Bill Text: MI HB6241 | 2009-2010 | 95th Legislature | Engrossed
Bill Title: Insurance; health care corporations; health benefit plans; prohibit preexisting condition limitations for children and provide for general amendments. Amends sec. 402b of 1980 PA 350 (MCL 550.1402b) & adds sec. 220. TIE BAR WITH: HB 6240'10
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2010-12-01 - Referred To Committee On Health Policy [HB6241 Detail]
Download: Michigan-2009-HB6241-Engrossed.html
HB-6241, As Passed House, November 10, 2010
SUBSTITUTE FOR
HOUSE BILL NO. 6241
A bill to amend 1980 PA 350, entitled
"The nonprofit health care corporation reform act,"
by amending sections 401a and 402b (MCL 550.1401a and 550.1402b),
section 401a as added by 1982 PA 290 and section 402b as amended by
1999 PA 7.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 401a. (1) If a group or nongroup certificate of a health
care corporation provides for health care benefits for a health
care service, those benefits or reimbursement for the provision of
the service shall not be denied because the service was rendered by
a dentist, provided the service was legally performed.
(2) As used in this section, "dentist" means an individual
licensed
under part 166 of Act No. 368 of the Public Acts of 1978,
being
sections 333.16601 to 333.16647 of the Michigan Compiled
Laws.the public health code, 1978 PA 368, MCL
333.16601 to
333.16648.
(3) This section shall apply only with respect to certificates
which
that are issued or renewed on or after the effective
date of
this
section October 7, 1982, and shall apply notwithstanding any
certificate provision to the contrary.
Sec. 402b. (1) For an individual covered under a nongroup
certificate or under a certificate not covered under subsection
(2), a health care corporation may exclude or limit coverage for a
condition only if the exclusion or limitation relates to a
condition for which medical advice, diagnosis, care, or treatment
was recommended or received within 6 months before enrollment and
the exclusion or limitation does not extend for more than 6 months
after
the certificate's effective date. of the certificate.
(2) A health care corporation shall not exclude or limit
coverage for a preexisting condition for an individual covered
under a group certificate.
(3) Notwithstanding subsection (1), a health care corporation
shall not issue a certificate to a person eligible for nongroup
coverage or eligible for a certificate not covered under subsection
(2) that excludes or limits coverage for a preexisting condition or
provides a waiting period if all of the following apply:
(a) The person's most recent health coverage prior to applying
for coverage with the health care corporation was under a group
health plan.
(b) The person was continuously covered prior to the
application for coverage with the health care corporation under 1
or more health plans for an aggregate of at least 18 months with no
break in coverage that exceeded 62 days.
(c) The person is no longer eligible for group coverage and is
not eligible for medicare or medicaid.
(d) The person did not lose eligibility for coverage for
failure to pay any required contribution or for an act to defraud a
health care corporation, a health insurer, or a health maintenance
organization.
(e) If the person was eligible for continuation of health
coverage from that group health plan pursuant to the consolidated
omnibus budget reconciliation act of 1985, Public Law 99-272, 100
Stat. 82, he or she has elected and exhausted that coverage.
(4) As used in this section, "group" means a group of 2 or
more subscribers.
