SB466, s. 20 7Section 20. 631.95 (2m) of the statutes is created to read:
SB466,9,118 631.95 (2m) Prohibitions and exceptions for self-insured health plans. (a)
9In this subsection, "self-insured governmental body" means a city, town, village,
10county, or school district that provides a self-insured health plan, with respect to the
11health plan.
SB466,9,1312 (b) Except as provided in par. (c), a self-insured governmental body may not
13do any of the following:
SB466,9,2014 1. Refuse to provide or renew coverage to a health plan participant under the
15self-insured health plan on the basis that the health plan participant has been, or
16the self-insured governmental body has reason to believe that the health plan
17participant is, a victim of abuse or domestic abuse or that a member of the health plan
18participant's family has been, or the self-insured governmental body has reason to
19believe that a member of the health plan participant's family is, a victim of abuse or
20domestic abuse.
SB466,9,2521 2. Use as a factor in the determination of employee contributions or any other
22aspect of coverage under the self-insured health plan, the knowledge or suspicion
23that a health plan participant has been or is a victim of abuse or domestic abuse or
24that a member of the health plan participant's family has been or is a victim of abuse
25or domestic abuse.
SB466,10,7
13. Exclude or limit coverage of, or deny a claim for, health care services or items
2related to the treatment of injury or disease resulting from abuse or domestic abuse
3on the basis that a health plan participant has been, or the self-insured
4governmental body has reason to believe that a health plan participant is, a victim
5of abuse or domestic abuse or that a member of the health plan participant's family
6has been, or the self-insured governmental body has reason to believe that a member
7of the health plan participant's family is, a victim of abuse or domestic abuse.
SB466,10,138 (c) In establishing any employee contribution amounts for a self-insured
9health plan, a self-insured governmental body may inquire about a person's existing
10medical condition and, based on the opinion of a qualified actuary, as defined in s.
11623.06 (1c), use information related to a person's existing medical condition,
12regardless of whether that condition is or may have been caused by abuse or domestic
13abuse.
SB466, s. 21 14Section 21. 631.95 (4) of the statutes is amended to read:
SB466,10,1915 631.95 (4) Immunity for insurers. An insurer or a city, town, village, county,
16or school district that provides a self-insured health plan, with respect to the
17self-insured health plan,
is immune from any civil or criminal liability for any action
18taken under sub. (2m) (c) or (3) or for the death of, or injury to, an insured or health
19plan participant
that results from abuse or domestic abuse.
SB466, s. 22 20Section 22. 631.95 (5) (a) of the statutes is renumbered 631.95 (5) (ar).
SB466, s. 23 21Section 23. 631.95 (5) (ag) of the statutes is created to read:
SB466,10,2222 631.95 (5) (ag) In this subsection, unless the context requires otherwise:
SB466,10,2423 1. "Insurance" includes a self-insured health plan of a city, town, village,
24county, or school district.
SB466,11,2
12. "Insured" includes a person who participates in a self-insured health plan
2provided by a city, town, village, county, or school district.
SB466,11,43 3. "Insurer" includes a city, town, village, county, or school district that provides
4a self-insured health plan, with respect to the self-insured health plan.
SB466, s. 24 5Section 24. 631.95 (5) (c) (intro.) of the statutes is amended to read:
SB466,11,96 631.95 (5) (c) (intro.) Paragraphs (a) (ar) and (b) do not apply if the use,
7disclosure or transfer of the information is made with the consent of the individual
8to whom the information relates or if the use, disclosure or transfer satisfies any of
9the following:
SB466, s. 25 10Section 25. 632.726 (2) of the statutes is amended to read:
SB466,11,1711 632.726 (2) If an insurer or a city, town, village, county, or school district that
12provides a self-insured health plan, with respect to the self-insured health plan,

13changes a current procedural terminology code that was submitted by a health care
14provider on a health insurance claim form, the insurer or city, town, village, county,
15or school district
shall include on the explanation of benefits form the reason for the
16change to the current procedural terminology code and shall cite on the explanation
17of benefits form the source for the change.
