AB68,1526,14 632.7496 Coverage requirements for short-term plans. (1) Definition. In this section, “short-term, limited duration plan” means an individual health benefit plan described in s. 632.7495 (4) that an insurer is not required to renew.

AB68,1526,17 (2) Guaranteed issue. Every short-term, limited duration plan shall accept every individual in this state who applies for coverage whether or not any individual has a preexisting condition.

AB68,1526,22 (3) Prohibiting discrimination based on health status. (a) A short-term, limited duration 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:

AB68,1526,23 1. Health status.

AB68,1526,24 2. Medical condition, including both physical and mental illnesses.

AB68,1526,25 3. Claims experience.

AB68,1527,1 4. Receipt of health care.

AB68,1527,2 5. Medical history.

AB68,1527,3 6. Genetic information.

AB68,1527,5 7. Evidence of insurability, including conditions arising out of acts of domestic violence.

AB68,1527,6 8. Disability.

AB68,1527,13 (b) A short-term, limited duration 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.

AB68,1527,15 (4) Premium rate variation. A short-term, limited duration plan may vary premium rates for a specific plan based only on the following considerations:

AB68,1527,16 (a) Whether the policy or plan covers an individual or a family.

AB68,1527,17 (b) Rating area in the state, as established by the commissioner.

AB68,1527,20 (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.

AB68,1527,21 (d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.

AB68,1527,23 (5) Annual and lifetime limits. A short-term, limited duration plan may not establish any of the following:

AB68,1527,25 (a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent of an enrollee under the plan.

AB68,1528,2 (b) Limits on the dollar value of benefits for an enrollee or a dependent of an enrollee under the plan for the initial or cumulative duration of the plan.

AB68,2949 Section 2949. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to read:

AB68,1528,12 632.76 (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).

AB68,1528,18 (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.

AB68,1528,25 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 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.

AB68,2950 Section 2950. 632.76 (2) (ac) 3. (intro.) of the statutes is amended to read:

AB68,1529,4 632.76 (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, limited duration policy subject to s. 632.7495 (4) and (5):

AB68,2951 Section 2951. 632.76 (2) (ac) 3. b. of the statutes is amended to read:

AB68,1529,11 632.76 (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.

AB68,2952 Section 2952. 632.795 (4) (a) of the statutes is amended to read: