AB365-SSA2-SA2,15,108 57. Human immunodeficiency virus screening for adults who have attained the
9age of 15 years but have not attained the age of 66 years and individuals at high risk
10of infection who are younger than 15 years of age or older than 65 years of age.
AB365-SSA2-SA2,15,1111 58. All contraceptives and services in accordance with sub. (17).
AB365-SSA2-SA2,15,1312 59. Any services not already specified under this paragraph having an A or B
13rating in current recommendations from the U.S. Preventive Services Task Force.
AB365-SSA2-SA2,15,1614 60. Any preventive services not already specified under this paragraph that are
15recommended by the federal health resources and services administration's Bright
16Futures project.
AB365-SSA2-SA2,15,1917 61. Any immunizations, not already specified under sub. (14), that are
18recommended and determined to be for routine use by the Advisory Committee on
19Immunization Practices.
AB365-SSA2-SA2,15,2220 (c) Subject to par. (d), no disability insurance policy and no self-insured health
21plan may subject the coverage of any of the preventive services under par. (b) to any
22deductibles, copayments, or coinsurance under the policy or plan.
AB365-SSA2-SA2,16,223 (d) 1. If an office visit and a preventive service specified under par. (b) are billed
24separately by the health care provider, the disability insurance policy or self-insured

1health plan may apply deductibles to and impose copayments or coinsurance on the
2office visit but not on the preventive service.
AB365-SSA2-SA2,16,53 2. If the primary reason for an office visit is not to obtain a preventive service,
4the disability insurance policy or self-insured health plan may apply deductibles to
5and impose copayments or coinsurance on the office visit.
AB365-SSA2-SA2,16,146 3. If a preventive service specified under par. (b) is provided by a health care
7provider that is outside the disability insurance policy's or self-insured health plan's
8network of providers, the policy or plan may apply deductibles to and impose
9copayments or coinsurance on the office visit and the preventive service. If a
10preventive service specified under par. (b) is provided by a health care provider that
11is outside the disability insurance policy's or self-insured health plan's network of
12providers because there is no available health care provider in the policy's or plan's
13network of providers that provides the preventive service, the policy or plan may not
14apply deductibles to or impose copayments or coinsurance on preventive service.
AB365-SSA2-SA2,16,1915 4. If multiple well-woman visits described under par. (b) 47. are required to
16fulfill all necessary preventive services and are in accordance with clinical
17recommendations, the disability insurance policy or self-insured health plan may
18not apply a deductible or impose a copayment or coinsurance to any of those
19well-woman visits.
AB365-SSA2-SA2,35 20Section 35. 632.895 (14) (a) 1. i. and j. of the statutes are amended to read:
AB365-SSA2-SA2,16,2121 632.895 (14) (a) 1. i. Hepatitis A and B.
AB365-SSA2-SA2,16,2222 j. Varicella and herpes zoster.
AB365-SSA2-SA2,36 23Section 36. 632.895 (14) (a) 1. k. to o. of the statutes are created to read:
AB365-SSA2-SA2,16,2424 632.895 (14) (a) 1. k. Human papillomavirus.
AB365-SSA2-SA2,16,2525 L. Meningococcal meningitis.
AB365-SSA2-SA2,17,1
1m. Pneumococcal pneumonia.
AB365-SSA2-SA2,17,22 n. Influenza.
AB365-SSA2-SA2,17,33 o. Rotavirus.
AB365-SSA2-SA2,37 4Section 37. 632.895 (14) (b) of the statutes is amended to read:
AB365-SSA2-SA2,17,105 632.895 (14) (b) Except as provided in par. (d), every disability insurance policy,
6and every self-insured health plan of the state or a county, city, town, village, or
7school district, that provides coverage for a dependent of the insured shall provide
8coverage of appropriate and necessary immunizations, from birth to the age of 6
9years,
for an insured or plan participant, including a dependent who is a child of the
10insured or plan participant.
AB365-SSA2-SA2,38 11Section 38. 632.895 (14) (c) of the statutes is amended to read:
AB365-SSA2-SA2,17,1612 632.895 (14) (c) The coverage required under par. (b) may not be subject to any
13deductibles, copayments, or coinsurance under the policy or plan. This paragraph
14applies to a defined network plan, as defined in s. 609.01 (1b), only with respect to
15appropriate and necessary immunizations provided by providers participating, as
16defined in s. 609.01 (3m), in the plan.
