2009 WISCONSIN ACT
165
An Act
to repeal
185.981 (4t), 185.981 (6) and 185.982 (3);
to renumber and amend
185.981 (4);
to amend
71.26 (1) (a), 71.45 (1) (a), 71.45 (5), 146.81 (1) (k), 146.997 (1) (d) 17., 155.01 (7), 185.09, 185.981 (title), 185.981 (1), 185.981 (2), 185.981 (3), 185.981 (5), 185.981 (7), 185.981 (8), 185.981 (9), 185.982 (1), 185.982 (2), 185.983 (1) (intro.), 185.983 (1) (a), 185.983 (1m), 185.983 (2), 185.985, 252.14 (1) (ar) 12., 254.11 (13), 632.86 (1) (a) and 655.002 (1) (f); and
to create
185.981 (4) (b) of the statutes;
relating to:
health care plans operated by cooperative associations.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
Section
1
.
71.26 (1) (a) of the statutes is amended to read:
71.26
(1)
(a)
Certain corporations.
Income of corporations organized under ch. 185, except income of a cooperative
sickness
health
care association organized under s. 185.981, or of a service insurance corporation organized under ch. 613, that is derived from a health maintenance organization as defined in s. 609.01 (2) or a limited service health organization as defined in s. 609.01 (3), or operating under subch. I of ch. 616 which are bona fide cooperatives operated without pecuniary profit to any shareholder or member, or operated on a cooperative plan pursuant to which they determine and distribute their proceeds in substantial compliance with s. 185.45, and the income, except the unrelated business taxable income as defined in section
512
of the internal revenue code and except income that is derived from a health maintenance organization as defined in s. 609.01 (2) or a limited service health organization as defined in s. 609.01 (3), of all religious, scientific, educational, benevolent or other corporations or associations of individuals not organized or conducted for pecuniary profit. This paragraph does not apply to the income of savings banks, mutual loan corporations or savings and loan associations. This paragraph does not apply to income that is realized from the sale of or purchase and subsequent sale or redemption of lottery prizes if the winning tickets were originally bought in this state. This paragraph applies to the income of credit unions except to the income of any credit union that is derived from public deposits for any taxable year in which the credit union is approved as a public depository under ch. 34 and acts as a depository of state or local funds under s. 186.113 (20). For purposes of this paragraph, the income of a credit union that is derived from public deposits is the product of the credit union's gross annual income for the taxable year multiplied by a fraction, the numerator of which is the average monthly balance of public deposits in the credit union during the taxable year, and the denominator of which is the average monthly balance of all deposits in the credit union during the taxable year.
Section
2
.
71.45 (1) (a) of the statutes is amended to read:
71.45
(1)
(a) Income of insurers exempt from federal income taxation pursuant to section
501
(c) (15) of the internal revenue code, town mutuals organized under or subject to ch. 612, foreign insurers, and domestic insurers engaged exclusively in life insurance business, domestic insurers insuring against financial loss by reason of nonpayment of principal, interest and other sums agreed to be paid under the terms of any note or bond or other evidence of indebtedness secured by a mortgage, deed of trust or other instrument constituting a lien or charge on real estate and corporations organized under ch. 185, but not including income of cooperative
sickness
health
care associations organized under s. 185.981, or of a service insurance corporation organized under ch. 613, that is derived from a health maintenance organization as defined in s. 609.01 (2) or a limited service health organization as defined in s. 609.01 (3), or operating under subch. I of ch. 616 which are bona fide cooperatives operated without pecuniary profit to any shareholder or member, or operated on a cooperative plan pursuant to which they determine and distribute their proceeds in substantial compliance with s. 185.45. This paragraph does not apply to income that is realized from the sale of or purchase and subsequent sale or redemption of lottery prizes if the winning tickets were originally bought in this state.
Section
3
.
71.45 (5) of the statutes is amended to read:
71.45
(5)
Exceptions.
The net income of a cooperative
sickness
health
care association organized under s. 185.981, or of a service insurance corporation organized under ch. 613, that is derived from a health maintenance organization, as defined in s. 609.01 (2), or a limited service health organization, as defined in s. 609.01 (3), is the net income that would be determined if the cooperative
sickness
health
care association or service insurance corporation were subject to federal income taxation and as if that income were that of an insurance company.
Section
4
.
146.81 (1) (k) of the statutes is amended to read:
146.81
(1)
(k)
An operational
A
cooperative
sickness
health
care
plan
association
organized under
ss.
s.
