Wisconsin 2023-2024 Regular Session

Wisconsin Assembly Bill AB159 Compare Versions

Only one version of the bill is available at this time.

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3	3	2023 - 2024 LEGISLATURE
4	4	2023 ASSEMBLY BILL 159
5	5	April 10, 2023 - Introduced by Representatives MAGNAFICI, ORTIZ-VELEZ, BALDEH,
6	6	BRANDTJEN, CABRERA, CONLEY, EDMING, GUNDRUM, MURSAU, SINICKI, SUBECK,
7	7	TITTL and WICHGERS, cosponsored by Senators JACQUE, NASS, TAYLOR and
8	8	WANGGAARD. Referred to Committee on Insurance.
9	9	*AUTHORS SUBJECT TO CHANGE*
10	10	AN ACT to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g) and 185.983
11	11	(1) (intro.); and to create 609.847 and 632.728 of the statutes; relating to:
12	12	coverage of individuals with preexisting conditions and benefit limits under
13	13	health plans.
14	14	Analysis by the Legislative Reference Bureau
15	15	This bill generally sets certain requirements and limitations on health
16	16	insurance coverage in the event the federal Patient Protection and Affordable Care
17	17	Act no longer preempts state law on the topic. Currently, the Affordable Care Act
18	18	generally allows premium rates to be based only on individual or family coverage,
19	19	rating area, age, and tobacco use; requires group and individual health insurance
20	20	policies to accept every employer and individual that applies for coverage, known as
21	21	guaranteed issue, and renew health insurance coverage at the option of the sponsor
22	22	or individual; and prohibits health insurance policies from imposing preexisting
23	23	condition exclusions. If those requirements and limitations of the Affordable Care
24	24	Act become no longer enforceable or no longer preempt state law, all of the following
25	25	apply under the bill:
26	26	1. Every individual health benefit plan must accept every individual in this
27	27	state who applies for coverage and every group health benefit plan must accept every
28	28	employer in this state that applies for coverage, regardless of whether any individual
29	29	or employee has a preexisting condition. A health benefit plan may restrict
30	30	enrollment in coverage to open or special enrollment periods, and the commissioner
31	31	of insurance must ensure a statewide 45-day open enrollment period allowing
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37	37	ASSEMBLY BILL 159
38	38	individuals, including individuals who do not have coverage, to enroll in coverage.
39	39	Health benefit plans must provide special enrollment periods for certain qualifying
40	40	events described in federal law.
41	41	2. A health benefit plan offered on the individual or small employer market or
42	42	a self-insured governmental health plan may not vary premium rates for a specific
43	43	plan on any basis except age, tobacco use, area in the state, and whether the plan
44	44	covers an individual or a family.
45	45	3. A health benefit plan or a self-insured governmental health plan may not
46	46	impose a preexisting condition exclusion. A preexisting condition exclusion is
47	47	defined in the bill as a limitation or exclusion of benefits relating to a condition based
48	48	on the fact that the condition was present before the date of enrollment for the
49	49	coverage, whether or not any medical advice, diagnosis, care, or treatment was
50	50	recommended or received before the date of enrollment for coverage.
51	51	4. A health benefit plan or a self-insured governmental health plan is
52	52	prohibited from imposing an annual or lifetime limit on the dollar value of benefits
53	53	under the plan.
54	54	The Affordable Care Act exempts certain plans from complying with the act's
55	55	provisions. Similarly, any health benefit plan that is exempt from a provision of the
56	56	Affordable Care Act is exempt from complying with the corresponding provision of
57	57	this bill.
58	58	This proposal may contain a health insurance mandate requiring a social and
59	59	financial impact report under s. 601.423, stats.
60	60	The people of the state of Wisconsin, represented in senate and assembly, do
61	61	enact as follows:
62	62	SECTION 1. 40.51 (8) of the statutes is amended to read:
63	63	40.51 (8) Every health care coverage plan offered by the state under sub. (6)
64	64	shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.728, 632.729,
65	65	632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85,
66	66	632.853, 632.855, 632.861, 632.867, 632.87 (3) to (6), 632.885, 632.89, 632.895 (5m)
67	67	and (8) to (17), and 632.896.
68	68	SECTION 2. 40.51 (8m) of the statutes is amended to read:
69	69	40.51 (8m) Every health care coverage plan offered by the group insurance
70	70	board under sub. (7) shall comply with ss. 631.95, 632.728, 632.729, 632.746 (1) to
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82	82	SECTION 2
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84	84	(8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855,
85	85	632.861, 632.867, 632.885, 632.89, and 632.895 (11) to (17).
86	86	SECTION 3. 66.0137 (4) of the statutes is amended to read:
87	87	66.0137 (4) SELF-INSURED HEALTH PLANS. If a city, including a 1st class city, or
88	88	a village provides health care benefits under its home rule power, or if a town
89	89	provides health care benefits, to its officers and employees on a self-insured basis,
90	90	the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
91	91	632.728, 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853,
92	92	632.855, 632.861, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17),
93	93	632.896, and 767.513 (4).
94	94	SECTION 4. 120.13 (2) (g) of the statutes is amended to read:
95	95	120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
96	96	49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.728, 632.729, 632.746 (10) (a) 2. and (b)
97	97	2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6),
98	98	632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).
