Wisconsin 2023-2024 Regular Session

Wisconsin Senate Bill SB152 Compare Versions

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

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1	1	LRB-0115/1
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3	3	2023 - 2024 LEGISLATURE
4	4	2023 SENATE BILL 152
5	5	April 3, 2023 - Introduced by Senators JACQUE, NASS, TAYLOR and WANGGAARD,
6	6	cosponsored by Representatives MAGNAFICI, ORTIZ-VELEZ, BALDEH, BEHNKE,
7	7	BRANDTJEN, CABRERA, CONLEY, EDMING, GUNDRUM, MURSAU, SUBECK, TITTL,
8	8	WICHGERS, SINICKI and HAYWOOD. Referred to Committee on Insurance and
9	9	Small Business.
10	10	*AUTHORS SUBJECT TO CHANGE*
11	11	AN ACT to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g) and 185.983
12	12	(1) (intro.); and to create 609.847 and 632.728 of the statutes; relating to:
13	13	coverage of individuals with preexisting conditions and benefit limits under
14	14	health plans.
15	15	Analysis by the Legislative Reference Bureau
16	16	This bill generally sets certain requirements and limitations on health
17	17	insurance coverage in the event the federal Patient Protection and Affordable Care
18	18	Act no longer preempts state law on the topic. Currently, the Affordable Care Act
19	19	generally allows premium rates to be based only on individual or family coverage,
20	20	rating area, age, and tobacco use; requires group and individual health insurance
21	21	policies to accept every employer and individual that applies for coverage, known as
22	22	guaranteed issue, and renew health insurance coverage at the option of the sponsor
23	23	or individual; and prohibits health insurance policies from imposing preexisting
24	24	condition exclusions. If those requirements and limitations of the Affordable Care
25	25	Act become no longer enforceable or no longer preempt state law, all of the following
26	26	apply under the bill:
27	27	1. Every individual health benefit plan must accept every individual in this
28	28	state who applies for coverage and every group health benefit plan must accept every
29	29	employer in this state that applies for coverage, regardless of whether any individual
30	30	or employee has a preexisting condition. A health benefit plan may restrict
31	31	enrollment in coverage to open or special enrollment periods, and the commissioner
32	32	of insurance must ensure a statewide 45-day open enrollment period allowing
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38	38	SENATE BILL 152
39	39	individuals, including individuals who do not have coverage, to enroll in coverage.
40	40	Health benefit plans must provide special enrollment periods for certain qualifying
41	41	events described in federal law.
42	42	2. A health benefit plan offered on the individual or small employer market or
43	43	a self-insured governmental health plan may not vary premium rates for a specific
44	44	plan on any basis except age, tobacco use, area in the state, and whether the plan
45	45	covers an individual or a family.
46	46	3. A health benefit plan or a self-insured governmental health plan may not
47	47	impose a preexisting condition exclusion. A preexisting condition exclusion is
48	48	defined in the bill as a limitation or exclusion of benefits relating to a condition based
49	49	on the fact that the condition was present before the date of enrollment for the
50	50	coverage, whether or not any medical advice, diagnosis, care, or treatment was
51	51	recommended or received before the date of enrollment for coverage.
52	52	4. A health benefit plan or a self-insured governmental health plan is
53	53	prohibited from imposing an annual or lifetime limit on the dollar value of benefits
54	54	under the plan.
55	55	The Affordable Care Act exempts certain plans from complying with the act's
56	56	provisions. Similarly, any health benefit plan that is exempt from a provision of the
57	57	Affordable Care Act is exempt from complying with the corresponding provision of
58	58	this bill.
59	59	This proposal may contain a health insurance mandate requiring a social and
60	60	financial impact report under s. 601.423, stats.
61	61	The people of the state of Wisconsin, represented in senate and assembly, do
62	62	enact as follows:
63	63	SECTION 1. 40.51 (8) of the statutes is amended to read:
64	64	40.51 (8) Every health care coverage plan offered by the state under sub. (6)
65	65	shall comply with ss. 631.89, 631.90, 631.93 (2), 631.95, 632.72 (2), 632.728, 632.729,
66	66	632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85,
67	67	632.853, 632.855, 632.861, 632.867, 632.87 (3) to (6), 632.885, 632.89, 632.895 (5m)
68	68	and (8) to (17), and 632.896.
69	69	SECTION 2. 40.51 (8m) of the statutes is amended to read:
70	70	40.51 (8m) Every health care coverage plan offered by the group insurance
71	71	board under sub. (7) shall comply with ss. 631.95, 632.728, 632.729, 632.746 (1) to
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83	83	SECTION 2
84	84	SENATE BILL 152
85	85	(8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85, 632.853, 632.855,
86	86	632.861, 632.867, 632.885, 632.89, and 632.895 (11) to (17).
87	87	SECTION 3. 66.0137 (4) of the statutes is amended to read:
88	88	66.0137 (4) SELF-INSURED HEALTH PLANS. If a city, including a 1st class city, or
89	89	a village provides health care benefits under its home rule power, or if a town
90	90	provides health care benefits, to its officers and employees on a self-insured basis,
91	91	the self-insured plan shall comply with ss. 49.493 (3) (d), 631.89, 631.90, 631.93 (2),
92	92	632.728, 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853,
93	93	632.855, 632.861, 632.867, 632.87 (4) to (6), 632.885, 632.89, 632.895 (9) to (17),
94	94	632.896, and 767.513 (4).
95	95	SECTION 4. 120.13 (2) (g) of the statutes is amended to read:
96	96	120.13 (2) (g) Every self-insured plan under par. (b) shall comply with ss.
97	97	49.493 (3) (d), 631.89, 631.90, 631.93 (2), 632.728, 632.729, 632.746 (10) (a) 2. and (b)
98	98	2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6),
