apply to any calculation 5of an out-of-pocket maximum amount and to any deductible of the disability 6insurance policy or self-insured health plan for an enrollee the amount that any 7discount provided by the manufacturer of a brand name drug reduces the cost 8sharing amount charged to the enrollee for that brand name drug. AB50-ASA2-AA16,28,1010(1) Application of manufacturer discounts. AB50-ASA2-AA16,28,1611(a) For policies and plans containing provisions inconsistent with the 12treatment of ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 13609.83, and 632.862, the treatment of ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) 14(g), 185.983 (1) (intro.), 609.83, and 632.862 first applies to policy or plan years 15beginning on January 1 of the year following the year in which this paragraph takes 16effect, except as provided in par. (b). AB50-ASA2-AA16,28,2317(b) For policies or plans that are affected by a collective bargaining agreement 18containing provisions inconsistent with the treatment of ss. 40.51 (8) and (8m), 1966.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.83, and 632.862, the treatment of 20ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.83, and 21632.862 first applies to policy or plan years beginning on the effective date of this 22paragraph or on the day on which the collective bargaining agreement is newly 23established, extended, modified, or renewed, whichever is later. AB50-ASA2-AA16,29,52(1) Application of manufacturer discounts. The treatment of ss. 40.51 (8) 3and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.83, and 632.862 and 4Section 9323 (1) take effect on the first day of the 4th month beginning after 5publication.”. AB50-ASA2-AA16,29,138(1) Board on aging and long-term care medigap helpline. In the 9schedule under s. 20.005 (3) for the appropriation to the board on aging and long-10term care under s. 20.432 (1) (kb), the dollar amount for fiscal year 2025-26 is 11increased by $100,600 and the dollar amount for fiscal year 2026-27 is increased by 12$122,000 to support telephone counseling services provided under s. 16.009 (2) (j) 13for individuals seeing information on medicare supplemental insurance policies.”. AB50-ASA2-AA16,29,1816609.712 Essential health benefits; preventive services. Defined 17network plans and preferred provider plans are subject to s. 632.895 (13m) and 18(14m). AB50-ASA2-AA16,29,2220609.847 Preexisting condition discrimination and certain benefit 21limits prohibited. Limited service health organizations, preferred provider 22plans, and defined network plans are subject to s. 632.728. AB50-ASA2-AA16,30,2
1625.12 (1) (a) Past and prospective loss and expense experience within and 2outside of this state, except as provided in s. 632.728. AB50-ASA2-AA16,30,54625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors, 5including the judgment of technical personnel. AB50-ASA2-AA16,30,157625.12 (2) Classification. Except as provided in s. ss. 632.728 and 632.729, 8risks may be classified in any reasonable way for the establishment of rates and 9minimum premiums, except that no classifications may be based on race, color, 10creed or national origin, and classifications in automobile insurance may not be 11based on physical condition or developmental disability as defined in s. 51.01 (5). 12Subject to ss. 632.365, 632.728, and 632.729, rates thus produced may be modified 13for individual risks in accordance with rating plans or schedules that establish 14reasonable standards for measuring probable variations in hazards, expenses, or 15both. Rates may also be modified for individual risks under s. 625.13 (2). AB50-ASA2-AA16,31,217625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may 18itself establish rates and supplementary rate information for one or more market 19segments based on the factors in s. 625.12 and, if the rates are for motor vehicle 20liability insurance, subject to s. 632.365, or the insurer may use rates and 21supplementary rate information prepared by a rate service organization, with 22average expense factors determined by the rate service organization or with such
1modification for its own expense and loss experience as the credibility of that 2experience allows. AB50-ASA2-AA16,31,114628.34 (3) (a) No insurer may unfairly discriminate among policyholders by 5charging different premiums or by offering different terms of coverage except on the 6basis of classifications related to the nature and the degree of the risk covered or the 7expenses involved, subject to ss. 632.365, 632.728, 632.729, 632.746, and 632.748. 8Rates are not unfairly discriminatory if they are averaged broadly among persons 9insured under a group, blanket or franchise policy, and terms are not unfairly 10discriminatory merely because they are more favorable than in a similar individual 11policy. AB50-ASA2-AA16,31,1413632.728 Coverage of persons with preexisting conditions; guaranteed 14issue; benefit limits. (1) Definitions. In this section: AB50-ASA2-AA16,31,1615(a) “Cost sharing” includes deductibles, coinsurance, copayments, or similar 16charges. AB50-ASA2-AA16,31,1717(b) “Health benefit plan” has the meaning given in s. 632.745 (11). AB50-ASA2-AA16,31,1818(c) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c). AB50-ASA2-AA16,32,219(2) Guaranteed issue. (a) Every individual health benefit plan shall accept 20every individual in this state who, and every group health benefit plan shall accept 21every employer in this state that, applies for coverage, regardless of the sexual 22orientation, the gender identity, or any preexisting condition of any individual or 23employee who will be covered by the plan. A health benefit plan may restrict
1enrollment in coverage described in this paragraph to open or special enrollment 2periods. AB50-ASA2-AA16,32,63(b) The commissioner shall establish a statewide open enrollment period that 4is no shorter than 30 days, during which every individual health benefit plan shall 5allow individuals, including individuals who do not have coverage, to enroll in 6coverage. AB50-ASA2-AA16,32,117(3) Prohibiting discrimination based on health status. (a) An 8individual health benefit plan or a self-insured health plan may not establish rules 9for the eligibility of any individual to enroll, or for the continued eligibility of any 10individual to remain enrolled, under the plan based on any of the following health 11status-related factors in relation to the individual or a dependent of the individual: AB50-ASA2-AA16,32,13132. Medical condition, including both physical and mental illnesses. AB50-ASA2-AA16,32,14143. Claims experience. AB50-ASA2-AA16,32,15154. Receipt of health care. AB50-ASA2-AA16,32,16165. Medical history. AB50-ASA2-AA16,32,17176. Genetic information. AB50-ASA2-AA16,32,19187. Evidence of insurability, including conditions arising out of acts of domestic 19violence. AB50-ASA2-AA16,33,521(b) An insurer offering an individual health benefit plan or a self-insured 22health plan may not require any individual, as a condition of enrollment or 23continued enrollment under the plan, to pay, on the basis of any health status-
1related factor under par. (a) with respect to the individual or a dependent of the 2individual, a premium or contribution or a deductible, copayment, or coinsurance 3amount that is greater than the premium or contribution or deductible, copayment, 4or coinsurance amount, respectively, for an otherwise similarly situated individual 5enrolled under the plan. AB50-ASA2-AA16,33,96(c) Nothing in this subsection prevents an insurer offering an individual 7health benefit plan or a self-insured health plan from establishing premium 8discounts or rebates or modifying otherwise applicable cost sharing in return for 9adherence to programs of health promotion and disease prevention. AB50-ASA2-AA16,33,1210(4) Premium rate variation. A health benefit plan offered on the individual 11or small employer market or a self-insured health plan may vary premium rates for 12a specific plan based only on the following considerations: AB50-ASA2-AA16,33,1313(a) Whether the policy or plan covers an individual or a family. AB50-ASA2-AA16,33,1414(b) Rating area in the state, as established by the commissioner. AB50-ASA2-AA16,33,1715(c) Age, except that the rate may not vary by more than 3 to 1 for adults over 16the age groups and the age bands shall be consistent with recommendations of the 17National Association of Insurance Commissioners.
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