Signed by Governor Tony Evers

Vote Smart's Synopsis:

Vote to pass a bill that requires state health insurance companies cover individuals with pre-existing conditions.

Highlights:

• Prohibits a group health benefit plan or a self-insured health plan from imposing a preexisting condition exclusion for any time on a participant or beneficiary under the policy plan (Sec. 7).

• Requires every individual health benefit plan to accept every individual in the state who applies for coverage and every group health benefit plan to accept every employer in the state that applies for coverage, regardless of whether an individual or employee has a preexisting conditions (Sec. 7).

• Authorizes a health benefit plan offered on the individual or small employer market or self-insured health plan to vary premium rates for a specific policy or plan based only on the following considerations (Sec. 7):

• Whether the policy or plan covers an individual or a family;

• Rating area in the state as established by the commissioner;

• Age, except that the rate may not vary by more than 3 to 1 for adults over the age groups and the age bands shall be consistent with recommendations of the National Association of Insurance Commissioners; and

• Tobacco use, except that the rate may not vary by more than 1.5 to 1.

• Specifies that a health benefit plan that is considered a grandfathered health plan or has transitional status granted by the federal Department of Health and Human Services and the commissioner is not required to comply with the previous point (Sec. 7).

• Requires the commissioner to ensure that every individual health benefit plan has open enrollment during a statewide open enrollment period to allow individuals, including individuals who do not have coverage, to enroll in coverage  (Sec. 7).

• Prohibits an individual health benefit plan to define a preexisting conditions more restrictive than a condition, whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or recieved (Sec. 7).

• Prohibits a claim or loss incurred or disability under an individual health benefit plan to be reduced or denied on the ground that a disease or physical condition existed prior to the effective date of coverage (Sec. 7).

Full Bill Text