AB68-SSA1,1350,137 (b) A short-term, limited duration plan may not require any individual, as a
8condition of enrollment or continued enrollment under the plan, to pay, on the basis
9of any health status-related factor under par. (a) with respect to the individual or a
10dependent of the individual, a premium or contribution or a deductible, copayment,
11or coinsurance amount that is greater than the premium or contribution or
12deductible, copayment, or coinsurance amount respectively for a similarly situated
13individual enrolled under the plan.
AB68-SSA1,1350,15 14(4) Premium rate variation. A short-term, limited duration plan may vary
15premium rates for a specific plan based only on the following considerations:
AB68-SSA1,1350,1616 (a) Whether the policy or plan covers an individual or a family.
AB68-SSA1,1350,1717 (b) Rating area in the state, as established by the commissioner.
AB68-SSA1,1350,2018 (c) Age, except that the rate may not vary by more than 3 to 1 for adults over
19the age groups and the age bands shall be consistent with recommendations of the
20National Association of Insurance Commissioners.
AB68-SSA1,1350,2121 (d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
AB68-SSA1,1350,23 22(5) Annual and lifetime limits. A short-term, limited duration plan may not
23establish any of the following:
AB68-SSA1,1350,2524 (a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent
25of an enrollee under the plan.
AB68-SSA1,1351,2
1(b) Limits on the dollar value of benefits for an enrollee or a dependent of an
2enrollee under the plan for the initial or cumulative duration of the plan.
AB68-SSA1,2990 3Section 2990. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to
4read:
AB68-SSA1,1351,125 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
6from the date of issue of the policy may be reduced or denied on the ground that a
7disease or physical condition existed prior to the effective date of coverage, unless the
8condition was excluded from coverage by name or specific description by a provision
9effective on the date of loss. This paragraph does not apply to a group health benefit
10plan, as defined in s. 632.745 (9), which is subject to s. 632.746 , a disability insurance
11policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s.
12632.85 (1) (c)
.
AB68-SSA1,1351,1813 (ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability
14commencing after 12 months from the date of issue of under an individual disability
15insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the
16ground that a disease or physical condition existed prior to the effective date of
17coverage, unless the condition was excluded from coverage by name or specific
18description by a provision effective on the date of the loss
.
AB68-SSA1,1351,2519 2. Except as provided in subd. 3., an An individual disability insurance policy,
20as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495
21(4) and (5), may not define a preexisting condition more restrictively than a condition
22that was present before the date of enrollment for the coverage, whether physical or
23mental, regardless of the cause of the condition, for which and regardless of whether
24medical advice, diagnosis, care, or treatment was recommended or received within
2512 months before the effective date of coverage
.
AB68-SSA1,2991
1Section 2991. 632.76 (2) (ac) 3. (intro.) of the statutes is amended to read:
AB68-SSA1,1352,42 632.76 (2) (ac) 3. (intro.) Except as the commissioner provides by rule under
3s. 632.7495 (5), all of the following apply to an individual disability insurance policy
4that is a short-term, limited duration policy subject to s. 632.7495 (4) and (5):
AB68-SSA1,2992 5Section 2992. 632.76 (2) (ac) 3. b. of the statutes is amended to read:
AB68-SSA1,1352,116 632.76 (2) (ac) 3. b. The policy shall reduce the length of time during which a
7may not impose any preexisting condition exclusion may be imposed by the
8aggregate of the insured's consecutive periods of coverage under the insurer's
9individual disability insurance policies that are short-term policies subject to s.
10632.7495 (4) and (5). For purposes of this subd. 3. b., coverage periods are consecutive
11if there are no more than 63 days between the coverage periods
.
AB68-SSA1,2993 12Section 2993. 632.795 (4) (a) of the statutes is amended to read:
AB68-SSA1,1352,2413 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the
14same policy form and for the same premium as it originally offered in the most recent
15enrollment period, subject only to the medical underwriting used in that enrollment
16period. Unless otherwise prescribed by rule, the insurer may apply deductibles,
17preexisting condition limitations, waiting periods , or other limits only to the extent
18that they would have been applicable had coverage been extended at the time of the
19most recent enrollment period and with credit for the satisfaction or partial
20satisfaction of similar provisions under the liquidated insurer's policy or plan. The
21insurer may exclude coverage of claims that are payable by a solvent insurer under
22insolvency coverage required by the commissioner or by the insurance regulator of
23another jurisdiction. Coverage shall be effective on the date that the liquidated
24insurer's coverage terminates.
AB68-SSA1,2994 25Section 2994. 632.796 of the statutes is created to read:
AB68-SSA1,1353,2
1632.796 Drug cost report. (1) Definition. In this section, “disability
2insurance policy” has the meaning given in s. 632.895 (1) (a).
AB68-SSA1,1353,8 3(2) Report required. Annually, at the time the insurer files its rate request
4with the commissioner, each insurer that offers a disability insurance policy that
5covers prescription drugs shall submit to the commissioner a report that identifies
6the 25 prescription drugs that are the highest cost to the insurer and the 25
7prescription drugs that have the highest cost increases over the 12 months before the
8submission of the report.
AB68-SSA1,2995 9Section 2995. 632.862 of the statutes is created to read:
AB68-SSA1,1353,11 10632.862 Application of prescription drug payments. (1) Definitions. In
11this section:
AB68-SSA1,1353,1212 (a) “Brand name” has the meaning given in s. 450.12 (1) (a).
AB68-SSA1,1353,1313 (b) “Brand name drug” means any of the following:
AB68-SSA1,1353,1514 1. A prescription drug that contains a brand name and that has no generic
15equivalent.
AB68-SSA1,1353,1916 2. A prescription drug that contains a brand name and has a generic equivalent
17but for which the enrollee has received prior authorization from the insurer offering
18the disability insurance policy or the self-insured health plan or authorization from
19a physician to obtain the prescription drug under the policy or plan.
AB68-SSA1,1353,2020 (c) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).