Bill Text: MI SB0992 | 2013-2014 | 97th Legislature | Introduced
Bill Title: Insurance; health benefits; creditable coverage applicable to purchasing medicare supplement policies; include medicare advantage policies. Amends secs. 3801 & 3833 of 1956 PA 218 (MCL 500.3801 & 500.3833).
Spectrum: Partisan Bill (Republican 6-0)
Status: (Introduced - Dead) 2014-06-12 - Referred To Committee On Insurance [SB0992 Detail]
Download: Michigan-2013-SB0992-Introduced.html
SENATE BILL No. 992
June 12, 2014, Introduced by Senators MARLEAU, JONES, GREEN, KAHN, BOOHER and NOFS and referred to the Committee on Insurance.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending sections 3801 and 3833 (MCL 500.3801 and 500.3833),
section 3801 as amended by 2009 PA 220 and section 3833 as added by
1992 PA 84.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3801. As used in this chapter:
(a) "Applicant" means:
(i) For an individual medicare supplement policy, the person
who seeks to contract for benefits.
(ii) For a group medicare supplement policy or certificate, the
proposed certificate holder.
(b)
"Bankruptcy" means when that a medicare advantage
organization that is not an insurer has filed, or has had filed
against it, a petition for declaration of bankruptcy and has ceased
doing business in this state.
(c) "Certificate" means any certificate delivered or issued
for delivery in this state under a group medicare supplement
policy.
(d) "Certificate form" means the form on which the certificate
is delivered or issued for delivery by the insurer.
(e) "Continuous period of creditable coverage" means the
period during which an individual was covered by creditable
coverage, if during the period of the coverage the individual had
no breaks in coverage greater than 63 days.
(f) "Creditable coverage" means coverage of an individual
provided under any of the following:
(i) A group health plan.
(ii) Health insurance coverage.
(iii) Part A or part B of medicare.
(iv) Medicaid other than coverage consisting solely of benefits
under
section 1928 of medicaid, 42 USC 1396s.
(v) Chapter 55 of title 10 of the United States
Code, Medical
and
dental care under 10 USC 1071 to 1110.1110b.
(vi) A medical care program of the Indian health service or of
a tribal organization.
(vii) A state health benefits risk pool.
(viii) A health plan offered under chapter 89 of title
5 of the
United
States Code, 5 USC 8901 to 8914.
(ix) A public health plan as defined in federal regulation.
(x) Health care under section 5(e) of title I of
the peace
corps
act, 22 USC 2504.
(xi) Medicare advantage.
(g) "Direct response solicitation" means solicitation in which
an insurer representative does not contact the applicant in person
and explain the coverage available, such as, but not limited to,
solicitation through direct mail or through advertisements in
periodicals and other media.
(h)
"Employee welfare benefit plan" means a plan, fund, or
program
of employee benefits that
term as defined in section 3 of
subtitle
A of title I of the employee retirement income security
act
of 1974, 29 USC 1002.
(i)
"Insolvency" means when that an insurer licensed to
transact the business of insurance in this state has had a final
order of liquidation entered against it with a finding of
insolvency by a court of competent jurisdiction in the insurer's
state of domicile.
(j)
"Insurer" includes any entity
, including a health care
corporation
operating pursuant to the nonprofit health care
corporation
reform act, 1980 PA 350, MCL 550.1101 to 550.1704,
delivering or issuing for delivery in this state medicare
supplement policies.
(k) "Medicaid" means title XIX of the social security act, 42
USC
1396 to 1396v.1396w-5.
(l) "Medicare" means title XVIII of the social security act, 42
USC
1395 to 1395hhh.1395kkk.
(m) "Medicare advantage" means a plan of coverage for health
benefits
under medicare part C as defined described in section 12-
2859
of part C of medicare, 42 USC
1395w-28, and includes any of
the following:
(i) Coordinated care plans that provide health care services,
including, but not limited to, health maintenance organization
plans with or without a point-of-service option, plans offered by
provider-sponsored organizations, and preferred provider
organization plans.
(ii) Medical savings account plans coupled with a contribution
into a medicare advantage medical savings account.
(iii) Medicare advantage private fee-for-service plans.
(n) "Medicare supplement buyer's guide" means the document
entitled, "guide to health insurance for people with medicare",
developed by the national association of insurance commissioners
and the United States department of health and human services or a
substantially similar document as approved by the commissioner.
(o) "Medicare supplement policy" means an individual,
nongroup, or group policy or certificate that is advertised,
marketed, or designed primarily as a supplement to reimbursements
under medicare for the hospital, medical, or surgical expenses of
persons eligible for medicare and medicare select policies and
certificates under section 3817. Medicare supplement policy does
not include a policy, certificate, or contract of 1 or more
employers or labor organizations, or of the trustees of a fund
established by 1 or more employers or labor organizations, or both,
for employees or former employees, or both, or for members or
former members, or both, of the labor organizations. Medicare
supplement
policy does not include medicare advantage, plans
established
under medicare part C, outpatient
prescription drug
plans established under medicare part D, or any health care
prepayment plan that provides benefits pursuant to an agreement
under section 1833(a)(1)(A) of the social security act, 42 USC
1395l.
(p) "PACE" means a program of all-inclusive care for the
elderly
as described in the social security act.42 USC 1396u-4.
(q) "Prestandardized medicare supplement benefit plan",
"prestandardized benefit plan", or "prestandardized plan" means a
group or individual policy of medicare supplement insurance issued
prior
to before June 2, 1992.
(r) "1990 standardized medicare supplement benefit plan",
"1990 standardized benefit plan", or "1990 plan" means a group or
individual policy of medicare supplement insurance issued on or
after
June 2, 1992 with an effective date for coverage prior to
before June 1, 2010 and includes medicare supplement insurance
policies
and certificates renewed on or after that date which that
are not replaced by the issuer at the request of the insured.
(s) "2010 standardized medicare supplement benefit plan",
"2010 standardized benefit plan", or "2010 plan" means a group or
individual policy of medicare supplement insurance with an
effective date for coverage on or after June 1, 2010.
(t) "Policy form" means the form on which the policy or
certificate is delivered or issued for delivery by the insurer.
(u) "Secretary" means the secretary of the United States
department of health and human services.
(v) "Social security act" means the social security act, 42
USC
301 to 1397jj.1397mm.
Sec.
3833. (1) If a medicare supplement policy or certificate
replaces
another medicare supplement policy, certificate, or
contract,
the replacing insurer shall waive
any time periods
applicable to preexisting conditions, waiting periods, elimination
periods, and probationary periods in the new medicare supplement
policy
for similar benefits to the extent such the time was spent
under the original coverage.
(2) If a medicare supplement policy replaces a medicare
advantage policy, the replacing insurer shall waive any time
periods applicable to preexisting conditions, waiting periods,
elimination periods, and probationary periods in the new medicare
supplement policy for similar benefits to the extent the time was
spent under the coverage provided by the medicare advantage policy.