AB365-SSA2-SA2,39 17Section 39. 632.895 (14) (d) 3. of the statutes is amended to read:
AB365-SSA2-SA2,17,2018 632.895 (14) (d) 3. A health care plan offered by a limited service health
19organization, as defined in s. 609.01 (3), or by a preferred provider plan, as defined
20in s. 609.01 (4), that is not a defined network plan, as defined in s. 609.01 (1b)
.
AB365-SSA2-SA2,40 21Section 40. 632.895 (14m) of the statutes is created to read:
AB365-SSA2-SA2,17,2322 632.895 (14m) Essential health benefits. (a) In this section, “self-insured
23health plan” has the meaning given in s. 632.85 (1) (c).
AB365-SSA2-SA2,18,3
1(b) On a date specified by the commissioner, by rule, every disability insurance
2policy and every self-insured health plan shall provide coverage for essential health
3benefits as determined by the commissioner, by rule, subject to par. (c).
AB365-SSA2-SA2,18,54 (c) In determining the essential health benefits for which coverage is required
5under par. (b), the commissioner shall do all of the following:
AB365-SSA2-SA2,18,76 1. Include benefits, items, and services in, at least, all of the following
7categories:
AB365-SSA2-SA2,18,88 a. Ambulatory patient services.
AB365-SSA2-SA2,18,99 b. Emergency services.
AB365-SSA2-SA2,18,1010 c. Hospitalization.
AB365-SSA2-SA2,18,1111 d. Maternity and newborn care.
AB365-SSA2-SA2,18,1312 e. Mental health and substance use disorder services, including behavioral
13health treatment.
AB365-SSA2-SA2,18,1414 f. Prescription drugs.
AB365-SSA2-SA2,18,1515 g. Rehabilitative and habilitative services and devices.
AB365-SSA2-SA2,18,1616 h. Laboratory services.
AB365-SSA2-SA2,18,1717 i. Preventive and wellness services and chronic disease management.
AB365-SSA2-SA2,18,1818 j. Pediatric services, including oral and vision care.
AB365-SSA2-SA2,18,2319 2. Conduct a survey of employer-sponsored coverage to determine benefits
20typically covered by employers and ensure that the scope of essential health benefits
21for which coverage is required under this subsection is equal to the scope of benefits
22covered under a typical disability insurance policy offered by an employer to its
23employees.
AB365-SSA2-SA2,18,2524 3. Ensure that essential health benefits reflect a balance among the categories
25described in subd. 1. such that benefits are not unduly weighted toward one category.
AB365-SSA2-SA2,19,2
14. Ensure that essential health benefit coverage is provided with no or limited
2cost-sharing requirements.
AB365-SSA2-SA2,19,63 5. Require that disability insurance policies and self-insured health plans do
4not make coverage decisions, determine reimbursement rates, establish incentive
5programs, or design benefits in ways that discriminate against individuals because
6of their age, disability, or expected length of life.
AB365-SSA2-SA2,19,97 6. Establish essential health benefits in a way that takes account of the health
8care needs of diverse segments of the population, including women, children, persons
9with disabilities, and other groups.
AB365-SSA2-SA2,19,1310 7. Ensure that essential health benefits established under this subsection not
11be subject to a coverage denial based on an insured's or plan participant's age,
12expected length of life, present or predicted disability, degree of dependency on
13medical care, or quality of life.
AB365-SSA2-SA2,19,2014 8. Require that disability insurance policies and self-insured health plans
15cover emergency department services that are essential health benefits without
16imposing any requirement to obtain prior authorization for those services and
17without limiting coverage for services provided by an emergency services provider
18that is not in the provider network of a policy or plan in a way that is more restrictive
19than requirements or limitations that apply to emergency services provided by a
20provider that is in the provider network of the policy or plan.
AB365-SSA2-SA2,19,2521 9. Require a disability insurance policy or self-insured health plan to apply to
22emergency department services that are essential health benefits provided by an
23emergency department provider that is not in the provider network of the policy or
24plan the same copayment amount or coinsurance rate that applies if those services
25are provided by a provider that is in the provider network of the policy or plan.
AB365-SSA2-SA2,20,2
1(d) The commissioner shall periodically update, by rule, the essential health
2benefits under this subsection to address any gaps in access to coverage.
