AB 1

Currently, the federal Patient Protection and Affordable Care Act generally

allows premium rates to be based only on individual or family coverage, rating area,

age, and tobacco use; requires group and individual health insurance policies to

accept every employer and individual that applies for coverage, known as

guaranteed issue, and renew health insurance coverage at the option of the sponsor

or individual; and prohibits health insurance policies from imposing preexisting

condition exclusions. If those requirements and prohibitions of the Affordable Care

Act are no longer enforceable or no longer preempt state law, all of the following apply

under this bill: every individual health benefit plan must accept every individual in

this state who applies for coverage and every group health benefit plan must accept

every employer in this state that applies for coverage, regardless of whether any

individual or employee has a preexisting condition; a health benefit plan may restrict

enrollment in coverage to open or special enrollment periods; the commissioner of

insurance must ensure a statewide open enrollment period allowing individuals,

including individuals who do not have coverage, to enroll in coverage; health benefit

plans must provide special enrollment periods for certain qualifying events

described in federal law; a health benefit plan offered on the individual or small

employer market or a self-insured health plan may not vary premium rates for a

specific policy or plan except on the basis of whether the policy or plan covers an

individual or a family, area in the state, age, and tobacco use; a group health benefit

plan, including a self-insured governmental health plan, may not impose a

preexisting condition exclusion; and an individual health benefit plan may not

reduce or deny a claim or loss incurred or disability commencing under the policy on

the ground that a disease or physical condition existed prior to the effective date of

coverage. Certain grandfathered and transitional health insurance policies that are

exempt from some requirements of the Affordable Care Act, including the premium

rate requirements, are exempt from the premium rate requirements under the bill.

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

financial impact report under s. 601.423, stats.