April 9, 2003, Introduced by Rep. Ehardt and referred to the Committee on Health Policy.

























                                                                                 A bill to amend 1956 PA 218, entitled                                             


    "The insurance code of 1956,"                                               


    by amending section 3406q (MCL 500.3406q), as added by 2002 PA              


    538, and by adding chapter 37.                                              


                THE PEOPLE OF THE STATE OF MICHIGAN ENACT:                      


1       Sec. 3406q.  (1) An expense-incurred hospital, medical, or                  


2   surgical policy or certificate delivered, issued for delivery, or           


3   renewed in this state that provides pharmaceutical coverage and a           


4   health maintenance organization contract that provides                      


5   pharmaceutical coverage shall provide coverage for an off-label             


6   use of a federal food and drug administration approved drug and             


7   the reasonable cost of supplies medically necessary to administer           


8   the drug.                                                                   


9       (2) Coverage for a drug under subsection (1) applies if all                 


10  of the following conditions are met:                                        



1       (a) The drug is approved by the federal food and drug                       


2   administration.                                                             


3       (b) The drug is prescribed by an allopathic or osteopathic                  


4   physician for the treatment of either of the following:                     


5                                                                                (i) A life-threatening condition so long as the drug is                             


6   medically necessary to treat that condition and the drug is on              


7   the plan formulary or accessible through the health plan's                  


8   formulary procedures.                                                       


9       (ii) A chronic and seriously debilitating condition so long                  


10  as the drug is medically necessary to treat that condition and              


11  the drug is on the plan formulary or accessible through the                 


12  health plan's formulary procedures.                                         


13      (c) The drug has been recognized for treatment for the                      


14  condition for which it is prescribed by 1 of the following:                 


15                                                                               (i) The American medical association drug evaluations.                              


16      (ii) The American hospital formulary service drug                            


17  information.                                                                


18      (iii) The United States pharmacopoeia dispensing information,                


19  volume 1, "drug information for the health care professional".              


20      (iv) Two articles from major peer-reviewed medical journals                  


21  that present data supporting the proposed off-label use or uses             


22  as generally safe and effective unless there is clear and                   


23  convincing contradictory evidence presented in a major                      


24  peer-reviewed medical journal.                                              


25      (3) Upon request, the prescribing allopathic or osteopathic                 


26  physician shall supply to the insurer or health maintenance                 


27  organization documentation supporting compliance with                       


1   subsection (2).                                                             


2       (4) This section does not prohibit the use of a copayment,                  


3   deductible, sanction, or a mechanism for appropriately                      


4   controlling the utilization of a drug that is prescribed for a              


5   use different from the use for which the drug has been approved             


6   by the food and drug administration.  This may include prior                


7   approval or a drug utilization review program.  Any copayment,              


8   deductible, sanction, prior approval, drug utilization review               


9   program, or mechanism described in this subsection shall not be             


10  more restrictive than for prescription coverage generally.                  


11      (5) As used in this section:                                                


12      (a) "Chronic and seriously debilitating" means a disease or                 


13  condition that requires ongoing treatment to maintain remission             


14  or prevent deterioration and that causes significant long-term              


15  morbidity.                                                                  


16      (b) "Life-threatening" means a disease or condition where the               


17  likelihood of death is high unless the course of the disease is             


18  interrupted or that has a potentially fatal outcome where the end           


19  point of clinical intervention is survival.                                 


20      (c) "Off-label" means the use of a drug for clinical                        


21  indications other than those stated in the labeling approved by             


22  the federal food and drug administration.                                   


23                              CHAPTER 37                                      


24                 SMALL EMPLOYER GROUP HEALTH COVERAGE                         


25      Sec. 3701.  As used in this chapter:                                        


26      (a) "Actuarial certification" means a written statement by a                


27  member of the American academy of actuaries or another individual           


1   acceptable to the commissioner that a small employer carrier is             


2   in compliance with the provisions of section 3705, based upon the           


3   person's examination, including a review of the appropriate                 


4   records and the actuarial assumptions and methods used by the               


5   carrier in establishing premium rates for applicable health                 


6   benefit plans.                                                              


7       (b) "Affiliation period" means a period of time required by a               


8   small employer carrier that must expire before health coverage              


9   becomes effective.                                                          


10      (c) "Carrier" means a person that provides health benefits,                 


11  coverage, or insurance in this state.  For the purposes of this             


12  chapter, carrier includes a health insurance company authorized             


13  to do business in this state, a nonprofit health care                       


14  corporation, a health maintenance organization, a multiple                  


15  employer welfare arrangement, or any other person providing a               


16  plan of health benefits, coverage, or insurance subject to state            


17  insurance regulation.                                                       


18      (d) "COBRA" means the consolidated omnibus budget                           


19  reconciliation act of 1985, Public Law 99-272, 100 Stat. 82.                


