Bill Text: MI HB5839 | 2009-2010 | 95th Legislature | Introduced
Bill Title: Insurance; health; fee setting for noncovered dental services; prohibit in certain circumstances. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406s
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2010-02-18 - Printed Bill Filed 02/18/2010 [HB5839 Detail]
Download: Michigan-2009-HB5839-Introduced.html
HOUSE BILL No. 5839
February 17, 2010, Introduced by Rep. Marleau and referred to the Committee on Insurance.
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 that provides dental coverage and a health
maintenance organization individual or group contract that provides
dental coverage shall not require that services provided by a
dentist be provided at a fee set by the insurer or health
maintenance organization, except for covered services provided to a
covered individual under the policy, certificate, or contract.
(2) An insurer and a health maintenance organization 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
policy, certificate, or contract 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 policy, certificate,
or contract and with a cost higher than the amount the policy,
certificate, or contract 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 reimbursement
under the policy, certificate, or contract and the patient has
agreed to pay the excess to the dentist.
(b) A service subject to a copayment obligation greater than
50%.
(c) A service subject to the satisfaction of a deductible
amount greater than $20.00 per service or any annual or other
deductible amount that the insurer or health maintenance
organization 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 policy,
certificate, or contract entered into after the date this
amendatory act is enacted into law. For a policy, certificate, or
contract in effect on or before the date this amendatory act is
enacted into law, this amendatory act applies on the date the
policy, certificate, or contract is next extended, renewed, or
modified in any manner.