SB466, s. 26 18Section 26. 632.745 (intro.) of the statutes is amended to read:
SB466,11,21 19632.745 Coverage requirements for group and individual health
20benefit plans; definitions.
(intro.) In this section and ss. 632.746 to 632.7495,
21unless the context requires otherwise
:
SB466, s. 27 22Section 27. 632.745 (9) of the statutes is renumbered 632.745 (9) (intro.) and
23amended to read:
SB466,11,2424 632.745 (9) (intro.) "Group health benefit plan" means a any of the following:
SB466,12,3
1(a) A health benefit plan that is issued by an insurer to or through an employer
2on behalf of a group consisting of at least 2 employees or a group including at least
32 eligible employees. The term includes individual
SB466,12,5 4(b) Individual health benefit plans covering eligible employees when 3 or more
5are sold to or through an employer.
SB466, s. 28 6Section 28. 632.745 (9) (c) of the statutes is created to read:
SB466,12,77 632.745 (9) (c) A self-insured health plan under sub. (24) (b) and (c).
SB466, s. 29 8Section 29. 632.745 (15) of the statutes is amended to read:
SB466,12,179 632.745 (15) "Insurer" means an insurer that is authorized to do business in
10this state, in one or more lines of insurance that includes health insurance, and that
11offers health benefit plans covering individuals in this state or eligible employees of
12one or more employers in this state. The term includes a health maintenance
13organization, a preferred provider plan, as defined in s. 609.01 (4), an insurer
14operating as a cooperative association organized under ss. 185.981 to 185.985, a city,
15town, village, county, or school district that provides a self-insured health plan, with
16respect to the self-insured health plan,
and a limited service health organization, as
17defined in s. 609.01 (3).
SB466, s. 30 18Section 30. 632.745 (24) of the statutes is renumbered 632.745 (24) (intro.) and
19amended to read:
SB466,12,2120 632.745 (24) "Self-insured health plan" means a self-insured health plan of
21the any of the following:
SB466,12,22 22(a) The state or a .
SB466,12,23 23(b) A county, city, village, or town or.
SB466,12,24 24(c) A school district.
SB466, s. 31
1Section 31. 632.83 (1) of the statutes is renumbered 632.83 (1) (intro.) and
2amended to read:
SB466,13,33 632.83 (1) In this section, "health :
SB466,13,8 4(a) "Health benefit plan" has the meaning given in s. 632.745 (11), except that
5"health benefit plan" includes the coverage specified in s. 632.745 (11) (b) 10. and
6includes a self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3., and a
7policy, certificate or contract under s. 632.745 (11) (b) 9. that provides only
8limited-scope dental or vision benefits.
SB466, s. 32 9Section 32. 632.83 (1) (b) of the statutes is created to read:
SB466,13,1110 632.83 (1) (b) "Insured" includes a person who participates in a self-insured
11health plan, as defined in s. 632.85 (1) (c) 2. and 3.
SB466, s. 33 12Section 33. 632.83 (1) (c) of the statutes is created to read:
SB466,13,1513 632.83 (1) (c) "Insurer" includes a city, town, village, county, or school district
14that provides a self-insured health plan, with respect to the self-insured health
15plan.
SB466, s. 34 16Section 34. 632.835 (1) (c) of the statutes is amended to read:
SB466,13,1917 632.835 (1) (c) "Health benefit plan" has the meaning given in s. 632.745 (11),
18except that "health benefit plan" includes the coverage specified in s. 632.745 (11) (b)
1910. and a self-insured health plan, as defined in s. 632.85 (1) (c) 2. and 3.
SB466, s. 35 20Section 35. 632.835 (1) (cg) of the statutes is created to read:
SB466,13,2221 632.835 (1) (cg) "Insured" includes a person who participates in a self-insured
22health plan, as defined in s. 632.85 (1) (c) 2. and 3.
