Wisconsin Administrative Code
Office of the Commissioner of Insurance
Chapter Ins 8 - Employee Welfare Funds; Employee Benefit Plan Administrators; Small Employer Health Insurance
Subchapter IV - Basic Health Benefit Plan For Small Employers
Section Ins 8.75 - Limitations and restrictions
Current through August 26, 2024
(1) PREEXISTING CONDITIONS. Section 635.17(1), Stats., applies to a plan subject to this subchapter.
Note: 1995 Wis. Act 289 repealed s. 635.17, Stats. See s. 632.746, Stats.
(2) ANNUAL MAXIMUM. The annual calendar year maximum benefit for a plan is $30,000 per insured individual. Charges for a hospitalization which extends from one calendar year to another shall be subject to the calendar year maximum for the year in which each charge was incurred and only one $100 copayment shall apply to the confinement.
(3) LIMITATION ON COVERAGE FOR MENTAL HEALTH AND SUBSTANCE ABUSE TREATMENT. The annual calendar year benefit payable for treatment of a covered person for nervous and mental disorders and alcoholism and other drug abuse is $1,400. A plan may not apply the cost of outpatient prescription drugs used in the treatment of nervous and mental disorders or alcoholism or other drug abuse toward the annual limit specified in this subsection.
