SB 268

This bill requires health insurance policies, known in the bill as disability

insurance policies, and governmental self-insured health plans to cover essential

health benefits that will be specified by the commissioner of the Office of the

Commissioner of Insurance by rule. The bill specifies a list of requirements that the

commissioner must follow when establishing the essential health benefits including

certain limitations on cost sharing and the following general categories of benefits,

items, or services in which the commissioner must require coverage: ambulatory

patient services, emergency services, hospitalization, maternity and newborn care,

mental health and substance use disorder services, prescription drugs,

rehabilitative and habilitative services and devices, laboratory services, preventive

and wellness services and chronic disease management, and pediatric services. If

an essential health benefit specified by the commissioner is also subject to its own

mandated coverage requirement, the bill requires the disability insurance policy or

self-insured health plan to provide coverage under whichever requirement provides

the insured or plan participant with more comprehensive coverage.

This proposal may contain a health insurance mandate requiring a social and

financial impact report under s. 601.423, stats.