HOUSE BILL No. 5842

February 17, 2010, Introduced by Rep. Stanley and referred to the Committee on Insurance.

A bill to amend 1980 PA 350, entitled

"The nonprofit health care corporation reform act,"

(MCL 550.1101 to 550.1704) by adding section 401k.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

Sec. 401k. (1) A health care corporation group or nongroup

certificate that provides dental coverage shall not require that

services provided by a dentist be provided at a fee set by the

health care corporation, except for covered services provided to a

covered subscriber under the certificate.

(2) A health care corporation shall not impose a deductible,

copayment, coinsurance, or any other requirement in such a way as

to provide de minimis reimbursement and avoid the impact of this

section. The commissioner shall investigate and issue a ruling on

all complaints arising under this section.

(3) As used in this section, "covered services" means those

health care services for which reimbursement is available under the

health care corporation certificate and those health care services

for which reimbursement is not available due only to an unexpired

waiting period, an annual or lifetime limitation, monetary or

frequency limitation, or other limitation applicable to the

coverage for the service. Covered services do not include any of

the following:

(a) A service selected by the patient requiring the use of

material different than those covered by the health care

corporation certificate and with a cost higher than the amount the

health care corporation certificate would provide for reimbursement

for that service, provided that the dentist has requested the

patient to pay the amount by which the cost of the service exceeds

the health care corporation certificate reimbursement and the

patient has agreed to pay the excess to the dentist.

(b) A service subject to a copayment obligation greater than

50%.

amount greater than $20.00 per service or any annual or other

deductible amount that the health care corporation reasonably knows

will not be met by at least 50% of those subject to the deductible

requirement.

Enacting section 1. This amendatory act applies to a

certificate entered into after the date this amendatory act is

enacted into law. For a certificate in effect on or before the date

this amendatory act is enacted into law, this amendatory act