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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:
AB50-ASA2-AA16,38,14141. Mammography in accordance with sub. (8).
AB50-ASA2-AA16,38,16152. Genetic breast cancer screening and counseling and preventive medication
16for adult women at high risk for breast cancer.
AB50-ASA2-AA16,38,18173. Papanicolaou test for cancer screening for women 21 years of age or older
18with an intact cervix.
AB50-ASA2-AA16,38,20194. Human papillomavirus testing for women who have attained the age of 30
20years but have not attained the age of 66 years.
AB50-ASA2-AA16,38,21215. Colorectal cancer screening in accordance with sub. (16m).
AB50-ASA2-AA16,39,2226. Annual tomography for lung cancer screening for adults who have attained

1the age of 55 years but have not attained the age of 80 years and who have health
2histories demonstrating a risk for lung cancer.
AB50-ASA2-AA16,39,437. Skin cancer screening for individuals who have attained the age of 10 years
4but have not attained the age of 22 years.
AB50-ASA2-AA16,39,658. Counseling for skin cancer prevention for adults who have attained the age
6of 18 years but have not attained the age of 25 years.
AB50-ASA2-AA16,39,879. Abdominal aortic aneurysm screening for men who have attained the age of
865 years but have not attained the age of 75 years and who have ever smoked.
AB50-ASA2-AA16,39,11910. Hypertension screening for adults and blood pressure testing for adults,
10for children under the age of 3 years who are at high risk for hypertension, and for
11children 3 years of age or older.
AB50-ASA2-AA16,39,131211. Lipid disorder screening for minors 2 years of age or older, adults 20 years
13of age or older at high risk for lipid disorders, and all men 35 years of age or older.
AB50-ASA2-AA16,39,161412. Aspirin therapy for cardiovascular health for adults who have attained the
15age of 55 years but have not attained the age of 80 years and for men who have
16attained the age of 45 years but have not attained the age of 55 years.
AB50-ASA2-AA16,39,181713. Behavioral counseling for cardiovascular health for adults who are
18overweight or obese and who have risk factors for cardiovascular disease.
AB50-ASA2-AA16,39,191914. Type II diabetes screening for adults with elevated blood pressure.
AB50-ASA2-AA16,39,212015. Depression screening for minors 11 years of age or older and for adults
21when follow-up supports are available.
AB50-ASA2-AA16,39,232216. Hepatitis B screening for minors at high risk for infection and adults at
23high risk for infection.
AB50-ASA2-AA16,40,2
117. Hepatitis C screening for adults at high risk for infection and onetime
2hepatitis C screening for adults born in any year from 1945 to 1965.
AB50-ASA2-AA16,40,6318. Obesity screening and management for all minors and adults with a body
4mass index indicating obesity, counseling and behavioral interventions for obese
5minors who are 6 years of age or older, and referral for intervention for obesity for
6adults with a body mass index of 30 kilograms per square meter or higher.
AB50-ASA2-AA16,40,8719. Osteoporosis screening for all women 65 years of age or older and for
8women at high risk for osteoporosis under the age of 65 years.
AB50-ASA2-AA16,40,9920. Immunizations in accordance with sub. (14).
AB50-ASA2-AA16,40,121021. Anemia screening for individuals 6 months of age or older and iron
11supplements for individuals at high risk for anemia who have attained the age of 6
12months but have not attained the age of 12 months.
AB50-ASA2-AA16,40,141322. Fluoride varnish for prevention of tooth decay for minors at the age of
14eruption of their primary teeth.
AB50-ASA2-AA16,40,161523. Fluoride supplements for prevention of tooth decay for minors 6 months of
16age or older who do not have fluoride in their water source.
AB50-ASA2-AA16,40,171724. Gonorrhea prophylaxis treatment for newborns.
AB50-ASA2-AA16,40,181825. Health history and physical exams for prenatal visits and for minors.
AB50-ASA2-AA16,40,201926. Length and weight measurements for newborns and height and weight
20measurements for minors.
AB50-ASA2-AA16,40,222127. Head circumference and weight-for-length measurements for newborns
22and minors who have not attained the age of 3 years.
AB50-ASA2-AA16,40,232328. Body mass index for minors 2 years of age or older.
AB50-ASA2-AA16,41,2
129. Blood pressure measurements for minors 3 years of age or older and a
2blood pressure risk assessment at birth.
AB50-ASA2-AA16,41,4330. Risk assessment and referral for oral health issues for minors who have
4attained the age of 6 months but have not attained the age of 7 years.
AB50-ASA2-AA16,41,6531. Blood screening for newborns and minors who have not attained the age of
62 months.
AB50-ASA2-AA16,41,7732. Screening for critical congenital health defects for newborns.
AB50-ASA2-AA16,41,8833. Lead screenings in accordance with sub. (10).
AB50-ASA2-AA16,41,10934. Metabolic and hemoglobin screening and screening for phenylketonuria,
10sickle cell anemia, and congenital hypothyroidism for minors including newborns.
AB50-ASA2-AA16,41,121135. Tuberculin skin test based on risk assessment for minors one month of age
12or older.
AB50-ASA2-AA16,41,141336. Tobacco counseling and cessation interventions for individuals who are 5
14years of age or older.
AB50-ASA2-AA16,41,161537. Vision and hearing screening and assessment for minors including
16newborns.
AB50-ASA2-AA16,41,181738. Sexually transmitted infection and human immunodeficiency virus
18counseling for sexually active minors.
AB50-ASA2-AA16,41,211939. Risk assessment for sexually transmitted infection for minors who are 10
20years of age or older and screening for sexually transmitted infection for minors
21who are 16 years of age or older.
AB50-ASA2-AA16,41,232240. Alcohol misuse screening and counseling for minors 11 years of age or
23older.
AB50-ASA2-AA16,42,2
141. Autism screening for minors who have attained the age of 18 months but
2have not attained the age of 25 months.
AB50-ASA2-AA16,42,3342. Developmental screening and surveillance for minors including newborns.
AB50-ASA2-AA16,42,4443. Psychosocial and behavioral assessment for minors including newborns.
AB50-ASA2-AA16,42,6544. Alcohol misuse screening and counseling for pregnant adults and a risk
6assessment for all adults.
AB50-ASA2-AA16,42,8745. Fall prevention and counseling and preventive medication for fall
8prevention for community-dwelling adults 65 years of age or older.
AB50-ASA2-AA16,42,9946. Screening and counseling for intimate partner violence for adult women.
AB50-ASA2-AA16,42,121047. Well-woman visits for women who have attained the age of 18 years but
11have not attained the age of 65 years and well-woman visits for recommended
12preventive services, preconception care, and prenatal care.
AB50-ASA2-AA16,42,141348. Counseling on, consultations with a trained provider on, and equipment
14rental for breastfeeding for pregnant and lactating women.
AB50-ASA2-AA16,42,151549. Folic acid supplement for adult women with reproductive capacity.
AB50-ASA2-AA16,42,161650. Iron deficiency anemia screening for pregnant and lactating women.
AB50-ASA2-AA16,42,181751. Preeclampsia preventive medicine for pregnant adult women at high risk
18for preeclampsia.
AB50-ASA2-AA16,42,201952. Low-dose aspirin after 12 weeks of gestation for pregnant women at high
20risk for miscarriage, preeclampsia, or clotting disorders.
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