SB45-SSA2-SA4,189,1211(c) 1. A disability insurance policy or self-insured health plan may not do any 12of the following: SB45-SSA2-SA4,189,1513a. Impose any exclusion, limitation, or other restriction on coverage required 14under par. (b) based on a covered individual’s participation in fertility services 15provided by or to a 3rd party. SB45-SSA2-SA4,189,1916b. Impose any exclusion, limitation, or other restriction on coverage of 17medications that are required to be covered under par. (b) that are different from 18those imposed on any other prescription medications covered under the policy or 19plan. SB45-SSA2-SA4,190,320c. Impose any exclusion, limitation, cost-sharing requirement, benefit 21maximum, waiting period, or other restriction on coverage that is required under 22par. (b) of diagnosis of and treatment for infertility and standard fertility 23preservation services that is different from an exclusion, limitation, cost-sharing
1requirement, benefit maximum, waiting period, or other restriction imposed on 2benefits for services that are covered by the policy or plan and that are not related to 3infertility. SB45-SSA2-SA4,190,742. A disability insurance policy or self-insured health plan shall provide 5coverage required under par. (b) to any covered individual under the policy or plan, 6including any covered spouse or nonspouse dependent, to the same extent as other 7pregnancy-related benefits covered under the policy or plan. SB45-SSA2-SA4,190,138(d) The commissioner, after consulting with the department of health services 9on appropriate treatment for infertility, shall promulgate any rules necessary to 10implement this subsection. Before the promulgation of rules, disability insurance 11policies and self-insured health plans are considered to comply with the coverage 12requirements of par. (b) if the coverage conforms to the standards of the American 13Society for Reproductive Medicine. SB45-SSA2-SA4,190,1514(e) This subsection does not apply to a disability insurance policy that is 15described under s. 632.745 (11) (b) 1. to 12. SB45-SSA2-SA4,26616Section 266. 632.895 (16m) (b) of the statutes is amended to read: SB45-SSA2-SA4,190,2117632.895 (16m) (b) The coverage required under this subsection may be subject 18to any limitations, or exclusions, or cost-sharing provisions that apply generally 19under the disability insurance policy or self-insured health plan. The coverage 20required under this subsection may not be subject to any deductibles, copayments, 21or coinsurance. SB45-SSA2-SA4,26722Section 267. 632.895 (17) (b) 1m. of the statutes is created to read: SB45-SSA2-SA4,191,2
1632.895 (17) (b) 1m. Oral contraceptives that are lawfully furnished over the 2counter without a prescription. SB45-SSA2-SA4,2683Section 268. 632.895 (17) (b) 2. of the statutes is amended to read: SB45-SSA2-SA4,191,84632.895 (17) (b) 2. Outpatient consultations, examinations, procedures, and 5medical services that are necessary to prescribe, administer, maintain, or remove a 6contraceptive, if covered for any other drug benefits under the policy or plan 7sterilization procedures, and patient education and counseling for all females with 8reproductive capacity. SB45-SSA2-SA4,192,210632.895 (17) (c) Coverage under par. (b) may be subject only to the exclusions, 11and limitations, or cost-sharing provisions that apply generally to the coverage of 12outpatient health care services, preventive treatments and services, or prescription 13drugs and devices that is provided under the policy or self-insured health plan. A 14disability insurance policy or self-insured health plan may not apply a deductible or 15impose a copayment or coinsurance to at least one of each type of contraceptive 16method approved by the federal food and drug administration for which coverage is 17required under this subsection. The disability insurance policy or self-insured 18health plan may apply reasonable medical management to a method of 19contraception to limit coverage under this subsection that is provided without being 20subject to a deductible, copayment, or coinsurance to prescription drugs without a 21brand name. The disability insurance policy or self-insured health plan may apply 22a deductible or impose a copayment or coinsurance for coverage of a contraceptive
