632.895(16v)(a)2.2. Impose a limit on the quantity of prescription drugs that may be obtained if the quantity is no more than a 90-day supply.
632.895(16v)(b)(b) This subsection does not apply to a prescription drug that is a controlled substance, as defined in s. 961.01 (4).
632.895(17)(17)Contraceptives and services.
632.895(17)(a)(a) In this subsection, “contraceptives” means drugs or devices approved by the federal food and drug administration to prevent pregnancy.
632.895(17)(b)(b) Every disability insurance policy, and every self-insured health plan of the state or of a county, city, town, village, or school district, that provides coverage of outpatient health care services, preventive treatments and services, or prescription drugs and devices shall provide coverage for all of the following:
632.895(17)(b)1.1. Contraceptives prescribed by a health care provider, as defined in s. 146.81 (1).
632.895(17)(b)2.2. Outpatient consultations, examinations, procedures, and medical services that are necessary to prescribe, administer, maintain, or remove a contraceptive, if covered for any other drug benefits under the policy or plan.
632.895(17)(c)(c) Coverage under par. (b) may be subject only to the exclusions, limitations, or cost-sharing provisions that apply generally to the coverage of outpatient health care services, preventive treatments and services, or prescription drugs and devices that is provided under the policy or self-insured health plan.
632.895(17)(d)(d) This subsection does not apply to any of the following:
632.895(17)(d)1.1. A disability insurance policy that covers only certain specified diseases.
632.895(17)(d)2.2. A disability insurance policy, or a self-insured health plan of the state or a county, city, town, village, or school district, that provides only limited-scope dental or vision benefits.
632.895(17)(d)3.3. A health care plan offered by a limited service health organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b).
632.895(17)(d)4.4. A long-term care insurance policy.
632.895(17)(d)5.5. A Medicare replacement policy or a Medicare supplement policy.
632.895 HistoryHistory: 1981 c. 39 ss. 4 to 12, 18, 20; 1981 c. 85, 99; 1981 c. 314 ss. 122, 123, 125; 1983 a. 36, 429; 1985 a. 29, 56, 311; 1987 a. 195, 327, 403; 1989 a. 129, 201, 229, 316, 332, 359; 1991 a. 32, 45, 123; 1993 a. 443, 450; 1995 a. 27 ss. 7048, 9126 (19); 1995 a. 201, 225; 1997 a. 27, 35, 75, 175, 237; 1999 a. 32, 115; 1999 a. 150 s. 672; 2001 a. 16, 82; 2007 a. 20 s. 9121 (6) (a); 2007 a. 36, 153; 2009 a. 14, 28, 282, 346; 2011 a. 260 s. 80; 2015 a. 55; 2017 a. 305; 2019 a. 185; 2023 a. 56.
632.895 Cross-referenceCross-reference: See also ss. Ins 3.38 and 3.54, Wis. adm. code.
632.895 AnnotationThe commissioner can reasonably construe sub. (3) to require an insurer to pay a facility’s charge for care up to the maximum Department of Health and Social Services rate. Mutual Benefit Life Ins. Co. v. OCI, 151 Wis. 2d 411, 444 N.W.2d 450 (Ct. App. 1989).
632.895 AnnotationSub. (2) (g) does not prohibit an insurer from contracting away the right to review medical necessity. The provision does not apply until the insurer has shown that its own determination is relevant to a insurance contract. Schroeder v. Blue Cross & Blue Shield United of Wisconsin, 153 Wis. 2d 165, 450 N.W.2d 470 (Ct. App. 1989).
632.895 AnnotationSub. (7) permits an insurer to exclude or limit certain services and procedures, as long as the exclusion or limitation applies to all policies. However, an insurer may not make routine maternity services that are generally covered under the policy unavailable to a specific subgroup of insureds, surrogate mothers, based solely on the insured’s reasons for becoming pregnant or the method used to achieve pregnancy. Mercycare Insurance Co. v. OCI, 2010 WI 87, 328 Wis. 2d 110, 786 N.W.2d 785, 08-2937.
632.896632.896Mandatory coverage of adopted children.
632.896(1)(1)Definitions. In this section:
632.896(1)(a)(a) “Department” means the department of health services.
632.896(1)(b)(b) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
632.896(1)(c)(c) “Placed for adoption” means any of the following:
632.896(1)(c)1.1. The department, a county department under s. 48.57 (1) (e) or (hm), or a child welfare agency licensed under s. 48.60 places a child in the insured’s home for adoption and enters into an agreement under s. 48.63 (3) (b) 4. or 48.833 (1) or (2) with the insured.
632.896(1)(c)2.2. The department, a county department under s. 48.57 (1) (e) or (hm), or a child welfare agency under s. 48.837 (1r) places, or a court under s. 48.837 (4) (d) or (6) (b) orders, a child placed in the insured’s home for adoption.
632.896(1)(c)3.3. A sending agency, as defined in s. 48.988 (2) (d), places a child in the insured’s home under s. 48.988 for adoption, or a public child placing agency, as defined in s. 48.99 (2) (r), or a private child placing agency, as defined in s. 48.99 (2) (p), of a sending state, as defined in s. 48.99 (2) (w), places a child in the insured’s home under s. 48.99 as a preliminary step to a possible adoption, and the insured takes physical custody of the child at any location within the United States.
632.896(1)(c)4.4. The person bringing the child into this state has complied with s. 48.98, and the insured takes physical custody of the child at any location within the United States.
632.896(1)(c)5.5. A court of a foreign jurisdiction appoints the insured as guardian of a child who is a citizen of that jurisdiction, and the child arrives in the insured’s home for the purpose of adoption by the insured under s. 48.839.