AB873, s. 2 14Section 2. 600.01 (1) (b) 12. of the statutes is created to read:
AB873,3,1515 600.01 (1) (b) 12. Health care plans offered by a foreign insurer under s. 618.29.
AB873, s. 3 16Section 3. 618.02 (4) of the statutes is created to read:
AB873,3,1717 618.02 (4) "Health care plan" has the meaning given in s. 628.36 (2) (a) 1.
AB873, s. 4 18Section 4. 618.11 (12m) of the statutes is created to read:
AB873,3,2119 618.11 (12m) If the insurer is a foreign insurer that intends to offer health care
20plans to employers or individuals in this state, the proposed disclosures required
21under s. 618.29 (3);
AB873, s. 5 22Section 5. 618.12 (5) of the statutes is created to read:
AB873,4,523 618.12 (5) Special consideration for foreign health insurers. When
24determining whether to issue a certificate of authority or a new certificate of
25authority to an applicant under sub. (4) or s. 618.11 who intends to offer health care

1plans under s. 618.29, the commissioner may consider the applicant's financial
2condition, marketing practices, and compliance with the applicable laws and
3regulations of the applicant's domiciliary state. However, the commissioner may not
4apply these factors in a manner that would place a greater burden on these foreign
5insurers than on domestic insurers.
AB873, s. 6 6Section 6. 618.21 (6) of the statutes is created to read:
AB873,4,87 618.21 (6) Foreign health insurers. This section does not apply to foreign
8insurers offering health care plans under s. 618.29.
AB873, s. 7 9Section 7. 618.26 (5) of the statutes is created to read:
AB873,4,1110 618.26 (5) Foreign health insurers. This section does not apply to foreign
11insurers offering health care plans under s. 618.29.
AB873, s. 8 12Section 8. 618.29 of the statutes is created to read:
AB873,4,18 13618.29 Sale by foreign insurer of health insurance. (1) Requirements
14for offering coverage.
(a) A foreign insurer may offer and provide coverage to
15employers in this state under group health care plans, and may offer and provide
16coverage to individuals in this state under individual health care plans, that are
17exempt from the requirements specified in this section, if all of the following are
18satisfied:
AB873,4,2019 1. The insurer is in compliance with the laws, regulations, and other
20requirements of its domiciliary state that apply to the insurer.
AB873,4,2321 2. The insurer has been issued a certificate of authority or a new certificate of
22authority to do business in this state under s. 618.12 and is in compliance with the
23laws and other requirements of this state that apply to the insurer.
AB873,4,2524 3. The insurer offers coverage in its domiciliary state under any group or
25individual health care plan under which it offers coverage in this state.
AB873,5,4
1(b) Notwithstanding par. (a) 1. and 2., if there is a conflict between an applicable
2law or requirement of the insurer's domiciliary state and an applicable law or
3requirement of this state, the law or requirement of this state applies, unless the
4commissioner orders an exemption from the law or requirement under s. 618.28.
AB873,5,9 5(2) Exemptions, requirements, and laws that apply. (a) A foreign insurer that
6satisfies the requirements under sub. (1), and any health care plan that the insurer
7offers or intends to offer in this state, shall be exempt from chs. 600 to 646, and any
8rules promulgated under those chapters, except as otherwise provided in this
9chapter and except as follows:
AB873,5,1410 1. The insurer and health care plan, as applicable, are subject to ss. 600.03,
11610.70, 631.27 with respect to rules of law that are applicable to the insurer or health
12care plan, 631.28, 631.90, 631.93, 632.715, 632.745 to 632.7495, and 632.785, subchs.
13III and IV of ch. 628, subch. I of ch. 631, and chs. 601 and 618, and any rules
14promulgated under any of them.
AB873,5,1815 2. If the insurer's domiciliary state does not require the insurer to establish and
16follow grievance and independent claims review procedures, the insurer and health
17care plan are subject to ss. 632.83 and 632.835 and any rules promulgated under
18them.
AB873,5,2419 3. The insurer may not refuse to provide or pay for benefits under the health
20care plan for health care services provided by a licensed health care professional on
21the ground that the services were not rendered by a physician as defined in s. 990.01
22(28), unless the health care plan clearly excludes services by such practitioners, but
23no health care plan under this section may exclude services in violation of s. 632.87
24(2), (2m), (3), (4), or (5).
AB873,6,2
1(b) An insurer under par. (a) is subject to assessment under ch. 149 and taxation
2under subch. III of ch. 76.
AB873,6,5 3(3) Disclosures regarding plan differences. Each application form for, and
4each policy of, a health care plan under this section shall disclose, in plain language,
5all of the following:
AB873,6,76 (a) The differences between the health care plan under this section and a health
7care plan issued in compliance with chs. 600 to 646.
AB873,6,98 (b) What state's laws govern the issuance of and requirements under the health
9care plan offered under this section.