1that is prescribed for a medical need if the services for the medical need would 2otherwise be subject to a deductible, copayment, or coinsurance. SB45-SSA2-SA4,192,124632.897 (11) (a) Notwithstanding subs. (2) to (10), the commissioner may 5promulgate rules establishing standards requiring insurers to provide continuation 6of coverage for any individual covered at any time under a group policy who is a 7terminated insured or an eligible individual under any federal program that 8provides for a federal premium subsidy for individuals covered under continuation 9of coverage under a group policy, including rules governing election or extension of 10election periods, notice, rates, premiums, premium payment, application of 11preexisting condition exclusions, election of alternative coverage, and status as an 12eligible individual, as defined in s. 149.10 (2t), 2011 stats. SB45-SSA2-SA4,192,1614(1) Prescription drug purchasing entity. During the 2025-27 fiscal 15biennium, the office of the commissioner of insurance shall conduct a study on the 16viability of creating or implementing a state prescription drug purchasing entity. SB45-SSA2-SA4,192,2317(2) Staggered terms for prescription drug affordability review board. 18Notwithstanding the length of terms specified for the members of the prescription 19drug affordability review board under s. 15.735 (1) (b) to (e), 2 of the initial 20members shall be appointed for terms expiring on May 1, 2027; 2 of the initial 21members shall be appointed for terms expiring on May 1, 2028; 2 of the initial 22members shall be appointed for terms expiring on May 1, 2029; and 2 of the initial 23members shall be appointed for terms expiring on May 1, 2030. SB45-SSA2-SA4,193,7
1(3) Prescription drug importation program. The commissioner of 2insurance shall submit the first report required under s. 601.575 (5) by the next 3January 1 or July 1, whichever is earliest, that is at least 180 days after the date the 4prescription drug importation program is fully operational under s. 601.575 (4). 5The commissioner of insurance shall include in the first 3 reports submitted under 6s. 601.575 (5) information on the implementation of the audit functions under s. 7601.575 (1) (n). SB45-SSA2-SA4,193,118(4) Public option health insurance plan. From the appropriation under s. 920.145 (1) (g), the office of the commissioner of insurance may expend not more than 10$500,000 in fiscal year 2025-26 and not more than $500,000 in fiscal year 2026-27 11for the development of a public option health insurance plan. SB45-SSA2-SA4,193,1212(5) Funding for health insurance navigators. SB45-SSA2-SA4,193,1313(a) In this subsection: SB45-SSA2-SA4,193,14141. “Commissioner” means the commissioner of insurance. SB45-SSA2-SA4,193,16152. “Navigator” means an individual navigator licensed under s. 628.92 (1) or a 16navigator entity licensed under s. 628.92 (2). SB45-SSA2-SA4,193,1917(b) From the appropriation under s. 20.145 (1) (g), the commissioner shall 18award $500,000 in fiscal year 2025-26 and shall award $500,000 in fiscal year 2026-1927 to a navigator to prioritize services for the direct care workforce population. SB45-SSA2-SA4,194,221(1) Health insurance risk-sharing plan balance transfer. Any balance 22of moneys that was credited to the appropriation account under s. 20.145 (5) (g), 232013 stats., or s. 20.145 (5) (k), 2013 stats., and that was not lapsed as a result of
12015 Wisconsin Act 55 is transferred in fiscal year 2025-26 to the appropriation 2account under s. 20.145 (1) (g). SB45-SSA2-SA4,194,44(1) Coverage of infertility services. SB45-SSA2-SA4,194,85(a) For policies and plans containing provisions inconsistent with these 6sections, the treatment of ss. 609.74 and 632.895 (15m) first applies to policy or 7plan years beginning on January 1 of the year following the year in which this 8paragraph takes effect, except as provided in pars. (b) and (c). SB45-SSA2-SA4,194,139(b) For policies and plans that have a term greater than one year and contain 10provisions inconsistent with these sections, the treatment of ss. 609.74 and 632.895 11(15m) first applies to policy or plan years beginning on January 1 of the year 12following the year in which the policy or plan is extended, modified, or renewed, 13whichever is later. SB45-SSA2-SA4,194,1814(c) For policies and plans that are affected by a collective bargaining 15agreement containing provisions inconsistent with these sections, the treatment of 16ss. 609.74 and 632.895 (15m) first applies to policy or plan years beginning on the 17effective date of this paragraph or on the day on which the collective bargaining 18agreement is entered into, extended, modified, or renewed, whichever is later. SB45-SSA2-SA4,194,2019(2) Coverage of individuals with preexisting conditions, essential 20health benefits, and preventive services. SB45-SSA2-SA4,195,421(a) For policies and plans containing provisions inconsistent with these 22sections, the treatment of ss. 632.728, 632.746 (1) (a) and (b), (2) (a), (c), (d), and (e), 23(3) (a) and (d) 1., 2., and 3., (5), and (8) (a) (intro.), 632.748 (2), 632.76 (2) (a) and (ac)