20      (e) "Creditable coverage" means, with respect to an                         


21  individual, health benefits, coverage, or insurance provided                


22  under any of the following:                                                 


23                                                                               (i) A group health plan.                                                            


24      (ii) A health benefit plan.                                                  


25      (iii) Part A or part B of title XVIII of the social security                 


26  act, chapter 531, 49 Stat. 620, 42 U.S.C. 1395c to 1395i and                


27  1395i-2 to 1395i-5, and 42 U.S.C. 1395j to 1395t, 1395u to 1395w,           


1   and 1395w-2 to 1395w-4.                                                     


2       (iv) Title XIX of the social security act, chapter 531, 49                   


3   Stat. 620, 42 U.S.C. 1396 to 1396r-6 and 1396r-8 to 1396v, other            


4   than coverage consisting solely of benefits under section 1929 of           


5   title XIX of the social security act, 42 U.S.C. 1396t.                      


6       (v) Chapter 55 of title 10 of the United States Code, 10                    


7   U.S.C. 1071 to 1110.  For purposes of chapter 55 of title 10 of             


8   the United States Code, 10 U.S.C. 1071 to 1110, "uniformed                  


9   services" means the armed forces and the commissioned corps of              


10  the national oceanic and atmospheric administration and of the              


11  public health service.                                                      


12      (vi) A medical care program of the Indian health service or                  


13  of a tribal organization.                                                   


14      (vii) A state health benefits risk pool.                                     


15      (viii) A health plan offered under the employees health                       


16  benefits program, chapter 89 of title 5 of the United States                


17  Code, 5 U.S.C. 8901 to 8914.                                                


18      (ix) A public health plan, which for purposes of this chapter               


19  means a plan established or maintained by a state, county, or               


20  other political subdivision of a state that provides health                 


21  insurance coverage to individuals enrolled in the plan.                     


22      (x) A health benefit plan under section 5(e) of title I of                  


23  the peace corps act, Public Law 87-293, 22 U.S.C. 2504.                     


24      (f) "Eligible employee" means an employee who works on a                    


25  full-time basis with a normal workweek of 30 or more hours.                 


26  Eligible employee includes an employee who works on a full-time             


27  basis with a normal workweek of 17.5 to 30 hours, if an employer            


1   so chooses and if this eligibility criterion is applied uniformly           


2   among all of the employer's employees and without regard to                 


3   health status-related factors.                                              


4       (g) "Geographic area" means an area in this state that                      


5   includes not less than 1 entire county, established by a carrier            


6   pursuant to section 3705 and used for adjusting rates for a                 


7   health benefit plan subject to this chapter.                                


8       (h) "Group health plan" means an employee welfare benefit                   


9   plan as defined in section 3(1) of subtitle A of title I of the             


10  employee retirement income security act of 1974, Public Law                 


11  93-406, 29 U.S.C. 1002, to the extent that the plan provides                


12  medical care, including items and services paid for as medical              


13  care to employees or their dependents as defined under the terms            


14  of the plan directly or through insurance, reimbursement, or                


15  otherwise.  As used in this chapter, all of the following apply             


16  to the term group health plan:                                              


17                                                                               (i) Any plan, fund, or program that would not be, but for                           


18  section 2721(e) of subpart 4 of part A of title XXVII of the                


19  public health service act, chapter 373, 110 Stat. 1967, 42                  


20  U.S.C. 300gg-21, an employee welfare benefit plan and that is               


21  established or maintained by a partnership, to the extent that              


22  the plan, fund, or program provides medical care, including items           


23  and services paid for as medical care, to present or former                 


24  partners in the partnership, or to their dependents, as defined             


25  under the terms of the plan, fund, or program, directly or                  


26  through insurance, reimbursement or otherwise, shall be treated,            


27  subject to subparagraph (ii), as an employee welfare benefit plan            


1   that is a group health plan.                                                


2       (ii) The term "employer" also includes the partnership in                    


3   relation to any partner.                                                    