99	99	SECTION 5. 185.983 (1) (intro.) of the statutes is amended to read:
100	100	185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
101	101	cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
102	102	646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
103	103	601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
104	104	631.95, 632.72 (2), 632.728, 632.729, 632.745 to 632.749, 632.775, 632.79, 632.795,
105	105	632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (2) to (6), 632.885,
106	106	632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630,
107	107	635, 645, and 646, but the sponsoring association shall:
108	108	SECTION 6. 609.847 of the statutes is created to read:
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135	135	SECTION 6 ASSEMBLY BILL 159
136	136	609.847 Preexisting condition discrimination prohibited; benefit
137	137	limits. Limited service health organizations, preferred provider plans, and defined
138	138	network plans are subject to s. 632.728.
139	139	SECTION 7. 632.728 of the statutes is created to read:
140	140	632.728 Coverage of individuals with preexisting conditions; rating;
141	141	benefit limits. (1) DEFINITIONS. In this section:
142	142	(a) “Health benefit plan” has the meaning given in s. 632.745 (11).
143	143	(b) “Preexisting condition exclusion” means, with respect to coverage, a
144	144	limitation or exclusion of benefits relating to a condition based on the fact that the
145	145	condition was present before the date of enrollment for the coverage, whether or not
146	146	any medical advice, diagnosis, care, or treatment was recommended or received
147	147	before the date of enrollment for coverage.
148	148	(c) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
149	149	(d) “Small employer” has the meaning given in s. 635.02 (7).
150	150	(2) ACCESS TO COVERAGE. Every individual health benefit plan shall accept
151	151	every individual in this state who applies for coverage and every group health benefit
152	152	plan shall accept every employer in this state that applies for coverage, regardless
153	153	of whether any individual or employee has a preexisting condition. A health benefit
154	154	plan may restrict enrollment in coverage described in this subsection to open or
155	155	special enrollment periods under sub. (4).
156	156	(3) PREMIUM RATE VARIATION. A health benefit plan offered on the individual or
157	157	small employer market or a self-insured health plan may vary premium rates for a
158	158	specific plan based only on the following considerations:
159	159	(a) Whether the plan covers an individual or a family.
160	160	(b) Rating area in the state, as established by the commissioner.
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188	188	SECTION 7
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190	190	(c) Age, except that the rate may not vary by more than 3 to 1 for adults over
191	191	the age groups and the age bands shall be consistent with recommendations of the
192	192	National Association of Insurance Commissioners.
193	193	(d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
194	194	(4) ENROLLMENT PERIODS. (a) The commissioner shall ensure that every
195	195	individual health benefit plan has open enrollment during a statewide open
196	196	enrollment period of no longer than 45 days to allow individuals, including
197	197	individuals who do not have coverage, to enroll in coverage.
198	198	(b) Every health benefit plan shall provide special enrollment periods for
199	199	qualifying events under 26 USC 9801 (f) and 29 USC 1163.
200	200	(5) PREEXISTING CONDITION EXCLUSION. An individual or group health benefit
201	201	plan or a self-insured health plan may not impose a preexisting condition exclusion
202	202	for any time on an enrollee or beneficiary under the plan.
203	203	(6) ANNUAL AND LIFETIME LIMITS. An individual or group health benefit plan or
204	204	a self-insured health plan may not establish any of the following:
205	205	(a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent
206	206	of an enrollee under the plan.
207	207	(b) Annual limits on the dollar value of benefits for an enrollee or a dependent
208	208	of an enrollee under the plan.
209	209	(7) APPLICABILITY. (a) This section applies only if provisions of the federal
210	210	Patient Protection and Affordable Care Act, P.L. 111-148, as amended, under 42
211	211	USC 300gg to 300gg-4 and 300gg-11 are no longer enforceable or no longer preempt
212	212	state law relating to individual or group health insurance policies. If this section
213	213	applies, this section supersedes any conflicting provision of s. 625.12 (1) or (2), 625.15
214	214	(1), 628.34 (3), 632.746, 632.76, 632.795 (4) (a), 632.896 (4), or 632.897 (11) (a) or any
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241	241	SECTION 7 ASSEMBLY BILL 159
242	242	other conflicting provision in chs. 600 to 655 to the extent this section conflicts with
243	243	that provision.
244	244	(b) 1. A health benefit plan that is not required to comply with 42 USC 300gg-1
245	245	as amended as of January 1, 2019, is not required to comply with sub. (2).
246	246	2. A health benefit plan that is not required to comply with 42 USC 300gg as
247	247	amended as of January 1, 2019, is not required to comply with sub. (3).
248	248	3. A health benefit plan that is not required to comply with 42 USC 300gg-3
249	249	as amended as of January 1, 2019, is not required to comply with sub. (5).
250	250	4. A health benefit plan that is not required to comply with 42 USC 300gg-11
251	251	(a) (1) (A) as amended as of January 1, 2019, is not required to comply with sub. (6)
252	252	(a).
253	253	5. A health benefit plan that is not required to comply with 42 USC 300gg-11
254	254	(a) (1) (B) as amended as of January 1, 2019, is not required to comply with sub. (6)
255	255	(b).
256	256	(END)
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