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SB37,8,86 (c) Age, except that the rate may not vary by more than 3 to 1 for adults over
7the age groups and the age bands shall be consistent with recommendations of the
8National Association of Insurance Commissioners.
SB37,8,99 (d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
SB37,8,11 10(5) Annual and lifetime limits. An individual or group health benefit plan or
11a self-insured health plan may not establish any of the following:
SB37,8,1312 (a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent
13of an enrollee under the plan.
SB37,8,1514 (b) Annual limits on the dollar value of benefits for an enrollee or a dependent
15of an enrollee under the plan.
SB37,8,23 16(6) Short-term plans. This section and s. 632.76 apply to every short-term,
17limited-duration health insurance policy. In this subsection, “short-term,
18limited-duration health insurance policy” means health coverage that is provided
19under a contract with an insurer, has an expiration date specified in the contract that
20is less than 12 months after the original effective date of the contract, and, taking
21into account renewals or extensions, has a duration of no longer than 36 months in
22total. “Short-term, limited-duration health insurance policy” includes any
23short-term policy subject to s. 632.7495 (4).
SB37,14 24Section 14. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and
25amended to read:
SB37,9,7
1632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health
2benefit plan may, with respect to a participant or beneficiary under the plan, not
3impose a preexisting condition exclusion only if the exclusion relates to a condition,
4whether physical or mental, regardless of the cause of the condition, for which
5medical advice, diagnosis, care or treatment was recommended or received within
6the 6-month period ending on the participant's or beneficiary's enrollment date
7under the plan
on a participant or beneficiary under the plan.
SB37,15 8Section 15. 632.746 (1) (b) of the statutes is repealed.
SB37,16 9Section 16. 632.746 (2) (a) of the statutes is amended to read:
SB37,9,1310 632.746 (2) (a) An insurer offering a group health benefit plan may not treat
11impose a preexisting condition exclusion based on genetic information as a
12preexisting condition under sub. (1) without a diagnosis of a condition related to the
13information
.
SB37,17 14Section 17. 632.746 (2) (c), (d) and (e) of the statutes are repealed.
SB37,18 15Section 18. 632.746 (3) (a) of the statutes is repealed.
SB37,19 16Section 19 . 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).
SB37,20 17Section 20 . 632.746 (3) (d) 2. and 3. of the statutes are repealed.
SB37,21 18Section 21 . 632.746 (5) of the statutes is repealed.
SB37,22 19Section 22. 632.746 (8) (a) (intro.) of the statutes is amended to read:
SB37,9,2320 632.746 (8) (a) (intro.) A health maintenance organization that offers a group
21health benefit plan and that does not impose any preexisting condition exclusion
22under sub. (1)
with respect to a particular coverage option may impose an affiliation
23period for that coverage option, but only if all of the following apply:
SB37,23 24Section 23 . 632.748 (2) of the statutes is amended to read:
SB37,10,7
1632.748 (2) An insurer offering a group health benefit plan may not require any
2individual, as a condition of enrollment or continued enrollment under the plan, to
3pay, on the basis of any health status-related factor with respect to the individual
4or a dependent of the individual, a premium or contribution or a deductible,
5copayment, or coinsurance amount
that is greater than the premium or contribution
6or deductible, copayment, or coinsurance amount respectively for a similarly
7situated individual enrolled under the plan.
SB37,24 8Section 24. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to read:
SB37,10,169 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
10from the date of issue of the policy may be reduced or denied on the ground that a
11disease or physical condition existed prior to the effective date of coverage, unless the
12condition was excluded from coverage by name or specific description by a provision
13effective on the date of loss. This paragraph does not apply to a group health benefit
14plan, as defined in s. 632.745 (9), which is subject to s. 632.746 , a disability insurance
15policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s.
16632.85 (1) (c)
.
SB37,10,2217 (ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability
18commencing after 12 months from the date of issue of under an individual disability
19insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the
20ground that a disease or physical condition existed prior to the effective date of
21coverage, unless the condition was excluded from coverage by name or specific
22description by a provision effective on the date of the loss
.
SB37,11,423 2. Except as provided in subd. 3., an An individual disability insurance policy,
24as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495
25(4) and (5),
may not define a preexisting condition more restrictively than a condition

1that was present before the date of enrollment for the coverage, whether physical or
2mental, regardless of the cause of the condition, for which and regardless of whether
3medical advice, diagnosis, care, or treatment was recommended or received within
412 months before the effective date of coverage
.