4       (iii) The term "participant" also includes an individual who                 


5   is, or may become, eligible to receive a benefit under the plan,            


6   or the individual's beneficiary who is, or may become, eligible             


7   to receive a benefit under the plan.  For a group health plan               


8   maintained by a partnership, the individual is a partner in                 


9   relation to the partnership and for a group health plan                     


10  maintained by a self-employed individual, under which 1 or more             


11  employees are participants, the individual is the self-employed             


12  individual.                                                                 


13      (i) "Health benefit plan" or "plan" means an expense-incurred               


14  hospital, medical, or surgical policy or certificate, nonprofit             


15  health care corporation certificate, or health maintenance                  


16  organization contract.  Health benefit plan does not include                


17  accident-only, credit, dental, or disability income insurance;              


18  coverage issued as a supplement to liability insurance; worker's            


19  compensation or similar insurance; or automobile medical-payment            


20  insurance.                                                                  


21      (j) "Index rate" means the arithmetic average of the premium                


22  rates in each health benefit plan available in a geographic area            


23  during a rating period for each small employer carrier.                     


24      (k) "Nonprofit health care corporation" means a nonprofit                   


25  health care corporation operating pursuant to the nonprofit                 


26  health care corporation reform act, 1980 PA 350, MCL 550.1101 to            


27  550.1704.                                                                   


1                                                                                (l) "Premium" means all money paid by a small employer, a                           


2   sole proprietor, eligible employees, or eligible persons as a               


3   condition of receiving coverage from a small employer carrier,              


4   including any fees or other contributions associated with the               


5   health benefit plan.                                                        


6       (m) "Rating period" means the calendar period for which                     


7   premium rates established by a small employer carrier are assumed           


8   to be in effect, as determined by the small employer carrier.               


9       (n) "Small employer" means any person, firm, corporation,                   


10  partnership, limited liability company, or association actively             


11  engaged in business who, on at least 50% of its working days                


12  during the preceding calendar year, employed at least 2 but not             


13  more than 50 eligible employees.  In determining the number of              


14  eligible employees, companies that are affiliated companies or              


15  that are eligible to file a combined tax return for state                   


16  taxation purposes shall be considered 1 employer.                           


17      (o) "Small employer carrier" means either of the following:                 


18                                                                               (i) A carrier that offers health benefit plans covering the                         


19  employees of a small employer.                                              


20      (ii) A carrier under section 3703(3).                                        


21      (p) "Sole proprietor" means an individual who is a sole                     


22  proprietor or sole shareholder in a trade or business through               


23  which he or she earns at least 50% or his or her taxable income             


24  and for which he or she has filed the appropriate internal                  


25  revenue service form 1040, schedule C or F, for the previous                


26  taxable year; who is a resident of this state; and who is                   


27  actively employed in the operation of the business, working at              


1   least 30 hours per week in at least 40 weeks out of the calendar            


2   year.                                                                       


3       (q) "Waiting period" means, with respect to a health benefit                


4   plan and an individual who is a potential enrollee in the plan,             


5   the period that must pass with respect to the individual before             


6   the individual is eligible to be covered for benefits under the             


7   terms of the plan.  For purposes of calculating periods of                  


8   creditable coverage pursuant to section 3707, a waiting period              


9   shall not be considered a gap in coverage.                                  


10      Sec. 3703.  (1) Except as provided in subsection (2), this                  


11  chapter applies to any health benefit plan that provides coverage           


12  to 2 or more employees of a small employer.                                 


13      (2) This chapter does not apply to individual health                        


14  insurance policies that are subject to policy form and premium              


15  rate approval by the commissioner.                                          


16      Sec. 3705.  (1) For adjusting rates for health benefit plans                


17  subject to this chapter, a carrier may establish up to 10                   


18  geographic areas in this state.  A nonprofit health care                    


19  corporation shall establish geographic areas that cover all                 


20  counties in this state.                                                     


21      (2) Premium rates for a health benefit plan under this                      


22  chapter are subject to rate and form filing with the                        


23  commissioner.                                                               


24      (3) Beginning 1 year after the effective date of this                       


25  chapter, if a small employer had been self-insured for health               


26  benefits immediately preceding application for a health benefit             


27  plan subject to this chapter, a carrier may charge an additional            


1   premium of up to 50% above the premium rate filed under                     


2   subsection (2) for no more than 2 years.                                    


3       (4) Except as provided in subsection (5), a carrier shall not               


4   apply characteristics to an individual in a small employer group            


5   that would result in 1 or more employees being charged a higher             


6   premium than another employee.                                              


7       (5) Health benefit plan options, number of family members,                  


8   and medicare eligibility may be used in establishing a small                


9   employer's or sole proprietor's premium.                                    


