Wisconsin Statutes 185.99 – Health benefit purchasing cooperatives
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Terms Used In Wisconsin Statutes 185.99
- Articles: means the articles of incorporation of a cooperative unless the context otherwise requires. See Wisconsin Statutes 185.01
- Association: includes both cooperatives and foreign cooperatives. See Wisconsin Statutes 185.01
- Board: means the board of directors of a cooperative. See Wisconsin Statutes 185.01
- Bylaws: means the bylaws of a cooperative. See Wisconsin Statutes 185.01
- Contract: A legal written agreement that becomes binding when signed.
- Cooperative: means an association incorporated under this chapter. See Wisconsin Statutes 185.01
- Dependent: A person dependent for support upon another.
- Following: when used by way of reference to any statute section, means the section next following that in which the reference is made. See Wisconsin Statutes 990.01
- Member: means a person who has been qualified and accepted for membership in an association. See Wisconsin Statutes 185.01
- members: as used in this chapter with respect to the right of a member to vote, voting procedure, the required proportion of member votes, actions that must or may be taken by members, the number of members required for a quorum and the eligibility of directors, means a member or members entitled to vote, unless the bylaws provide otherwise. See Wisconsin Statutes 185.01
- Month: means a calendar month unless otherwise expressed. See Wisconsin Statutes 990.01
- Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
- Person: includes all partnerships, associations and bodies politic or corporate. See Wisconsin Statutes 990.01
- State: when applied to states of the United States, includes the District of Columbia, the commonwealth of Puerto Rico and the several territories organized by Congress. See Wisconsin Statutes 990.01
- Town: may be construed to include cities, villages, wards or districts. See Wisconsin Statutes 990.01
- Village: means incorporated village. See Wisconsin Statutes 990.01
- Year: means a calendar year, unless otherwise expressed; "year" alone means "year of our Lord". See Wisconsin Statutes 990.01
(1) Definitions. In this section:
(a) “Commissioner” means the commissioner of insurance.
(b) “Eligible employee” has the meaning given in s. 632.745 (5) (a).
(c) “Person” means any corporation, limited liability company, partnership, cooperative, association, trade or labor organization, city, village, town, county, or self-employed individual.
(2) Organization and purpose.
(a) Notwithstanding s. 185.02, health benefit purchasing cooperatives may be organized under this chapter in each of the geographic areas designated under sub. (6). Notwithstanding s. 185.043, a health benefit purchasing cooperative may be formed by one or more persons.
(b) The purpose of a health benefit purchasing cooperative is to provide health care benefits for the individuals specified in sub. (4) (a) 1. to 3., under a single group health care policy or plan through a contract between the health benefit purchasing cooperative and an insurer authorized to do business in this state in one or more lines of insurance that includes health insurance.
(c) A health benefit purchasing cooperative shall be designed so that all of the following are accomplished:
1. The members become better informed about health care trends and cost increases.
2. All members receive their health care benefits under the group health care policy or plan negotiated under sub. (4) (a).
3. The members are actively engaged in designing health care benefit options that are offered by the insurer and that meet the needs of their community.
4. The health insurance risk of all of the members is pooled.
5. The members actively participate in health improvement decisions for their community.
(2m) Temporary board of directors. Notwithstanding s. 185.05 (1) (m), the articles of a health benefit purchasing cooperative shall set forth the name and address of at least one incorporator who will act as the temporary board.
(3) Cooperative membership.
(a) Notwithstanding s. 185.11 (1), each health benefit purchasing cooperative shall be organized on a membership basis with no capital stock.
(b) Subject to par. (c), any person that does business in, is located in, has a principal office in, or resides in the geographic area in which a health benefit purchasing cooperative is organized, that meets the membership criteria established by the health benefit purchasing cooperative in its bylaws, and that pays the membership fee may be a member of the health benefit purchasing cooperative.
(c) A health benefit cooperative may limit membership of self-employed individuals through its membership criteria, but such criteria must be applied in the same manner to all self-employed individuals.
(d) Each health benefit purchasing cooperative shall file its membership criteria, as well as any amendments to the criteria, with the commissioner.
(4) Health care benefits.
(a) The health care benefits offered by a health benefit purchasing cooperative shall be negotiated between the health benefit purchasing cooperative and the insurer and shall be offered in a single group health care policy or plan. The insurer must offer coverage under the group health care policy or plan to all of the following:
1. An individual who is a member, officer, or eligible employee of a member of the health benefit purchasing cooperative.
2. A self-employed individual who is a member of the health benefit purchasing cooperative.
(b) The contract between the health benefit purchasing cooperative and an insurer shall be for a term of 3 years. Upon enrollment in the insurer’s group health care policy or plan, each member shall pay to the health benefit purchasing cooperative an amount determined by the health benefit purchasing cooperative that is not less than the member’s applicable premium for the 36th month of coverage under the contract. If a member withdraws from the health benefit purchasing cooperative before the end of the contract term, the health benefit purchasing cooperative may retain, as a penalty, an amount specified by the health benefit purchasing cooperative that is not less than the premium that the member paid for the 36th month of coverage.
(c) An insurer that contracts under this section with a health benefit purchasing cooperative that provides health care benefits for more than 50 individuals who are members or employees of one or more members is not a small employer insurer, as defined in s. 635.02 (8), with respect to the contract between the insurer and the health benefit purchasing cooperative.
(5) Required reports. Each health benefit purchasing cooperative shall submit to the legislature under s. 13.172 (2) and to the commissioner all of the following:
(a) Annually, no later than September 30, a report on the progress of the health benefit purchasing arrangement described in this section and, to the extent possible, any significant findings in the criteria under par. (b) 1. to 3.
(b) Within one year after the end of the term of the contract under sub. (4) (b), a final report that details significant findings from the project and that includes, at a minimum, to the extent available, information on all of the following:
1. The extent to which the health benefit purchasing arrangement had an impact on the number of uninsured in the geographic area in which it operated.
2. The effect on health care coverage premiums for groups in the geographic area in which the health benefit purchasing arrangement operated, including groups other than the health benefit purchasing cooperative.
3. The degree to which health care consumers were involved in the development and implementation of the health benefit purchasing arrangement.
(6) Designation of geographic areas. After consultation with Cooperative Network, the commissioner shall designate, by order, the geographic areas of the state in which health benefit purchasing cooperatives may be organized. A geographic area may overlap with one or more other geographic areas.