Bill Text: MI HB5841 | 2009-2010 | 95th Legislature | Introduced
Bill Title: Insurance; third party administrators; fee setting for noncovered dental services; prohibit in certain circumstances. Amends 1984 PA 218 (MCL 550.901 - 550.960) by adding sec. 33.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2010-02-18 - Printed Bill Filed 02/18/2010 [HB5841 Detail]
Download: Michigan-2009-HB5841-Introduced.html
HOUSE BILL No. 5841
February 17, 2010, Introduced by Rep. Meekhof and referred to the Committee on Insurance.
A bill to amend 1984 PA 218, entitled
"Third party administrator act,"
(MCL 550.901 to 550.960) by adding section 33.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 33. (1) A third party administrator shall not enter into
a service contract if the benefit plan covered by the service
contract requires that services provided by a dentist be provided
at a fee set by the benefit plan, except for covered services
provided to a covered individual under the benefit plan.
(2) A third party administrator shall not enter into a service
contract that imposes a deductible, copayment, coinsurance, or any
other requirement in such a way as to provide de minimis
reimbursement and avoid the impact of this section. The
commissioner shall investigate and issue a ruling on all complaints
arising under this section.
(3) As used in this section, "covered services" means those
health care services for which reimbursement is available under the
benefit plan and those health care services for which reimbursement
is not available due only to an unexpired waiting period, an annual
or lifetime limitation, monetary or frequency limitation, or other
limitation applicable to the coverage for the service. Covered
services do not include any of the following:
(a) A service selected by the patient requiring the use of
material different than those covered by the benefit plan and with
a cost higher than the amount the benefit plan would provide for
reimbursement for that service, provided that the dentist has
requested the patient to pay the amount by which the cost of the
service exceeds the benefit plan reimbursement and the patient has
agreed to pay the excess to the dentist.
(b) A service subject to a copayment obligation greater than
50%.
(c) A service subject to the satisfaction of a deductible
amount greater than $20.00 per service or any annual or other
deductible amount that the benefit plan reasonably expects will not
be met by at least 50% of those subject to the deductible
requirement.
Enacting section 1. This amendatory act applies to a service
contract entered into after the date this amendatory act is enacted
into law. For a service contract in effect on or before the date
this amendatory act is enacted into law, this amendatory act
applies on the date the service contract is next extended, renewed,
or modified in any manner.
