Wisconsin 2023-2024 Regular Session

Wisconsin Senate Bill SB341 Compare Versions

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

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1	1	LRB-3252/1
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3	3	2023 - 2024 LEGISLATURE
4	4	2023 SENATE BILL 341
5	5	June 21, 2023 - Introduced by Senators ROYS, L. JOHNSON, AGARD, HESSELBEIN,
6	6	LARSON, PFAFF, CARPENTER, SPREITZER, TAYLOR, SMITH and WIRCH, cosponsored
7	7	by Representatives VINING, DRAKE, ANDRACA, BARE, BILLINGS, CABRERA,
8	8	CLANCY, CONLEY, CONSIDINE, EMERSON, GOYKE, HAYWOOD, HONG, J. ANDERSON,
9	9	JACOBSON, JOERS, MOORE OMOKUNDE, MURPHY, MYERS, OHNSTAD, PALMERI,
10	10	RATCLIFF, SHELTON, SINICKI, SNODGRASS, STUBBS, SHANKLAND, BALDEH and
11	11	SUBECK. Referred to Committee on Insurance and Small Business.
12	12	AN ACT to create 632.895 (14m) of the statutes; relating to: coverage of
13	13	maternity and newborn care under health insurance policies and plans and
14	14	granting rule-making authority.
15	15	Analysis by the Legislative Reference Bureau
16	16	This bill requires certain health insurance policies, known in the bill as
17	17	disability insurance policies, and governmental self-insured health plans to cover
18	18	the essential health benefit of maternity and newborn care, as specified by the
19	19	commissioner of insurance by rule. The bill specifies a list of requirements that the
20	20	commissioner must follow when establishing the maternity and newborn care
21	21	benefit, including certain limitations on cost sharing. If the maternity or newborn
22	22	care benefit specified by the commissioner is also subject to its own mandated
23	23	coverage requirement under current law, the bill requires the disability insurance
24	24	policy or self-insured health plan to provide coverage under whichever requirement
25	25	provides the insured or plan participant with more comprehensive coverage.
26	26	This proposal may contain a health insurance mandate requiring a social and
27	27	financial impact report under s. 601.423, stats.
28	28	The people of the state of Wisconsin, represented in senate and assembly, do
29	29	enact as follows:
30	30	SECTION 1. 632.895 (14m) of the statutes is created to read:
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34	34	4 - 2 -2023 - 2024 Legislature LRB-3252/1
35	35	JPC:cjs
36	36	SECTION 1 SENATE BILL 341
37	37	632.895 (14m) MATERNITY AND NEWBORN CARE; ESSENTIAL HEALTH BENEFIT. (a)
38	38	In this subsection, “self-insured health plan” has the meaning given in s. 632.85 (1)
39	39	(c).
40	40	(b) On a date specified by the commissioner, by rule, every disability insurance
41	41	policy, except as provided in par. (g), and every self-insured health plan shall provide
42	42	coverage for the essential health benefit of maternity and newborn care, including
43	43	benefits, items, and services, as determined by the commissioner, by rule, subject to
44	44	par. (c).
45	45	(c) In determining the scope of maternity and newborn care benefits for which
46	46	coverage is required under par. (b), the commissioner shall do all of the following:
47	47	1. Conduct a survey of employer-sponsored coverage to determine maternity
48	48	and newborn care benefits typically covered by employers and ensure that the scope
49	49	of benefits for which coverage is required under this subsection is equal to the scope
50	50	of benefits covered under a typical disability insurance policy offered by an employer
51	51	to its employees.
52	52	2. Ensure that the maternity and newborn care benefit is provided with no or
53	53	limited cost-sharing requirements.
54	54	3. Require that disability insurance policies and self-insured health plans do
55	55	not, with regards to maternity and newborn care coverage required under par. (b),
56	56	make coverage decisions, determine reimbursement rates, establish incentive
57	57	programs, or design benefits in ways that discriminate against individuals because
58	58	of their disability or expected length of life.
59	59	(d) The commissioner shall periodically update, by rule, the maternity and
60	60	newborn care benefits under this subsection to address any gaps in access to
61	61	coverage.
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87	87	LRB-3252/1
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89	89	SECTION 1
90	90	SENATE BILL 341
91	91	(e) If the maternity or newborn care benefit is also subject to mandated
92	92	coverage elsewhere under this section and the coverage requirements are not
93	93	identical, the disability insurance policy or self-insured health plan shall provide
94	94	coverage under whichever subsection provides the insured or plan participant with
95	95	more comprehensive coverage of the benefit, item, or service.
96	96	(f) Nothing in this subsection or rules promulgated under this subsection
97	97	prohibits a disability insurance policy or a self-insured health plan from providing
98	98	benefits in excess of the essential health benefit coverage required under this
99	99	subsection.
100	100	(g) This subsection does not apply to any disability insurance policy that is
101	101	described in s. 632.745 (11) (b) 1. to 12.
102	102	(END)
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