SB37,25 5Section 25. 632.76 (2) (ac) 3. of the statutes is repealed.
SB37,26 6Section 26. 632.795 (4) (a) of the statutes is amended to read:
SB37,11,187 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the
8same policy form and for the same premium as it originally offered in the most recent
9enrollment period, subject only to the medical underwriting used in that enrollment
10period. Unless otherwise prescribed by rule, the insurer may apply deductibles,
11preexisting condition limitations, waiting periods , or other limits only to the extent
12that they would have been applicable had coverage been extended at the time of the
13most recent enrollment period and with credit for the satisfaction or partial
14satisfaction of similar provisions under the liquidated insurer's policy or plan. The
15insurer may exclude coverage of claims that are payable by a solvent insurer under
16insolvency coverage required by the commissioner or by the insurance regulator of
17another jurisdiction. Coverage shall be effective on the date that the liquidated
18insurer's coverage terminates.
SB37,27 19Section 27. 632.895 (8) (d) of the statutes is amended to read:
SB37,12,220 632.895 (8) (d) Coverage is required under this subsection despite whether the
21woman shows any symptoms of breast cancer. Except as provided in pars. (b), (c), and
22(e), coverage under this subsection may only be subject to exclusions and limitations,
23including deductibles, copayments and restrictions on excessive charges, that are
24applied to other radiological examinations covered under the disability insurance

1policy. Coverage under this subsection may not be subject to any deductibles,
2copayments, or coinsurance.
SB37,28 3Section 28. 632.895 (13m) of the statutes is created to read:
SB37,12,54 632.895 (13m) Preventive services. (a) In this section, “self-insured health
5plan” has the meaning given in s. 632.85 (1) (c).
SB37,12,86 (b) Every disability insurance policy, except any disability insurance policy that
7is described in s. 632.745 (11) (b) 1. to 12., and every self-insured health plan shall
8provide coverage for all of the following preventive services:
SB37,12,99 1. Mammography in accordance with sub. (8).
SB37,12,1110 2. Genetic breast cancer screening and counseling and preventive medication
11for adult women at high risk for breast cancer.
SB37,12,1312 3. Papanicolaou test for cancer screening for women 21 years of age or older
13with an intact cervix.
SB37,12,1514 4. Human papillomavirus testing for women who have attained the age of 30
15years but have not attained the age of 66 years.
SB37,12,1616 5. Colorectal cancer screening in accordance with sub. (16m).
SB37,12,1917 6. Annual tomography for lung cancer screening for adults who have attained
18the age of 55 years but have not attained the age of 80 years and who have health
19histories demonstrating a risk for lung cancer.
SB37,12,2120 7. Skin cancer screening for individuals who have attained the age of 10 years
21but have not attained the age of 22 years.
SB37,12,2322 8. Counseling for skin cancer prevention for adults who have attained the age
23of 18 years but have not attained the age of 25 years.
SB37,12,2524 9. Abdominal aortic aneurysm screening for men who have attained the age of
2565 years but have not attained the age of 75 years and who have ever smoked.
SB37,13,3
110. Hypertension screening for adults and blood pressure testing for adults, for
2children under the age of 3 years who are at high risk for hypertension, and for
3children 3 years of age or older.
SB37,13,54 11. Lipid disorder screening for minors 2 years of age or older, adults 20 years
5of age or older at high risk for lipid disorders, and all men 35 years of age or older.
SB37,13,86 12. Aspirin therapy for cardiovascular health for adults who have attained the
7age of 55 years but have not attained the age of 80 years and for men who have
8attained the age of 45 years but have not attained the age of 55 years.
SB37,13,109 13. Behavioral counseling for cardiovascular health for adults who are
10overweight or obese and who have risk factors for cardiovascular disease.
SB37,13,1111 14. Type II diabetes screening for adults with elevated blood pressure.
SB37,13,1312 15. Depression screening for minors 11 years of age or older and for adults when
13follow-up supports are available.
SB37,13,1514 16. Hepatitis B screening for minors at high risk for infection and adults at high
15risk for infection.
SB37,13,1716 17. Hepatitis C screening for adults at high risk for infection and one-time
17hepatitis C screening for adults born in any year from 1945 to 1965.
SB37,13,2118 18. Obesity screening and management for all minors and adults with a body
19mass index indicating obesity, counseling and behavioral interventions for obese
20minors who are 6 years of age or older, and referral for intervention for obesity for
21adults with a body mass index of 30 kilograms per square meter or higher.
SB37,13,2322 19. Osteoporosis screening for all women 65 years of age or older and for women
23at high risk for osteoporosis under the age of 65 years.