99	99	632.885, 632.89, 632.895 (9) to (17), 632.896, and 767.513 (4).
100	100	SECTION 5. 185.983 (1) (intro.) of the statutes is amended to read:
101	101	185.983 (1) (intro.) Every voluntary nonprofit health care plan operated by a
102	102	cooperative association organized under s. 185.981 shall be exempt from chs. 600 to
103	103	646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44,
104	104	601.45, 611.26, 611.67, 619.04, 623.11, 623.12, 628.34 (10), 631.17, 631.89, 631.93,
105	105	631.95, 632.72 (2), 632.728, 632.729, 632.745 to 632.749, 632.775, 632.79, 632.795,
106	106	632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (2) to (6), 632.885,
107	107	632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609, 620, 630,
108	108	635, 645, and 646, but the sponsoring association shall:
109	109	SECTION 6. 609.847 of the statutes is created to read:
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136	136	SECTION 6 SENATE BILL 152
137	137	609.847 Preexisting condition discrimination prohibited; benefit
138	138	limits. Limited service health organizations, preferred provider plans, and defined
139	139	network plans are subject to s. 632.728.
140	140	SECTION 7. 632.728 of the statutes is created to read:
141	141	632.728 Coverage of individuals with preexisting conditions; rating;
142	142	benefit limits. (1) DEFINITIONS. In this section:
143	143	(a) “Health benefit plan” has the meaning given in s. 632.745 (11).
144	144	(b) “Preexisting condition exclusion” means, with respect to coverage, a
145	145	limitation or exclusion of benefits relating to a condition based on the fact that the
146	146	condition was present before the date of enrollment for the coverage, whether or not
147	147	any medical advice, diagnosis, care, or treatment was recommended or received
148	148	before the date of enrollment for coverage.
149	149	(c) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
150	150	(d) “Small employer” has the meaning given in s. 635.02 (7).
151	151	(2) ACCESS TO COVERAGE. Every individual health benefit plan shall accept
152	152	every individual in this state who applies for coverage and every group health benefit
153	153	plan shall accept every employer in this state that applies for coverage, regardless
154	154	of whether any individual or employee has a preexisting condition. A health benefit
155	155	plan may restrict enrollment in coverage described in this subsection to open or
156	156	special enrollment periods under sub. (4).
157	157	(3) PREMIUM RATE VARIATION. A health benefit plan offered on the individual or
158	158	small employer market or a self-insured health plan may vary premium rates for a
159	159	specific plan based only on the following considerations:
160	160	(a) Whether the plan covers an individual or a family.
161	161	(b) Rating area in the state, as established by the commissioner.
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189	189	SECTION 7
190	190	SENATE BILL 152
191	191	(c) Age, except that the rate may not vary by more than 3 to 1 for adults over
192	192	the age groups and the age bands shall be consistent with recommendations of the
193	193	National Association of Insurance Commissioners.
194	194	(d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
195	195	(4) ENROLLMENT PERIODS. (a) The commissioner shall ensure that every
196	196	individual health benefit plan has open enrollment during a statewide open
197	197	enrollment period of no longer than 45 days to allow individuals, including
198	198	individuals who do not have coverage, to enroll in coverage.
199	199	(b) Every health benefit plan shall provide special enrollment periods for
200	200	qualifying events under 26 USC 9801 (f) and 29 USC 1163.
201	201	(5) PREEXISTING CONDITION EXCLUSION. An individual or group health benefit
202	202	plan or a self-insured health plan may not impose a preexisting condition exclusion
203	203	for any time on an enrollee or beneficiary under the plan.
204	204	(6) ANNUAL AND LIFETIME LIMITS. An individual or group health benefit plan or
205	205	a self-insured health plan may not establish any of the following:
206	206	(a) Lifetime limits on the dollar value of benefits for an enrollee or a dependent
207	207	of an enrollee under the plan.
208	208	(b) Annual limits on the dollar value of benefits for an enrollee or a dependent
209	209	of an enrollee under the plan.
210	210	(7) APPLICABILITY. (a) This section applies only if provisions of the federal
211	211	Patient Protection and Affordable Care Act, P.L. 111-148, as amended, under 42
212	212	USC 300gg to 300gg-4 and 300gg-11 are no longer enforceable or no longer preempt
213	213	state law relating to individual or group health insurance policies. If this section
214	214	applies, this section supersedes any conflicting provision of s. 625.12 (1) or (2), 625.15
215	215	(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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242	242	SECTION 7 SENATE BILL 152
243	243	other conflicting provision in chs. 600 to 655 to the extent this section conflicts with
244	244	that provision.
245	245	(b) 1. A health benefit plan that is not required to comply with 42 USC 300gg-1
246	246	as amended as of January 1, 2019, is not required to comply with sub. (2).
247	247	2. A health benefit plan that is not required to comply with 42 USC 300gg as
248	248	amended as of January 1, 2019, is not required to comply with sub. (3).
249	249	3. A health benefit plan that is not required to comply with 42 USC 300gg-3
250	250	as amended as of January 1, 2019, is not required to comply with sub. (5).
251	251	4. A health benefit plan that is not required to comply with 42 USC 300gg-11
252	252	(a) (1) (A) as amended as of January 1, 2019, is not required to comply with sub. (6)
253	253	(a).
254	254	5. A health benefit plan that is not required to comply with 42 USC 300gg-11
255	255	(a) (1) (B) as amended as of January 1, 2019, is not required to comply with sub. (6)
256	256	(b).
257	257	(END)
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