This bill establishes a state-based health insurance exchange that will operate on the federal platform by 2029 and transition to a standalone state-run exchange by 2030. It authorizes the state insurance commissioner to collect user fees from insurers offering plans through the exchange, starting at 0.5 percent of monthly premiums for the federal platform phase and adjusting rates for the standalone phase. The legislation also creates a specific appropriation account for exchange operations, with any unspent funds exceeding 10 percent of annual expenditures returning to the state's general fund at the end of each fiscal year.
This bill requires health insurance policies and self-insured plans in Wisconsin to cover speech therapy as a treatment for stuttering, including both services that help maintain or improve skills and those that restore lost abilities. The law applies to disability insurance policies and health plans offered by the state, counties, cities, towns, villages, and school districts, ensuring coverage regardless of whether the stuttering is developmental or caused by other factors. Key provisions mandate that covered plans cannot impose annual visit limits, deny coverage based on the cause of stuttering, or require prior authorization for speech therapy services. The bill also includes telehealth options and establishes a process for the state insurance commissioner to seek federal waivers if the new requirements would trigger additional state costs under federal healthcare laws.
This bill allows private individuals, families, and private employers to choose health care coverage through plans offered by the Group Insurance Board, expanding options beyond traditional state employee plans. It creates new statutory provisions for health savings accounts for both state employees and private sector participants who select high-deductible health plans, with separate accounts established to track funds from each group. The legislation grants the Group Insurance Board rule-making authority to manage enrollment, premium collection, and coverage procedures for these expanded options. Additionally, the bill authorizes the collection of administrative fees from state agencies, individuals, and private employers to fund the operation of these health savings account programs.
This bill establishes a state premium assistance tax credit for Wisconsin residents who pay monthly premiums for qualified health plans during the 2026 tax year. The credit allows eligible individuals to claim a refund equal to the federal premium assistance amount they would have qualified for between 2021 and 2025, but only if they are not already eligible for similar federal tax credits. The legislation applies only to full-year residents who file claims within the standard tax filing deadline and requires state funding to cover any credit amounts exceeding the taxpayer's tax liability.
This bill creates a new state tax credit to help Wisconsin residents pay for health insurance premiums. It allows individuals who purchase qualified health plans to claim a credit on their state income tax return for the amount they would have received under federal premium assistance rules between 2021 and 2025. The credit is available only to full-year state residents who file their own tax returns and cannot be claimed if the taxpayer already qualifies for similar federal assistance. The legislation also authorizes state funds to pay any portion of the credit that exceeds the taxpayer's state tax liability.
This bill establishes legal rights for individuals to access fertility treatments, including egg and sperm preservation, artificial insemination, in vitro fertilization, and related medications, while also protecting health care providers and insurance companies from interference when delivering these services. It creates a reimbursement mechanism for fertility treatments under the state's Medical Assistance program, though payment is contingent on federal approval or the absence of required federal waivers. The legislation defines fertility treatment broadly to include genetic testing, gamete donation, and other services aligned with American Society for Reproductive Medicine guidelines, and grants individuals rights to make decisions about their reproductive genetic material. Additionally, the bill provides legal recourse through civil actions for individuals, providers, or manufacturers whose rights are violated, with courts authorized to award equitable relief and litigation costs.
This bill establishes a new basic health plan for individuals with household incomes below 200 percent of the poverty line and creates a purchase option program allowing eligible people with higher incomes to buy coverage through the state program instead of private insurance. The program would offer benefits similar to existing state coverage, include tax credits for eligible participants, and set premium rates comparable to managed care plans while requiring federal waivers to implement. It also directs the creation of a state-based insurance exchange where individuals can access these purchase options and grants officials authority to create rules needed for implementation. The bill requires a report on federal waiver status and economic analyses by March 2027 before the program can be fully launched.
This bill creates a new Office of the Public Intervenor within the state insurance commissioner's office to help individuals navigate insurance claim denials for medical procedures, medications, and other health services. The office would be funded through assessments on insurance companies based on their disability insurance premium volumes and has authority to conduct audits of insurer claims processing practices. The legislation establishes specific requirements for how insurers must handle claim denials, including providing detailed explanations with policy citations, setting time limits for processing claims, and requiring transparency when using artificial intelligence in decision-making. Additionally, the bill prohibits several unfair practices such as using vague policy terms, stalling reviews, or denying claims without reviewing all relevant medical records.
This bill requires health insurance plans and self-insured state and local health plans to cover vaccines for children from birth to age six that are recommended by the Centers for Disease Control and Prevention. If the CDC withdraws a vaccine recommendation, the bill mandates that these plans continue to cover the vaccine based on recommendations from the American Academy of Pediatrics or the American Academy of Family Physicians. The legislation also directs the state immunization program to consider recommendations from these medical organizations when deciding which diseases to target for elimination. Additionally, the bill requires healthcare providers to maintain records of vaccine administration, including the manufacturer, lot number, and administering provider information.
This bill requires health insurance plans and self-insured programs to stop using the Salzmann Evaluation Index alone when deciding whether to cover treatment for severe misalignment or malocclusion of teeth. It directly affects dental coverage under disability insurance policies, self-insured plans, limited service health organizations, preferred provider plans, and defined network plans. The law mandates that these plans must consider additional factors beyond the index when making prior authorization decisions for orthodontic treatments. The changes apply to policy years starting after the law takes effect, with specific timing for plans affected by collective bargaining agreements.
