Wisconsin 2025-2026 Regular Session

Wisconsin Senate Bill SB174 Compare Versions

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

Old	New	Differences
1	1	2025 - 2026 LEGISLATURE
2	2	LRB-1868/1
3	3	JPC:cdc
4	4	2025 SENATE BILL 174
5	5	April 3, 2025 - Introduced by Senators JACQUE, NASS, RATCLIFF and SPREITZER,
6	6	cosponsored by Representatives FRANKLIN, BEHNKE, BRILL, JOHNSON,
7	7	KAUFERT, KREIBICH, SUBECK and MURSAU. Referred to Committee on
8	8	Insurance, Housing, Rural Issues and Forestry.
9	9	AN ACT to amend 40.51 (8), 40.51 (8m), 66.0137 (4), 120.13 (2) (g) and 185.983
10	10	(1) (intro.); to create 609.847 and 632.728 of the statutes; relating to:
11	11	coverage of individuals with preexisting conditions and benefit limits under
12	12	health plans.
13	13	Analysis by the Legislative Reference Bureau
14	14	This bill generally sets certain requirements and limitations on health
15	15	insurance coverage in the event the federal Patient Protection and Affordable Care
16	16	Act no longer preempts state law on the topic. Currently, the Affordable Care Act
17	17	generally allows premium rates to be based only on individual or family coverage,
18	18	rating area, age, and tobacco use; requires group and individual health insurance
19	19	policies to accept every employer and individual that applies for coverage, known as
20	20	guaranteed issue, and renew health insurance coverage at the option of the sponsor
21	21	or individual; and prohibits health insurance policies from imposing preexisting
22	22	condition exclusions. If those requirements and limitations of the Affordable Care
23	23	Act become no longer enforceable or no longer preempt state law, all of the following
24	24	apply under the bill:
25	25	1. Every individual health benefit plan must accept every individual in this
26	26	state who applies for coverage and every group health benefit plan must accept
27	27	every employer in this state that applies for coverage, regardless of whether any
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31	31	4 2025 - 2026 Legislature
32	32	SENATE BILL 174
33	33	- 2 - LRB-1868/1
34	34	JPC:cdc
35	35	SECTION 1
36	36	individual or employee has a preexisting condition. A health benefit plan may
37	37	restrict enrollment in coverage to open or special enrollment periods, and the
38	38	commissioner of insurance must ensure a statewide 45-day open enrollment period
39	39	allowing individuals, including individuals who do not have coverage, to enroll in
40	40	coverage. Health benefit plans must provide special enrollment periods for certain
41	41	qualifying 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
49	49	based on the fact that the condition was present before the date of enrollment for
50	50	the 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), 632.722,
66	66	632.728, 632.729, 632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83,
67	67	632.835, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (3) to (6), 632.885,
68	68	632.89, 632.895 (5m) 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
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79	79	SENATE BILL 174
80	80	- 3 - LRB-1868/1
81	81	JPC:cdc
82	82	SECTION 2
83	83	board under sub. (7) shall comply with ss. 631.95, 632.722, 632.728, 632.729,
84	84	632.746 (1) to (8) and (10), 632.747, 632.748, 632.798, 632.83, 632.835, 632.85,
85	85	632.853, 632.855, 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,
88	88	or 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	632.722, 632.728, 632.729, 632.746 (10) (a) 2. and (b) 2., 632.747 (3), 632.798,
92	92	632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (4) to (6), 632.885, 632.89,
93	93	632.895 (9) to (17), 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), 632.722, 632.728, 632.729, 632.746 (10) (a)
97	97	2. and (b) 2., 632.747 (3), 632.798, 632.85, 632.853, 632.855, 632.861, 632.867,
98	98	632.87 (4) to (6), 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), 632.722, 632.728, 632.729, 632.745 to 632.749, 632.775, 632.79,
105	105	632.795, 632.798, 632.85, 632.853, 632.855, 632.861, 632.867, 632.87 (2) to (6),
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129	129	SENATE BILL 174
130	130	- 4 - LRB-1868/1
131	131	JPC:cdc
132	132	SECTION 5
133	133	632.885, 632.89, 632.895 (5) and (8) to (17), 632.896, and 632.897 (10) and chs. 609,
134	134	620, 630, 635, 645, and 646, but the sponsoring association shall:
135	135	SECTION 6. 609.847 of the statutes is created to read:
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) XHealth benefit planY has the meaning given in s. 632.745 (11).
143	143	(b) XPreexisting condition exclusionY 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) XSelf-insured health planY has the meaning given in s. 632.85 (1) (c).
149	149	(d) XSmall employerY 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
152	152	benefit plan shall accept every employer in this state that applies for coverage,
153	153	regardless of whether any individual or employee has a preexisting condition. A
154	154	health benefit plan may restrict enrollment in coverage described in this subsection
155	155	to open or special enrollment periods under sub. (4).
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179	179	SENATE BILL 174
180	180	- 5 - LRB-1868/1
181	181	JPC:cdc
182	182	SECTION 7
183	183	(3) PREMIUM RATE VARIATION. A health benefit plan offered on the individual
184	184	or small employer market or a self-insured health plan may vary premium rates for
185	185	a specific plan based only on the following considerations:
186	186	(a) Whether the plan covers an individual or a family.
187	187	(b) Rating area in the state, as established by the commissioner.
188	188	(c) Age, except that the rate may not vary by more than 3 to 1 for adults over
189	189	the age groups and the age bands shall be consistent with recommendations of the
190	190	National Association of Insurance Commissioners.
191	191	(d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.
192	192	(4) ENROLLMENT PERIODS. (a) The commissioner shall ensure that every
193	193	individual health benefit plan has open enrollment during a statewide open
194	194	enrollment period of no longer than 45 days to allow individuals, including
195	195	individuals who do not have coverage, to enroll in coverage.
196	196	(b) Every health benefit plan shall provide special enrollment periods for
197	197	qualifying events under 26 USC 9801 (f) and 29 USC 1163.
198	198	(5) PREEXISTING CONDITION EXCLUSION. An individual or group health
199	199	benefit plan or a self-insured health plan may not impose a preexisting condition
200	200	exclusion for any time on an enrollee or beneficiary under the plan.
201	201	(6) ANNUAL AND LIFETIME LIMITS. An individual or group health benefit plan
202	202	or a self-insured health plan may not establish any of the following:
203	203	(a) Lifetime limits on the dollar value of benefits for an enrollee or a
204	204	dependent of an enrollee under the plan.
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226	226	22 2025 - 2026 Legislature
227	227	SENATE BILL 174
228	228	- 6 - LRB-1868/1
229	229	JPC:cdc
230	230	SECTION 7
231	231	(b) Annual limits on the dollar value of benefits for an enrollee or a dependent
232	232	of an enrollee under the plan.
233	233	(7) APPLICABILITY. (a) This section applies only if provisions of the federal
234	234	Patient Protection and Affordable Care Act, P.L. 111-148, as amended, under 42
235	235	USC 300gg to 300gg-4 and 300gg-11 are no longer enforceable or no longer preempt
236	236	state law relating to individual or group health insurance policies. If this section
237	237	applies, this section supersedes any conflicting provision of s. 625.12 (1) or (2),
238	238	625.15 (1), 628.34 (3), 632.746, 632.76, 632.795 (4) (a), 632.896 (4), or 632.897 (11)
239	239	(a) or any other conflicting provision in chs. 600 to 655 to the extent this section
240	240	conflicts with that provision.
241	241	(b) 1. A health benefit plan that is not required to comply with 42 USC 300gg-
242	242	1, as amended, as of January 1, 2023, is not required to comply with sub. (2).
243	243	2. A health benefit plan that is not required to comply with 42 USC 300gg, as
244	244	amended, as of January 1, 2023, is not required to comply with sub. (3).
245	245	3. A health benefit plan that is not required to comply with 42 USC 300gg-3,
246	246	as amended, as of January 1, 2023, is not required to comply with sub. (5).
247	247	4. A health benefit plan that is not required to comply with 42 USC 300gg-11
248	248	(a) (1) (A), as amended, as of January 1, 2023, is not required to comply with sub. (6)
249	249	(a).
250	250	5. A health benefit plan that is not required to comply with 42 USC 300gg-11
251	251	(a) (1) (B), as amended, as of January 1, 2023, is not required to comply with sub. (6)
252	252	(b).
253	253	(END)
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