185.981
to 185.985
that directly provides services through salaried employees in its own facility.
Section
5
.
146.997 (1) (d) 17. of the statutes is amended to read:
146.997
(1)
(d) 17.
An operational
A
cooperative
sickness
health
care
plan
association
organized under
ss.
s.
185.981
to 185.985
that directly provides services through salaried employees in its own facility.
Section
6
.
155.01 (7) of the statutes is amended to read:
155.01
(7)
"Health care provider" means a nurse licensed or permitted under ch. 441, a chiropractor licensed under ch. 446, a dentist licensed under ch. 447, a physician, physician assistant, perfusionist, podiatrist, physical therapist, physical therapist assistant, occupational therapist, or occupational therapy assistant licensed under ch. 448, a person practicing Christian Science treatment, an optometrist licensed under ch. 449, a psychologist licensed under ch. 455, a partnership thereof, a corporation or limited liability company thereof that provides health care services,
an operational
a
cooperative
sickness
health
care
plan
association
organized under
ss.
s.
185.981
to 185.985
that directly provides services through salaried employees in its own facility, or a home health agency, as defined in s. 50.49 (1) (a).
Section
7
.
185.09 of the statutes is amended to read:
185.09
Promotion expense; limitation.
No cooperative funds may be used, nor any stock issued, in payment of any promotion expenses in excess of 5 per cent of the paid-up capital stock or membership fees.
This section does not apply to a cooperative association organized under s. 185.981.
Section
8
.
185.981 (title) of the statutes is amended to read:
185.981
(title)
Cooperative
sickness
health
care.
185.981
(1)
Cooperative associations may be organized under this chapter without capital stock,
exclusively
primarily
to establish and operate in the state or in any county or counties
therein a
in the state
nonprofit
plan or
plans
or programs
for
sickness
health
care, including hospital care, for their members and their
members'
dependents through contracts with physicians, medical societies, chiropractors, optometrists, dentists, dental societies, hospitals, podiatrists
,
and others.
185.981
(2)
Such associations
A cooperative association organized under this section
shall operate only on a cooperative nonprofit basis and for the
primary
purpose of establishing, maintaining
,
and operating a voluntary nonprofit health, dental
,
or vision care plan or plans
,
or for constructing, operating
,
and maintaining nonprofit hospitals or other facilities whereby
sickness
health
care, including hospital, dental
,
or vision care, is provided
at the expense of such association,
to
its members
or both,
and
to
such
other
persons or groups of persons
as shall
who
become subscribers to
such plan,
the plans, subject to s. 185.982 (2),
under contracts
which will entitle each such subscriber to definite
that provide access to
medical, surgical, chiropractic, vision, dental
,
or hospital care,
other health care services,
appliances
,
and supplies, by physicians and surgeons licensed and registered under ch. 448, podiatrists licensed under ch. 448, optometrists licensed under ch. 449, chiropractors licensed under ch. 446
and
,
dentists licensed under ch. 447
, and other health care providers
in their offices, in hospitals, in other facilities
,
and in the home.
Nothing in this subsection precludes a cooperative association organized under this section from owning an interest in other entities for enhancing or improving member services or for investment or other purposes, as long as the association's primary purpose remains as provided in this subsection.
185.981
(3)
No cooperative association organized
primarily
for the purposes provided in ss. 185.981 to 185.983 shall be prevented from contracting with any hospital in this state for the rendition of such hospital care as is included within
such a plan
the cooperative association's plans
because
such
the
hospital participates in
a plan of
any other
such plan
cooperative association
, or in a plan organized and operated under ss. 148.03 and 613.80. No hospital may discriminate against any physician and surgeon, chiropractor, dentist, or podiatrist with respect to the use of
such
the
hospital's facilities by reason of his or her participation in a
sickness
health
care plan of a cooperative.
Section
12c
.
185.981 (4) of the statutes, as affected by
2009 Wisconsin Act 113
, is renumbered 185.981 (4) (a) and amended to read:
185.981
(4)
(a)
No
Except as provided in par. (b), no
contract by or on behalf of any such cooperative association shall provide for the payment of any cash, indemnity
,
or other material benefit by that association to the subscriber or the subscriber's estate on account of death, illness
,
or injury,
nor be in any way related to the payment of any such benefit by any other agency,
but any such association may stipulate in its
plan
plans
that it will pay any nonparticipating physician and surgeon, optometrist, chiropractor, dentist, podiatrist,
or
hospital
outside of its normal territory for sickness or
, or other provider for
hospital
or other health
care rendered
to
any covered
member or a member's covered dependent
person
who is in need of
the
a plan's
benefits
of such plan when he or she is outside of the territory of such association in which the benefits of such plan are normally available. Any such plan
. The plans
may prescribe monetary limitations with respect to
such extraterritorial
the
benefits.
