Bill Text: MI HB6240 | 2009-2010 | 95th Legislature | Engrossed
Bill Title: Insurance; health; health benefit plans; extend age of dependent coverage, prohibit restriction on lifetime and certain annual limits on benefits, include certain preventive health services, prohibit rescinding coverage, and provide for general amendments. Amends secs. 3406f, 3503 & 3539 of 1956 PA 218 (MCL 500.3406f et seq.) & adds ch. 37A. TIE BAR WITH: HB 6241'10
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2010-12-01 - Referred To Committee On Health Policy [HB6240 Detail]
Download: Michigan-2009-HB6240-Engrossed.html
HB-6240, As Passed House, November 10, 2010
SUBSTITUTE FOR
HOUSE BILL NO. 6240
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending sections 3406f and 3539 (MCL 500.3406f and 500.3539),
section 3406f as added by 1996 PA 517 and section 3539 as amended
by 2005 PA 306.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3406f. (1) An insurer may exclude or limit coverage for a
condition as follows:
(a) For an individual covered under an individual policy or
certificate or any other policy or certificate not covered under
subdivision (b) or (c), only if the exclusion or limitation relates
to a condition for which medical advice, diagnosis, care, or
treatment was recommended or received within 6 months before
enrollment and the exclusion or limitation does not extend for more
than 12 months after the effective date of the policy or
certificate.
(b) For an individual covered under a group policy or
certificate covering 2 to 50 individuals, only if the exclusion or
limitation relates to a condition for which medical advice,
diagnosis, care, or treatment was recommended or received within 6
months before enrollment and the exclusion or limitation does not
extend for more than 12 months after the effective date of the
policy or certificate.
(c) For an individual covered under a group policy or
certificate covering more than 50 individuals, only if the
exclusion or limitation relates to a condition for which medical
advice, diagnosis, care, or treatment was recommended or received
within 6 months before enrollment and the exclusion or limitation
does not extend for more than 6 months after the effective date of
the policy or certificate.
(2) As used in this section, "group" means a group health plan
as
defined in section 2791(a)(1) and (2) of part C of title XXVII
of
the public health service act, chapter 373, 110 Stat. 1972, 42
U.S.C.
300gg-91 42 USC 300gg-91, and includes government plans that
are not federal government plans.
(3) This section applies only to an insurer that delivers,
issues for delivery, or renews in this state an expense-incurred
hospital, medical, or surgical policy or certificate. This section
does not apply to any policy or certificate that provides coverage
for specific diseases or accidents only, or to any hospital
indemnity, medicare supplement, long-term care, disability income,
or 1-time limited duration policy or certificate of no longer than
6 months.
(4)
The commissioner and the director of community health
shall
examine the issue of crediting prior continuous health care
coverage
to reduce the period of time imposed by preexisting
condition
limitations or exclusions under subsection (1)(a), (b),
and
(c) and shall report to the governor and the senate and the
house
of representatives standing committees on insurance and
health
policy issues by May 15, 1997. The report shall include the
commissioner's
and director's findings and shall propose
alternative
mechanisms or a combination of mechanisms to credit
prior
continuous health care coverage towards the period of time
imposed
by a preexisting condition limitation or exclusion. The
report
shall address at a minimum all of the following:
(a)
Cost of crediting prior continuous health care coverages.
(b)
Period of lapse or break in coverage, if any, permitted in
a
prior health care coverage.
(c)
Types and scope of prior health care coverages that are
permitted
to be credited.
(d)
Any exceptions or exclusions to crediting prior health
care
coverage.
(e)
Uniform method of certifying periods of prior creditable
coverage.
Sec. 3539. (1) For an individual covered under a nongroup
contract or under a contract not covered under subsection (2), a
health maintenance organization may exclude or limit coverage for a
condition only if the exclusion or limitation relates to a
condition for which medical advice, diagnosis, care, or treatment
was recommended or received within 6 months before enrollment and
the exclusion or limitation does not extend for more than 6 months
after the effective date of the health maintenance contract.
(2) A health maintenance organization shall not exclude or
limit coverage for a preexisting condition for an individual
covered under a group contract.
(3) Except as provided in subsection (5), a health maintenance
organization that has issued a nongroup contract shall renew or
continue in force the contract at the option of the individual.
(4) Except as provided in subsection (5), a health maintenance
organization that has issued a group contract shall renew or
continue in force the contract at the option of the plan's sponsor.
of
the plan.
(5) Guaranteed renewal is not required in cases of fraud,
intentional misrepresentation of material fact, lack of payment, if
the health maintenance organization no longer offers that
particular type of coverage in the market, or if the individual or
group moves outside the service area.
(6) A health maintenance organization is not required to
continue a healthy lifestyle program or to continue any incentive
associated with a healthy lifestyle program, including, but not
limited to, goods, vouchers, or equipment.
(7) As used in this section, "group" means a group of 2 or
more subscribers.
