AB68-SSA1,1385,3
12. If the primary reason for an office visit is not to obtain a preventive service,
2the disability insurance policy or self-insured health plan may apply deductibles to
3and impose copayments or coinsurance on the office visit.
AB68-SSA1,1385,134
3. Except as otherwise provided in this subdivision, if a preventive service
5specified under par. (b) is provided by a health care provider that is outside the
6disability insurance policy's or self-insured health plan's network of providers, the
7policy or plan may apply deductibles to and impose copayments or coinsurance on the
8office visit and the preventive service. If a preventive service specified under par. (b)
9is provided by a health care provider that is outside the disability insurance policy's
10or self-insured health plan's network of providers because there is no available
11health care provider in the policy's or plan's network of providers that provides the
12preventive service, the policy or plan may not apply deductibles to or impose
13copayments or coinsurance on the preventive service.
AB68-SSA1,1385,1814
4. If multiple well-woman visits described under par. (b) 47. are required to
15fulfill all necessary preventive services and are in accordance with clinical
16recommendations, the disability insurance policy or self-insured health plan may
17not apply a deductible to or impose a copayment or coinsurance on any of those
18well-woman visits.
AB68-SSA1,3010
19Section
3010. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:
AB68-SSA1,1385,2020
632.895
(14) (a) 1. i. Hepatitis
A and B.
AB68-SSA1,1385,2121
j. Varicella
and herpes zoster.
AB68-SSA1,3011
22Section
3011. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:
AB68-SSA1,1385,2323
632.895
(14) (a) 1. k. Human papillomavirus.
AB68-SSA1,1385,2424
L. Meningococcal meningitis.
AB68-SSA1,1385,2525
m. Pneumococcal pneumonia.
AB68-SSA1,3012
3Section
3012. 632.895 (14) (b) of the statutes is amended to read:
AB68-SSA1,1386,94
632.895
(14) (b) Except as provided in par. (d), every disability insurance policy,
5and every self-insured health plan of the state or a county, city, town, village
, or
6school district,
that provides coverage for a dependent of the insured shall provide
7coverage of appropriate and necessary immunizations
, from birth to the age of 6
8years, for
an insured or plan participant, including a dependent
who is a child of the
9insured
or plan participant.
AB68-SSA1,3013
10Section
3013. 632.895 (14) (c) of the statutes is amended to read:
AB68-SSA1,1386,1511
632.895
(14) (c) The coverage required under par. (b) may not be subject to any
12deductibles, copayments, or coinsurance under the policy or plan.
This paragraph
13applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to
14appropriate and necessary immunizations provided by providers participating, as
15defined in s. 609.01 (3m), in the plan.
AB68-SSA1,3014
16Section
3014. 632.895 (14) (d) 3. of the statutes is amended to read:
AB68-SSA1,1386,1917
632.895
(14) (d) 3. A health care plan offered by a limited service health
18organization, as defined in s. 609.01 (3)
, or by a preferred provider plan, as defined
19in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b).
AB68-SSA1,3015
20Section
3015. 632.895 (14m) of the statutes is created to read:
AB68-SSA1,1386,2221
632.895
(14m) Essential health benefits. (a) In this subsection,
22“self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB68-SSA1,1387,223
(b) On a date specified by the commissioner, by rule, every disability insurance
24policy, except as provided in par. (g), and every self-insured health plan shall provide
1coverage for essential health benefits as determined by the commissioner, by rule,
2subject to par. (c).
AB68-SSA1,1387,43
(c) In determining the essential health benefits for which coverage is required
4under par. (b), the commissioner shall do all of the following:
AB68-SSA1,1387,65
1. Include benefits, items, and services in, at least, all of the following
6categories:
AB68-SSA1,1387,77
a. Ambulatory patient services.
AB68-SSA1,1387,88
b. Emergency services.
AB68-SSA1,1387,99
c. Hospitalization.
AB68-SSA1,1387,1010
d. Maternity and newborn care.
AB68-SSA1,1387,1211
e. Mental health and substance use disorder services, including behavioral
12health treatment.
AB68-SSA1,1387,1313
f. Prescription drugs.