SB466, s. 36 23Section 36. 632.835 (1) (ck) of the statutes is created to read:
SB466,14,3
1632.835 (1) (ck) "Insurer" includes a city, town, village, county, or school district
2that provides a self-insured health plan, with respect to the self-insured health
3plan.
SB466, s. 37 4Section 37. 632.845 (2) of the statutes, as created by 2009 Wisconsin Act 28,
5is amended to read:
SB466,14,106 632.845 (2) An A self-insured health plan, as defined in s. 632.85 (1) (c) 2. and
73. or an
insurer that provides coverage under a health care plan may not refuse to
8cover health care services that are provided to an insured under the plan and for
9which there is coverage under the plan on the basis that there may be coverage for
10the services under a liability insurance policy.
SB466, s. 38 11Section 38. 632.85 (1) (c) of the statutes is renumbered 632.85 (1) (c) (intro.)
12and amended to read:
SB466,14,1413 632.85 (1) (c) "Self-insured health plan" means a self-insured health plan of
14the any of the following:
SB466,14,15 151. The state or a .
SB466,14,16 162. A county, city, village, or town or.
SB466,14,17 173. A school district.
SB466, s. 39 18Section 39. 632.857 of the statutes is amended to read:
SB466,15,2 19632.857 Explanation required for restriction or termination of
20coverage.
If an insurer or a self-insured health plan, as defined in s. 632.85 (1) (c)
212. and 3.,
restricts or terminates an insured's or a health plan participant's coverage
22for the treatment of a condition or complaint and, as a result, the insured or health
23plan participant
becomes liable for payment for all of his or her treatment for the
24condition or complaint, the insurer or self-insured health plan shall provide on the
25explanation of benefits form a detailed explanation of the clinical rationale and of the

1basis in the policy, plan, or contract or in applicable law for the insurer's or
2self-insured health plan's
restriction or termination of coverage.
SB466, s. 40 3Section 40. 632.86 (2) (intro.) of the statutes is amended to read:
SB466,15,74 632.86 (2) No group or blanket disability insurance policy or self-insured
5health plan, as defined in s. 632.85 (1) (c) 2. and 3.,
that provides coverage of
6prescribed drugs or devices through a pharmaceutical mail order plan may do any
7of the following:
SB466, s. 41 8Section 41. 632.87 (1) of the statutes is renumbered 632.87 (1r).
SB466, s. 42 9Section 42. 632.87 (1g) of the statutes is created to read:
SB466,15,1010 632.87 (1g) In this section, unless the context requires otherwise:
SB466,15,1211 (a) "Insured" includes a person who participates in a self-insured health plan,
12as defined in s. 632.85 (1) (c) 2. and 3.
SB466,15,1413 (b) "Insurer" includes a city, town, village, county, or school district that
14provides a self-insured health plan, with respect to that self-insured health plan.
SB466,15,1615 (c) "Plan" includes a self-insured health plan, as defined in s. 632.85 (1) (c) 2.
16and 3.
SB466, s. 43 17Section 43. 632.875 (1) (bg) of the statutes is created to read:
SB466,15,2018 632.875 (1) (bg) "Insurer" includes a city, town, village, county, or school district
19that provides a self-insured health plan, with respect to the self-insured health
20plan.
SB466, s. 44 21Section 44. 632.875 (1) (cg) of the statutes is created to read:
SB466,15,2322 632.875 (1) (cg) "Plan" includes a self-insured health plan, as defined in s.
23632.85 (1) (c) 2. and 3.
SB466, s. 45 24Section 45. 632.88 (1) (intro.) of the statutes is amended to read:
SB466,16,7
1632.88 (1) Termination of coverage. (intro.) Every hospital or medical
2expense insurance policy or contract or self-insured health plan, as defined in s.