10      (6) A small employer carrier shall apply all rating factors                 


11  consistently with respect to all small employers and sole                   


12  proprietors in a geographic area and shall bill a small employer            


13  group only with a composite rate.                                           


14      Sec. 3706.  (1) A small employer carrier may apply an open                  


15  enrollment period for sole proprietors.  If a small employer                


16  carrier applies an open enrollment period for sole proprietors,             


17  the open enrollment period shall be offered at least annually and           


18  shall be at least 1 month long.                                             


19      (2) A small employer carrier is not required to offer or                    


20  provide to a sole proprietor all health benefit plans available             


21  to small employers who are not sole proprietors.                            


22      (3) A small employer carrier may exclude or limit coverage                  


23  for a sole proprietor for a condition only if the exclusion or              


24  limitation relates to a condition for which medical advice,                 


25  diagnosis, care, or treatment was recommended or received within            


26  6 months before enrollment and the exclusion or limitation does             


27  not extend for more than 6 months after the effective date of the           


1   health benefit plan.                                                        


2       (4) A small employer carrier shall not impose a preexisting                 


3   condition exclusion for a sole proprietor that relates to                   


4   pregnancy as a preexisting condition or with regard to a child              


5   who is covered under any creditable coverage within 30 days of              


6   birth, adoption, or placement for adoption, provided that the               


7   child does not experience a significant break in coverage and               


8   provided that the child was adopted or placed for adoption before           


9   attaining 18 years of age.  A period of creditable coverage under           


10  this subsection shall not be counted for enrollment of an                   


11  individual under a health benefit plan if, after this period and            


12  before the enrollment date, there was a 90-day period during all            


13  of which the individual was not covered under any creditable                


14  coverage.                                                                   


15      Sec. 3707.  (1) As a condition of transacting business in                   


16  this state with small employers, every small employer carrier               


17  shall actively offer to small employers all health benefit plans            


18  it actively markets to small employers in this state.  A small              


19  employer carrier shall be considered to be actively marketing a             


20  health benefit plan if it offers that plan to a small employer              


21  not currently receiving a health benefit plan from that small               


22  employer carrier.  A small employer carrier shall issue any                 


23  health benefit plan to any small employer that applies for the              


24  plan and agrees to make the required premium payments and to                


25  satisfy the other reasonable provisions of the health benefit               


26  plan not inconsistent with this chapter.  A small employer                  


27  carrier shall not offer or sell to small employers a health                 


1   benefit plan that excludes or limits coverage for a preexisting             


2   condition.                                                                  


3       (2) If applied uniformly to all employees of the small                      


4   employer and without regard to any health-status-related factor,            


5   a small employer carrier may impose for health benefit plans                


6   offered to all small employers an affiliation period that does              


7   not exceed 60 days for new entrants and does not exceed 90 days             


8   for late enrollees and for which the carrier charges no premiums            


9   and the coverage issued is not effective.                                   


10      (3) A small employer carrier shall not offer or sell to small               


11  employers a health benefit plan that contains a waiting period              


12  applicable to new enrollees or late enrollees.                              


13      Sec. 3708.  (1) A health benefit plan offered to a small                    


14  employer by a small employer carrier shall provide for the                  


15  acceptance of late enrollees subject to this chapter.                       


16      (2) A small employer carrier shall permit an employee or a                  


17  dependent of the employee, who is eligible, but not enrolled, to            


18  enroll for coverage under the terms of the small employer health            


19  benefit plan during a special enrollment period if all of the               


20  following apply:                                                            


21      (a) The employee or dependent was covered under a group                     


22  health plan or had coverage under a health benefit plan at the              


23  time coverage was previously offered to the employee or                     


24  dependent.                                                                  


25      (b) The employee stated in writing at the time coverage was                 


26  previously offered that coverage under a group health plan or               


27  other health benefit plan was the reason for declining                      


1   enrollment, but only if the small employer or carrier, if                   


2   applicable, required such a statement at the time coverage was              


3   previously offered and provided notice to the employee of the               


4   requirement and the consequences of the requirement at that                 


5   time.                                                                       


