Wisconsin insurance laws

What it would do: Establishes portable benefit accounts for delivery network couriers and transportation network drivers, allowing network companies to contribute 4% of eligible drivers' quarterly earnings. Requires occupational accident insurance coverage of at least $1,000,000 and excludes application-based drivers from employee classification if companies meet specified conditions.

What it would do: Prohibits health insurers, self-insured plans, and Medical Assistance from covering organ transplants or posttransplant care if the transplant occurs in or the organ originates from China or countries designated by the department as having participated in forced organ harvesting, with exceptions for life-saving posttransplant care.

What it would do: Prohibits disability insurance policies and self-insured health plans from using artificial intelligence to deny prior authorization for medical necessity or experimental status, requiring an individual licensed health care provider to review such denials before they take effect.

What it would do: Requires health care plans to maintain and publicly disclose complete lists of services requiring prior authorization with clinical review criteria, provide 60 days advance notice of new or amended requirements, and grants the commissioner authority to exempt providers with high approval rates from prior authorization.

What it would do: Requires defined network plans, preferred provider plans, and self-insured governmental plans to cover emergency medical services without prior authorization, deny coverage based on provider network status, or impose greater cost-sharing than in-network services, and establishes protections against surprise bills for non-participating providers at participating facilities.

What it would do: Allows private individuals and families to purchase health care coverage through the Group Insurance Board's plans starting January 1, 2027, and allows private employers to offer such coverage to their employees, with individuals and employers paying full premiums and signing one or two-year agreements respectively.

What it would do: Requires the Medical Assistance program to reimburse maternal mental health screenings meeting state-developed standards, and mandates disability insurance policies and self-insured health plans covering maternity to cover one maternal mental health screening per pregnancy.

What it would do: Requires health insurers to continue covering vaccines recommended by the American Academy of Pediatrics or American Academy of Family Physicians if the CDC withdraws its recommendation. Requires the state immunization program to consider recommendations from these organizations when determining the vaccination schedule.

What it would do: Requires disability insurance policies and self-insured health plans covering obstetrical services to cover fertility treatments as defined by the American Society for Reproductive Medicine. Also makes fertility treatments reimbursable under Medical Assistance and establishes statutory rights for individuals, health care providers, insurers, and manufacturers regarding fertility treatment.

What it would do: Requires disability insurance policies and self-insured health plans to cover prosthetic limbs and custom orthotic braces when medically necessary, including materials, services, repairs, and replacements, subject to cost-sharing applicable to inpatient physician and surgical services.

What it would do: Requires disability insurance policies and self-insured health plans of state and local entities to cover habilitative and rehabilitative speech therapy for stuttering without annual visit limits, medical necessity reviews, or prior authorization, and includes coverage via telehealth.

What it would do: Creates the Office of the Public Intervenor to assist individuals with insurance claims and appeals. Establishes requirements for fair claims processing, transparency reporting on claim denial rates, and prohibits specified insurer practices regarding disability insurance policies.

What it would do: Creates a basic health plan for individuals with household income not exceeding 200 percent of the poverty line, establishes a BadgerCare purchase option for individuals above income limits, and directs the commissioner to develop a state-based insurance exchange.

What it would do: Creates a 12-month limitation on retroactive claim denials by insurers under disability insurance policies, extending to 18 months if coordination of benefits with other payers applies, with an exception for fraudulent claims.

What it would do: Prohibits disability insurance policies and self-insured health plans covering dental services from solely relying on the Salzmann Evaluation Index when making prior authorization decisions for treatment of severe misalignment or malocclusion of teeth.

What it would do: Creates a state-based insurance exchange to be operated by the commissioner of insurance, requiring transition to a federally-independent exchange by plan year 2030, and authorizes user fees on insurers offering plans through the exchange.

What it would do: Regulates pharmacy benefit managers by requiring formulary disclosures, prohibiting pharmacy choice penalties, establishing reimbursement standards, mandating fiduciary duties to plan sponsors, and requiring prescription drug payments to apply toward health insurance cost-sharing requirements.

What it would do: Prohibits health benefit plans from excluding coverage based on preexisting conditions, imposing lifetime or annual benefit limits, and restricts premium rate variation to family versus individual coverage, rating area, age (3 to 1 ratio), and tobacco use (1.5 to 1 ratio), applicable only if federal Affordable Care Act provisions become unenforceable.

What it would do: Adds gender identity and gender expression as protected classes against discrimination in employment, housing, public accommodations, education, insurance, adoption, jury duty, vocational rehabilitation, and mental health services throughout Wisconsin law.

What it would do: Requires disability insurance policies and self-insured health plans of Wisconsin state and local governments to cover asthma prescription drugs and related medical supplies with cost-sharing capped at $25 per one-month supply per drug and $50 monthly for all supplies, with no deductible.

What it would do: Requires disability insurance policies and self-insured health plans to cover diagnostic breast examinations and supplemental breast screening examinations for individuals at increased risk or with dense breast tissue, with no cost-sharing amounts allowed for these examinations.

What it would do: Requires disability insurance policies and self-insured health plans covering mental health or substance use disorders to provide at least 28 appointments or visits annually with a mental health care provider without prior authorization, unless actuarial analysis shows costs exceed 10 percent increase.

What it would do: Prohibits health insurers from requiring health care providers to accept virtual credit card payments and requires insurers to notify providers of payment method fees and selection options before using virtual credit card payments. Prohibits transmission fees unless the provider consents.

What it would do: Prohibits health plans from requiring prior authorization for the first 12 physical therapy, occupational therapy, speech therapy, or chiropractic visits per episode of care, and for chronic pain treatment up to 90 days at twice weekly frequency. Requires reauthorization decisions within 3 business days or authorization is deemed granted.