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Health insurance policies sold in
Wisconsin often include "mandated benefits."
These are benefits that an insurer must include in
certain types of health insurance policies. Some
"mandated benefits" apply only to group
policies. Some apply both to policies sold to
individuals and to groups. Most apply only to policies
issued or renewed after a certain date. Except for
health maintenance organizations (HMOs) organized as
cooperatives under ch. 185, Wis. Stat., HMOs are
required to provide the same benefits as traditional
insurers. Cooperative HMOs are subject to the mandates
regarding chiropractors, optometrists, genetic testing,
nurse practitioners, newborns, adopted children, HIV
drugs, dentists, temporomandibular (TMJ) disorders,
breast reconstruction, and hospital and ambulatory
surgery center charges and anesthetics for dental
care.
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