6       (c) The employee's or dependent's coverage described in                     


7   subdivision (a) was either under a COBRA continuation provision             


8   and that coverage has been exhausted or was not under a COBRA               


9   continuation provision and that other coverage has been                     


10  terminated as a result of loss of eligibility for coverage,                 


11  including because of a legal separation, divorce, death,                    


12  termination of employment, or reduction in the number of hours of           


13  employment or employer contributions toward that other coverage             


14  have been terminated.  In either case, under the terms of the               


15  health benefit plan, the employee must request enrollment not               


16  later than 30 days after the date of exhaustion of coverage or              


17  termination of coverage or employer contribution.  If an employee           


18  requests enrollment pursuant to this subdivision, the enrollment            


19  is effective not later than the first day of the first calendar             


20  month beginning after the date the completed request for                    


21  enrollment is received.                                                     


22      (3) A small employer carrier that makes dependent coverage                  


23  available under a health benefit plan shall provide for a                   


24  dependent special enrollment period during which the person may             


25  be enrolled under the health benefit plan as a dependent of the             


26  individual or, if not otherwise enrolled, the individual may be             


27  enrolled under the health benefit plan.  For a birth or adoption            


1   of a child, the spouse of the individual may be enrolled as a               


2   dependent of the individual if the spouse is otherwise eligible             


3   for coverage.  This subsection applies only if both of the                  


4   following occur:                                                            


5       (a) The individual is a participant under the health benefit                


6   plan or has met any affiliation period applicable to becoming a             


7   participant under the plan and is eligible to be enrolled under             


8   the plan, but for a failure to enroll during a previous                     


9   enrollment period.                                                          


10      (b) The person becomes a dependent of the individual through                


11  marriage, birth, or adoption or placement for adoption.                     


12      (4) The dependent special enrollment period under subsection                


13  (3) for individuals shall be a period of not less than 30 days              


14  and begins on the later of the date dependent coverage is made              


15  available or the date of the marriage, birth, or adoption or                


16  placement for adoption.  If an individual seeks to enroll a                 


17  dependent during the first 30 days of the dependent special                 


18  enrollment period under subsection (3), the coverage of the                 


19  dependent shall be effective as follows:                                    


20      (a) For marriage, not later than the first day of the first                 


21  month beginning after the date the completed request for                    


22  enrollment is received.                                                     


23      (b) For a dependent's birth, as of the date of birth.                       


24      (c) For a dependent's adoption or placement for adoption, the               


25  date of the adoption or placement for adoption.                             


26      Sec. 3709.  (1) Except as provided in this section,                         


27  requirements used by a small employer carrier in determining                


1   whether to provide coverage to a small employer shall be applied            


2   uniformly among all small employers applying for coverage or                


3   receiving coverage from the small employer carrier.                         


4       (2) A small employer carrier may deny coverage to a small                   


5   employer if the small employer fails to enroll enough of its                


6   employees to meet the minimum participation rules established by            


7   the carrier pursuant to sound underwriting requirements.                    


8       Sec. 3711.  (1) Except as provided in this section, a small                 


9   employer carrier that offers health coverage in the small                   


10  employer group market in connection with a health benefit plan              


11  shall renew or continue in force that plan at the option of the             


12  small employer or sole proprietor.                                          


13      (2) Guaranteed renewal is not required in cases of:  fraud or               


14  intentional misrepresentation of the small employer or, for                 


15  coverage of an insured individual, fraud or misrepresentation by            


16  the insured individual or the individual's representative; lack             


17  of payment; if the small employer carrier no longer offers that             


18  particular type of coverage in the market; or if the sole                   


19  proprietor or small employer moves outside the geographic area.             


20      Sec. 3712.  (1) If a small employer carrier decides to                      


21  discontinue offering all health benefit plans in a geographic               


22  area, all of the following apply:                                           


23      (a) The small employer carrier shall provide notice to the                  


24  commissioner and to each small employer covered by the small                


25  employer carrier in the geographic area of the discontinuation at           


26  least 180 days prior to the date of the discontinuation of the              


27  coverage.                                                                   


1       (b) All health benefit plans issued or delivered for issuance               


2   in the geographic area are discontinued and all current health              


3   benefit plans in the geographic area are not renewed.                       


4       (c) The small employer carrier shall not provide for the                    


5   issuance of any health coverage in the geographic area for a                


6   5-year period beginning on the date of the discontinuation of the           


7   last health coverage not renewed under this subsection.                     


8       (d) The small employer carrier shall not provide for the                    


9   issuance of any health coverage in an area that was not a                   


10  geographic area of the small employer carrier on the date of the            


11  discontinuation of the last health coverage not renewed under               


12  this subsection for a 5-year period beginning on the date of                


13  discontinuation of the last health coverage not renewed under               


14  this subsection.                                                            


15      (2) A nonprofit health care corporation shall not cease to                  


16  renew all health benefit plans in a geographic area.                        