AB873,6,12 10(4) Rules. The commissioner may promulgate rules for the administration of
11this section. The commissioner may not promulgate a rule that does any of the
12following:
AB873,6,1513 (a) Requires a foreign insurer under this section to modify coverage or benefit
14requirements or to restrict rate increases in any way that exceeds the insurer's
15domiciliary state's laws or regulations.
AB873,6,1716 (b) Expands the commissioner's authority over foreign insurers in a way that
17conflicts with this section.
AB873,6,1918 (c) Conflicts with the purpose of exempting foreign insurers under this section
19from requirements under chs. 600 to 646.
AB873,7,7 20(5) Exemptions for domestic insurers. A domestic insurer authorized to do
21business in this state in one or more lines of insurance that includes health insurance
22may apply for an exemption from the provisions under chs. 600 to 646, and any rules
23promulgated under those provisions, as determined by the commissioner, that would
24allow the insurer to offer health care plans that are comparable in plan design to
25health care plans offered by foreign insurers under this section. Upon an insurer's

1application, the commissioner shall make an order exempting the insurer from those
2provisions and rules that would allow the domestic insurer to offer a health care plan
3or plans that are comparable in design to health care plans offered by foreign
4insurers under this section. Any health care plan offered by a domestic insurer under
5an exemption under this subsection shall be subject to the requirements that apply
6to health care plans offered by foreign insurers under this section, including the
7disclosure requirements under sub. (3).
AB873, s. 9 8Section 9. 618.36 (1) of the statutes is amended to read:
AB873,7,129 618.36 (1) Continuance of regulation. A Subject to s. 618.29 (2) (a), a
10nondomestic insurer authorized under this chapter is subject to regulation under the
11applicable provisions of chs. 600 to 646 until released from regulation under this
12section.
AB873, s. 10 13Section 10. 625.03 (1m) (d) of the statutes is amended to read:
AB873,7,1414 625.03 (1m) (d) Variable and fixed annuities; and
AB873, s. 11 15Section 11. 625.03 (1m) (e) of the statutes is amended to read:
AB873,7,1716 625.03 (1m) (e) Group and blanket accident and sickness insurance other than
17credit accident and sickness insurance.; and
AB873, s. 12 18Section 12. 625.03 (1m) (f) of the statutes is created to read:
AB873,7,2019 625.03 (1m) (f) Individual health care plans, as defined in s. 628.36 (2) (a) 1.,
20offered by a foreign insurer under s. 618.29.
AB873, s. 13 21Section 13. 631.01 (1) (a) of the statutes is amended to read:
AB873,7,2222 631.01 (1) (a) As provided in ss. 600.01, 618.29, and 618.42;
AB873, s. 14 23Section 14. 635.01 of the statutes is renumbered 635.01 (1) and amended to
24read:
AB873,8,7
1635.01 (1) This Except as provided in sub. (2), this chapter applies to all group
2health insurance plans, policies, or certificates, written on risks or operations in this
3state, providing coverage for employees of a small employer, or employees of a small
4employer and the employer, and to individual health insurance policies, written on
5risks or operations in this state, providing coverage for employees of a small
6employer, or employees of a small employer and the employer when 3 or more are sold
7to or through a small employer.
AB873, s. 15 8Section 15. 635.01 (2) of the statutes is created to read:
AB873,8,109 635.01 (2) This chapter does not apply to a group or individual health care plan,
10as defined in s. 628.36 (2) (a) 1., that is offered by a foreign insurer under s. 618.29.
AB873, s. 16 11Section 16. 645.02 (3) of the statutes is amended to read:
AB873,8,1312 645.02 (3) All Except as provided in s. 618.29 (2) (a) 1., all insurers who have
13insureds resident in this state.
AB873, s. 17 14Section 17. 646.01 (1) (a) 2. m. of the statutes is created to read:
AB873,8,1515 646.01 (1) (a) 2. m. Foreign insurers offering health care plans under s. 618.29.
AB873, s. 18 16Section 18. 646.01 (1) (b) 19. of the statutes is created to read:
AB873,8,1717 646.01 (1) (b) 19. Health care plans offered by foreign insurers under s. 618.29.
AB873, s. 19 18Section 19. Initial applicability.
AB873,8,1919 (1) This act first applies to all of the following:
AB873,8,2320 (a) Foreign insurers that apply for a certificate of authority under section
21618.11 of the statutes, as affected by this act, or that apply for a new certificate of
22authority under section 618.12 (4) of the statutes, on the effective date of this
23paragraph.
AB873,8,2524 (b) Domestic insurers that apply for an exemption under section 618.29 (5) of
25the statutes, as created by this act, on the effective date of this paragraph.
AB873, s. 20
1Section 20. Effective date.
AB873,9,22 (1) This act takes effect on July 1, 2009.
AB873,9,33 (End)
Loading...
Loading...