This is the preview version of the Wisconsin State Legislature site.
Please see http://docs.legis.wisconsin.gov for the production version.
This proposal may contain a health insurance mandate requiring a social and financial impact report under s. 601.423, stats.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SB174,1
1Section 1. 40.51 (8) of the statutes is amended to read:
SB174,2,6240.51 (8) Every health care coverage plan offered by the state under sub. (6)
3shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.722,
4632.728, 632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83,
5632.835, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (3) to (6), 632.885,
6632.89, 632.895 (5m) and (8) to (17), and 632.896.
SB174,27Section 2. 40.51 (8m) of the statutes is amended to read:
SB174,3,3840.51 (8m) Every health care coverage plan offered by the group insurance

1board under sub. (7) shall comply with ss. 631.95, 632.722, 632.728, 632.729,
2632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85,
3632.853, 632.855, 632.861, 632.867, 632.885, 632.89, and 632.895 (11) to (17).
SB174,34Section 3. 66.0137 (4) of the statutes is amended to read:
SB174,3,11566.0137 (4) Self-insured health plans. If a city, including a 1st class city,
6or a village provides health care benefits under its home rule power, or if a town
7provides health care benefits, to its officers and employees on a self-insured basis,
8the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
9632.722, 632.728, 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798,
10632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6), 632.885, 632.89,
11632.895 (9) to (17), 632.896, and 767.513 (4).
SB174,412Section 4. 120.13 (2) (g) of the statutes is amended to read:
SB174,3,1613120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
1449.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.722, 632.728, 632.729, 632.746 (10) (a)
152. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.867,
16632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).
SB174,517Section 5. 185.983 (1) (intro.) of the statutes is amended to read:
SB174,4,218185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
19cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
20646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
21601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
22631.95, 632.72 (2), 632.722, 632.728, 632.729, 632.745 to 632.749, 632.775, 632.79,
23632.795, 632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (2) to (6),

1632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609,
2620, 630, 635, 645, and 646, but the sponsoring association shall:
SB174,63Section 6. 609.847 of the statutes is created to read:
SB174,4,64609.847 Preexisting condition discrimination prohibited; benefit
5limits. Limited service health organizations, preferred provider plans, and defined
6network plans are subject to s. 632.728.
SB174,77Section 7. 632.728 of the statutes is created to read:
SB174,4,98632.728 Coverage of individuals with preexisting conditions; rating;
9benefit limits. (1) Definitions. In this section:
SB174,4,1010(a) Health benefit plan has the meaning given in s. 632.745 (11).
SB174,4,1511(b) Preexisting condition exclusion means, with respect to coverage, a
12limitation or exclusion of benefits relating to a condition based on the fact that the
13condition was present before the date of enrollment for the coverage, whether or not
14any medical advice, diagnosis, care, or treatment was recommended or received
15before the date of enrollment for coverage.
SB174,4,1616(c) Self-insured health plan has the meaning given in s. 632.85 (1) (c).
SB174,4,1717(d) Small employer has the meaning given in s. 635.02 (7).
SB174,4,2318(2) Access to coverage. Every individual health benefit plan shall accept
19every individual in this state who applies for coverage and every group health
20benefit plan shall accept every employer in this state that applies for coverage,
21regardless of whether any individual or employee has a preexisting condition. A
22health benefit plan may restrict enrollment in coverage described in this subsection
23to open or special enrollment periods under sub. (4).
SB174,5,3
1(3) Premium rate variation. A health benefit plan offered on the individual
2or small employer market or a self-insured health plan may vary premium rates for
3a specific plan based only on the following considerations:
SB174,5,44(a) Whether the plan covers an individual or a family.
SB174,5,55(b) Rating area in the state, as established by the commissioner.
SB174,5,86(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.
SB174,5,99(d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
SB174,5,1310(4) Enrollment periods. (a) The commissioner shall ensure that every
11individual health benefit plan has open enrollment during a statewide open
12enrollment period of no longer than 45 days to allow individuals, including
13individuals who do not have coverage, to enroll in coverage.
SB174,5,1514(b) Every health benefit plan shall provide special enrollment periods for
15qualifying events under 26 USC 9801 (f) and 29 USC 1163.
SB174,5,1816(5) Preexisting condition exclusion. An individual or group health
17benefit plan or a self-insured health plan may not impose a preexisting condition
18exclusion for any time on an enrollee or beneficiary under the plan.
SB174,5,2019(6) Annual and lifetime limits. An individual or group health benefit plan
20or a self-insured health plan may not establish any of the following:
SB174,5,2221(a) Lifetime limits on the dollar value of benefits for an enrollee or a
22dependent of an enrollee under the plan.
SB174,6,2
1(b) Annual limits on the dollar value of benefits for an enrollee or a dependent
2of an enrollee under the plan.
SB174,6,103(7) Applicability. (a) This section applies only if provisions of the federal
4Patient Protection and Affordable Care Act, P.L. 111-148, as amended, under 42
5USC 300gg to 300gg-4 and 300gg-11 are no longer enforceable or no longer preempt
6state law relating to individual or group health insurance policies. If this section
7applies, this section supersedes any conflicting provision of s. 625.12 (1) or (2),
8625.15 (1), 628.34 (3), 632.746, 632.76, 632.795 (4) (a), 632.896 (4), or 632.897 (11)
9(a) or any other conflicting provision in chs. 600 to 655 to the extent this section
10conflicts with that provision.
SB174,6,1211(b) 1. A health benefit plan that is not required to comply with 42 USC 300gg-
121, as amended, as of January 1, 2023, is not required to comply with sub. (2).
SB174,6,14132. A health benefit plan that is not required to comply with 42 USC 300gg, as
14amended, as of January 1, 2023, is not required to comply with sub. (3).
SB174,6,16153. A health benefit plan that is not required to comply with 42 USC 300gg-3,
16as amended, as of January 1, 2023, is not required to comply with sub. (5).
SB174,6,19174. A health benefit plan that is not required to comply with 42 USC 300gg-11
18(a) (1) (A), as amended, as of January 1, 2023, is not required to comply with sub. (6)
19(a).
SB174,6,22205. A health benefit plan that is not required to comply with 42 USC 300gg-11
21(a) (1) (B), as amended, as of January 1, 2023, is not required to comply with sub. (6)
22(b).
SB174,6,2323(end)
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