LRB-4055/1
PJK:lmk:jf
2007 - 2008 LEGISLATURE
February 13, 2008 - Introduced by Senators Kanavas, Darling, Roessler and
Schultz, cosponsored by Representatives F. Lasee, Davis, Gunderson,
LeMahieu, Mursau, Nygren, Strachota and Vos. Referred to Committee on
Health, Human Services, Insurance, and Job Creation.
SB484,1,4
1An Act to amend 632.745 (9), 635.01 and 635.02 (8); and
to create 601.428 of
2the statutes;
relating to: the definition of a group health benefit plan and
3reports by the commissioner of insurance on the effect of changing the
4definition.
Analysis by the Legislative Reference Bureau
Current law contains various requirements that apply to group health benefit
plans or the insurers that issue group health benefit plans. For example, consistent
with the federal Health Insurance Portability and Accountability Act, insurers that
sell group health benefit plans to employers must comply with requirements related
to preexisting conditions, enrollment periods, and contract renewals. Insurers that
sell group health benefit plans to small employers (those with between 2 and 50
employees) are subject to certain marketing standards and to certain restrictions on
premium rates that may be charged for those policies.
Current law generally defines a group health benefit plan as a health benefit
plan that is sold to or through an employer on behalf of a group that consists of at
least two employees, or individual health benefit plans covering eligible employees
when three or more are sold to or through an employer. This bill changes the
definition of a group health benefit plan by increasing, from three to 25, the number
of individual health benefit plans that constitute a group health benefit plan when
sold to or through an employer covering eligible employees of the employer. This
change applies regardless of the number of employees the employer has.
The bill requires the commissioner of insurance annually to submit reports to
the standing committees of the legislature with jurisdiction over insurance and
health matters assessing the effect on the commercial insurance market of the
change that the bill makes to the definition of a group health benefit plan. The
reports must address changes to various populations in the state with different types
of health care coverage that may be attributable to the definition change, and must
include information on the number of applicants for coverage under the Health
Insurance Risk-Sharing Plan who are employees of small employers that offer or
facilitate the sale of individual health insurance policies to employees instead of
offering group health benefits.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB484, s. 1
1Section
1. 601.428 of the statutes is created to read:
SB484,2,10
2601.428 Reports on definition of group health benefit plan. (1) 3Annually, beginning in 2009, the commissioner shall prepare, and provide to the
4standing committees of the legislature with jurisdiction over insurance and health
5matters under s. 13.172 (3), a report that assesses the effect on the commercial
6insurance market of the changes to the definitions of "group health benefit plan" and
7"small employer insurer" made by 2007 Wisconsin Act .... (this act). The
8commissioner shall measure and include in the report changes that may be
9attributable to 2007 Wisconsin Act .... (this act) to the following populations in the
10state:
SB484,2,1111
(a) Individuals without health insurance coverage.
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(b) Individuals with coverage under Medical Assistance.
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(c) Individuals with small group health insurance coverage.
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(d) Individuals with individual health insurance coverage.
SB484,2,1515
(e) Individuals with coverage under the Health Insurance Risk-Sharing Plan.
SB484,3,5
16(2) Annually, beginning in 2009, the commissioner shall request information
17from the Health Insurance Risk-Sharing Plan Authority on the number of
1applicants for coverage under the Health Insurance Risk-Sharing Plan who are
2employees of small employers, as defined in s. 635.02 (7), that no longer offer group
3health benefits but offer, or facilitate the sale of, individual health insurance policies
4to employees. The commissioner shall include the information obtained under this
5subsection in the reports under sub. (1).
SB484,3,15
6(3) To assist the commissioner in determining the effect, if any, of the definition
7changes made by 2007 Wisconsin Act .... (this act), the commissioner shall establish
8benchmarks with respect to changes in the populations specified under sub. (1) (a)
9to (e) by assessing the status of those populations over the 3-year period preceding
10the beginning of the period covered by the first report prepared and submitted under
11sub. (1). The assessment shall include such parameters as population size and
12demographic statistics and shall identify changes in those parameters over the
133-year period. The commissioner shall prepare a report of the assessment and
14submit the report under s. 13.172 (3) to the standing committees specified in sub. (1)
15along with the first report submitted under sub. (1).
SB484, s. 2
16Section
2. 632.745 (9) of the statutes is amended to read:
SB484,3,2117
632.745
(9) "Group health benefit plan" means a health benefit plan that is
18issued by an insurer to or through an employer on behalf of a group consisting of at
19least 2 employees or a group including at least 2 eligible employees. The term
20includes individual health benefit plans covering eligible employees when
3 25 or
21more are sold to or through an employer.
SB484, s. 3
22Section
3. 635.01 of the statutes is amended to read:
SB484,4,4
23635.01 Scope. This chapter applies to all group health insurance plans,
24policies or certificates, written on risks or operations in this state, providing coverage
25for employees of a small employer, or employees of a small employer and the
1employer, and to individual health insurance policies, written on risks or operations
2in this state, providing coverage for employees of a small employer, or employees of
3a small employer and the employer when
3 25 or more are sold to or through a small
4employer.
SB484, s. 4
5Section
4. 635.02 (8) of the statutes is amended to read:
SB484,4,146
635.02
(8) "Small employer insurer" means an insurer that is authorized to do
7business in this state, in one or more lines of insurance that includes health
8insurance, and that offers group health benefit plans covering eligible employees of
9one or more small employers in this state, or that sells
3 25 or more individual health
10benefit plans to a small employer, covering eligible employees of the small employer.
11The term includes a health maintenance organization, as defined in s. 609.01 (2), a
12preferred provider plan, as defined in s. 609.01 (4), and an insurer operating as a
13cooperative association organized under ss. 185.981 to 185.985, but does not include
14a limited service health organization, as defined in s. 609.01 (3).
