AB50-ASA2-AA8,29,52(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-AA8,29,147“Section 25. 20.005 (3) (schedule) of the statutes: at the appropriate place, 8insert the following amounts for the purposes indicated: AB50-ASA2-AA8,2615Section 26. 20.115 (4) (aq) of the statutes is created to read: AB50-ASA2-AA8,29,181620.115 (4) (aq) Food security and Wisconsin products grants. As a continuing 17appropriation, the amounts in the schedule for food security and Wisconsin 18products grants under s. 93.62. AB50-ASA2-AA8,30,22093.62 Food security and Wisconsin products grant program. The 21department may award grants from the appropriation under s. 20.115 (4) (aq) to 22nonprofit food banks, nonprofit food pantries, and other nonprofit organizations
1that provide food assistance for the purpose of purchasing food products that are 2made or grown in this state.”. AB50-ASA2-AA8,30,75609.712 Essential health benefits; preventive services. Defined 6network plans and preferred provider plans are subject to s. 632.895 (13m) and 7(14m). AB50-ASA2-AA8,30,119609.847 Preexisting condition discrimination and certain benefit 10limits prohibited. Limited service health organizations, preferred provider 11plans, and defined network plans are subject to s. 632.728. AB50-ASA2-AA8,3012Section 30. 625.12 (1) (a) of the statutes is amended to read: AB50-ASA2-AA8,30,1413625.12 (1) (a) Past and prospective loss and expense experience within and 14outside of this state, except as provided in s. 632.728. AB50-ASA2-AA8,3115Section 31. 625.12 (1) (e) of the statutes is amended to read: AB50-ASA2-AA8,30,1716625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors, 17including the judgment of technical personnel. AB50-ASA2-AA8,31,419625.12 (2) Classification. Except as provided in s. ss. 632.728 and 632.729, 20risks may be classified in any reasonable way for the establishment of rates and 21minimum premiums, except that no classifications may be based on race, color, 22creed or national origin, and classifications in automobile insurance may not be 23based on physical condition or developmental disability as defined in s. 51.01 (5).
1Subject to ss. 632.365, 632.728, and 632.729, rates thus produced may be modified 2for individual risks in accordance with rating plans or schedules that establish 3reasonable standards for measuring probable variations in hazards, expenses, or 4both. Rates may also be modified for individual risks under s. 625.13 (2). AB50-ASA2-AA8,31,136625.15 (1) Rate making. An Except as provided in s. 632.728, an insurer may 7itself establish rates and supplementary rate information for one or more market 8segments based on the factors in s. 625.12 and, if the rates are for motor vehicle 9liability insurance, subject to s. 632.365, or the insurer may use rates and 10supplementary rate information prepared by a rate service organization, with 11average expense factors determined by the rate service organization or with such 12modification for its own expense and loss experience as the credibility of that 13experience allows. AB50-ASA2-AA8,3414Section 34. 628.34 (3) (a) of the statutes is amended to read: AB50-ASA2-AA8,31,2215628.34 (3) (a) No insurer may unfairly discriminate among policyholders by 16charging different premiums or by offering different terms of coverage except on the 17basis of classifications related to the nature and the degree of the risk covered or the 18expenses involved, subject to ss. 632.365, 632.728, 632.729, 632.746, and 632.748. 19Rates are not unfairly discriminatory if they are averaged broadly among persons 20insured under a group, blanket or franchise policy, and terms are not unfairly 21discriminatory merely because they are more favorable than in a similar individual 22policy. AB50-ASA2-AA8,32,2
