Bill
AB 402
Requires disability insurance and government self‑insured plans in Wisconsin to cover maternity and newborn care as an essential benefit, defined by Insurance Commissioner rules.
Status & procedural posture
- Jurisdiction: Wisconsin (2025 session).
- Introduced: August 29, 2025 (read first time and referred to Committee on Health, Aging and Long‑Term Care).
- Administrative review: Office of the Commissioner of Insurance (OCI) issued a Social & Financial Impact Report on September 3, 2025.
- Coauthors/sponsors: Large bipartisan sponsor list (see bill file); Representative Arney added as coauthor (noted Sept 9, 2025).
Purpose / intent
- Require that disability insurance policies and non‑federal governmental self‑insured health plans provide coverage for the essential health benefit of maternity and newborn care.
- Give the Commissioner of Insurance rule‑making authority to define the required maternity/newborn benefit and set certain limits on cost‑sharing to improve access and affordability.
Key provisions
- Mandatory coverage: Disability insurance policies and governmental self‑insured plans must cover maternity and newborn care as an essential health benefit as specified by the Commissioner of Insurance by rule.
- Rule‑making authority: The Commissioner is directed to establish by rule the scope of maternity and newborn services to be covered and to follow specified limits on cost‑sharing (the OCI report references “no‑to‑low cost‑sharing” as a likely feature).
- Coordination with existing mandates: If a maternity/newborn benefit established by the Commissioner overlaps with another statutory mandated benefit, the policy or plan must provide coverage under whichever requirement yields more comprehensive coverage for the enrollee.
- Applicability: Applies to fully insured disability policies and to governmental self‑funded (non‑federal) health plans covered under state law (per OCI analysis).
Who is affected
- Primary: Individuals covered by disability insurance policies and by state or local government self‑insured health plans (non‑federal) — particularly pregnant people and newborns who need maternity and newborn services.
- Secondary: Insurers, governmental plan sponsors, health care providers, and potentially employers who sponsor affected plans.
- Fiscal/stakeholder impacts: OCI notes consumers using the coverage would likely face lower out‑of‑pocket costs; however, OCI could not quantify the effect on premiums, administrative or claims costs.
Social and financial impacts (per OCI)
- Social: Likely increases access to and affordability of maternity and newborn services for enrollees in affected plans; could reduce out‑of‑pocket spending for those using these benefits.
- Financial: OCI cannot precisely estimate premium impacts or the magnitude of increased administrative/claims costs; overall impact on insurers and employers is uncertain.
Other notes / next steps
- OCI’s Social & Financial Impact Report is part of the legislative record and highlights uncertainty about premium effects despite anticipated improved affordability for enrollees.
- Bill status should be checked with the legislative clerk for committee hearings, amendments, votes, and any enacted rule language from the Commissioner of Insurance.
Compiled from official sources — confirm details with the bill’s official record.
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