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AB50-ASA2-AA8,942317Section 9423. Effective dates; Insurance.
AB50-ASA2-AA8,193,2118(1) Coverage of emergency ambulance services. The treatment of ss.
1940.51 (8) and (8m), 66.0137 (4), 120.13 (2) (g), 185.983 (1) (intro.), 609.825, and
20632.851 and Section 9323 (1) of this act take effect on the first day of the 4th month
21beginning after publication..
AB50-ASA2-AA8,193,222274. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,193,2323Section 345. 601.45 (1) of the statutes is amended to read:
AB50-ASA2-AA8,194,824601.45 (1) Costs to be paid by examinees. The reasonable costs of

1examinations and audits under ss. 601.43, 601.44, 601.455, and 601.83 (5) (f) shall
2be paid by examinees except as provided in sub. (4), either on the basis of a system
3of billing for actual salaries and expenses of examiners and other apportionable
4expenses, including office overhead, or by a system of regular annual billings to
5cover the costs relating to a group of companies, or a combination of such systems,
6as the commissioner may by rule prescribe. Additional funding, if any, shall be
7governed by s. 601.32. The commissioner shall schedule annual hearings under s.
8601.41 (5) to review current problems in the area of examinations.
AB50-ASA2-AA8,3469Section 346. 601.455 of the statutes is created to read:
AB50-ASA2-AA8,194,1110601.455 Fair claims processing, health insurance transparency, and
11claim denial rate audits. (1) Definitions. In this section:
AB50-ASA2-AA8,194,1712(a) Claim denial means the refusal by an insurer to provide payment under
13a disability insurance policy for a service, treatment, or medication recommended
14by a health care provider. Claim denial includes the prospective refusal to pay for
15a service, treatment, or medication when a disability insurance policy requires
16advance approval before a prescribed medical service, treatment, or medication is
17provided.
AB50-ASA2-AA8,194,1818(b) Disability insurance policy has the meaning given in s. 632.895 (1) (a).
AB50-ASA2-AA8,194,1919(c) Health care provider has the meaning given in s. 146.81 (1) (a) to (p).
AB50-ASA2-AA8,194,2220(2) Claims processing. (a) Insurers shall process each claim for a disability
21insurance policy within a time frame that is reasonable and prevents an undue
22delay in an insureds care, taking into account the medical urgency of the claim.
AB50-ASA2-AA8,195,223(b) If an insurer determines additional information is needed to process a
24claim for a disability insurance policy, the insurer shall request the information

1from the insured within 5 business days of making the determination and shall
2provide at least 15 days for the insured to respond.
AB50-ASA2-AA8,195,33(c) All claim denials shall include all of the following:
AB50-ASA2-AA8,195,541. A specific and detailed explanation of the reason for the denial that cites
5the exact medical or policy basis for the denial.
AB50-ASA2-AA8,195,862. A copy of or a publicly accessible link to any policy, coverage rules, clinical
7guidelines, or medical evidence relied upon in making the denial decision, with
8specific citation to the provision justifying the denial.
AB50-ASA2-AA8,195,1193. Additional documentation, medical rationale, or criteria that must be met
10or provided for approval of the claim, including alternative options available under
11the policy.
AB50-ASA2-AA8,195,1412(d) If an insurer uses artificial intelligence or algorithmic decision-making in
13processing a claim for a disability insurance policy, the insurer must notify the
14insured in writing of that fact. The notice shall include all of the following:
AB50-ASA2-AA8,195,17151. A disclosure that artificial intelligence or algorithmic decision-making was
16used at any stage in reviewing the claim, even if a human later reviewed the
17outcome.
AB50-ASA2-AA8,195,20182. A detailed explanation of how the artificial intelligence or algorithmic
19decision-making reached its decision, including any factors the artificial
20intelligence or algorithmic decision-making weighed.
AB50-ASA2-AA8,195,22213. A contact point for requesting a human review of the claim if the claim was
22denied.
AB50-ASA2-AA8,196,223(3) Independent review of denials. In addition to an insureds right to an

1independent review under s. 632.835, as applicable, insureds have the right to
2request a review by the office of the public intervenor of any claim denial.
AB50-ASA2-AA8,196,43(4) Prohibited practices. An insurer may not do any of the following with
4respect to a disability insurance policy:
AB50-ASA2-AA8,196,55(a) Use vague or misleading policy terms to justify a claim denial.
AB50-ASA2-AA8,196,66(b) Fail to provide a specific and comprehensible reason for a claim denial.
AB50-ASA2-AA8,196,87(c) Cancel coverage under the policy after a claim is submitted due to alleged
8misstatements on the policy application.
AB50-ASA2-AA8,196,109(d) Deny a claim based on hidden or ambiguous exclusions in a disability
10insurance policy.
AB50-ASA2-AA8,196,1111(e) Stall review of a claim to avoid timely payment.
AB50-ASA2-AA8,196,1312(f) Reject a claim without reviewing all relevant medical records or consulting
13qualified experts.
AB50-ASA2-AA8,196,1514(g) Fail to properly review or respond to an insureds appeal in a timely
15manner.
AB50-ASA2-AA8,196,1716(h) Allow non-physician personnel to determine whether care is medically
17necessary.
AB50-ASA2-AA8,196,1918(i) Apply different medical necessity criteria based on financial interests
19rather than patient needs.
AB50-ASA2-AA8,196,2120(j) Disregard a treating health care providers medical assessment without a
21valid clinical reason.
AB50-ASA2-AA8,196,2322(k) Mandate prior approval for routine or urgent procedures in a manner that
23causes harmful delays.
AB50-ASA2-AA8,197,224(L) For a disability insurance policy that provides coverage of emergency

