SB-0283, As Passed Senate, October 4, 2007

 

 

 

 

 

 

 

 

 

 

 

SUBSTITUTE FOR

 

SENATE BILL NO. 283

 

 

 

 

 

 

 

 

     A bill to amend 1956 PA 218, entitled

 

"The insurance code of 1956,"

 

by amending section 3519 (MCL 500.3519), as amended by 2005 PA 306,

 

and by adding sections 2264b and 3406s.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 2264b. (1) Any policy, certificate, or contract

 

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

 

provides for hospital or medical care coverage or reimbursement for

 

hospital or medical care for dependent children shall permit

 

continuation of that coverage for a child until that child attains

 

age 26 even if the child is no longer considered a dependent if the

 

child meets all of the following:

 

     (a) Is unmarried.

 

     (b) Has no dependents of his or her own.

 

     (c) Is a resident of this state or resides somewhere else

 

temporarily.


 

     (d) Is not eligible for a group health benefits or coverage

 

plan from his or her employer.

 

     (e) Is not provided coverage under any other group or

 

individual health benefits or coverage plan.

 

     (f) Has not accepted a financial incentive from his or her

 

employer or other source to decline any other group or individual

 

health benefits or coverage plan.

 

     (g) Was continuously covered prior to the application for

 

continuation coverage under subsection (1) under 1 or more

 

individual or group health benefits or coverage plans with no break

 

in coverage that exceeded 62 days.

 

     (2) A covered person's policy, certificate, or contract may

 

require payment of a premium by the covered person or child,

 

subject to the commissioner's approval, for any period of

 

continuation coverage elected under subsection (1). The premium

 

shall not exceed 102% of the applicable portion of the premium

 

previously paid for that dependent's coverage under the policy,

 

certificate, or contract before the termination of coverage at the

 

specific age provided for in the policy, certificate, or contract.

 

The applicable portion of the premium previously paid for that

 

dependent's coverage shall be determined pursuant to rules adopted

 

by the commissioner under the administrative procedures act of

 

1969, 1969 PA 306, MCL 24.201 to 24.328, based upon the difference

 

between the policy's, certificate's, or contract's rating tiers for

 

adult and dependent coverage or family coverage, as appropriate,

 

and single coverage, or based upon any other formula or dependent

 

rating tier that the commissioner considers appropriate and that


 

provides a substantially similar result.

 

     (3) This section does not prohibit an employer from requiring

 

an employee to pay all or part of the cost of coverage provided for

 

that employee's child under this section.

 

     Sec. 3406s. (1) If the MI-HEART exchange board under the MI-

 

HEART act determines that section 3406a, 3406b, 3406c, 3406d,

 

3406e, 3406m, 3406n, 3406p, 3406q, 3406r, 3425, 3609a, 3613, 3614,

 

3615, 3616, or 3616a should be waived as provided in section 8 of

 

the MI-HEART act, then the sections so identified by the board

 

under the MI-HEART act are not required to be provided or offered

 

in an eligible health coverage plan.

 

     (2) As used in this section:

 

     (a) "Eligible health coverage plan" means that term as defined

 

in section 3 of the MI-HEART act.

 

     (b) "MI-HEART exchange board" means that term as defined in

 

section 3 of the MI-HEART act.

 

     Sec. 3519. (1) A health maintenance organization contract and

 

the contract's rates, including any deductibles, copayments, and

 

coinsurances, between the organization and its subscribers shall be

 

fair, sound, and reasonable in relation to the services provided,

 

and the procedures for offering and terminating contracts shall not

 

be unfairly discriminatory.

 

     (2) A health maintenance organization contract and the

 

contract's rates shall not discriminate on the basis of race,

 

color, creed, national origin, residence within the approved

 

service area of the health maintenance organization, lawful

 

occupation, sex, handicap, or marital status, except that marital


 

status may be used to classify individuals or risks for the purpose

 

of insuring family units. The commissioner may approve a rate

 

differential based on sex, age, residence, disability, marital

 

status, or lawful occupation, if the differential is supported by

 

sound actuarial principles, a reasonable classification system, and

 

is related to the actual and credible loss statistics or reasonably

 

anticipated experience for new coverages. A healthy lifestyle

 

program as defined in section 3517(2) is not subject to the

 

commissioner's approval under this subsection and is not required

 

to be supported by sound actuarial principles, a reasonable

 

classification system, or be related to actual and credible loss

 

statistics or reasonably anticipated experience for new coverages.

 

     (3) All health maintenance organization contracts, except

 

health maintenance organization contracts that are eligible health

 

coverage plans offered through the MI-HEART exchange under the MI-

 

HEART act, shall include, at a minimum, basic health services.

 

     Enacting section 1. This amendatory act does not take effect

 

unless all of the following bills of the 94th Legislature are

 

enacted into law:

 

     (a) Senate Bill No. 278.

 

     (b) Senate Bill No. 280.