AB 210

This bill incorporates the health insurance coverage requirements of the

federal Patient Protection and Affordable Care Act (PPACA) into the Wisconsin

statutes. The bill requires insurers to comply with PPACA provisions that went into

effect for plan years beginning on or after March 23, 2010, relating to all of the

following: 1) standards relating to benefits for mothers and newborns; 2) required

coverage for reconstructive surgery following a mastectomy; and 3) coverage of a

dependent student on a medically necessary leave of absence. The bill requires

insurers to comply with PPACA provisions that went into effect for plan years

beginning on or after September 23, 2010, relating to all of the following: 1)

prohibiting annual or lifetime limits; 2) prohibiting coverage rescissions; 3)

prohibiting preexisting condition exclusions for individuals under age 19; 4)

coverage of certain preventive health services without cost-sharing; 5) extension of

coverage to dependents up to age 26; 6) the provision of additional information; 7)

giving plan enrollees choice as to a primary care provider; and 8) coverage of

emergency services without prior authorization. In addition, the bill requires

insurers to comply with PPACA provisions for plan years beginning on or after March

23, 2012, relating to all of the following: 1) the development and use of uniform

explanation of coverage documents and standardized definitions; and 2)

requirements for ensuring the quality of care. The bill also requires insurers to

comply with the PPACA requirement to file a report for each plan year concerning

the ratio of incurred loss, plus loss adjustment expense, to earned premiums and to

provide a rebate to enrollees under certain circumstances. Under PPACA, the

provisions apply to insurers offering medical care benefits under any hospital or

medical service policy or plan contract.

A health care policy or plan that was in effect when PPACA was enacted is

called a grandfathered health plan. The bill specifically requires a grandfathered

health plan to comply, when the grandfathered health plan is renewed, with the

following PPACA provisions: 1) coverage of a dependent student on a medically

necessary leave of absence; 2) coverage of certain preventive health services without

cost-sharing; 3) coverage of emergency services without prior authorization; and 4)

at renewal on or after March 23, 2012, requirements for ensuring the quality of care.

The bill provides that the additional requirements under the bill with which insurers

must comply apply to grandfathered health plans only with respect to those

requirements that apply to grandfathered health plans under PPACA.

Current law requires health insurers to cover emergency services without prior

authorization, breast reconstruction after a mastectomy, dependent coverage of a

student while on a medically necessary leave of absence, and colorectal screening.

These coverage provisions are consistent with, and therefore duplicative of, the

relevant PPACA requirements and are not repealed in the bill. Current law also

requires health insurers to provide coverage of a dependent up to age 27, or up to any