3632.85 (1) (c) 2. and 3.,
that provides that coverage of a dependent child of a person
4insured under the policy or covered under the plan shall terminate upon attainment
5of a limiting age for dependent children specified in the policy or plan shall also
6provide that the age limitation may not operate to terminate the coverage of a
7dependent child while the child is and continues to be both:
SB466, s. 46 8Section 46. 632.88 (2) of the statutes is amended to read:
SB466,16,159 632.88 (2) Proof of incapacity. The insurer or self-insured health plan, as
10defined in s. 632.85 (1) (c) 2. and 3.,
may require that proof of the incapacity and
11dependency be furnished by the person insured under the policy or participating in
12the self-insured health plan
within 31 days of the date the child attains the limiting
13age, and at any time thereafter except that the insurer or self-insured health plan
14may not require proof more frequently than annually after the 2-year period
15immediately following attainment of the limiting age by the child.
SB466, s. 47 16Section 47. 632.89 (1) (bm) of the statutes is created to read:
SB466,16,1817 632.89 (1) (bm) "Group or blanket disability insurance policy" includes a
18self-insured health plan, as defined in 632.85 (1) (c) 2. and 3.
SB466, s. 48 19Section 48. 632.89 (1) (dg) of the statutes is created to read:
SB466,16,2220 632.89 (1) (dg) "Insurer" includes a city, town, village, county, or school district
21that provides a self-insured health plan, with respect to the self-insured health
22plan.
SB466, s. 49 23Section 49. 632.895 (1) (e) of the statutes is created to read:
SB466,16,2524 632.895 (1) (e) "Insured" includes a person who participates in a self-insured
25health plan.
SB466, s. 50
1Section 50. 632.895 (1) (f) of the statutes is created to read:
SB466,17,42 632.895 (1) (f) "Insurer" includes a city, town, village, county, or school district
3that provides a self-insured health plan, with respect to that self-insured health
4plan.
SB466, s. 51 5Section 51. 632.895 (1) (g) of the statutes is created to read:
SB466,17,76 632.895 (1) (g) "Self-insured health plan" means a self-insured health plan of
7any of the following:
SB466,17,88 1. The state.
SB466,17,99 2. A county, city, village, or town.
SB466,17,1010 3. A school district.
SB466, s. 52 11Section 52. 632.895 (2) (a), (d) and (e) of the statutes are amended to read:
SB466,17,2012 632.895 (2) (a) Every disability insurance policy or self-insured health plan
13under sub. (1) (g) 2. and 3.
which provides coverage of expenses incurred for inpatient
14hospital care shall provide coverage for the usual and customary fees for home care.
15Such coverage shall be subject to the same deductible and coinsurance provisions of
16the policy or self-insured health plan as other covered services. The maximum
17weekly benefit for such coverage need not exceed the usual and customary weekly
18cost for care in a skilled nursing facility. If an insurer provides disability insurance,
19or if 2 or more insurers jointly provide disability insurance, to an insured under 2 or
20more policies, home care coverage is required under only one of the policies.
SB466,18,221 (d) Each visit by a person providing services under a home care plan or
22evaluating the need for or developing a plan shall be considered as one home care
23visit. The policy or self-insured health plan under sub. (1) (g) 2. and 3. may contain
24a limit on the number of home care visits, but not less than 40 visits in any 12-month
25period, for each person covered under the policy or self-insured health plan. Up to

14 consecutive hours in a 24-hour period of home health service shall be considered
2as one home care visit.
SB466,18,83 (e) Every disability insurance policy or self-insured health plan under sub. (1)
4(g) 2. and 3.
which purports to provide coverage supplementing parts A and B of Title
5XVIII of the social security act shall make available and if requested by the insured
6provide coverage of supplemental home care visits beyond those provided by parts
7A and B, sufficient to produce an aggregate coverage of 365 home care visits per plan
8or
policy year.
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