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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-AA16,2422Section 24. 632.895 (6) (b) of the statutes is created to read:
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-AA16,942312Section 9423. Effective dates; Insurance.
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-AA16,25,171717. At the appropriate places, insert all of the following:
AB50-ASA2-AA16,25,1818Section 25. 40.51 (8) of the statutes is amended to read:
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
1Section 26. 40.51 (8m) of the statutes is amended to read:
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-AA16,276Section 27. 66.0137 (4) of the statutes is amended to read:
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-AA16,2814Section 28. 120.13 (2) (g) of the statutes is amended to read:
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-AA16,304Section 30. 609.83 of the statutes is amended to read:
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-AA16,319Section 31. 632.862 of the statutes is created to read:
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-AA16,93239Section 9323. Initial applicability; Insurance.
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-AA16,9423
1Section 9423. Effective dates; Insurance.
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-AA16,29,6618. At the appropriate places, insert all of the following:
AB50-ASA2-AA16,29,77Section 9216. Fiscal changes; Administration.
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-AA16,29,141419. At the appropriate places, insert all of the following:
AB50-ASA2-AA16,29,1515Section 32. 609.712 of the statutes is created to read:
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-AA16,3319Section 33. 609.847 of the statutes is created to read:
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-AA16,3423Section 34. 625.12 (1) (a) of the statutes is amended to read:
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-AA16,353Section 35. 625.12 (1) (e) of the statutes is amended to read:
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-AA16,366Section 36. 625.12 (2) of the statutes is amended to read:
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-AA16,3716Section 37. 625.15 (1) of the statutes is amended to read:
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-AA16,383Section 38. 628.34 (3) (a) of the statutes is amended to read:
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-AA16,3912Section 39. 632.728 of the statutes is created to read:
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-AA16,32,12121. Health status.
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-AA16,32,20208. Disability.
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.
AB50-ASA2-AA16,33,1818(d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
AB50-ASA2-AA16,33,2319(5) Statewide risk pool. An insurer offering a health benefit plan may not
20segregate enrollees into risk pools other than a single statewide risk pool for the
21individual market and a single statewide risk pool for the small employer market or
22a single statewide risk pool that combines the individual and small employer
23markets.
AB50-ASA2-AA16,34,2
1(6) Annual and lifetime limits. An individual or group health benefit plan
2or a self-insured health plan may not establish any of the following:
AB50-ASA2-AA16,34,43(a) Lifetime limits on the dollar value of benefits for an enrollee or a
4dependent of an enrollee under the plan.
AB50-ASA2-AA16,34,65(b) Annual limits on the dollar value of benefits for an enrollee or a dependent
6of an enrollee under the plan.
AB50-ASA2-AA16,34,107(7) Cost sharing maximum. A health benefit plan offered on the individual
8or small employer market may not require an enrollee under the plan to pay more in
9cost sharing than the maximum amount calculated under 42 USC 18022 (c),
10including the annual indexing of the limits.
AB50-ASA2-AA16,34,1311(8) Medical loss ratio. (a) In this subsection, medical loss ratio means
12the proportion, expressed as a percentage, of premium revenues spent by a health
13benefit plan on clinical services and quality improvement.
AB50-ASA2-AA16,34,1514(b) A health benefit plan on the individual or small employer market shall
15have a medical loss ratio of at least 80 percent.
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