AB50,1441,87(b) A health benefit plan on the individual or small employer market shall 8have a medical loss ratio of at least 80 percent. AB50,1441,109(c) A group health benefit plan other than one described under par. (b) shall 10have a medical loss ratio of at least 85 percent. AB50,1441,1411(9) Actuarial values of plan tiers. Any health benefit plan offered on the 12individual or small employer market shall provide a level of coverage that is 13designed to provide benefits that are actuarially equivalent to at least 60 percent of 14the full actuarial value of the benefits provided under the plan. AB50,292315Section 2923. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and 16amended to read: AB50,1441,2317632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group 18health benefit plan may, with respect to a participant or beneficiary under the plan, 19not impose a preexisting condition exclusion only if the exclusion relates to a 20condition, whether physical or mental, regardless of the cause of the condition, for 21which medical advice, diagnosis, care or treatment was recommended or received 22within the 6-month period ending on the participant’s or beneficiary’s enrollment 23date under the plan on a participant or beneficiary under the plan. AB50,2924
1Section 2924. 632.746 (1) (b) of the statutes is repealed. AB50,29252Section 2925. 632.746 (2) (a) of the statutes is amended to read: AB50,1442,63632.746 (2) (a) An insurer offering a group health benefit plan may not treat 4impose a preexisting condition exclusion based on genetic information as a 5preexisting condition under sub. (1) without a diagnosis of a condition related to the 6information. AB50,29267Section 2926. 632.746 (2) (c), (d) and (e) of the statutes are repealed. AB50,29278Section 2927. 632.746 (3) (a) of the statutes is repealed. AB50,29289Section 2928. 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d). AB50,292910Section 2929. 632.746 (3) (d) 2. and 3. of the statutes are repealed. AB50,293011Section 2930. 632.746 (5) of the statutes is repealed. AB50,293112Section 2931. 632.746 (8) (a) (intro.) of the statutes is amended to read: AB50,1442,1613632.746 (8) (a) (intro.) A health maintenance organization that offers a group 14health benefit plan and that does not impose any preexisting condition exclusion 15under sub. (1) with respect to a particular coverage option may impose an affiliation 16period for that coverage option, but only if all of the following apply: AB50,293217Section 2932. 632.748 (2) of the statutes is amended to read: AB50,1443,218632.748 (2) An insurer offering a group health benefit plan may not require 19any individual, as a condition of enrollment or continued enrollment under the 20plan, to pay, on the basis of any health status-related factor with respect to the 21individual or a dependent of the individual, a premium or contribution or a 22deductible, copayment, or coinsurance amount that is greater than the premium or
1contribution or deductible, copayment, or coinsurance amount, respectively, for a 2an otherwise similarly situated individual enrolled under the plan. AB50,29333Section 2933. 632.7495 (4) (b) of the statutes is amended to read: AB50,1443,44632.7495 (4) (b) The coverage has a term of not more than 12 3 months. AB50,29345Section 2934. 632.7495 (4) (c) of the statutes is amended to read: AB50,1443,106632.7495 (4) (c) The coverage term aggregated with all consecutive periods of 7the insurer’s coverage of the insured by individual health benefit plan coverage not 8required to be renewed under this subsection does not exceed 18 6 months. For 9purposes of this paragraph, coverage periods are consecutive if there are no more 10than 63 days between the coverage periods. AB50,293511Section 2935. 632.7496 of the statutes is created to read: AB50,1443,1412632.7496 Coverage requirements for short-term plans. (1) Definition. 13In this section, “short-term, limited duration plan” means an individual health 14benefit plan described in s. 632.7495 (4). AB50,1443,1715(2) Guaranteed issue. An insurer that offers a short-term, limited duration 16plan shall accept every individual in this state who applies for coverage regardless 17of whether the individual has a preexisting condition. AB50,1443,2318(3) Prohibiting discrimination based on health status. (a) An insurer 19that offers a short-term, limited duration plan may not establish rules for the 20eligibility of any individual to enroll, or for the continued eligibility of any 21individual to remain enrolled, under a short-term, limited duration plan based on 22any of the following health status-related factors with respect to the individual or a 23dependent of the individual: AB50,1444,1
11. Health status. AB50,1444,222. Medical condition, including both physical and mental illnesses. AB50,1444,333. Claims experience. AB50,1444,444. Receipt of health care.