11. and 2., 632.795 (4) (a), 632.895 (8) (d), (13m), (14) (a) 1. i., j., and k. to o., (b), (c), 2and (d) 3., (14m), (16m) (b), and (17) (b) 2. and (c), and 632.897 (11) (a) first applies 3to policy or plan years beginning on January 1 of the year following the year in 4which this paragraph takes effect, except as provided in par. (b). SB45-SSA2-SA4,195,135(b) For policies and plans that are affected by a collective bargaining 6agreement containing provisions inconsistent with these sections, the treatment of 7ss. 632.728, 632.746 (1) (a) and (b), (2) (a), (c), (d), and (e), (3) (a) and (d) 1., 2., and 83., (5), and (8) (a) (intro.), 632.748 (2), 632.76 (2) (a) and (ac) 1. and 2., 632.795 (4) 9(a), 632.895 (8) (d), (13m), (14) (a) 1. i., j., and k. to o., (b), (c), and (d) 3., (14m), (16m) 10(b), and (17) (b) 2. and (c), and 632.897 (11) (a) first applies to policy or plan years 11beginning on the effective date of this paragraph or on the day on which the 12collective bargaining agreement is entered into, extended, modified, or renewed, 13whichever is later. SB45-SSA2-SA4,195,1414(3) Coverage of over-the-counter oral contraceptives. SB45-SSA2-SA4,195,1815(a) For policies and plans containing provisions inconsistent with s. 632.895 16(17) (b) 1m., the treatment of s. 632.895 (17) (b) 1m. first applies to policy or plan 17years beginning on January 1 of the year following the year in which this paragraph 18takes effect, except as provided in par. (b). SB45-SSA2-SA4,195,2319(b) For policies and plans that are affected by a collective bargaining 20agreement containing provisions inconsistent with s. 632.895 (17) (b) 1m., the 21treatment of s. 632.895 (17) (b) 1m. first applies to policy or plan years beginning on 22the effective date of this paragraph or on the day on which the collective bargaining 23agreement is newly established, extended, modified, or renewed, whichever is later. SB45-SSA2-SA4,195,2424(4) Qualified treatment trainee coverage. SB45-SSA2-SA4,196,6
1(a) For policies and plans containing provisions inconsistent with ss. 40.51 (8) 2and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.713, and 632.87 (7), the 3treatment of ss. 40.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 4609.713, and 632.87 (7) first applies to policy or plan years beginning on January 1 5of the year following the year in which this paragraph takes effect, except as 6provided in par. (b). SB45-SSA2-SA4,196,137(b) For policies and plans that are affected by a collective bargaining 8agreement containing provisions inconsistent with ss. 40.51 (8) and (8m), 66.0137 9(4), 120.13 (2) (g), 185.983 (1) (intro.), 609.713, and 632.87 (7), the treatment of ss. 1040.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.713, and 11632.87 (7) first applies to policy or plan years beginning on the effective date of this 12paragraph or on the day on which the collective bargaining agreement is entered 13into, extended, modified, or renewed, whichever is later. SB45-SSA2-SA4,196,1414(5) Dental therapist coverage. SB45-SSA2-SA4,196,1815(a) For policies and plans containing provisions inconsistent with ss. 609.718 16and 632.87 (1), (4), and (4e), the treatment of ss. 609.718 and 632.87 (1), (4), and 17(4e) first applies to policy or plan years beginning on January 1 of the year following 18the year in which this paragraph takes effect, except as provided in par. (b). SB45-SSA2-SA4,196,2419(b) For policies and plans that are affected by a collective bargaining 20agreement containing provisions inconsistent with ss. 609.718 and 632.87 (1), (4), 21and (4e), the treatment of ss. 609.718 and 632.87 (1), (4), and (4e) first applies to 22policy or plan years beginning on the effective date of this paragraph or on the day 23on which the collective bargaining agreement is entered into, extended, modified, or 24renewed, whichever is later. SB45-SSA2-SA4,197,1