1medical services, refuse to cover emergency medical services provided by out-of-
2network providers.
AB50-ASA2-AA8,197,43(m) List a health care provider as in-network on a provider directory and then
4deny a claim by stating the health care provider is out-of-network.
AB50-ASA2-AA8,197,65(n) Deny coverage based on age, gender, disability, or a chronic condition
6rather than medical necessity.
AB50-ASA2-AA8,197,87(o) Apply stricter standards in reviewing claims related to mental health
8conditions than claims related to physical health conditions.
AB50-ASA2-AA8,197,109(p) Perform a blanket denial of claims for high-cost conditions without an
10individualized review of each claim.
AB50-ASA2-AA8,197,1111(r) Reclassify a claim to a lower-cost treatment to reduce insurer payout.
AB50-ASA2-AA8,197,1312(s) Require an insured to fail a cheaper treatment before approving coverage
13for necessary care.
AB50-ASA2-AA8,197,1414(t) Manipulate cost-sharing rules to shift higher costs to insureds.
AB50-ASA2-AA8,197,1915(5) Transparency and reporting. (a) Beginning on January 1, 2027, an
16insurer shall annually publish a report detailing the insurers claim denial rates,
17reasons for claim denials, and the outcome of any appeal of a claim denial for the
18previous year for all disability insurance policies under which the insurer provides
19coverage.
AB50-ASA2-AA8,197,2120(b) The commissioner shall maintain a public database of insurers claim
21denial rates and the outcomes of independent reviews under s. 632.835.
AB50-ASA2-AA8,198,222(c) Beginning on January 1, 2027, an insurer that uses artificial intelligence
23or algorithmic decision-making in claims processing shall annually publish a report

1detailing all of the following for the previous year for all disability insurance policies
2under which the insurer provides coverage:
AB50-ASA2-AA8,198,431. The percentage of claims submitted to the insurer that were reviewed by
4artificial intelligence or algorithmic decision-making.
AB50-ASA2-AA8,198,752. The claim denial rate of claims reviewed by artificial intelligence or
6algorithmic decision-making compared to the claim denial rate of claims reviewed
7by humans.
AB50-ASA2-AA8,198,983. The steps the insurer takes to ensure fairness and accuracy in decisions
9made by artificial intelligence or algorithmic decision-making.
AB50-ASA2-AA8,198,1310(6) Claim denial rate audits. (a) The commissioner may conduct an audit
11of an insurer if the insurers claim denials are of such frequency as to indicate a
12general business practice. This paragraph is supplemental to and does not limit
13any other powers or duties of the commissioner.
AB50-ASA2-AA8,198,1514(b) The commissioner may collect any relevant information from an insurer
15that is necessary to conduct an audit under par. (a).
AB50-ASA2-AA8,198,1716(c) The commissioner may contract with a 3rd party to conduct an audit under
17par. (a).
AB50-ASA2-AA8,198,2218(d) The commissioner may, based on the findings of an audit under par. (a),
19order the insurer who is the subject of the audit to comply with a corrective action
20plan approved by the commissioner. The commissioner shall specify in any
21corrective action plan under this paragraph the deadline by which an insurer must
22be in compliance with the corrective action plan.
AB50-ASA2-AA8,198,2423(e) An insurer who is the subject of an audit under par. (a) shall provide a
24written response to any adverse findings of the audit.
AB50-ASA2-AA8,199,3
1(f) If an insurer fails to comply with a corrective action plan under par. (d) by
2the deadline specified by the commissioner, the commissioner may order the
3insurer to pay a forfeiture pursuant to s. 601.64 (3).
AB50-ASA2-AA8,199,74(7) Forfeitures. A violation of this section that results in a harmful delay in
5an insureds care or an adverse health outcome for an insured shall be subject to a
6civil forfeiture of $10,000 per occurrence, in addition to any other penalties provided
7in s. 601.64 (3) or other law..
AB50-ASA2-AA8,199,8875. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,199,99Section 9123. Nonstatutory provisions; Insurance.
AB50-ASA2-AA8,199,1010(1) Funding for health insurance navigators.
AB50-ASA2-AA8,199,1111(a) In this subsection:
AB50-ASA2-AA8,199,12121. Commissioner means the commissioner of insurance.
AB50-ASA2-AA8,199,14132. Navigator means an individual navigator licensed under s. 628.92 (1) or a
14navigator entity licensed under s. 628.92 (2).
AB50-ASA2-AA8,199,1715(b) From the appropriation under s. 20.145 (1) (g), the commissioner shall
16award $500,000 in fiscal year 2025-26 and shall award $500,000 in fiscal year 2026-
1727 to a navigator to prioritize services for the direct care workforce population..
AB50-ASA2-AA8,199,181876. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,199,1919Section 347. 15.01 (6) of the statutes is amended to read:
AB50-ASA2-AA8,200,102015.01 (6) Division, bureau, section, and unit means the subunits of a
21department or an independent agency, whether specifically created by law or
22created by the head of the department or the independent agency for the more
23economic and efficient administration and operation of the programs assigned to

