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2023 - 2024 LEGISLATURE
2023 ASSEMBLY BILL 340
June 30, 2023 - Introduced by Representatives VINING, DRAKE, ANDRACA, BARE,
BILLINGS, CABRERA, CLANCY, CONLEY, CONSIDINE, EMERSON, GOYKE, HAYWOOD,
HONG, J. ANDERSON, JACOBSON, JOERS, MOORE OMOKUNDE, MYERS, OHNSTAD,
PALMERI, RATCLIFF, SHELTON, SINICKI, SNODGRASS, STUBBS, SHANKLAND, BALDEH,
SUBECK and RIEMER, cosponsored by Senators ROYS, L. JOHNSON, AGARD,
HESSELBEIN, LARSON, PFAFF, CARPENTER, SPREITZER, TAYLOR, SMITH and WIRCH.
Referred to Committee on Health, Aging and Long-Term Care.
***AUTHORS SUBJECT TO CHANGE***
AN ACT to create 632.895 (14m) of the statutes; relating to: coverage of
maternity and newborn care under health insurance policies and plans and
granting rule-making authority.
Analysis by the Legislative Reference Bureau
This bill requires certain health insurance policies, known in the bill as
disability insurance policies, and governmental self-insured health plans to cover
the essential health benefit of maternity and newborn care, as specified by the
commissioner of insurance by rule. The bill specifies a list of requirements that the
commissioner must follow when establishing the maternity and newborn care
benefit, including certain limitations on cost sharing. If the maternity or newborn
care benefit specified by the commissioner is also subject to its own mandated
coverage requirement under current law, the bill requires the disability insurance
policy or self-insured health plan to provide coverage under whichever requirement
provides the insured or plan participant with more comprehensive coverage.
This proposal may contain a health insurance mandate requiring a social and
financial impact report under s. 601.423, stats.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SECTION 1. 632.895 (14m) of the statutes is created to read:
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SECTION 1 ASSEMBLY BILL 340
632.895 (14m) MATERNITY AND NEWBORN CARE; ESSENTIAL HEALTH BENEFIT. (a)
In this subsection, “self-insured health plan” has the meaning given in s. 632.85 (1)
(c).
(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 the essential health benefit of maternity and newborn care, including
benefits, items, and services, as determined by the commissioner, by rule, subject to
par. (c).
(c) In determining the scope of maternity and newborn care benefits for which
coverage is required under par. (b), the commissioner shall do all of the following:
1. Conduct a survey of employer-sponsored coverage to determine maternity
and newborn care benefits typically covered by employers and ensure that the scope
of 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.
2. Ensure that the maternity and newborn care benefit is provided with no or
limited cost-sharing requirements.
3. Require that disability insurance policies and self-insured health plans do
not, with regards to maternity and newborn care coverage required under par. (b),
make coverage decisions, determine reimbursement rates, establish incentive
programs, or design benefits in ways that discriminate against individuals because
of their disability or expected length of life.
(d) The commissioner shall periodically update, by rule, the maternity and
newborn care benefits under this subsection to address any gaps in access to
coverage.
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SECTION 1
ASSEMBLY BILL 340
(e) If the maternity or newborn care benefit is also subject to mandated
coverage elsewhere under this section and the coverage requirements are not
identical, the disability insurance policy or self-insured health plan shall provide
coverage under whichever subsection provides the insured or plan participant with
more comprehensive coverage of the benefit, item, or service.
(f) Nothing in this subsection or rules promulgated under this subsection
prohibits a disability insurance policy or a self-insured health plan from providing
benefits in excess of the essential health benefit coverage required under this
subsection.
(g) This subsection does not apply to any disability insurance policy that is
described in s. 632.745 (11) (b) 1. to 12.
(END)
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