- 2020 LEGISLATURE LRBs0005/1LRB-1169/1 TJD:kjf&wljTJD:kjf ASSEMBLY SUBSTITUTE AMENDMENT 1, TO ASSEMBLY BILL 1 January 22,10, 2019 - OfferedIntroduced by RepresentativeRepresentatives P ETERSENETERSEN, .ROHRKASTE , M AGNAFIC, O LDENBURG , KITCHENS, STEINEKE, PETRYK , VORPAGEL, K RUG, HORLACHER , KULP, TRANEL , AGLER , LOUDENBECK , SKOWRONSKI, B ALLWEG, QUINN , DITTRIC, BRANDTJEN , KATSMA, THIESFELDT, FELZKOWSKI, PLUMER , SPIROS, NOVAK, E DMING, STEFFEN , SNYDER, T ITT, STAFSHOLT, TAUCHEN , KUGLITSCH, M URPHY , PRONSCHINSKE , RODRIGUEZ, S WEARINGEN, D UCHOW , SCHRAA, TUSLER , IMMERMAN , KURTZ , VOS, MACCO, AUGUST, SUMMERFIELD , KERKMAN , B ORN, BROOKS , RAMTHUN , VANDERM EER, W ITTKE, SANFELIPPO, JAMES, GUNDRUM , MURSAU and O TT, cosponsored by Senators JACQUE, L.

TAYLOR, DARLING, WANGGAARD, MARKLEIN and O LSEN.

Referred to Committee on Health.

coverage of individuals with preexisting conditionsconditions. and benefit limits under health plans.

the commissioner of insurance must ensure a statewide 45-day open enrollment period allowing LRBs0005/1 - 2020 Legislature - 2 - TJD:kjf&wlj individuals, including individuals who do not have coverage, to enroll in coverage;

a health benefit plan offered on the individual or small employer market or a self-insured health plan may not vary premium rates for a - 2020 Legislature - 2 - LRB-1169/1 TJD:kjf ASSEMBLY BILL 1 specific policy or plan except on the basis of whether the policy or plan covers an individual or a family, area in the state, age, and tobacco use;

a group health benefit planplan, orincluding a self-insured governmental health planplan, may not impose a preexisting condition exclusion;

and an individual health benefit plansplan andmay self-insurednot heathreduce plansor aredeny prohibiteda fromclaim imposingor anloss annualincurred or lifetimedisability limitcommencing under the policy on the dollarground valuethat ofa benefitsdisease underor physical condition existed prior to the plan.effective date of coverage.

ACertain preexistinggrandfathered conditionand exclusiontransitional ishealth definedinsurance inpolicies thethat billare asexempt afrom limitationsome orrequirements exclusion of benefitsthe relatingAffordable toCare aAct, conditionincluding based on the factpremium thatrate therequirements, conditionare wasexempt presentfrom before the datepremium ofrate enrollmentrequirements forunder the coverage,bill. whether or not any medical advice, diagnosis, care, or treatment was recommended or received before the date of enrollment for coverage.

The Affordable Care Act exempts certain plans from complying with provisions of the act, and the bill exempts any health benefit plan that is exempt from a provision of the Affordable Care Act from complying with the corresponding provision of this bill.

LRBs0005/1 - 2020 Legislature - 3 - TJD:kjf&wlj SECTION 3 66.0137 (4) SELF-INSUREDS ELF-INSURED HEALTH PLANSIfPLANS. a city, including a 1st class city, or a village provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss.

49.493If (3)a (d),city, 631.89,including 631.90,a 631.931st (2),class 632.728,city, 632.746or (10)a (a)village 2.provides health care benefits under its home rule power, or if a town provides health care benefits, to its officers and employees on a self-insured basis, the self-insured plan shall comply with ss.

49.493 (3) (d), 631.89, 631.90, 631.93 (2), LRB-1169/1 - 2020 Legislature - 3 - TJD:kjf SECTION 3 ASSEMBLY BILL 1 632.728,632.746 (10) (a) 2.

609.847 Preexisting condition discrimination prohibited;prohibited.

benefit limits.

LRBs0005/1 - 2020 Legislature - 4 - TJD:kjf&wlj SECTION 7 SECTION 7.

rating;rating.

benefit(1) limits.DEFINITION.

(1) D EFINITIONS.

(b)- “Preexisting2020 conditionLegislature exclusion”- means,4 with- respectLRB-1169/1 toTJD:kjf coverage,ASSEMBLY aBILL limitation1 orSECTION exclusion7 of(b) benefits“Self-insured relatinghealth toplan” ahas condition based on the factmeaning thatgiven thein conditions. was present before the date of enrollment for the coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before the date of enrollment for coverage.

(c) “Self-insured health plan” has the meaning given in s.

(d)(c) “Small employer” has the meaning given in s.

(2) AACCESS CCESS TO COVERAGE.

(3) PREMIUM RATE VARIATION.VARIATION(a) A health benefit plan offered on the individual or small employer market or a self-insured health plan may vary premium rates for a specific policy or plan based only on the following considerations:

A1. health benefit plan offered on the individual or small employer market or a self-insured health plan may vary premium rates for a specific plan based only on the following considerations:

(a) Whether the policy or plan covers an individual or a family.

(b)2. Rating area in the state, as established by the commissioner.

(c)Rating Age,area exceptin that the ratestate, mayas notestablished vary by more than 3 to 1 for adults over the agecommissioner. groups and the age bands shall be consistent with recommendations of the National Association of Insurance Commissioners.

LRBs0005/13. - 2020 Legislature - 5 - TJD:kjf&wlj S ECTION 7 (d) Tobacco use, except that the rate may not vary by more than 1.5 to 1.

Age, except that the rate may not vary by more than 3 to 1 for adults over the age groups and the age bands shall be consistent with recommendations of the National Association of Insurance Commissioners.

4.

Tobacco use, except that the rate may not vary by more than 1.5 to 1.

(b) A health benefit plan that is considered a grandfathered health plan under 42 USC 18011 or has transitional status granted by the federal department of health and human services and the commissioner is not required to comply with par.

(a).

(a) The commissioner shall ensure that every individual health benefit plan has open enrollment during a statewide open enrollment period of no longer than 45 days to allow individuals, including individuals who do not have coverage, to enroll in coverage.

LRB-1169/1 - 2020 Legislature - 5 - TJD:kjf S ECTION 7 ASSEMBLY BILL 1 (b) Every health benefit plan shall provide special enrollment periods for qualifying events under 26 USC 9801 (f) and 29 USC 1163.

(5) PREEXISTING CONDITION EXCLUSION.AnEXCLUSION. individual or group health benefit plan or a self-insured health plan may not impose a preexisting condition exclusion for any time on a participant or beneficiary under the plan.

(6)(a) ANNUALA AND LIFETIME LIMITSAn individual or group health benefit plan or a self-insured health plan may not establishimpose a preexisting condition exclusion for any oftime on a participant or beneficiary under the following:policy or plan.

(a)(b) LifetimeNo limitsclaim onor theloss dollarincurred valueor ofdisability benefitsunder for an enrolleeindividual health benefit plan may be reduced or denied on the ground that a dependentdisease ofor anphysical enrolleecondition underexisted prior to the plan.effective date of coverage.

(b)An Annualindividual limitshealth onbenefit theplan dollarmay valuenot ofdefine benefitsa forpreexisting ancondition enrolleemore orrestrictively than a dependentcondition, whether physical or mental, regardless of anthe enrolleecause underof the plan.condition, for which medical advice, diagnosis, care, or treatment was recommended or received.