SB111,1516,19 e. Terminally ill and receiving treatment for the illness from a provider or facility.

SB111,1516,20 2. “Serious and complex condition” means any of the following:

SB111,1516,23 a. In the case of an acute illness, a condition that is serious enough to require specialized medical treatment to avoid the reasonable possibility of death or permanent harm.

SB111,1517,3 b. In the case of a chronic illness or condition, a condition that is life-threatening, degenerative, potentially disabling, or congenital and requires specialized medical care over a prolonged period of time.

SB111,1517,9 (b) If an enrollee is a continuing care patient and is obtaining items or services from a participating provider or facility and the contract between the defined network plan, preferred provider plan, or self-insured governmental plan and the participating provider or facility is terminated or the coverage of benefits that include the items or services provided by the participating provider or facility are terminated by the plan, the plan shall do all of the following:

SB111,1517,12 1. Notify each enrollee of the termination of the contract or benefits and of the right for the enrollee to elect to continue transitional care from the provider or facility under this subsection.

SB111,1517,14 2. Provide the enrollee an opportunity to notify the plan of the need for transitional care.

SB111,1517,21 3. Allow the enrollee to elect to continue to have the benefits provided under the plan under the same terms and conditions as would have applied to the item or service if the termination had not occurred for the course of treatment related to the enrollee's status as a continuing care patient beginning on the date on which the notice under subd. 1. is provided and ending 90 days after the date on which the notice under subd. 1. is provided or the date on which the enrollee is no longer a continuing care patient, whichever is earlier.

SB111,1517,25 (9) Rule making. The commissioner may promulgate any rules necessary to implement this section, including specifying the independent dispute resolution process. The commissioner may promulgate rules to modify the list of those items and services for which a provider may not balance bill under sub. (5) (c).

SB111,2920 Section 2920. 609.713 of the statutes is created to read:

SB111,1518,3 609.713 Essential health benefits; preventive services. Defined network plans and preferred provider plans are subject to s. 632.895 (13m) and (14m).

SB111,2921 Section 2921 . 609.719 of the statutes is created to read:

SB111,1518,6 609.719 Telehealth services. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.871.

SB111,2922 Section 2922 . 609.83 of the statutes is amended to read:

SB111,1518,10 609.83 Coverage of drugs and devices ; application of payments. Limited service health organizations, preferred provider plans, and defined network plans are subject to ss. 632.853, 632.862, and 632.895 (16t) and (16v).

SB111,2923 Section 2923 . 609.83 of the statutes, as affected by 2021 Wisconsin Act .... (this act), section 2922, is amended to read:

SB111,1518,15 609.83 Coverage of drugs and devices; application of payments. Limited service health organizations, preferred provider plans, and defined network plans are subject to ss. 632.853, 632.862, and 632.895 (6) (b), (16t), and (16v).

SB111,2924 Section 2924 . 609.83 of the statutes, as affected by 2021 Wisconsin Act .... (this act), section 2923, is amended to read:

SB111,1518,21 609.83 Coverage of drugs and devices; application of payments. Limited service health organizations, preferred provider plans, and defined network plans are subject to ss. 632.853, 632.861, 632.862, and 632.895 (6) (b), (16t), and (16v).

SB111,2925 Section 2925 . 609.847 of the statutes is created to read:

SB111,1518,25 609.847 Preexisting condition discrimination and certain benefit limits prohibited. Limited service health organizations, preferred provider plans, and defined network plans are subject to s. 632.728.

SB111,2926 Section 2926. 616.09 (1) (a) 2. of the statutes is amended to read:

SB111,1519,5 616.09 (1) (a) 2. Plans authorized under s. 616.06 are subject to s. 610.21, 1977 stats., s. 610.55, 1977 stats., s. 610.57, 1977 stats., and ss. 628.34 to 628.39, 1977 stats., to chs. 600, 601, 620, 625, 627 and 645, to ss. 632.72, 632.755, 632.86 632.861 and 632.87 and to this subchapter except s. 616.08.

SB111,2927 Section 2927 . 625.12 (1) (a) of the statutes is amended to read:

SB111,1519,8 625.12 (1) (a) Past and prospective loss and expense experience within and outside of this state, except as provided in s. 632.728.

SB111,2928 Section 2928 . 625.12 (1) (e) of the statutes is amended to read:

SB111,1519,11 625.12 (1) (e) Subject to s. ss. 632.365 and 632.728, all other relevant factors, including the judgment of technical personnel.

SB111,2929 Section 2929 . 625.12 (2) of the statutes is amended to read:

SB111,1519,21 625.12 (2) Classification. Except as provided in s. ss. 632.728 and 632.729, risks may be classified in any reasonable way for the establishment of rates and minimum premiums, except that no classifications may be based on race, color, creed or national origin, and classifications in automobile insurance may not be based on physical condition or developmental disability as defined in s. 51.01 (5). Subject to ss. 632.365, 632.728, and 632.729, rates thus produced may be modified for individual risks in accordance with rating plans or schedules that establish reasonable standards for measuring probable variations in hazards, expenses, or both. Rates may also be modified for individual risks under s. 625.13 (2).