609.10 Standard plan and point-of-service option plan required.

222 words·~1 min read·/wi/chapter-609/609-10-2

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

(ac)In this section, “point-of-service option plan” means a health maintenance organization or preferred provider plan that permits an enrollee to obtain covered health care services from a provider that is not a participating provider of the health maintenance organization or preferred provider plan under all of the following conditions:

1. The nonparticipating provider holds a license or certificate that authorizes or qualifies the provider to provide the health care services.

2. The health maintenance organization or preferred provider plan is required to pay the nonparticipating provider only the amount that the health maintenance organization or preferred provider plan would pay a participating provider for those health care services.

3. The enrollee is responsible for any additional costs or charges related to the coverage.

(am)Except as provided in subs.

(2)to

(4), an employer that offers any of its employees a health maintenance organization or a preferred provider plan that provides comprehensive health care services shall also offer the employees a standard plan that provides at least substantially equivalent coverage of health care expenses and a point-of-service option plan, as provided in pars.

(b)and

(c).

(b)At least once annually, the employer shall provide the employees the opportunity to enroll in the health care plans under par.

(am).