Bill Text: MI HB4875 | 2013-2014 | 97th Legislature | Introduced

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Bill Title: Insurance; health; health care benefits that require certain deductibles or copays; provide for certain restrictions on whether health care service can be listed as a health care benefit. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3402a.

Spectrum: Slight Partisan Bill (Republican 10-6)

Status: (Introduced - Dead) 2013-07-03 - Per Rule 41 Referred To Committee On Health Policy [HB4875 Detail]

Download: Michigan-2013-HB4875-Introduced.html

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HOUSE BILL No. 4875

 

June 20, 2013, Introduced by Reps. Callton, Jacobsen, Foster, Farrington, Yonker, Genetski, Haines, Darany, Stallworth, Zorn, Hooker, Hovey-Wright, Kivela, Kowall, Abed and Knezek and referred to the Committee on Insurance.

 

     A bill to amend 1956 PA 218, entitled

 

"The insurance code of 1956,"

 

(MCL 500.100 to 500.8302) by adding section 3402a.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 3402a. (1) A health insurer providing an expense-incurred

 

hospital, medical, or surgical policy or certificate delivered,

 

issued for delivery, or renewed in this state or a health

 

maintenance organization providing an individual or group contract

 

shall not include a health care service as a covered health care

 

benefit under the terms and conditions of the policy, certificate,

 

or contract or in any other communication concerning the policy,

 

certificate, or contract if either of the following applies:

 

     (a) The copayment or coinsurance for the health care service

 

payable by the insured or enrollee is greater than 50% of the cost

 

of the health care service.

 

     (b) The deductible for the health care service payable by the

 

insured or enrollee meets either of the following:

 

     (i) Is established in such a way as to provide de minimis

 

reimbursement for the service by the insurer or health maintenance

 

organization.

 

     (ii) Has an annual or other deductible amount that the insurer

 

or health maintenance organization reasonably knows will not be met

 

by at least 80% of the insureds or enrollees.

 

     (2) The director of insurance and financial services shall

 

investigate and issue a ruling on all complaints arising under this

 

section.

 

     Enacting section 1. This amendatory act applies to a policy,

 

certificate, or contract entered into after the date this

 

amendatory act is enacted into law. For a policy, certificate, or

 

contract in effect on or before the date this amendatory act is

 

enacted into law, this amendatory act applies on the date the

 

policy, certificate, or contract is next extended, renewed, or

 

modified in any manner.