Sec. DHS 138.03 - Definitions

ยง DHS 138.03. Definitions

In this chapter:

(1) "COBRA" means the federal consolidated omnibus budget reconciliation act of 1986, PL 99-272.

(2) "Department" means the Wisconsin department of health services.

(3) "Dependent" means a spouse, domestic partner under ch. 770, Stats., or an unmarried child under the age of 19 years, an unmarried child who is a full-time student under the age of 21 years and who is financially dependent upon the parent, or an unmarried child of any age who is medically certified as disabled and who is dependent upon the parent.

(4) "Employee" means any of the following:

(a) An active or retired wage, commissioned or salaried earner whose services are or were utilized by the employer who provided health care coverage to the individual by virtue of the individual's employment.

(b) A member of a union, trust or association where the member is entitled to health care coverage by virtue of the individual's membership in the union, trust or association.

(5) "Employer" means a group policyholder subject to s. 632.897, Stats., or the sponsor of a group health plan subject to 29 USC 1161 to 1168 or 42 USC 300bb-1 to 300bb-8, including a controlled group, partnership or other arrangement under common control, an affiliated service group and employee leasing arrangements.

(6) "Family income" means the gross earnings of an employee and his or her spouse, including wages and salary, net income from non-farm self-employment, net income from farm self-employment, as well as unearned income including social security, dividends, interest income, income from estates or trusts, net rental income or royalties, public assistance, pensions or annuities, unemployment compensation, workers compensation, maintenance or alimony, child support, family support and veterans pensions.

(7) "Family size" means the number of individuals in a group of persons related by birth, marriage or adoption who reside together.

(8) "Federal poverty line" means the poverty income threshold by size of family unit for the current calendar year published as part of the poverty income guidelines by the U.S. department of health and human services in the federal register, pursuant to 42 USC 9902(2).

(9) "Group health plan" means an insurance policy or a partially or wholly uninsured plan or program that provides hospital, medical or other health care coverage to members of a group whether or not dependents of the members are also covered. The term includes a medicare supplement policy, as defined in s. 600.03(28r), Stats., but does not include a medicare replacement policy, as defined in s. 600.03(28p), Stats., or a long-term care insurance policy, as defined in s. 600.03(28g), Stats.

(10) "HIV" means any strain of human immunodeficiency virus, which causes acquired immunodeficiency syndrome.

(11) "HIV infection" means the pathological state produced by a human body in response to the presence of HIV.

(12) "Individual health policy" means an insurance policy or a partially or wholly uninsured plan or program that provides hospital, medical or other health coverage to an individual on an individual basis and not as a member of a group, whether or not dependents of the individual are also covered. The term includes a medicare supplement policy as defined in s. 600.03(28r), Stats., but does not include a medicare replacement policy, as defined in s. 600.03(28p), Stats., or a long-term care insurance policy, as defined in s. 600.03(28g), Stats.

(13) "Insurer" has the meaning prescribed in s. 600.03(27), Stats.

(14) "Medicare" means coverage under part A, part B, or part D of Title XVIII of the federal Social Security Act, 42 USC 1395 to 1395 hhh.

(15) "Physician" has the meaning prescribed in s. 448.01(5), Stats., namely, an individual possessing the degree of doctor of medicine or doctor of osteopathy or an equivalent degree as determined by the medical examining board, and holding a license granted by the medical examining board.

(16) "Residence" means the concurrence of physical presence with intent to remain in a place of fixed habitation, with physical presence being prima facie evidence of intent to remain.

(17) "Subsidy under s. 252.16, Stats." means a subsidy to pay all or part of the premium costs of health insurance coverage for a person with HIV infection who because of the HIV infection is unable to continue working or must reduce hours of work.

(18) "Subsidy under s. 252.17, Stats." means a subsidy to pay the premium owed for costs of health insurance coverage for a person with HIV infection who because of the HIV infection is on unpaid medical leave from his or her employment.

(19) "Unpaid medical leave" means an unpaid leave from employment for an employee who has a serious health condition, as defined in s. 103.10(1) (g), Stats., which makes the employee unable to perform his or her employment duties.

(Cr. Register, May, 1991, No. 425, eff. 6-1-91; cr. (15), Register, July, 1993, No. 451, eff. 8-1-93; r. and recr. Register, August, 1998, No. 512, eff. 9-1-98; correction in (2) made under s. 13.92(4) (b) 6, Stats., Register January 2009 No. 637; CR 10-084: am. (2), (3), and (14) Register December 2010 No. 660, eff. 1-1-11.)

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