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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.
AB50-ASA2-AA16,34,1716(c) A group health benefit plan other than one described under par. (b) shall
17have a medical loss ratio of at least 85 percent.
AB50-ASA2-AA16,34,2118(9) Actuarial values of plan tiers. Any health benefit plan offered on the
19individual or small employer market shall provide a level of coverage that is
20designed to provide benefits that are actuarially equivalent to at least 60 percent of
21the full actuarial value of the benefits provided under the plan.
AB50-ASA2-AA16,4022Section 40. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and
23amended to read:
AB50-ASA2-AA16,35,7
1632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group
2health benefit plan may, with respect to a participant or beneficiary under the plan,
3not impose a preexisting condition exclusion only if the exclusion relates to a
4condition, whether physical or mental, regardless of the cause of the condition, for
5which medical advice, diagnosis, care or treatment was recommended or received
6within the 6-month period ending on the participants or beneficiarys enrollment
7date under the plan on a participant or beneficiary under the plan.
AB50-ASA2-AA16,418Section 41. 632.746 (1) (b) of the statutes is repealed.
AB50-ASA2-AA16,429Section 42. 632.746 (2) (a) of the statutes is amended to read:
AB50-ASA2-AA16,35,1310632.746 (2) (a) An insurer offering a group health benefit plan may not treat
11impose a preexisting condition exclusion based on genetic information as a
12preexisting condition under sub. (1) without a diagnosis of a condition related to the
13information.
AB50-ASA2-AA16,4314Section 43. 632.746 (2) (c), (d) and (e) of the statutes are repealed.
AB50-ASA2-AA16,4415Section 44. 632.746 (3) (a) of the statutes is repealed.
AB50-ASA2-AA16,4516Section 45. 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).
AB50-ASA2-AA16,4617Section 46. 632.746 (3) (d) 2. and 3. of the statutes are repealed.
AB50-ASA2-AA16,4718Section 47. 632.746 (5) of the statutes is repealed.
AB50-ASA2-AA16,4819Section 48. 632.746 (8) (a) (intro.) of the statutes is amended to read:
AB50-ASA2-AA16,35,2320632.746 (8) (a) (intro.) A health maintenance organization that offers a group
21health benefit plan and that does not impose any preexisting condition exclusion
22under sub. (1) with respect to a particular coverage option may impose an affiliation
23period for that coverage option, but only if all of the following apply:
AB50-ASA2-AA16,49
1Section 49. 632.748 (2) of the statutes is amended to read:
AB50-ASA2-AA16,36,82632.748 (2) An insurer offering a group health benefit plan may not require
3any individual, as a condition of enrollment or continued enrollment under the
4plan, to pay, on the basis of any health status-related factor with respect to the
5individual or a dependent of the individual, a premium or contribution or a
6deductible, copayment, or coinsurance amount that is greater than the premium or
7contribution or deductible, copayment, or coinsurance amount, respectively, for a
8an otherwise similarly situated individual enrolled under the plan.
AB50-ASA2-AA16,509Section 50. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to
10read:
AB50-ASA2-AA16,36,1811632.76 (2) (a) No claim for loss incurred or disability commencing after 2
12years from the date of issue of the policy may be reduced or denied on the ground
13that a disease or physical condition existed prior to the effective date of coverage,
14unless the condition was excluded from coverage by name or specific description by
15a provision effective on the date of loss. This paragraph does not apply to a group
16health benefit plan, as defined in s. 632.745 (9), which is subject to s. 632.746, a
17disability insurance policy, as defined in s. 632.895 (1) (a), or a self-insured health
18plan, as defined in s. 632.85 (1) (c).
AB50-ASA2-AA16,37,219(ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability
20commencing after 12 months from the date of issue of under an individual disability
21insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the
22ground that a disease or physical condition existed prior to the effective date of

1coverage, unless the condition was excluded from coverage by name or specific
2description by a provision effective on the date of the loss.
AB50-ASA2-AA16,37,932. Except as provided in subd. 3., an An individual disability insurance policy,
4as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495
5(4) and (5), may not define a preexisting condition more restrictively than a
6condition that was present before the date of enrollment for the coverage, whether
7physical or mental, regardless of the cause of the condition, for which and
8regardless of whether medical advice, diagnosis, care, or treatment was
9recommended or received within 12 months before the effective date of coverage.
AB50-ASA2-AA16,5110Section 51. 632.795 (4) (a) of the statutes is amended to read:
AB50-ASA2-AA16,37,2211632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the
12same policy form and for the same premium as it originally offered in the most
13recent enrollment period, subject only to the medical underwriting used in that
14enrollment period. Unless otherwise prescribed by rule, the insurer may apply
15deductibles, preexisting condition limitations, waiting periods, or other limits only
16to the extent that they would have been applicable had coverage been extended at
17the time of the most recent enrollment period and with credit for the satisfaction or
18partial satisfaction of similar provisions under the liquidated insurers policy or
19plan. The insurer may exclude coverage of claims that are payable by a solvent
20insurer under insolvency coverage required by the commissioner or by the
21insurance regulator of another jurisdiction. Coverage shall be effective on the date
22that the liquidated insurers coverage terminates.
AB50-ASA2-AA16,5223Section 52. 632.895 (8) (d) of the statutes is amended to read:
AB50-ASA2-AA16,38,7
1632.895 (8) (d) Coverage is required under this subsection despite whether
2the woman shows any symptoms of breast cancer. Except as provided in pars. (b),
3(c), and (e), coverage under this subsection may only be subject to exclusions and
4limitations, including deductibles, copayments and restrictions on excessive
5charges, that are applied to other radiological examinations covered under the
6disability insurance policy. Coverage under this subsection may not be subject to
7any deductibles, copayments, or coinsurance.
AB50-ASA2-AA16,538Section 53. 632.895 (13m) of the statutes is created to read:
AB50-ASA2-AA16,38,109632.895 (13m) Preventive services. (a) In this section, self-insured health
10plan has the meaning given in s. 632.85 (1) (c).
AB50-ASA2-AA16,38,1311(b) Every disability insurance policy, except any disability insurance policy
12that is described in s. 632.745 (11) (b) 1. to 12., and every self-insured health plan
13shall provide coverage for all of the following preventive services:
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