AB365-SSA1,5,99 (a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
AB365-SSA1,5,1010 (b) “Self-insured health plan” has the meaning given in s. 632.85 (1) (c).
AB365-SSA1,5,16 11(2) Prohibition. For the purpose of setting rates or premiums for coverage
12under a group or individual disability insurance policy or a self-insured health plan
13and for the purpose of setting any deductibles, copayments, or coinsurance under a
14group or individual disability insurance policy or a self-insured health plan, the
15policy or plan may not consider whether an individual, including a dependent, who
16would be covered under the plan has a preexisting condition.
AB365-SSA1,13 17Section 13. 632.746 (1) (a) of the statutes is renumbered 632.746 (1) and
18amended to read:
AB365-SSA1,5,2519 632.746 (1) Subject to subs. (2) and (3), an An insurer that offers a group health
20benefit plan may, with respect to a participant or beneficiary under the plan, not
21impose a preexisting condition exclusion only if the exclusion relates to a condition,
22whether physical or mental, regardless of the cause of the condition, for which
23medical advice, diagnosis, care or treatment was recommended or received within
24the 6-month period ending on the participant's or beneficiary's enrollment date
25under the plan
on a participant or beneficiary under the plan.
AB365-SSA1,14
1Section 14. 632.746 (1) (b) of the statutes is repealed.
AB365-SSA1,15 2Section 15. 632.746 (2) (a) of the statutes is amended to read:
AB365-SSA1,6,53 632.746 (2) (a) An insurer offering a group health benefit plan may not treat
4genetic information as a preexisting condition under sub. (1) without a diagnosis of
5a condition related to the information
.
AB365-SSA1,16 6Section 16. 632.746 (2) (c), (d) and (e) of the statutes are repealed.
AB365-SSA1,17 7Section 17. 632.746 (3) (a) of the statutes is repealed.
AB365-SSA1,18 8Section 18 . 632.746 (3) (d) 1. of the statutes is renumbered 632.746 (3) (d).
AB365-SSA1,19 9Section 19 . 632.746 (3) (d) 2. and 3. of the statutes are repealed.
AB365-SSA1,20 10Section 20 . 632.746 (5) of the statutes is repealed.
AB365-SSA1,21 11Section 21. 632.746 (8) (a) (intro.) of the statutes is amended to read:
AB365-SSA1,6,1512 632.746 (8) (a) (intro.) A health maintenance organization that offers a group
13health benefit plan and that does not impose any preexisting condition exclusion
14under sub. (1)
with respect to a particular coverage option may impose an affiliation
15period for that coverage option, but only if all of the following apply:
AB365-SSA1,22 16Section 22. 632.76 (2) (a) and (ac) 1. and 2. of the statutes are amended to read:
AB365-SSA1,6,2417 632.76 (2) (a) No claim for loss incurred or disability commencing after 2 years
18from the date of issue of the policy may be reduced or denied on the ground that a
19disease or physical condition existed prior to the effective date of coverage, unless the
20condition was excluded from coverage by name or specific description by a provision
21effective on the date of loss. This paragraph does not apply to a group health benefit
22plan, as defined in s. 632.745 (9), which is subject to s. 632.746 , a disability insurance
23policy, as defined in s. 632.895 (1) (a), or a self-insured health plan, as defined in s.
24632.85 (1) (c)
.
AB365-SSA1,7,6
1(ac) 1. Notwithstanding par. (a), no No claim or loss incurred or disability
2commencing after 12 months from the date of issue of under an individual disability
3insurance policy, as defined in s. 632.895 (1) (a), may be reduced or denied on the
4ground that a disease or physical condition existed prior to the effective date of
5coverage, unless the condition was excluded from coverage by name or specific
6description by a provision effective on the date of the loss
.
AB365-SSA1,7,127 2. Except as provided in subd. 3., an An individual disability insurance policy,
8as defined in s. 632.895 (1) (a), other than a short-term policy subject to s. 632.7495
9(4) and (5),
may not define a preexisting condition more restrictively than a condition,
10whether physical or mental, regardless of the cause of the condition, for which
11medical advice, diagnosis, care, or treatment was recommended or received within
1212 months before the effective date of coverage
.
AB365-SSA1,23 13Section 23. 632.76 (2) (ac) 3. of the statutes is repealed.
AB365-SSA1,24 14Section 24. 632.795 (4) (a) of the statutes is amended to read:
AB365-SSA1,8,215 632.795 (4) (a) An insurer subject to sub. (2) shall provide coverage under the
16same policy form and for the same premium as it originally offered in the most recent
17enrollment period, subject only to the medical underwriting used in that enrollment
18period. Unless otherwise prescribed by rule, the insurer may apply deductibles,
19preexisting condition limitations, waiting periods , or other limits only to the extent
20that they would have been applicable had coverage been extended at the time of the
21most recent enrollment period and with credit for the satisfaction or partial
22satisfaction of similar provisions under the liquidated insurer's policy or plan. The
23insurer may exclude coverage of claims that are payable by a solvent insurer under
24insolvency coverage required by the commissioner or by the insurance regulator of

1another jurisdiction. Coverage shall be effective on the date that the liquidated
2insurer's coverage terminates.
AB365-SSA1,25 3Section 25. 632.897 (11) (a) of the statutes is amended to read:
AB365-SSA1,8,124 632.897 (11) (a) Notwithstanding subs. (2) to (10), the commissioner may
5promulgate rules establishing standards requiring insurers to provide continuation
6of coverage for any individual covered at any time under a group policy who is a
7terminated insured or an eligible individual under any federal program that
8provides for a federal premium subsidy for individuals covered under continuation
9of coverage under a group policy, including rules governing election or extension of
10election periods, notice, rates, premiums, premium payment, application of
11preexisting condition exclusions,
election of alternative coverage, and status as an
12eligible individual, as defined in s. 149.10 (2t), 2011 stats.
AB365-SSA1,26 13Section 26 . Initial applicability.
AB365-SSA1,8,1414 (1) Preexisting conditions.
AB365-SSA1,8,1715 (a) For policies and plans containing provisions inconsistent with this act, the
16act first applies to policy or plan years beginning on January 1 of the year following
17the year in which this paragraph takes effect, except as provided in paragraph (b).
AB365-SSA1,8,2218 (b) For policies or plans that are affected by a collective bargaining agreement
19containing provisions inconsistent with this act, this act first applies to policy or plan
20years beginning on the effective date of this paragraph or on the day on which the
21collective bargaining agreement is newly established, extended, modified, or
22renewed, whichever is later.
AB365-SSA1,27 23Section 27 . Effective date.
AB365-SSA1,9,2
1(1) This act takes effect on the first day of the 4th month beginning after
2publication.
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