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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-AA8,3218Section 32. 625.12 (2) of the statutes is amended to read:
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-AA8,335Section 33. 625.15 (1) of the statutes is amended to read:
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-AA8,3523Section 35. 632.728 of the statutes is created to read:
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-AA8,33,888. Disability.
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 participants or beneficiarys enrollment
19date under the plan on a participant or beneficiary under the plan.
AB50-ASA2-AA8,3720Section 37. 632.746 (1) (b) of the statutes is repealed.
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-AA8,404Section 40. 632.746 (3) (a) of the statutes is 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-AA8,437Section 43. 632.746 (5) of the statutes is 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-AA8,4513Section 45. 632.748 (2) of the statutes is amended to read:
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 insurers 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 insurers 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-AA8,4919Section 49. 632.895 (13m) of the statutes is created to read:
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.
AB50-ASA2-AA8,39,222010. Hypertension screening for adults and blood pressure testing for adults,
21for children under the age of 3 years who are at high risk for hypertension, and for
22children 3 years of age or older.
AB50-ASA2-AA8,40,2
111. Lipid disorder screening for minors 2 years of age or older, adults 20 years
2of age or older at high risk for lipid disorders, and all men 35 years of age or older.
AB50-ASA2-AA8,40,5312. Aspirin therapy for cardiovascular health for adults who have attained the
4age of 55 years but have not attained the age of 80 years and for men who have
5attained the age of 45 years but have not attained the age of 55 years.
AB50-ASA2-AA8,40,7613. Behavioral counseling for cardiovascular health for adults who are
7overweight or obese and who have risk factors for cardiovascular disease.
AB50-ASA2-AA8,40,8814. Type II diabetes screening for adults with elevated blood pressure.
AB50-ASA2-AA8,40,10915. Depression screening for minors 11 years of age or older and for adults
10when follow-up supports are available.
AB50-ASA2-AA8,40,121116. Hepatitis B screening for minors at high risk for infection and adults at
12high risk for infection.
AB50-ASA2-AA8,40,141317. Hepatitis C screening for adults at high risk for infection and onetime
14hepatitis C screening for adults born in any year from 1945 to 1965.
AB50-ASA2-AA8,40,181518. Obesity screening and management for all minors and adults with a body
16mass index indicating obesity, counseling and behavioral interventions for obese
17minors who are 6 years of age or older, and referral for intervention for obesity for
18adults with a body mass index of 30 kilograms per square meter or higher.
AB50-ASA2-AA8,40,201919. Osteoporosis screening for all women 65 years of age or older and for
20women at high risk for osteoporosis under the age of 65 years.
AB50-ASA2-AA8,40,212120. Immunizations in accordance with sub. (14).
AB50-ASA2-AA8,41,22221. Anemia screening for individuals 6 months of age or older and iron

1supplements for individuals at high risk for anemia who have attained the age of 6
2months but have not attained the age of 12 months.
AB50-ASA2-AA8,41,4322. Fluoride varnish for prevention of tooth decay for minors at the age of
4eruption of their primary teeth.
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