1(6) Application of manufacturer discounts. SB45-SSA2-SA4,197,52(a) For policies and plans containing provisions inconsistent with the 3treatment of s. 609.83, the treatment of s. 609.83 first applies to policy or plan years 4beginning on January 1 of the year following the year in which this paragraph takes 5effect, except as provided in par. (b). SB45-SSA2-SA4,197,106(b) For policies or plans that are affected by a collective bargaining agreement 7containing provisions inconsistent with the treatment of s. 609.83, the treatment of 8s. 609.83 first applies to policy or plan years beginning on the effective date of this 9paragraph or on the day on which the collective bargaining agreement is newly 10established, extended, modified, or renewed, whichever is later. SB45-SSA2-SA4,197,1111(7) Application of manufacturer discounts. SB45-SSA2-SA4,197,1512(a) For policies and plans containing provisions inconsistent with the 13treatment of s. 632.862, the treatment of s. 632.862 first applies to policy or plan 14years beginning on January 1 of the year following the year in which this paragraph 15takes effect, except as provided in par. (b). SB45-SSA2-SA4,197,2016(b) For policies or plans that are affected by a collective bargaining agreement 17containing provisions inconsistent with the treatment of s. 632.862, the treatment 18of s. 632.862 first applies to policy or plan years beginning on the effective date of 19this paragraph or on the day on which the collective bargaining agreement is newly 20established, extended, modified, or renewed, whichever is later. SB45-SSA2-SA4,197,2121(8) Substance abuse counselor coverage. SB45-SSA2-SA4,198,222(a) For policies and plans containing provisions inconsistent with the 23treatment of ss. 609.714 and 632.87 (8), the treatment of ss. 609.714 and 632.87 (8)
1first applies to policy or plan years beginning on January 1 of the year following the 2year in which this paragraph takes effect, except as provided in par. (b). SB45-SSA2-SA4,198,83(b) For policies and plans that are affected by a collective bargaining 4agreement containing provisions inconsistent with the treatment of ss. 609.714 and 5632.87 (8), the treatment of ss. 609.714 and 632.87 (8) first applies to policy or plan 6years beginning on the effective date of this paragraph or on the day on which the 7collective bargaining agreement is newly established, extended, modified, or 8renewed, whichever is later. SB45-SSA2-SA4,198,99(9) Telehealth parity. SB45-SSA2-SA4,198,1310(a) For policies and plans containing provisions inconsistent with the 11treatment of s. 632.871, the treatment of s. 632.871 first applies to policy or plan 12years beginning on January 1 of the year following the year in which this paragraph 13takes effect, except as provided in par. (b). SB45-SSA2-SA4,198,1814(b) For policies and plans that are affected by a collective bargaining 15agreement containing provisions inconsistent with the treatment of s. 632.871, the 16treatment of s. 632.871 first applies to policy or plan years beginning on the 17effective date of this paragraph or on the day on which the collective bargaining 18agreement is newly established, extended, modified, or renewed, whichever is later. SB45-SSA2-SA4,198,1919(10) Coverage of emergency ambulance services. SB45-SSA2-SA4,198,2320(a) For policies and plans containing provisions inconsistent with ss. 609.825 21and 632.851, the treatment of ss. 609.825 and 632.851 first applies to policy or plan 22years beginning on the effective date of this paragraph, except as provided in par. 23(b). SB45-SSA2-SA4,199,524(b) For policies and plans that are affected by a collective bargaining
1agreement containing provisions inconsistent with ss. 609.825 and 632.851, the 2treatment of ss. 609.825 and 632.851 first applies to policy or plan years beginning 3on the effective date of this paragraph or on the day on which the collective 4bargaining agreement is entered into, extended, modified, or renewed, whichever is 5later. SB45-SSA2-SA4,199,66(11) Inpatient mental health prior authorization. SB45-SSA2-SA4,199,107(a) For policies and plans containing provisions inconsistent with ss. 609.823 8and 632.891, the treatment of ss. 609.823 and 632.891 first applies to policy or plan 9years beginning on January 1 of the year following the year in which this paragraph 10takes effect, except as provided in par. (b). SB45-SSA2-SA4,199,1611(b) For policies and plans that are affected by a collective bargaining 12agreement containing provisions inconsistent with ss. 609.823 and 632.891, the 13treatment of ss. 609.823 and 632.891 first applies to policy or plan years beginning 14on the effective date of this subsection or on the day on which the collective 15bargaining agreement is newly established, extended, modified, or renewed, 16whichever is later. SB45-SSA2-SA4,199,1717(12) Special enrollment period for pregnancy. SB45-SSA2-SA4,199,2118(a) For policies and plans containing provisions inconsistent with ss. 609.40 19and 632.7498, the treatment of ss. 609.40 and 632.7498 first applies to policy or 20plan years beginning on January 1 of the year following the year in which this 21paragraph takes effect, except as provided in par. (b). SB45-SSA2-SA4,200,322(b) For policies and plans that are affected by a collective bargaining 23agreement containing provisions inconsistent with ss. 609.40 and 632.7498, the 24treatment of ss. 609.40 and 632.7498 first applies to policy or plan years beginning
