HOUSE BILL No. 5135


     September 30, 1997, Introduced by Rep. Crissman 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 3406j.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 1         SEC. 3406J.  (1) AN EXPENSE-INCURRED HOSPITAL, MEDICAL, OR

 2    SURGICAL POLICY OR CERTIFICATE DELIVERED, ISSUED FOR DELIVERY, OR

 3    RENEWED IN THIS STATE THAT PROVIDES COVERAGE FOR EMERGENCY HEALTH

 4    SERVICES SHALL PROVIDE COVERAGE FOR MEDICALLY NECESSARY SERVICES

 5    PROVIDED TO AN INSURED FOR THE SUDDEN ONSET OF A MEDICAL CONDI-

 6    TION THAT MANIFESTS ITSELF BY SIGNS AND SYMPTOMS OF SUFFICIENT

 7    SEVERITY, INCLUDING SEVERE PAIN, SUCH THAT THE ABSENCE OF IMMEDI-

 8    ATE MEDICAL ATTENTION COULD REASONABLY BE EXPECTED TO RESULT IN

 9    SERIOUS JEOPARDY TO THE INDIVIDUAL'S HEALTH OR TO A PREGNANCY IN

10    THE CASE OF A PREGNANT WOMAN, SERIOUS IMPAIRMENT TO BODILY

11    FUNCTIONS, OR SERIOUS DYSFUNCTION OF ANY BODILY ORGAN OR PART.


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 1    AN INSURER SHALL NOT DENY PAYMENT FOR EMERGENCY HEALTH SERVICES

 2    UP TO THE POINT OF STABILIZATION PROVIDED TO AN INSURED UNDER

 3    THIS SUBSECTION BECAUSE OF EITHER OF THE FOLLOWING:

 4         (A) THE FINAL DIAGNOSIS.

 5         (B) PRIOR AUTHORIZATION WAS NOT GIVEN BY THE INSURER BEFORE

 6    EMERGENCY HEALTH SERVICES WERE PROVIDED.

 7         (2) AS USED IN THIS SECTION, "STABILIZATION" MEANS THE POINT

 8    AT WHICH NO MATERIAL DETERIORATION OF A CONDITION IS LIKELY,

 9    WITHIN REASONABLE MEDICAL PROBABILITY, TO RESULT FROM OR OCCUR

10    DURING TRANSFER OF THE PATIENT.




































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