HB-4660, As Passed Senate, April 19, 2016
June 2, 2015, Introduced by Rep. Leonard and referred to the Committee on Insurance.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending section 3515 (MCL 500.3515), as amended by 2005 PA 306.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3515. (1) A health maintenance organization may provide
additional health maintenance services or any other related health
care service or treatment not required under this chapter.
(2) A health maintenance organization may have health
maintenance contracts with deductibles. A health maintenance
organization may have health maintenance contracts that include
copayments, stated as dollar amounts for the cost of covered
services, and coinsurance, stated as percentages for the cost of
covered services. Coinsurance for basic health services, excluding
deductibles, shall not exceed 50% of a health maintenance
organization's reimbursement to an affiliated provider for
providing the service to an enrollee and shall not be based on the
provider's standard charge for the service. This subsection does
not limit the commissioner's authority to regulate and establish
fair, sound, and reasonable copayment and coinsurance limits
including out of pocket maximums.
(3)
By May 15, 2008, and by each May 15 after 2008, the
commissioner
shall make a determination as to whether the greater
copayment
and coinsurance levels allowed by the amendatory act that
added
this subsection have increased the number of employers who
have
contracted for health maintenance organization services and
whether
these levels have increased the number of enrollees
receiving
health maintenance organization services. In making this
determination,
the commissioner shall hold a public hearing by
February
1, 2008, and may hold a public hearing thereafter, shall
seek
the advice and input from appropriate independent sources,
including,
but not limited to, all health maintenance organizations
operating
in this state and with enrollees in this state, and shall
issue
a report delineating specific examples of copayment and
coinsurance
levels in force and suggestions to increase the number
of
persons enrolled in health maintenance organizations.
(4)
If the results of the report issued under subsection (3)
are
disputed or if the commissioner determines that the
circumstances
that the report was based on have changed, the
commissioner
shall issue a supplemental report to the report under
subsection
(3) that includes copies of the written objections
disputing
the commissioner's report determinations or that
specifies
the change of circumstances. The supplemental report
shall
be issued not later than December 15 immediately following
the
release of the report under subsection (3) that this report
supplements
and shall be supported by substantial evidence.
(5)
All of the following shall be considered by the
commissioner
for purposes of subsections (3) and (4):
(a)
Information and data gathered from health maintenance
organizations
regarding the effects of greater copayment and
coinsurance
levels allowed by the amendatory act that added this
subsection.
(b)
Information and data provided by employers who employ
residents
of this state.
(c)
Any other information and data the commissioner considers
relevant.
(6)
The reports and certifications required under subsections
(3)
and (4) shall be forwarded to the governor, the clerk of the
house
of representatives, the secretary of the senate, and all
members
of the senate and house of representatives standing
committees
on insurance and health issues.
(3) (7) A health maintenance organization shall not require
contributions be made to a deductible for preventive health care
services. As used in this subsection, "preventive health care
services" means services designated to maintain an individual in
optimum health and to prevent unnecessary injury, illness, or
disability.
(4) (8) A health maintenance organization may accept from
governmental agencies and from private persons payments covering
any part of the cost of health maintenance contracts.
Enacting section 1. This amendatory act takes effect 90 days
after the date it is enacted into law.