1on the effective date of this paragraph or on the day on which the collective 2bargaining agreement is newly established, extended, modified, or renewed, 3whichever is later. SB45-SSA2-SA4,200,75(1) Coverage of infertility services. The treatment of ss. 609.74 and 6632.895 (15m) and Section 9323 (1) of this act take effect on the first day of the 4th 7month beginning after publication. SB45-SSA2-SA4,200,148(2) Coverage of individuals with preexisting conditions, essential 9health benefits, and preventive services. The treatment of ss. 632.728, 10632.746 (1) (a) and (b), (2) (a), (c), (d), and (e), (3) (a) and (d) 1., 2., and 3., (5), and (8) 11(a) (intro.), 632.748 (2), 632.76 (2) (a) and (ac) 1. and 2., 632.795 (4) (a), 632.895 (8) 12(d), (13m), (14) (a) 1. i., j., and k. to o., (b), (c), and (d) 3., (14m), (16m) (b), and (17) (b) 132. and (c), and 632.897 (11) (a) and Section 9323 (2) of this act take effect on the 14first day of the 4th month beginning after publication. SB45-SSA2-SA4,200,1715(3) Coverage of over-the-counter oral contraceptives. The treatment 16of s. 632.895 (17) (b) 1m. and Section 9323 (3) of this act take effect on the first day 17of the 4th month beginning after publication. SB45-SSA2-SA4,200,2118(4) Qualified treatment trainee coverage. The treatment of ss. 40.51 (8) 19and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.713, and 632.87 (7) and 20Section 9323 (4) of this act take effect on the first day of the 4th month beginning 21after publication. SB45-SSA2-SA4,200,2422(5) Dental therapist coverage. The treatment of ss. 609.718 and 632.87 23(1), (4), and (4e) and Section 9323 (5) of this act take effect on the first day of the 244th month beginning after publication. SB45-SSA2-SA4,201,4
1(6) Cost-sharing cap on insulin. The treatment of ss. 609.83 and 632.895 2(6) (title), the renumbering and amendment of s. 632.895 (6), and the creation of s. 3632.895 (6) (b) and Section 9323 (6) take effect on the first day of the 4th month 4beginning after publication. SB45-SSA2-SA4,201,75(7) Application of manufacturer discounts. The treatment of s. 632.862 6and Section 9323 (7) take effect on the first day of the 4th month beginning after 7publication. SB45-SSA2-SA4,201,108(8) Substance abuse counselor coverage. The treatment of ss. 609.714 9and 632.87 (8) and Section 9323 (8) of this act take effect on the first day of the 4th 10month beginning after publication. SB45-SSA2-SA4,201,1411(9) Prescription drug affordability review board. The treatment of ss. 1215.07 (3) (bm) 7., 15.735, 601.78, 601.785, and 601.79 and subch. VI (title) of ch. 601 13and Section 9123 (2) of this act take effect on the first day of the 7th month 14beginning after publication. SB45-SSA2-SA4,201,1715(10) Coverage of emergency ambulance services. The treatment of ss. 16609.825 and 632.851 and Section 9323 (10) of this act take effect on the first day of 17the 4th month beginning after publication. SB45-SSA2-SA4,201,2018(11) Inpatient mental health prior authorization. The treatment of ss. 19609.823 and 632.891 and Section 9323 (11) of this act take effect on the first day of 20the 4th month beginning after publication. SB45-SSA2-SA4,201,2321(12) Special enrollment period for pregnancy. The treatment of ss. 22609.40 and 632.7498 takes effect on the first day of the 4th month beginning after 23publication.”. SB45-SSA2-SA4,202,42250.15 (1) (c) “Health center look-alike” means a health care entity that is 3designated by the federal health resources and services administration as a 4federally qualified health center look-alike. SB45-SSA2-SA4,25Section 2. 250.15 (2) (bm) of the statutes is created to read: SB45-SSA2-SA4,202,66250.15 (2) (bm) To community health centers, $800,000. SB45-SSA2-SA4,37Section 3. 250.15 (2) (d) of the statutes is amended to read: SB45-SSA2-SA4,202,98250.15 (2) (d) Two million two hundred fifty thousand Three million dollars to 9free and charitable clinics. SB45-SSA2-SA4,410Section 4. 250.15 (2) (e) of the statutes is created to read: SB45-SSA2-SA4,202,1211250.15 (2) (e) To health center look-alikes, $200,000. A grant awarded to a 12health center look-alike under this paragraph may not exceed $100,000.
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