January 13, 2011, Introduced by Rep. Callton and referred to the Committee on Health Policy.
A bill to amend 1980 PA 350, entitled
"The nonprofit health care corporation reform act,"
(MCL 550.1101 to 550.1704) by adding section 420.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 420. (1) A health care corporation providing a nongroup
or group certificate shall not include a health care service as a
covered health care benefit under the terms and conditions of the
certificate or in any other communication concerning the
certificate if either of the following applies:
(a) The copayment or coinsurance for a health care service
payable by the member is greater than 50% of the cost of the health
care service.
(b) The deductible for a health care service payable by the
member meets either of the following:
(i) Is established in such a way as to provide de minimus
reimbursement for the service by the health care corporation.
(ii) Has an annual or other deductible amount that the insurer
or health care corporation reasonably knows will not be met by at
least 80% of the members.
(2) The commissioner shall investigate and issue a ruling on
all complaints arising under this section.
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
applies on the date the certificate is next extended, renewed, or
modified in any manner.