185.981

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185.981 Cooperative health care.

185.981(1)

(1) Cooperative associations may be organized under this chapter without capital stock, primarily to establish and operate in the state or in any county or counties in the state nonprofit plans or programs for 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)

(2) 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 health care, including hospital, dental, or vision care, is provided to its members and to other persons or groups of persons who become subscribers to the plans, subject to § 185.982 (2), under contracts 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, 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)

(3) No cooperative association organized primarily for the purposes provided in §§ 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 the cooperative association’s plans because the hospital participates in a plan of any other cooperative association, or in a plan organized and operated under §§ 148.03 and 613.80. No hospital may discriminate against any physician and surgeon, chiropractor, dentist, or podiatrist with respect to the use of the hospital’s facilities by reason of his or her participation in a health care plan of a cooperative.

185.981(4)

(4)

185.981(4)(a)

(a) Except as provided in para. (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, but any such association may stipulate in its plans that it will pay any nonparticipating physician and surgeon, optometrist, chiropractor, dentist, podiatrist, hospital, or other provider for hospital or other health care rendered to any covered person who is in need of a plan’s benefits. The plans may prescribe monetary limitations with respect to the benefits.

185.981(5)

(5) Every cooperative association organized under this section is a charitable and benevolent corporation.

185.981(4)(b)

(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.

185.981(7)

(7) Notwithstanding sub. (4) and ss. 185.982 (1) and 185.983 (1), a health care plan that is operated by a cooperative association and that qualifies as a health maintenance organization, as defined in § 609.01 (2), is subject to § 609.655.

185.981(8)

(8) Coverage by a health care plan operated by a cooperative association that qualifies as a health maintenance organization, as defined in § 609.01 (2), of mammograms under § 632.895 (8) may be subject to any requirements that the health care plan imposes under § 609.05 (2) and (3) on the coverage of other health care services obtained by members and their dependents.

185.981(9)

(9) Coverage by a health care plan operated by a cooperative association that qualifies as a health maintenance organization, as defined in § 609.01 (2), of health care services obtained by adopted children and children placed for adoption may be subject to any requirements that the health care plan imposes under § 609.05 (2) and (3) on the coverage of health care services obtained by other members and their dependents.