AB43,,8967 m. Pneumococcal pneumonia.

AB43,,8968 n. Influenza.

AB43,,8969 o. Rotavirus.

AB43,3103 Section 3103. 632.895 (14) (b) of the statutes is amended to read:

AB43,,8971 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy, and every self-insured health plan of the state or a county, city, town, village, or school district, that provides coverage for a dependent of the insured shall provide coverage of appropriate and necessary immunizations, from birth to the age of 6 years, for an insured or plan participant, including a dependent who is a child of the insured or plan participant.

AB43,3104 Section 3104. 632.895 (14) (c) of the statutes is amended to read:

AB43,,8973 632.895 (14) (c) The coverage required under par. (b) may not be subject to any deductibles, copayments, or coinsurance under the policy or plan. This paragraph applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to appropriate and necessary immunizations provided by providers participating, as defined in s. 609.01 (3m), in the plan.

AB43,3105 Section 3105. 632.895 (14) (d) 3. of the statutes is amended to read:

AB43,,8975 632.895 (14) (d) 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).

AB43,3106 Section 3106. 632.895 (14m) of the statutes is created to read:

AB43,,8977 632.895 (14m) Essential health benefits. (a) In this subsection, “self-insured health plan” has the meaning given in s. 632.85 (1) (c).

AB43,,8978 (b) On a date specified by the commissioner, by rule, every disability insurance policy, except as provided in par. (g), and every self-insured health plan shall provide coverage for essential health benefits as determined by the commissioner, by rule, subject to par. (c).

AB43,,8979 (c) In determining the essential health benefits for which coverage is required under par. (b), the commissioner shall do all of the following:

AB43,,8980 1. Include benefits, items, and services in, at least, all of the following categories:

AB43,,8981 a. Ambulatory patient services.

AB43,,8982 b. Emergency services.

AB43,,8983 c. Hospitalization.

AB43,,8984 d. Maternity and newborn care.

AB43,,8985 e. Mental health and substance use disorder services, including behavioral health treatment.

AB43,,8986 f. Prescription drugs.

AB43,,8987 g. Rehabilitative and habilitative services and devices.

AB43,,8988 h. Laboratory services.

AB43,,8989 i. Preventive and wellness services and chronic disease management.

AB43,,8990 j. Pediatric services, including oral and vision care.

AB43,,8991 2. Conduct a survey of employer-sponsored coverage to determine benefits typically covered by employers and ensure that the scope of essential health benefits for which coverage is required under this subsection is equal to the scope of benefits covered under a typical disability insurance policy offered by an employer to its employees.

AB43,,8992 3. Ensure that essential health benefits reflect a balance among the categories described in subd. 1. such that benefits are not unduly weighted toward one category.

AB43,,8993 4. Ensure that essential health benefit coverage is provided with no or limited cost-sharing requirements.

AB43,,8994 5. Require that disability insurance policies and self-insured health plans do not make coverage decisions, determine reimbursement rates, establish incentive programs, or design benefits in ways that discriminate against individuals because of their age, disability, or expected length of life.

AB43,,8995 6. Establish essential health benefits in a way that takes into account the health care needs of diverse segments of the population, including women, children, persons with disabilities, and other groups.