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SB1147: Bill Text
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2025 - 2026 LEGISLATURE
LRB-6570/1
JPC&EKL:emw
2025 SENATE BILL 1147
March 19, 2026 - Introduced by Senators
Spreitzer
,
Ratcliff
and
Roys
, cosponsored by Representatives
Anderson
,
Clancy
,
Joers
,
Prado
,
Sinicki
,
Stroud
,
Stubbs
and
Subeck
. Referred to Committee on Insurance, Housing, Rural Issues and Forestry.
SB1147,1,2
1
An Act
to create
631.84 of the statutes;
relating to:
limitation on retroactive
2
claim denials under health insurance policies.
Analysis by the Legislative Reference Bureau
This bill provides that an insurer may retroactively deny reimbursement for a claim under a health insurance policy only during the 12-month period following the date that the insurer initially provided reimbursement for the claim. If the claim was subject to coordination of benefits with another third-party payer, the bill instead provides that an insurer may retroactively deny reimbursement for a claim under a health insurance policy only during the 18-month period following the date that the insurer initially provided reimbursement for the claim. The limitations described under the bill do not apply to any retroactive denial of reimbursement if an insurer retroactively denied reimbursement for the claim because the information submitted to the insurer to support the claim was fraudulent. Health insurance policies are referred to as disability insurance policies in the bill and under current law.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
SB1147,1
3
Section
1
.
631.84 of the statutes is created to read:
SB1147,2,1
1
631.84 Limitation on retroactive denials. (1)
In this section:
SB1147,2,2
2
(a) “Disability insurance policy” has the meaning given in s. 632.895 (1) (a).
SB1147,2,7
3
(b) “Retroactive denial of payment” means any attempt by an insurer to
4
retroactively collect payments already made for a claimant with respect to a claim
5
by requiring repayment of such payments, by reducing other payments owed to the
6
claimant, by withholding or setting off against future payments to the claimant, or
7
in any other manner reducing or affecting future claim payments to the claimant.
SB1147,2,8
8
(c) “Third-party payer” means any of the following:
SB1147,2,9
9
1. A disability insurance policy.
SB1147,2,11
10
2. A health maintenance organization, preferred provider plan, or limited
11
service health organization under ch. 609.
SB1147,2,13
12
3. A health care coverage plan offered by the state under s. 40.51 (6) or by the
13
group insurance board under s. 40.51 (7).
SB1147,2,15
14
4. A self-insured health plan of the state or a county, city, village, town, or
15
school district.
SB1147,2,17
16
5. A health care plan operated by a cooperative association organized under s.
17
185.981.
SB1147,2,19
18
6. Any other person that is obligated by contract to provide reimbursement for
19
covered health care services rendered to beneficiaries under the contract.
SB1147,2,23
20
(2)
Except as provided in sub. (3), an insurer may only impose a retroactive
21
denial of payment for a claim under a disability insurance policy during the 12-
22
month period following the date that the insurer initially provided reimbursement
23
for the claim.
SB1147,3,5
1
(3)
If a claim was subject to coordination of benefits with another 3rd-party
2
payer, the Medical Assistance program under subch. IV of ch. 49, or the federal
3
Medicare program, an insurer may only impose a retroactive denial of payment for
4
the claim under a disability insurance policy during the 18-month period following
5
the date that the insurer initially provided reimbursement for the claim.
SB1147,3,8
6
(4)
This section does not apply to any retroactive denial of payment for a claim
7
if an insurer retroactively denied payment for the claim because information
8
submitted to the insurer to support the claim was fraudulent.
SB1147,2
9
Section
2
. Initial applicability.
SB1147,3,12
10
(
1
) For policies and plans containing provisions inconsistent with this act, the
11
act first applies to policy or plan years beginning on the effective date of this
12
subsection, except as provided in sub. (
2
).
SB1147,3,17
13
(
2
) For policies and plans that are affected by a collective bargaining
14
agreement containing provisions inconsistent with this act, the act first applies to
15
policy or plan years beginning on the effective date of this subsection or on the day
16
on which the collective bargaining agreement is newly established, extended,
17
modified, or renewed, whichever is later.
SB1147,3,18
18
(end)
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