SB111,1578,16 633.01 (4r) “Prescription drug benefit” has the meaning given in s. 632.865 (1) (e).

SB111,2994 Section 2994 . 633.01 (5) of the statutes is amended to read:

SB111,1578,19 633.01 (5) “Principal" means a person, including an insurer, that uses the services of an administrator to provide a an employee benefit plan.

SB111,2995 Section 2995 . 633.01 (6) of the statutes is created to read:

SB111,1578,21 633.01 (6) “Self-insured health plan" has the meaning given in s. 632.85 (1) (c).

SB111,2996 Section 2996 . 633.04 (intro.) of the statutes is amended to read:

SB111,1579,2 633.04 Written agreement required. (intro.) An administrator may not administer a an employee benefit plan in the absence of a written agreement between the administrator and a principal. The administrator and principal shall each retain a copy of the written agreement for the duration of the agreement and for 5 years thereafter. The written agreement shall contain the following terms:

SB111,2997 Section 2997 . 633.05 of the statutes is amended to read:

SB111,1579,10 633.05 Payment to administrator. If a principal is an insurer, payment to the administrator of a premium or charge by or on behalf of an insured employee is payment to the insurer, but payment of a return premium or claim by the insurer to the administrator is not payment to an insured employee until the payment is received by the insured employee. This section does not limit any right of the insurer against the administrator for failure to make payments to the insurer or an insured employee.

SB111,2998 Section 2998 . 633.06 of the statutes is amended to read:

SB111,1579,16 633.06 Examination and inspection of books and records. (1) The commissioner may examine, audit or accept an audit of the books and records of an administrator or pharmacy benefit manager as provided for examination of licensees under s. 601.43 (1), (3), (4) and (5), to be conducted as provided in s. 601.44, and with costs to be paid as provided in s. 601.45.

SB111,1579,20 (2) A principal that uses an administrator may inspect the books and records of the administrator, subject to any restrictions set forth in ss. 146.81 to 146.835 and in the written agreement required under s. 633.04, for the purpose of enabling the principal to fulfill its contractual obligations to insureds insured employees.

SB111,2999 Section 2999 . 633.07 of the statutes is amended to read:

SB111,1579,24 633.07 Approval of advertising. An administrator may not use any advertising for a an employee benefit plan underwritten by an insurer unless the insurer approves the advertising in advance.

SB111,3000 Section 3000 . 633.09 (4) (b) 2. and 3. of the statutes are amended to read:

SB111,1580,2 633.09 (4) (b) 2. To a an employee benefit plan policyholder for payment to a principal, the funds belonging to the principal.

SB111,1580,3 3. To an insured employee, the funds belonging to the insured employee.

SB111,3001 Section 3001 . 633.11 of the statutes is amended to read:

SB111,1580,10 633.11 Claim adjustment compensation. If an administrator adjusts or settles claims under a an employee benefit plan, the commission, fees or charges that the principal pays the administrator may not be based on the employee benefit plan's loss experience. This section does not prohibit compensation based on the number or amount of premiums or charges collected, or the number or amount of claims paid or processed by the administrator.

SB111,3002 Section 3002 . 633.12 (1) (intro.), (b) and (c) of the statutes are amended to read:

SB111,1580,17 633.12 (1) (intro.) An administrator shall prepare sufficient copies of a written notice approved in advance by the principal for distribution to all insureds insured employees of the principal and either shall distribute the copies to the insureds insured employees or shall provide the copies to the principal for distribution to the insureds insured employees. The written notice shall contain all of the following:

SB111,1580,19 (b) An explanation of the respective rights and responsibilities of the administrator, the principal and the insureds insured employees.

SB111,1580,21 (c) A statement of the extent to which the employee benefit plan is insured or self-insured, and an explanation of the terms “insured" and “self-insured".

SB111,3003 Section 3003 . 633.13 (1) and (3) of the statutes are amended to read:

SB111,1581,2 633.13 (1) General. Except as provided in sub. (2), a person may not perform, offer to perform or advertise any service as an administrator or a pharmacy benefit manager unless the person has obtained a license under s. 633.14. A pharmacy benefit manager that also performs services as an administrator need only obtain an administrator license under s. 633.14.

SB111,1581,7 (3) Responsibilities of principal. A principal may not use the services of an administrator unless the administrator furnishes proof of licensure under s. 633.14 or exemption under sub. (2). An insurer or a self-insured health plan may not use the services of a pharmacy benefit manager unless the pharmacy benefit manager furnishes proof of licensure under s. 633.14.

SB111,3004 Section 3004 . 633.14 (2) (intro.) and (c) 1. and 3. and (3) of the statutes are amended to read:

SB111,1581,12 633.14 (2) (intro.) The commissioner shall issue a license to act as an administrator or pharmacy benefit manager to a corporation, limited liability company or partnership that does all of the following:

SB111,1581,16 (c) 1. That the corporation, limited liability company or partnership intends in good faith to act as an administrator or pharmacy benefit manager through individuals designated under subd. 3. in compliance with applicable laws of this state and rules and orders of the commissioner.