1632.728 Coverage of persons with preexisting conditions; guaranteed 2issue; benefit limits. (1) Definitions. In this section: AB50-ASA2-AA8,32,43(a) “Cost sharing” includes deductibles, coinsurance, copayments, or similar 4charges. AB50-ASA2-AA8,32,55(b) “Health benefit plan” has the meaning given in s. 632.745 (11). AB50-ASA2-AA8,32,66(c) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c). AB50-ASA2-AA8,32,137(2) Guaranteed issue. (a) Every individual health benefit plan shall accept 8every individual in this state who, and every group health benefit plan shall accept 9every employer in this state that, applies for coverage, regardless of the sexual 10orientation, the gender identity, or any preexisting condition of any individual or 11employee who will be covered by the plan. A health benefit plan may restrict 12enrollment in coverage described in this paragraph to open or special enrollment 13periods. AB50-ASA2-AA8,32,1714(b) The commissioner shall establish a statewide open enrollment period that 15is no shorter than 30 days, during which every individual health benefit plan shall 16allow individuals, including individuals who do not have coverage, to enroll in 17coverage. AB50-ASA2-AA8,32,2218(3) Prohibiting discrimination based on health status. (a) An 19individual health benefit plan or a self-insured health plan may not establish rules 20for the eligibility of any individual to enroll, or for the continued eligibility of any 21individual to remain enrolled, under the plan based on any of the following health 22status-related factors in relation to the individual or a dependent of the individual: AB50-ASA2-AA8,32,23231. Health status. AB50-ASA2-AA8,33,1
12. Medical condition, including both physical and mental illnesses. AB50-ASA2-AA8,33,223. Claims experience. AB50-ASA2-AA8,33,334. Receipt of health care. AB50-ASA2-AA8,33,445. Medical history. AB50-ASA2-AA8,33,556. Genetic information. AB50-ASA2-AA8,33,767. Evidence of insurability, including conditions arising out of acts of domestic 7violence. AB50-ASA2-AA8,33,169(b) An insurer offering an individual health benefit plan or a self-insured 10health plan may not require any individual, as a condition of enrollment or 11continued enrollment under the plan, to pay, on the basis of any health status-12related factor under par. (a) with respect to the individual or a dependent of the 13individual, a premium or contribution or a deductible, copayment, or coinsurance 14amount that is greater than the premium or contribution or deductible, copayment, 15or coinsurance amount, respectively, for an otherwise similarly situated individual 16enrolled under the plan. AB50-ASA2-AA8,33,2017(c) Nothing in this subsection prevents an insurer offering an individual 18health benefit plan or a self-insured health plan from establishing premium 19discounts or rebates or modifying otherwise applicable cost sharing in return for 20adherence to programs of health promotion and disease prevention. AB50-ASA2-AA8,33,2321(4) Premium rate variation. A health benefit plan offered on the individual 22or small employer market or a self-insured health plan may vary premium rates for 23a specific plan based only on the following considerations: AB50-ASA2-AA8,34,1
1(a) Whether the policy or plan covers an individual or a family. AB50-ASA2-AA8,34,22(b) Rating area in the state, as established by the commissioner. AB50-ASA2-AA8,34,53(c) Age, except that the rate may not vary by more than 3 to 1 for adults over 4the age groups and the age bands shall be consistent with recommendations of the 5National Association of Insurance Commissioners. AB50-ASA2-AA8,34,66(d) Tobacco use, except that the rate may not vary by more than 1.5 to 1. AB50-ASA2-AA8,34,117(5) Statewide risk pool. An insurer offering a health benefit plan may not 8segregate enrollees into risk pools other than a single statewide risk pool for the 9individual market and a single statewide risk pool for the small employer market or 10a single statewide risk pool that combines the individual and small employer 11markets. AB50-ASA2-AA8,34,1312(6) Annual and lifetime limits. An individual or group health benefit plan 13or a self-insured health plan may not establish any of the following: AB50-ASA2-AA8,34,1514(a) Lifetime limits on the dollar value of benefits for an enrollee or a 15dependent of an enrollee under the plan. AB50-ASA2-AA8,34,1716(b) Annual limits on the dollar value of benefits for an enrollee or a dependent 17of an enrollee under the plan. AB50-ASA2-AA8,34,2118(7) Cost sharing maximum. A health benefit plan offered on the individual 19or small employer market may not require an enrollee under the plan to pay more in 20cost sharing than the maximum amount calculated under 42 USC 18022 (c), 21including the annual indexing of the limits. AB50-ASA2-AA8,35,222(8) Medical loss ratio. (a) In this subsection, “medical loss ratio” means
