AB43,,8632 (a) “Cost sharing” includes deductibles, coinsurance, copayments, or similar charges.

AB43,,8633 (b) “Health benefit plan” has the meaning given in s. 632.745 (11).

AB43,,8634 (c) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB43,,8635 (2) Guaranteed issue. (a) Every individual health benefit plan shall accept every individual in this state who, and every group health benefit plan shall accept every employer in this state that, applies for coverage, regardless of sexual orientation, gender identity, or whether or not any employee or individual has a preexisting condition. A health benefit plan may restrict enrollment in coverage described in this paragraph to open or special enrollment periods.

AB43,,8636 (b) The commissioner shall establish a statewide open enrollment period of no shorter than 30 days for every individual health benefit plan to allow individuals, including individuals who do not have coverage, to enroll in coverage.

AB43,,8637 (3) Prohibiting discrimination based on health status. (a) An individual health benefit plan or a self-insured health plan may not establish rules for the eligibility of any individual to enroll, or for the continued eligibility of any individual to remain enrolled, under the plan based on any of the following health status-related factors in relation to the individual or a dependent of the individual:

AB43,,8638 1. Health status.

AB43,,8639 2. Medical condition, including both physical and mental illnesses.

AB43,,8640 3. Claims experience.

AB43,,8641 4. Receipt of health care.

AB43,,8642 5. Medical history.

AB43,,8643 6. Genetic information.

AB43,,8644 7. Evidence of insurability, including conditions arising out of acts of domestic violence.

AB43,,8645 8. Disability.

AB43,,8646 (b) An insurer offering an individual health benefit plan or a self-insured health plan may not require any individual, as a condition of enrollment or continued enrollment under the plan, to pay, on the basis of any health status-related factor under par. (a) with respect to the individual or a dependent of the individual, a premium or contribution or a deductible, copayment, or coinsurance amount that is greater than the premium or contribution or deductible, copayment, or coinsurance amount respectively for a similarly situated individual enrolled under the plan.

AB43,,8647 (c) Nothing in this subsection prevents an insurer offering an individual health benefit plan or a self-insured health plan from establishing premium discounts or rebates or modifying otherwise applicable cost sharing in return for adherence to programs of health promotion and disease prevention.

AB43,,8648 (4) Premium rate variation. A health benefit plan offered on the individual or small employer market or a self-insured health plan may vary premium rates for a specific plan based only on the following considerations:

AB43,,8649 (a) Whether the policy or plan covers an individual or a family.

AB43,,8650 (b) Rating area in the state, as established by the commissioner.

AB43,,8651 (c) Age, except that the rate may not vary by more than 3 to 1 for adults over the age groups and the age bands shall be consistent with recommendations of the National Association of Insurance Commissioners.

AB43,,8652 (d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.

AB43,,8653 (5) Statewide risk pool. An insurer offering a health benefit plan may not segregate enrollees into risk pools other than a single statewide risk pool for the individual market and a single statewide risk pool for the small employer market or a single statewide risk pool that combines the individual and small employer markets.

AB43,,8654 (6) Annual and lifetime limits. An individual or group health benefit plan or a self-insured health plan may not establish any of the following:

AB43,,8655 (a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent of an enrollee under the plan.

AB43,,8656 (b) Annual limits on the dollar value of benefits for an enrollee or a dependent of an enrollee under the plan.

AB43,,8657 (7) Cost sharing maximum. A health benefit plan offered on the individual or small employer market may not require an enrollee under the plan to pay more in cost sharing than the maximum amount calculated under 42 USC 18022 (c), including the annual indexing of the limits.

AB43,,8658 (8) Medical loss ratio. (a) In this subsection, “medical loss ratio” means the proportion, expressed as a percentage, of premium revenues spent by a health benefit plan on clinical services and quality improvement.

AB43,,8659 (b) A health benefit plan on the individual or small employer market shall have a medical loss ratio of at least 80 percent.

AB43,,8660 (c) A group health benefit plan other than one described under par. (b) shall have a medical loss ratio of at least 85 percent.