Section
12f
.
185.981 (4) (b) of the statutes is created to read:
185.981
(4)
(b) A cooperative association may make a payment in cash, indemnity, or other material benefit for a purpose that is incidental to its plans, including for the purpose of administering coordination of benefits.
Section
14
.
185.981 (5) of the statutes is amended to read:
185.981
(5)
Every
such
cooperative association
organized under this section
is a charitable and benevolent corporation.
Section
15
.
185.981 (6) of the statutes is repealed.
Section
16
.
185.981 (7) of the statutes is amended to read:
185.981
(7)
Notwithstanding sub. (4) and
s.
ss.
185.982 (1)
and 185.983 (1)
, a
sickness
health
care plan that is operated by a cooperative association and that qualifies as a health maintenance organization, as defined in s. 609.01 (2), is subject to s. 609.655.
Section
17
.
185.981 (8) of the statutes is amended to read:
185.981
(8)
A sickness care plan operated by a cooperative association is subject to s. 632.895 (8).
Coverage
by a health care plan operated by a cooperative association that qualifies as a health maintenance organization, as defined in s. 609.01 (2),
of mammograms under s. 632.895 (8) may be subject to any requirements that the
sickness
health
care plan imposes under s. 609.05 (2) and (3) on the coverage of other health care services obtained by members and their dependents.
Section
18
.
185.981 (9) of the statutes is amended to read:
185.981
(9)
Every cooperative sickness care association organized under this section that provides coverage for dependent children of members shall provide coverage for adopted children and children placed for adoption, as required under s. 632.896.
Coverage
by a health care plan operated by a cooperative association that qualifies as a health maintenance organization, as defined in s. 609.01 (2),
of health care services obtained by adopted children and children placed for adoption may be subject to any requirements that the
sickness
health
care plan imposes under s. 609.05 (2) and (3) on the coverage of health care services obtained by other members and their dependents.
185.982
(1)
No
sickness
health
care plan or contract issued
thereunde
r by
such
a
cooperative association shall interfere with the manner or mode of the practice of medicine, optometry, chiropractic, dentistry, or podiatry,
the manner or mode of providing wellness or other services,
the relationship of physician, chiropractor, optometrist, dentist,
or
podiatrist
, or other provider
and patient, nor the responsibility of physician, chiropractor, optometrist, dentist,
or
podiatrist
, or other provider
to patient.
A plan
Plans
may require persons covered to utilize health care providers designated by the cooperative association. The cooperative association may provide health care services directly through providers who are employees of the cooperative association or through agreements with individual providers or groups of providers organized on a group practice or individual practice basis.
In making such agreements, no plan may refuse to provide coverage for vision care services or procedures provided by an optometrist licensed under ch. 449 within the scope of the practice of optometry, as defined in s. 449.01 (1), if the plan provides coverage for the same services or procedures when provided by another health care provider.
Section
20
.
185.982 (2) of the statutes is amended to read:
185.982
(2)
Any cooperative association operating
a
voluntary
sickness
health
care
plan
plans
under the provisions of this chapter may pay physicians and surgeons, optometrists, chiropractors
or
,
dentists
, or other providers
on a salary, per person
,
or fee-for-service basis to provide
sickness
health
care to members of
such
the
association. Every
cooperative
association
shall contract only with its own members for the benefits of any plan which it operates, but any
may offer its health care services to nonmembers. Any cooperative
association
which
that
operates a hospital may make the
hospital's
facilities
thereof
available to nonmembers and to nonparticipating physicians, optometrists
or
,
dentists
, or other providers
.
Section
21
.
185.982 (3) of the statutes is repealed.
Section
22
.