1the proportion, expressed as a percentage, of premium revenues spent by a health 2benefit plan on clinical services and quality improvement. AB50-ASA2-AA8,35,43(b) A health benefit plan on the individual or small employer market shall 4have a medical loss ratio of at least 80 percent. AB50-ASA2-AA8,35,65(c) A group health benefit plan other than one described under par. (b) shall 6have a medical loss ratio of at least 85 percent. AB50-ASA2-AA8,35,107(9) Actuarial values of plan tiers. Any health benefit plan offered on the 8individual or small employer market shall provide a level of coverage that is 9designed to provide benefits that are actuarially equivalent to at least 60 percent of 10the full actuarial value of the benefits provided under the plan. AB50-ASA2-AA8,3611Section 36. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and 12amended to read: AB50-ASA2-AA8,35,1913632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group 14health benefit plan may, with respect to a participant or beneficiary under the plan, 15not impose a preexisting condition exclusion only if the exclusion relates to a 16condition, whether physical or mental, regardless of the cause of the condition, for 17which medical advice, diagnosis, care or treatment was recommended or received 18within the 6-month period ending on the participant’s or beneficiary’s enrollment 19date under the plan on a participant or beneficiary under the plan. AB50-ASA2-AA8,3821Section 38. 632.746 (2) (a) of the statutes is amended to read: AB50-ASA2-AA8,36,222632.746 (2) (a) An insurer offering a group health benefit plan may not treat 23impose a preexisting condition exclusion based on genetic information as a
1preexisting condition under sub. (1) without a diagnosis of a condition related to the 2information. AB50-ASA2-AA8,393Section 39. 632.746 (2) (c), (d) and (e) of the statutes are repealed. AB50-ASA2-AA8,415Section 41. 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d). AB50-ASA2-AA8,426Section 42. 632.746 (3) (d) 2. and 3. of the statutes are repealed. AB50-ASA2-AA8,448Section 44. 632.746 (8) (a) (intro.) of the statutes is amended to read: AB50-ASA2-AA8,36,129632.746 (8) (a) (intro.) A health maintenance organization that offers a group 10health benefit plan and that does not impose any preexisting condition exclusion 11under sub. (1) with respect to a particular coverage option may impose an affiliation 12period for that coverage option, but only if all of the following apply: AB50-ASA2-AA8,36,2014632.748 (2) An insurer offering a group health benefit plan may not require 15any individual, as a condition of enrollment or continued enrollment under the 16plan, to pay, on the basis of any health status-related factor with respect to the 17individual or a dependent of the individual, a premium or contribution or a 18deductible, copayment, or coinsurance amount that is greater than the premium or 19contribution or deductible, copayment, or coinsurance amount, respectively, for a 20an otherwise similarly situated individual enrolled under the plan. AB50-ASA2-AA8,4621Section 46. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to 22read: AB50-ASA2-AA8,37,723632.76 (2) (a) No claim for loss incurred or disability commencing after 2
1years from the date of issue of the policy may be reduced or denied on the ground 2that a disease or physical condition existed prior to the effective date of coverage, 3unless the condition was excluded from coverage by name or specific description by 4a provision effective on the date of loss. This paragraph does not apply to a group 5health benefit plan, as defined in s. 632.745 (9), which is subject to s. 632.746, a 6disability insurance policy, as defined in s. 632.895 (1) (a), or a self-insured health 7plan, as defined in s. 632.85 (1) (c). AB50-ASA2-AA8,37,138(ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability 9commencing after 12 months from the date of issue of under an individual disability 10insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the 11ground that a disease or physical condition existed