632.867 Oral and injected chemotherapy.
(1) Definitions. In this section:
(a) “Chemotherapy" means drugs and biologics that kill cancer cells directly, including antineoplastics, biologic response modifiers, hormone therapy, and monoclonal antibodies, and that are used to do any of the following:
1. Cure a specific cancer.
2. Control tumor growth when cure is not possible.
3. Shrink tumors before surgery or radiation therapy.
4. Destroy microscopic cancer cells that may be present after a tumor is removed by surgery to prevent a cancer recurrence.
(b) “Disability insurance policy" has the meaning given in s. 632.895 (1) (a).
(c) “Self-insured health plan" has the meaning given in s. 632.85 (1) (c).
(2) Copayment, deductible, or coinsurance requirements; limitations.
(a) Except as provided in par. (am), a disability insurance policy that covers injected or intravenous chemotherapy and oral chemotherapy, or a self-insured health plan that covers injected or intravenous chemotherapy and oral chemotherapy, may not require a higher copayment, deductible, or coinsurance amount for oral chemotherapy than it requires for injected or intravenous chemotherapy, regardless of the formulation or benefit category determination by the policy or plan.
(am) A disability insurance policy or self-insured health plan that limits copayments paid by a covered individual to no more than $100 for a 30-day supply of oral chemotherapy medication is considered to comply with this section. On January 1, 2016, and on each January 1 annually thereafter, a disability insurance policy or self-insured health plan may adjust the $100 limit under this paragraph by an amount that does not exceed the percentage increase in the U.S. consumer price index for all urban consumers, U.S. city average, as determined by the U.S. department of labor.
(b) A disability insurance policy or a self-insured health plan may not comply with par. (a) by increasing the copayment, deductible, or coinsurance amount required for injected or intravenous chemotherapy that is covered under the policy or plan.
(c) Notwithstanding par. (a), for a disability insurance policy, or self-insured health plan, that is a high deductible health plan, as defined in 26 USC 223 (c) (2), par. (a) applies only after the plan enrollee's deductible has been satisfied for the year.
History: 2013 a. 186.
Structure Wisconsin Statutes & Annotations
Wisconsin Statutes & Annotations
Chapter 632 - Insurance contracts in specific lines.
632.07 - Prohibiting requiring property insurance in excess of replacement value.
632.10 - Definitions applicable to property insurance escrow.
632.102 - Payment of final settlement.
632.103 - Procedure for payment of withheld funds.
632.104 - Funds released to mortgagee.
632.14 - Bonds need not be under seal.
632.17 - Validity of surety bonds.
632.18 - Rustproofing warranties insurance.
632.185 - Vehicle protection product warranty insurance policy.
632.22 - Required provisions of liability insurance policies.
632.23 - Prohibited exclusions in aircraft insurance policies.
632.24 - Direct action against insurer.
632.25 - Limited effect of conditions in employer's liability policies.
632.32 - Provisions of motor vehicle insurance policies.
632.34 - Defense of noncooperation.
632.35 - Prohibited rejection, cancellation and nonrenewal.
632.36 - Accident in the course of business or employment.
632.365 - Use of emission inspection data in setting rates.
632.37 - Motor vehicle glass repair practices; restriction on specifying vendor.
632.375 - Motor vehicle repair practices; restriction on specifying vendor.
632.38 - Nonoriginal manufacturer replacement parts.
632.41 - Prohibited provisions in life insurance.
632.42 - Trustee and deposit agreements in life insurance.
632.43 - Standard nonforfeiture law for life insurance.
632.435 - Standard nonforfeiture law for individual deferred annuities.
632.44 - Required provisions in life insurance.
632.45 - Contracts providing variable benefits.
632.46 - Incontestability and misstated age.
632.47 - Assignment of life insurance rights.
632.475 - Life insurance policy loans.
632.48 - Designation of beneficiary.
632.50 - Estoppel from medical examination.
632.56 - Required group life insurance provisions.
632.57 - Conversion option in group and franchise life insurance.
632.60 - Limitation on credit life insurance.
632.62 - Participating and nonparticipating policies.
632.63 - Unclaimed life insurance and annuities.
632.64 - Certification of disability.
632.65 - Annuities exempt from regulation.
632.66 - Annuity contracts without life contingencies.
632.67 - Effect of power of attorney for health care.
632.695 - Applicability of general transfers at death provisions.
632.697 - Benefits subject to department's right to recover.
632.71 - Estoppel from medical examination, assignability and change of beneficiary.
632.715 - Reports of action against health care provider.
632.72 - Medical benefits or assistance; assignment.
632.725 - Standardization of health care billing and insurance claim forms.
632.726 - Current procedural terminology code changes.
632.729 - Prohibiting discrimination based on COVID-19.
632.73 - Right to return policy.
632.74 - Reinstatement of individual or franchise disability insurance policies.
632.745 - Coverage requirements for group and individual health benefit plans; definitions.
632.746 - Preexisting condition; portability; restrictions; and special enrollment periods.
632.747 - Guaranteed acceptance.
632.748 - Prohibiting discrimination.
632.749 - Contract termination and renewability.
632.7495 - Guaranteed renewability of individual health insurance coverage.
632.7497 - Modifications at renewal.
632.75 - Prohibited provisions for disability insurance.
632.755 - Public assistance and early intervention services.
632.76 - Incontestability for disability insurance.
632.77 - Permitted provisions for disability insurance policies.
632.775 - Effect of power of attorney for health care.
632.78 - Required grace period for disability insurance policies.
632.793 - Notice of loss of primary insurance coverage due to age.
632.795 - Open enrollment upon liquidation.
632.797 - Disclosure of group health claims experience.
632.798 - Out-of-pocket costs.
632.80 - Restrictions on medical payments insurance.
632.81 - Minimum standards for certain disability policies.
632.82 - Renewability of long-term care insurance policies.
632.825 - Midterm termination of long-term care insurance policy by insured.
632.83 - Internal grievance procedure.
632.835 - Independent review of coverage denial determinations.
632.84 - Benefit appeals under certain policies.
632.845 - Prohibiting refusal to cover services because liability policy may cover.
632.85 - Coverage without prior authorization for treatment of an emergency medical condition.
632.853 - Coverage of drugs and devices.
632.855 - Requirements if experimental treatment limited.
632.857 - Explanation required for restriction or termination of coverage.
632.861 - Prescription drug charges.
632.865 - Pharmacy benefit managers.
632.866 - Step therapy protocols.
632.867 - Oral and injected chemotherapy.
632.87 - Restrictions on health care services.
632.873 - Restrictions relating to fees for dental services.
632.875 - Independent evaluations relating to chiropractic treatment.
632.88 - Policy extension for handicapped children.
632.885 - Coverage of dependents.
632.89 - Coverage of mental disorders, alcoholism, and other diseases.
632.896 - Mandatory coverage of adopted children.
632.897 - Hospital and medical coverage for persons insured under individual and group policies.
632.8985 - Prohibiting abortion coverage.
632.899 - Medical savings accounts study.
632.93 - The fraternal contract.
632.95 - Fraud in obtaining membership.
632.96 - Beneficiaries in fraternal contracts.
632.97 - Application of proceeds of credit insurance policy.
632.975 - Portable electronics insurance.