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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AB50-ASA2-AA8,3720Section 37. 632.746 (1) (b) of the statutes is repealed.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AB50-ASA2-AA8,393Section 39. 632.746 (2) (c), (d) and (e) of the statutes are repealed.
AB50-ASA2-AA8,404Section 40. 632.746 (3) (a) of the statutes is repealed.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 of the statutes are repealed.
AB50-ASA2-AA8,437Section 43. 632.746 (5) of the statutes is repealed.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.
AB50-ASA2-AA8,41,6523. Fluoride supplements for prevention of tooth decay for minors 6 months of
6age or older who do not have fluoride in their water source.
AB50-ASA2-AA8,41,7724. Gonorrhea prophylaxis treatment for newborns.
AB50-ASA2-AA8,41,8825. Health history and physical exams for prenatal visits and for minors.
AB50-ASA2-AA8,41,10926. Length and weight measurements for newborns and height and weight
10measurements for minors.
AB50-ASA2-AA8,41,121127. Head circumference and weight-for-length measurements for newborns
12and minors who have not attained the age of 3 years.
AB50-ASA2-AA8,41,131328. Body mass index for minors 2 years of age or older.
AB50-ASA2-AA8,41,151429. Blood pressure measurements for minors 3 years of age or older and a
15blood pressure risk assessment at birth.
AB50-ASA2-AA8,41,171630. Risk assessment and referral for oral health issues for minors who have
17attained the age of 6 months but have not attained the age of 7 years.
AB50-ASA2-AA8,41,191831. Blood screening for newborns and minors who have not attained the age of
192 months.
AB50-ASA2-AA8,41,202032. Screening for critical congenital health defects for newborns.
AB50-ASA2-AA8,41,212133. Lead screenings in accordance with sub. (10).
AB50-ASA2-AA8,41,232234. Metabolic and hemoglobin screening and screening for phenylketonuria,
23sickle cell anemia, and congenital hypothyroidism for minors including newborns.
AB50-ASA2-AA8,42,2
135. Tuberculin skin test based on risk assessment for minors one month of age
2or older.
AB50-ASA2-AA8,42,4336. Tobacco counseling and cessation interventions for individuals who are 5
4years of age or older.
AB50-ASA2-AA8,42,6537. Vision and hearing screening and assessment for minors including
6newborns.
AB50-ASA2-AA8,42,8738. Sexually transmitted infection and human immunodeficiency virus
8counseling for sexually active minors.
AB50-ASA2-AA8,42,11939. Risk assessment for sexually transmitted infection for minors who are 10
10years of age or older and screening for sexually transmitted infection for minors
11who are 16 years of age or older.
AB50-ASA2-AA8,42,131240. Alcohol misuse screening and counseling for minors 11 years of age or
13older.
AB50-ASA2-AA8,42,151441. Autism screening for minors who have attained the age of 18 months but
15have not attained the age of 25 months.
AB50-ASA2-AA8,42,161642. Developmental screening and surveillance for minors including newborns.
AB50-ASA2-AA8,42,171743. Psychosocial and behavioral assessment for minors including newborns.
AB50-ASA2-AA8,42,191844. Alcohol misuse screening and counseling for pregnant adults and a risk
19assessment for all adults.
AB50-ASA2-AA8,42,212045. Fall prevention and counseling and preventive medication for fall
21prevention for community-dwelling adults 65 years of age or older.
AB50-ASA2-AA8,42,222246. Screening and counseling for intimate partner violence for adult women.
AB50-ASA2-AA8,43,22347. Well-woman visits for women who have attained the age of 18 years but

1have not attained the age of 65 years and well-woman visits for recommended
2preventive services, preconception care, and prenatal care.
AB50-ASA2-AA8,43,4348. Counseling on, consultations with a trained provider on, and equipment
4rental for breastfeeding for pregnant and lactating women.
AB50-ASA2-AA8,43,5549. Folic acid supplement for adult women with reproductive capacity.
AB50-ASA2-AA8,43,6650. Iron deficiency anemia screening for pregnant and lactating women.
AB50-ASA2-AA8,43,8751. Preeclampsia preventive medicine for pregnant adult women at high risk
8for preeclampsia.
AB50-ASA2-AA8,43,10952. Low-dose aspirin after 12 weeks of gestation for pregnant women at high
10risk for miscarriage, preeclampsia, or clotting disorders.
AB50-ASA2-AA8,43,111153. Screenings for hepatitis B and bacteriuria for pregnant women.
AB50-ASA2-AA8,43,141254. Screening for gonorrhea for pregnant and sexually active females 24 years
13of age or younger and females older than 24 years of age who are at risk for
14infection.
AB50-ASA2-AA8,43,171555. Screening for chlamydia for pregnant and sexually active females 24 years
16of age and younger and females older than 24 years of age who are at risk for
17infection.
AB50-ASA2-AA8,43,191856. Screening for syphilis for pregnant women and adults who are at high risk
19for infection.
AB50-ASA2-AA8,43,222057. Human immunodeficiency virus screening for adults who have attained
21the age of 15 years but have not attained the age of 66 years and individuals at high
22risk of infection who are younger than 15 years of age or older than 65 years of age.
AB50-ASA2-AA8,43,232358. All contraceptives and services in accordance with sub. (17).
AB50-ASA2-AA8,44,2
159. Any services not already specified under this paragraph having an A or B
2rating in current recommendations from the U.S. preventive services task force.
AB50-ASA2-AA8,44,5360. Any preventive services not already specified under this paragraph that
4are recommended by the federal health resources and services administrations
5Bright Futures project.
AB50-ASA2-AA8,44,8661. Any immunizations, not already specified under sub. (14), that are
7recommended and determined to be for routine use by the federal advisory
8committee on immunization practices.
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