185.983 (1) (intro.) of the statutes, as affected by
2009 Wisconsin Act 28
, is amended to read:
185.983
(1)
(intro.) Every
such
voluntary nonprofit
sickness
health
care plan
operated by a cooperative association organized under s. 185.981
shall be exempt from chs. 600 to 646, with the exception of ss. 601.04, 601.13, 601.31, 601.41, 601.42, 601.43, 601.44, 601.45,
611.26,
611.67, 619.04,
623.11, 623.12,
628.34 (10), 631.17, 631.89, 631.93, 631.95, 632.72 (2), 632.745 to 632.749, 632.775, 632.79, 632.795, 632.85, 632.853, 632.855, 632.87
(2),
(2m), (3), (4), (5), and (6), 632.885, 632.895 (5) and
(9)
(8)
to (17), 632.896, and 632.897 (10) and chs. 609,
620,
630, 635, 645, and 646, but the sponsoring association shall:
Section
23
.
185.983 (1) (a) of the statutes is amended to read:
185.983
(1)
(a) File with the commissioner of insurance a declaration defining the organization and operation of the plan, all printed literature
,
and specimen copies of all proposed contracts
of insurance
with persons covered and with participating physicians
and
,
hospitals,
and other providers,
including all amendments thereto. The form of all such contracts and amendments shall be subject to approval by the commissioner of insurance but the commissioner may not withhold approval if the form of
such
the
contracts or changes
therein
in the contracts
comply with the provisions of ss. 185.981 to 185.985.
Section
24
.
185.983 (1m) of the statutes is amended to read:
185.983
(1m)
In addition to ss. 601.04, 601.31, 632.79
,
and 632.895 (5), the commissioner of insurance may by rule subject a medicare supplement policy
,
as defined in s. 600.03 (28r), a medicare replacement policy
,
as defined in s. 600.03 (28p)
,
or a long-term care insurance policy
,
as defined in s. 600.03 (28g)
, that is
sold by a
voluntary nonprofit sickness
cooperative health
care
plan
association organized under s. 185.981
to other provisions of chs. 600 to 646, except
that
the commissioner may not subject a medicare supplement policy, a medicare replacement policy
,
or a long-term care insurance policy to s. 632.895 (8).
Section
25
.
185.983 (2) of the statutes is amended to read:
185.983
(2)
Every
such
voluntary nonprofit health care
plan
operated by a cooperative association organized under s. 185.981
shall make provision for a minimum of one physician and surgeon, or dentist to each 2,000 persons covered for medical or dental care and a minimum of 6 hospital beds for each 2,000 persons covered for hospital care.
Section
26
.
185.985 of the statutes is amended to read:
185.985
Inconsistent provisions of the statutes.
Sickness
Health
care or hospital plans operated by cooperative associations organized under this chapter shall be operated exclusively under the provisions of ss. 185.981 to 185.985. Other provisions of the statutes
that are
inconsistent with any of
such
those
provisions shall not be applicable to cooperative associations or
sickness
health
care plans operated by cooperative associations
pursuant to
under
this chapter.
Section
27
.
252.14 (1) (ar) 12. of the statutes is amended to read:
252.14
(1)
(ar) 12.
An operational
A
cooperative
sickness
health
care
plan
association
organized under
ss.
s.
185.981
to 185.985
that directly provides services through salaried employees in its own facility.
Section
28
.
254.11 (13) of the statutes is amended to read:
254.11
(13)
"Third-party payer" means a disability insurance policy that is required to provide coverage for a blood lead test under s. 632.895 (10) (a); a health maintenance organization or preferred provider plan under ch. 609; a health care coverage plan offered by the state under s. 40.51 (6); a self-insured health plan offered by a city or village under s. 66.0137 (4), a political subdivision under s. 66.0137 (4m), a town under s. 60.23 (25), a county under s. 59.52 (11) (c), or a school district under s. 120.13 (2) (b); or a
sickness
health
care plan operated by a cooperative association
organized
under s. 185.981.
Section
29
.
632.86 (1) (a) of the statutes is amended to read:
632.86
(1)
(a) "Disability insurance policy" has the meaning given in s. 632.895 (1) (a), except that the term does not include coverage under a health maintenance organization, as defined in s. 609.01 (2), a limited service health organization, as defined in s. 609.01 (3), a preferred provider plan, as defined in s. 609.01 (4), or a
sickness
health
care plan operated by a cooperative association organized under
ss.
s.
185.981
to 185.985
.
Section
30
.
655.002 (1) (f) of the statutes is amended to read:
655.002
(1)
(f) A cooperative
sickness
health
care association organized under
ss.
s.
185.981
to 185.985
that operates
a
nonprofit
sickness
health
care
plan
plans
in this state and that directly provides services through salaried employees in its own facility.
Section
31
.
Effective date.
(1)
This act takes effect on January 1, 2010, or on the day after publication, whichever is later.