SB37,13,2424 20. Immunizations in accordance with sub. (14).
SB37,14,3
121. Anemia screening for individuals 6 months of age or older and iron
2supplements for individuals at high risk for anemia and who have attained the age
3of 6 months but have not attained the age of 12 months.
SB37,14,54 22. Fluoride varnish for prevention of tooth decay for minors at the age of
5eruption of their primary teeth.
SB37,14,76 23. Fluoride supplements for prevention of tooth decay for minors 6 months of
7age or older who do not have fluoride in their water source.
SB37,14,88 24. Gonorrhea prophylaxis treatment for newborns.
SB37,14,99 25. Health history and physical exams for prenatal visits and for minors.
SB37,14,1110 26. Length and weight measurements for newborns and height and weight
11measurements for minors.
SB37,14,1312 27. Head circumference and weight-for-length measurements for newborns
13and minors who have not attained the age of 3 years.
SB37,14,1414 28. Body mass index for minors 2 years of age or older.
SB37,14,1615 29. Blood pressure measurements for minors 3 years of age or older and a blood
16pressure risk assessment at birth.
SB37,14,1817 30. Risk assessment and referral for oral health issues for minors who have
18attained the age of 6 months but have not attained the age of 7 years.
SB37,14,2019 31. Blood screening for newborns and minors who have not attained the age of
202 months.
SB37,14,2121 32. Screening for critical congenital health defects for newborns.
SB37,14,2222 33. Lead screenings in accordance with sub. (10).
SB37,14,2423 34. Metabolic and hemoglobin screening and screening for phenylketonuria,
24sickle cell anemia, and congenital hypothyroidism for minors including newborns.
SB37,15,2
135. Tuberculin skin test based on risk assessment for minors one month of age
2or older.
SB37,15,43 36. Tobacco counseling and cessation interventions for individuals who are 5
4years of age or older.
SB37,15,65 37. Vision and hearing screening and assessment for minors including
6newborns.
SB37,15,87 38. Sexually transmitted infection and human immunodeficiency virus
8counseling for sexually active minors.
SB37,15,119 39. Risk assessment for sexually transmitted infection for minors who are 10
10years of age or older and screening for sexually transmitted infection for minors who
11are 16 years of age or older.
SB37,15,1212 40. Alcohol misuse screening and counseling for minors 11 years of age or older.
SB37,15,1413 41. Autism screening for minors who have attained the age of 18 months but
14have not attained the age of 25 months.
SB37,15,1515 42. Developmental screening and surveillance for minors including newborns.
SB37,15,1616 43. Psychosocial and behavioral assessment for minors including newborns.
SB37,15,1817 44. Alcohol misuse screening and counseling for pregnant adults and a risk
18assessment for all adults.
SB37,15,2019 45. Fall prevention and counseling and preventive medication for fall
20prevention for community-dwelling adults 65 years of age or older.
SB37,15,2121 46. Screening and counseling for intimate partner violence for adult women.
SB37,15,2422 47. Well-woman visits for women who have attained the age of 18 years but
23have not attained the age of 65 years and well-woman visits for recommended
24preventive services, preconception care, and prenatal care.
SB37,16,2
148. Counseling on, consultations with a trained provider on, and equipment
2rental for breastfeeding for pregnant and lactating women.
SB37,16,33 49. Folic acid supplement for adult women with reproductive capacity.
SB37,16,44 50. Iron deficiency anemia screening for pregnant and lactating women.
SB37,16,65 51. Preeclampsia preventive medicine for pregnant adult women at high risk
6for preeclampsia.
SB37,16,87 52. Low-dose aspirin after 12 weeks of gestation for pregnant women at high
8risk for miscarriage, preeclampsia, or clotting disorders.
SB37,16,99 53. Screenings for hepatitis B and bacteriuria for pregnant women.
SB37,16,1110 54. Screening for gonorrhea for pregnant and sexually active females 24 years
11of age or younger and females older than 24 years of age who are at risk for infection.
SB37,16,1412 55. Screening for chlamydia for pregnant and sexually active females 24 years
13of age and younger and females older than 24 years of age who are at risk for
14infection.
SB37,16,1615 56. Screening for syphilis for pregnant women and adults who are at high risk
16for infection.
SB37,16,1917 57. Human immunodeficiency virus screening for adults who have attained the
18age of 15 years but have not attained the age of 66 years and individuals at high risk
19of infection who are younger than 15 years of age or older than 65 years of age.
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