17      Sec. 3713.  Each small employer carrier shall provide all of                


18  the following to a small employer upon request and upon entering            


19  into a contract with the small employer:                                    


20      (a) The extent to which premium rates for a specific small                  


21  employer are established or adjusted due to characteristics of              


22  the employees of a small employer and the employer, if covered.             


23      (b) The provisions concerning the carrier's right to change                 


24  premium rates and the characteristics of the employees of a small           


25  employer and the employer, if covered.                                      


26      (c) The provisions relating to renewability of coverage.                    


27      Sec. 3715.  (1) Each small employer carrier shall maintain                  


1   at its principal place of business a complete and detailed                  


2   description of its rating practices and renewal underwriting                


3   practices, including information and documentation that                     


4   demonstrate that its rating methods and practices are based upon            


5   commonly accepted actuarial assumptions and are in accordance               


6   with sound actuarial principles.                                            


7       (2) Each small employer carrier shall file each March 1 with                


8   the commissioner an actuarial certification that the carrier is             


9   in compliance with this section and that the rating methods of              


10  the carrier are actuarially sound.  A copy of the actuarial                 


11  certification shall be retained by the carrier at its principal             


12  place of business.                                                          


13      (3) A small employer carrier shall make the information and                 


14  documentation described in subsection (1) available to the                  


15  commissioner upon request.                                                  


16      Sec. 3717.  The commissioner may suspend all or any part of                 


17  section 3705 as to the premium rates applicable to 1 or more                


18  small employers for 1 or more rating periods upon a filing by the           


19  small employer carrier and a finding by the commissioner that               


20  either the suspension is reasonable in light of the financial               


21  condition of the carrier or that the suspension would enhance the           


22  efficiency and fairness of the marketplace for small employer               


23  health insurance.                                                           


24      Sec. 3721.  (1) By June 1, 2006 and by each June 1 after                    


25  2006, the commissioner shall make a determination as to whether a           


26  reasonable degree of competition in the small employer carrier              


27  health market exists on a statewide basis.  If the commissioner             


1   determines that a reasonable degree of competition in the small             


2   employer carrier health market does not exist on a statewide                


3   basis, the commissioner shall hold a public hearing and shall               


4   issue a report delineating specific classifications and kinds or            


5   types of insurance, if any, where competition does not exist and            


6   any suggested statutory or other changes necessary to increase or           


7   encourage competition.  The report shall be based on relevant               


8   economic tests, including, but not limited to, those in                     


9   subsection (3).  The findings in the report shall not be based on           


10  any single measure of competition, but appropriate weight shall             


11  be given to all measures of competition.                                    


12      (2) If the results of the report issued under subsection (1)                


13  are disputed or if the commissioner determines that circumstances           


14  that the report was based on have changed, the commissioner shall           


15  issue a supplemental report to the report under subsection (1)              


16  that includes a certification of whether or not a reasonable                


17  degree of competition exists in the small employer carrier health           


18  market.  The supplemental report and certification shall be                 


19  issued not later than December 15 immediately following the                 


20  release of the report under subsection (1) that this report                 


21  supplements and shall be supported by substantial evidence.                 


22      (3) All of the following shall be considered by the                         


23  commissioner for purposes of subsections (1) and (2):                       


24      (a) The extent to which any carrier controls all or a                       


25  portion of the small employer carrier health market.                        


26      (b) Whether the total number of small employer carriers                     


27  writing small employer carrier health coverage in this state is             


1   sufficient to provide multiple options to employers.                        


2       (c) The disparity among small employer carrier rates and                    


3   classifications to the extent that those classifications result             


4   in rate differentials.                                                      


5       (d) The availability of small employer carrier health                       


6   coverage to employers in all geographic areas and all types of              


7   business.                                                                   


8       (e) The residual market share.                                              


9       (f) The overall rate level that is not excessive,                           


10  inadequate, or unfairly discriminatory.                                     


11      (g) Any other factors the commissioner considers relevant.                  


12      (4) The reports and certifications required under                           


13  subsections (1) and (2) shall be forwarded to the governor, the             


14  clerk of the house, the secretary of the senate, and all the                


15  members of the senate and house of representatives standing                 


16  committees on insurance and health issues.                                  


17      Enacting section 1.  This amendatory act does not take                      


18  effect unless House Bill No. 4279 of the 92nd Legislature is                


19  enacted into law.