HOUSE BILL No. 5007


     July 10, 2001, Introduced by Reps. Sanborn and Caul and referred to the Committee on Insurance and Financial Services.


        A bill to amend 1956 PA 218, entitled

   "The insurance code of 1956,"

   by amending section 3406m (MCL 500.3406m), as added by 1998

   PA 402.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 1
           Sec. 3406m.  (1) An insurer that delivers, issues for deliv-

 2
      ery, or renews in this state an expense-incurred hospital, medi-

 3
      cal, or surgical policy or certificate that requires an insured

 4
      to designate a participating primary care provider and provides

 5
      for annual well-woman examinations and routine obstetrical and

 6
      gynecologic services AND A HEALTH MAINTENANCE ORGANIZATION shall

 7
      permit a female insured OR ENROLLEE to access an

 8
      obstetrician-gynecologist for annual well-woman examinations and

 9
      routine obstetrical and gynecologic services.




   02854'01                                                 DKH                                   2

 1
           (2) An insurer AND A HEALTH MAINTENANCE ORGANIZATION shall

 2
      not require prior authorization or referral for access under

 3
      subsection (1) to an obstetrician-gynecologist who is participat-

 4
      ing OR AFFILIATED with the insurer OR HEALTH MAINTENANCE

 5
      ORGANIZATION.  An insurer OR HEALTH MAINTENANCE ORGANIZATION may

 6
      require prior authorization or referral for access to a nonpar-

 7
      ticipating OR NONAFFILIATED obstetrician-gynecologist.

 8
           (3) IF AN OBSTETRICIAN-GYNECOLOGIST REFERS AN INSURED OR

 9
      ENROLLEE TO ANOTHER OBSTETRICIAN-GYNECOLOGIST FOR

10
      OBSTETRICAL-GYNECOLOGIC SERVICES OR TO A PERINATALOGIST OR OTHER

11
      PROVIDER OF PRENATAL CARE FOR PRENATAL CARE DURING A PREGNANCY,

12
      THE INSURER OR HEALTH MAINTENANCE ORGANIZATION SHALL NOT REQUIRE

13
      THAT THE REFERRAL MUST COME FROM THE INSURED'S OR ENROLLEE'S PRI-

14
      MARY CARE PROVIDER IF BOTH OF THE FOLLOWING APPLY:

15
           (A) THE REFERRING OBSTETRICIAN-GYNECOLOGIST PARTICIPATES OR

16
      IS AFFILIATED WITH THE INSURER OR HEALTH MAINTENANCE

17
      ORGANIZATION.

18
           (B) THE REFERRED OBSTETRICIAN-GYNECOLOGIST OR PERINATALO-

19
      GIST, OR OTHER PROVIDER OF PRENATAL CARE PARTICIPATES OR IS

20
      AFFILIATED WITH THE INSURER OR HEALTH MAINTENANCE ORGANIZATION.

21
           (4)  (3)  A description of the coverage provided by this

22
      section shall be included by the insurer AND HEALTH MAINTENANCE

23
      ORGANIZATION in a communication sent to the insured OR ENROLLEE

24
      or group purchaser of coverage.









   02854'01          Final page.                            DKH