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.