AB365-SSA2-SA2,20,73 (e) If an essential health benefit is also subject to mandated coverage elsewhere
4under this section and the coverage requirements are not identical, the disability
5insurance policy or self-insured health plan shall provide coverage under whichever
6subsection provides the insured or plan participant with more comprehensive
7coverage of the medical condition, item, or service.
AB365-SSA2-SA2,20,118 (f) Nothing in this subsection or rules promulgated under this subsection
9prohibits a disability insurance policy or a self-insured health plan from providing
10benefits in excess of the essential health benefit coverage required under this
11subsection.
AB365-SSA2-SA2,41 12Section 41. 632.895 (16m) (b) of the statutes is amended to read:
AB365-SSA2-SA2,20,1713 632.895 (16m) (b) The coverage required under this subsection may be subject
14to any limitations, or exclusions , or cost-sharing provisions that apply generally
15under the disability insurance policy or self-insured health plan. The coverage
16required under this subsection may not be subject to any deductibles, copayments,
17or coinsurance.
AB365-SSA2-SA2,42 18Section 42. 632.895 (17) (b) 2. of the statutes is amended to read:
AB365-SSA2-SA2,20,2319 632.895 (17) (b) 2. Outpatient consultations, examinations, procedures, and
20medical services that are necessary to prescribe, administer, maintain, or remove a
21contraceptive, if covered for any other drug benefits under the policy or plan
22sterilization procedures, and patient education and counseling for all females with
23reproductive capacity
.
AB365-SSA2-SA2,43 24Section 43. 632.895 (17) (c) of the statutes is amended to read:
AB365-SSA2-SA2,21,15
1632.895 (17) (c) Coverage under par. (b) may be subject only to the exclusions,
2and limitations, or cost-sharing provisions that apply generally to the coverage of
3outpatient health care services, preventive treatments and services, or prescription
4drugs and devices that is provided under the policy or self-insured health plan. A
5disability insurance policy or self-insured health plan may not apply a deductible or
6impose a copayment or coinsurance to at least one of each type of contraceptive
7method approved by the federal food and drug administration for which coverage is
8required under this subsection. The disability insurance policy or self-insured
9health plan may apply reasonable medical management to a method of contraception
10to limit coverage under this subsection that is provided without being subject to a
11deductible, copayment, or coinsurance to prescription drugs without a brand name.
12The disability insurance policy or self-insured health plan may apply a deductible
13or impose a copayment or coinsurance for coverage of a contraceptive that is
14prescribed for a medical need if the services for the medical need would otherwise be
15subject to a deductible, copayment, or coinsurance.
AB365-SSA2-SA2,44 16Section 44. 632.897 (11) (a) of the statutes is amended to read:
AB365-SSA2-SA2,21,2517 632.897 (11) (a) Notwithstanding subs. (2) to (10), the commissioner may
18promulgate rules establishing standards requiring insurers to provide continuation
19of coverage for any individual covered at any time under a group policy who is a
20terminated insured or an eligible individual under any federal program that
21provides for a federal premium subsidy for individuals covered under continuation
22of coverage under a group policy, including rules governing election or extension of
23election periods, notice, rates, premiums, premium payment, application of
24preexisting condition exclusions,
election of alternative coverage, and status as an
25eligible individual, as defined in s. 149.10 (2t), 2011 stats.
AB365-SSA2-SA2,45
1Section 45. Initial applicability.
AB365-SSA2-SA2,22,42 (1) (a) For policies and plans containing provisions inconsistent with this act,
3the act first applies to policy or plan years beginning on January 1 of the year
4following the year in which this paragraph takes effect, except as provided in par. (b).
AB365-SSA2-SA2,22,95 (b) For policies and plans that are affected by a collective bargaining agreement
6containing provisions inconsistent with this act, this act first applies to policy or plan
7years beginning on the effective date of this paragraph or on the day on which the
8collective bargaining agreement is newly established, extended, modified, or
9renewed, whichever is later.
AB365-SSA2-SA2,46 10Section 46. Effective date.
AB365-SSA2-SA2,22,1211 (1) This act takes effect on the first day of the 4th month beginning after
12publication, except as follows:
AB365-SSA2-SA2,22,1413 (a) The treatment of ss. 49.45 (23) (a) and 49.471 (1) (cr), (4) (a) 4. b., and (4g)
14takes effect on July 1, 2018.”.
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