prior to the effective date of 12coverage, unless the condition was excluded from coverage by name or specific 13description by a provision effective on the date of the loss. AB50-ASA2-AA8,37,20142. Except as provided in subd. 3., an An individual disability insurance policy, 15as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495 16(4) and (5), may not define a preexisting condition more restrictively than a 17condition that was present before the date of enrollment for the coverage, whether 18physical or mental, regardless of the cause of the condition, for which and 19regardless of whether medical advice, diagnosis, care, or treatment was 20recommended or received within 12 months before the effective date of coverage. AB50-ASA2-AA8,4721Section 47. 632.795 (4) (a) of the statutes is amended to read: AB50-ASA2-AA8,38,1022632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the 23same policy form and for the same premium as it originally offered in the most
1recent enrollment period, subject only to the medical underwriting used in that 2enrollment period. Unless otherwise prescribed by rule, the insurer may apply 3deductibles, preexisting condition limitations, waiting periods, or other limits only 4to the extent that they would have been applicable had coverage been extended at 5the time of the most recent enrollment period and with credit for the satisfaction or 6partial satisfaction of similar provisions under the liquidated insurer’s policy or 7plan. The insurer may exclude coverage of claims that are payable by a solvent 8insurer under insolvency coverage required by the commissioner or by the 9insurance regulator of another jurisdiction. Coverage shall be effective on the date 10that the liquidated insurer’s coverage terminates. AB50-ASA2-AA8,4811Section 48. 632.895 (8) (d) of the statutes is amended to read: AB50-ASA2-AA8,38,1812632.895 (8) (d) Coverage is required under this subsection despite whether 13the woman shows any symptoms of breast cancer. Except as provided in pars. (b), 14(c), and (e), coverage under this subsection may only be subject to exclusions and 15limitations, including deductibles, copayments and restrictions on excessive 16charges, that are applied to other radiological examinations covered under the 17disability insurance policy. Coverage under this subsection may not be subject to 18any deductibles, copayments, or coinsurance. AB50-ASA2-AA8,38,2120632.895 (13m) Preventive services. (a) In this section, “self-insured health 21plan” has the meaning given in s. 632.85 (1) (c). AB50-ASA2-AA8,39,222(b) Every disability insurance policy, except any disability insurance policy
1that is described in s. 632.745 (11) (b) 1. to 12., and every self-insured health plan 2shall provide coverage for all of the following preventive services: AB50-ASA2-AA8,39,331. Mammography in accordance with sub. (8). AB50-ASA2-AA8,39,542. Genetic breast cancer screening and counseling and preventive medication 5for adult women at high risk for breast cancer. AB50-ASA2-AA8,39,763. Papanicolaou test for cancer screening for women 21 years of age or older 7with an intact cervix. AB50-ASA2-AA8,39,984. Human papillomavirus testing for women who have attained the age of 30 9years but have not attained the age of 66 years. AB50-ASA2-AA8,39,10105. Colorectal cancer screening in accordance with sub. (16m). AB50-ASA2-AA8,39,13116. Annual tomography for lung cancer screening for adults who have attained 12the age of 55 years but have not attained the age of 80 years and who have health 13histories demonstrating a risk for lung cancer. AB50-ASA2-AA8,39,15147. Skin cancer screening for individuals who have attained the age of 10 years 15but have not attained the age of 22 years. AB50-ASA2-AA8,39,17168. Counseling for skin cancer prevention for adults who have attained the age 17of 18 years but have not attained the age of 25 years. AB50-ASA2-AA8,39,19189. Abdominal aortic aneurysm screening for men who have attained the age of 1965 years but have not attained the age of 75 years and who have ever smoked.
/2025/related/amendments/ab50/aa8_asa2_ab50
true
amends
/2025/related/amendments/ab50/aa8_asa2_ab50/35/_6
amends/2025/REG/AB50-ASA2-AA8,32,17
amends/2025/REG/AB50-ASA2-AA8,32,17
section
true