HOUSE BILL No. 5132

 

October 27, 2011, Introduced by Reps. Haines, Tyler and Knollenberg and referred to the Committee on Health Policy.

 

     A bill to amend 1956 PA 218, entitled

 

"The insurance code of 1956,"

 

(MCL 500.100 to 500.8302) by adding section 3406s.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

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

 

surgical policy or certificate delivered, issued for delivery, or

 

renewed in this state and a health maintenance organization group

 

or individual contract that provides coverage for prescribed orally

 

administered cancer medications and intravenously administered or

 

injected cancer medications shall ensure both of the following:

 

     (a) That financial requirements applicable to prescribed

 

orally administered cancer medications are no more restrictive than

 

the financial requirements applied to intravenously administered or

 

injected cancer medications that are covered by the policy,

 


certificate, or contract and that there are no separate cost-

 

sharing requirements that are applicable only to prescribed orally

 

administered cancer medications.

 

     (b) That treatment limitations applicable to prescribed orally

 

administered cancer medications are no more restrictive than the

 

treatment limitations applied to intravenously administered or

 

injected cancer medications that are covered by the policy,

 

certificate, or contract and that there are no separate treatment

 

limitations that are applicable only to prescribed orally

 

administered cancer medications.

 

     (2) An insurer or health maintenance organization cannot

 

achieve compliance with this section by increasing financial

 

requirements or imposing more restrictive treatment limitations on

 

prescribed orally administered cancer medications or intravenously

 

administered or injected cancer medications covered under the

 

policy, certificate, or the contract on the effective date of the

 

amendatory act that added this section.

 

     (3) As used in this section:

 

     (a) "Financial requirement" means deductibles, copayments,

 

coinsurance, out-of-pocket expenses, aggregate lifetime limits, and

 

annual limits.

 

     (b) "Treatment limitation" means limits on the frequency of

 

treatment, days of coverage, or other similar limits on the scope

 

or duration of treatment.