1the department or independent agency. The office of credit unions in the
2department of financial institutions, the office of the inspector general in the
3department of children and families, the office of the public intervenor in the office
4of the commissioner of insurance, the office of the inspector general in the
5department of health services, and the office of childrens mental health in the
6department of health services have the meaning of division under this
7subsection. The office of the long-term care ombudsman under the board on aging
8and long-term care and the office of educational accountability and the office of
9literacy in the department of public instruction have the meaning of bureau
10under this subsection.
AB50-ASA2-AA8,34811Section 348. 15.732 of the statutes is created to read:
AB50-ASA2-AA8,200,141215.732 Same; attached office. (1) Office of the public intervenor.
13There is created an office of the public intervenor which is attached to the office of
14the commissioner of insurance.
AB50-ASA2-AA8,34915Section 349. 20.145 (1) (g) 1. of the statutes is amended to read:
AB50-ASA2-AA8,200,181620.145 (1) (g) 1. All moneys received under ss. 601.25 (2), 601.31, 601.32,
17601.42 (7), 601.45, and 601.47 and by the commissioner for expenses related to
18insurance company restructurings, except for restructurings specified in par. (h).
AB50-ASA2-AA8,35019Section 350. 601.25 of the statutes is created to read:
AB50-ASA2-AA8,200,2320601.25 Office of the public intervenor. (1) The office of the public
21intervenor shall assist individuals with insurance claims, policies, appeals, and
22other legal actions to pursue insurance coverage for medical procedures,
23prescription medications, and other health care services.
AB50-ASA2-AA8,201,424(2) The office of the public intervenor may levy an assessment on each insurer

1that is authorized to engage in the business of insurance in this state. The
2assessment levied under this subsection shall be based on the insurers premium
3volume for disability insurance policies, as defined in s. 632.895 (1) (a), written in
4this state.
AB50-ASA2-AA8,201,65(3) The commissioner may provide by rule for the governance, duties, and
6administration of the office of the public intervenor..
AB50-ASA2-AA8,201,7777. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,201,168Section 351. 20.005 (3) (schedule) of the statutes: at the appropriate place,
9insert the following amounts for the purposes indicated:
AB50-ASA2-AA8,35217Section 352. 20.165 (1) (e) of the statutes is created to read:
AB50-ASA2-AA8,201,191820.165 (1) (e) Statewide clinician wellness program. The amounts in the
19schedule for the statewide clinician wellness program under s. 440.03 (18).
AB50-ASA2-AA8,35320Section 353. 440.03 (18) of the statutes is created to read:
AB50-ASA2-AA8,202,221440.03 (18) The department may provide a statewide clinician wellness
22program to provide support to healthcare workers in this state in maintaining their
23physical and mental health and ensuring long-term vitality and effectiveness for

1their patients and their profession. The department shall ensure that the program
2is coordinated with the procedure under sub. (1c)..
AB50-ASA2-AA8,202,3378. At the appropriate places, insert all of the following:
AB50-ASA2-AA8,202,44Section 354. 609.823 of the statutes is created to read:
AB50-ASA2-AA8,202,75609.823 Coverage without prior authorization for inpatient mental
6health services. Limited service health organizations, preferred provider plans,
7and defined network plans are subject to s. 632.891.
AB50-ASA2-AA8,3558Section 355. 632.891 of the statutes is created to read:
AB50-ASA2-AA8,202,139632.891 Coverage without prior authorization for inpatient mental
10health services. A disability insurance policy, as defined in s. 632.895 (1) (a), or
11self-insured health plan, as defined in s. 632.745 (24), that covers inpatient mental
12health services may not require prior authorization for the provision or coverage of
13those services.
AB50-ASA2-AA8,932314Section 9323. Initial applicability; Insurance.
AB50-ASA2-AA8,202,1515(1) Inpatient mental health prior authorization.
AB50-ASA2-AA8,202,1916(a) For policies and plans containing provisions inconsistent with ss. 609.823
17and 632.891, the treatment of ss. 609.823 and 632.891 first applies to policy or plan
18years beginning on January 1 of the year following the year in which this paragraph
19takes effect, except as provided in par. (b).
AB50-ASA2-AA8,203,220(b) For policies and plans that are affected by a collective bargaining
21agreement containing provisions inconsistent with ss. 609.823 and 632.891, the
22treatment of ss. 609.823 and 632.891 first applies to policy or plan years beginning
23on the effective date of this subsection or on the day on which the collective

1bargaining agreement is newly established, extended, modified, or renewed,
2whichever is later.
AB50-ASA2-AA8,94233Section 9423. Effective dates; Insurance.
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