Bill Text: MI HB6085 | 2017-2018 | 99th Legislature | Introduced

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Bill Title: Insurance; health insurers; coverage benefits for prosthetics and orthotics; require. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406u.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Introduced - Dead) 2018-05-30 - Bill Electronically Reproduced 05/29/2018 [HB6085 Detail]

Download: Michigan-2017-HB6085-Introduced.html

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HOUSE BILL No. 6085

 

 

May 29, 2018, Introduced by Rep. LaFave 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 3406u.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 3406u. (1) An insurer providing a health policy

 

delivered, issued for delivery, or renewed in this state shall

 

offer coverage for prosthetic devices and components and for their

 

repair, fitting, and replacement if determined medically necessary

 

by the insured's treating physician.

 

     (2) Coverage under this section is not subject to any of the

 

following:

 

     (a) An annual or lifetime dollar maximum other than the annual

 

or lifetime dollar maximum that applies in the aggregate to all

 

items and services covered under the health insurance policy.

 

     (b) Dollar limits, deductibles, or copayment provisions that

 

are greater than those for physical illness generally.

 

     (c) If the prosthetic device or service is provided by an out-

 

of-network provider, coinsurance in excess of 30% of the insurer's

 

allowable charge for the prosthetic device or service when the

 

device or service is provided by an in-network provider.

 

     (3) An insurer shall not apply amounts paid for prosthetic

 

devices to any annual or lifetime dollar maximum applicable to

 

other durable medical equipment covered under the health insurance

 

policy other than an annual or lifetime dollar maximum that applies

 

in the aggregate to all items and services covered under the health

 

insurance policy.

 

     (4) Coverage under this section does not include repair and

 

replacement due to insured or enrollee neglect, misuse, or abuse or

 

to prosthetic devices designed primarily for an athletic purpose.

 

     (5) As used in this section:

 

     (a) "Component" means the materials and equipment needed to

 

ensure the comfort and functioning of a prosthetic device.

 

     (b) "Limb" means an arm, hand, leg, or foot or any portion of

 

an arm, hand, leg, or foot.

 

     (c) "Prosthetic device" means an artificial device to replace,

 

in whole or in part, a limb.

 

     Enacting section 1. This amendatory act applies to policies

 

delivered, issued for delivery, renewed, or extended on or after

 

January 1, 2019 or if any term of the policy is changed or the

 

premium for the policy is adjusted on or after January 1, 2019.