Bill Text: MI HB5840 | 2009-2010 | 95th Legislature | Introduced

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Bill Title: Insurance; dental care corporations; fee setting for noncovered dental services; prohibit in certain circumstances. Amends 1963 PA 125 (MCL 550.351 - 550.373) by adding sec. 15a.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Introduced - Dead) 2010-02-18 - Printed Bill Filed 02/18/2010 [HB5840 Detail]

Download: Michigan-2009-HB5840-Introduced.html

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HOUSE BILL No. 5840

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

 

     A bill to amend 1963 PA 125, entitled

 

"An act to provide for the incorporation, supervision, and

regulation of nonprofit dental care corporations; to prescribe the

functions of the commissioner of insurance as to such corporations;

to provide for the imposition of a regulatory fee; and to prescribe

penalties for violations of this act,"

 

(MCL 550.351 to 550.373) by adding section 15a.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 15a. (1) A dental care corporation shall not require that

 

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

 

dental care corporation, except for covered services provided to a

 

covered subscriber under the subscriber agreement.

 

     (2) A dental 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

 

dental care corporation 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 dental care

 

corporation contract and with a cost higher than the amount the

 

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 the contract reimbursement

 

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 dental 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 contract

 

entered into after the date this amendatory act is enacted into

 

law. For a contract in effect on or before the date this amendatory

 

act is enacted in law, this amendatory act applies on the date the

 

contract is next extended, renewed, or modified in any manner.