SB45,1446,2 (2) Special enrollment period. A health benefit plan or self-insured health plan shall allow a pregnant individual who is eligible for coverage under the plan, and any individual who is eligible for coverage under the plan because of a relationship to the pregnant individual, to enroll for coverage at any time during the pregnancy. The coverage shall begin no later than the first day of the first calendar month in which the pregnant individual receives medical verification of the pregnancy, except that a pregnant individual may direct coverage to begin on the first day of any month occurring during the pregnancy.

SB45,1446,6 (3) Notice. An insurer offering group health insurance coverage in this state shall provide notice of the special enrollment period under sub. (2) at or before the time an individual is initially offered the opportunity to enroll for coverage under the plan.

SB45,2937 Section 2937. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to read:

SB45,1446,16 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years from the date of issue of the policy may be reduced or denied on the ground that a disease or physical condition existed prior to the effective date of coverage, unless the condition was excluded from coverage by name or specific description by a provision effective on the date of loss. This paragraph does not apply to a group health benefit plan, as defined in s. 632.745 (9), which is subject to s. 632.746, a disability insurance policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s. 632.85 (1) (c).

SB45,1446,22 (ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability commencing after 12 months from the date of issue of under an individual disability insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the ground that a disease or physical condition existed prior to the effective date of coverage, unless the condition was excluded from coverage by name or specific description by a provision effective on the date of the loss.

SB45,1447,6 2. Except as provided in subd. 3., an An individual disability insurance policy, as defined in s. 632.895 (1) (a), other than a short-term policy limited duration plan subject to s. 632.7495 (4) and (5), may not define a preexisting condition more restrictively than a condition that was present before the date of enrollment for the coverage, whether physical or mental, regardless of the cause of the condition, for which and regardless of whether medical advice, diagnosis, care, or treatment was recommended or received within 12 months before the effective date of coverage.

SB45,2938 Section 2938. 632.76 (2) (ac) 3. (intro.) of the statutes is amended to read:

SB45,1447,10 632.76 (2) (ac) 3. (intro.) Except as the commissioner provides by rule under s. 632.7495 (5), all of the following apply to an individual disability insurance policy that is a short-term policy, limited duration plan subject to s. 632.7495 (4) and (5):

SB45,2939 Section 2939. 632.76 (2) (ac) 3. b. of the statutes is amended to read:

SB45,1447,17 632.76 (2) (ac) 3. b. The policy shall reduce the length of time during which a may not impose any preexisting condition exclusion may be imposed by the aggregate of the insured’s consecutive periods of coverage under the insurer’s individual disability insurance policies that are short-term policies subject to s. 632.7495 (4) and (5). For purposes of this subd. 3. b., coverage periods are consecutive if there are no more than 63 days between the coverage periods.

SB45,2940 Section 2940. 632.795 (4) (a) of the statutes is amended to read:

SB45,1448,6 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the same policy form and for the same premium as it originally offered in the most recent enrollment period, subject only to the medical underwriting used in that enrollment period. Unless otherwise prescribed by rule, the insurer may apply deductibles, preexisting condition limitations, waiting periods, or other limits only to the extent that they would have been applicable had coverage been extended at the time of the most recent enrollment period and with credit for the satisfaction or partial satisfaction of similar provisions under the liquidated insurer’s policy or plan. The insurer may exclude coverage of claims that are payable by a solvent insurer under insolvency coverage required by the commissioner or by the insurance regulator of another jurisdiction. Coverage shall be effective on the date that the liquidated insurer’s coverage terminates.

SB45,2941 Section 2941. 632.848 of the statutes is created to read:

SB45,1448,9 632.848 Exemption from prior authorization requirements. (1) In this section:

SB45,1448,12 (a) “Evaluation period” means the period of time established by the commissioner by rule that is used to evaluate whether a health care provider qualifies for an exemption from obtaining prior authorizations under sub. (2).

SB45,1448,13 (b) “Health benefit plan” has the meaning given in s. 632.745 (11).

SB45,1448,14 (c) “Health care item or service” includes all of the following:

SB45,1448,15 1. Prescription drugs.

SB45,1448,16 2. Laboratory testing.

SB45,1448,17 3. Medical equipment.

SB45,1448,18 4. Medical supplies.

SB45,1448,19 (d) “Health care provider” has the meaning given in s. 146.81 (1) (a) to (p).

SB45,1448,23 (e) “Prior authorization” means a determination by a health benefit plan, self- insured health plans, or person contracting with a health benefit plan or self- insured health plan that health care items or services proposed to be provided to a patient are medically necessary and appropriate.

SB45,1448,24 (f) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).

SB45,1449,8 (2) The commissioner may by rule provide that any health benefit plan or self- insured health plan that uses a prior authorization process shall exempt health care providers from obtaining prior authorizations for a health care item or service for a period of time established by the commissioner if, in the most recent evaluation period, the health benefit plan or self-insured health plan has approved or would have approved not less than the proportion of prior authorization requests established under sub. (3) submitted by the health care provider for the health care item or service.

SB45,1449,12 (3) The commissioner shall specify the proportion of prior authorization requests submitted by a health care provider that have to be approved for the health care provider to qualify for an exemption from obtaining prior authorizations under sub. (2).

SB45,1449,15 (4) The commissioner may specify by rule the health care items or services that may be subject to the exemption from obtaining prior authorizations under sub. (2).

SB45,1449,18 (5) The commissioner may specify how health care providers may obtain an exemption from obtaining prior authorizations under sub. (2) including by providing a process for automatic evaluation.

SB45,1449,20 (6) The commissioner may promulgate further rules necessary to implement this section.