HOUSE BILL No. 5244


     October 8, 1997, Introduced by Rep. Gustafson and referred to the Committee on Insurance.


        A bill to amend 1978 PA 368, entitled

   "Public health code,"

   (MCL 333.1101 to 333.25211) by adding sections 21053d and

   21053e.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 1         SEC. 21053D.  (1) EFFECTIVE JANUARY 1, 1998, A HEALTH MAIN-

 2    TENANCE ORGANIZATION GROUP OR INDIVIDUAL CONTRACT THAT OFFERS

 3    DEPENDENT COVERAGE SHALL PROVIDE OR OFFER TO PROVIDE THAT THE

 4    DEPENDENT COVERAGE APPLICABLE TO CHILDREN INCLUDE COVERAGE FOR

 5    VACCINES TO IMMUNIZE AGAINST THE DISEASES OR INFECTIONS LISTED IN

 6    SUBSECTION (2) AND SHALL PROVIDE OR OFFER TO PROVIDE FOR COVERAGE

 7    FOR THEIR ADMINISTRATION FROM THE MOMENT OF BIRTH OR PLACEMENT

 8    FOR ADOPTION THROUGH THE AGE OF 7 YEARS.






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 1         (2) COVERAGE UNDER SUBSECTION (1) APPLIES TO VACCINATIONS TO

 2    IMMUNIZE CHILDREN AGAINST EACH OF THE FOLLOWING DISEASES OR

 3    INFECTIONS:

 4         (A) DIPHTHERIA.

 5         (B) HAEMOPHILUS INFLUENZAE TYPE B.

 6         (C) HEPATITIS B.

 7         (D) MEASLES.

 8         (E) MUMPS.

 9         (F) PERTUSSIS.

10         (G) POLIO.

11         (H) RUBELLA.

12         (I) TETANUS.

13         (J) VARICELLA.

14         (3) COVERAGE UNDER SUBSECTION (1) IS NOT SUBJECT TO ANY

15    COPAYMENTS, COINSURANCE PROVISIONS, DEDUCTIBLES, OR DOLLAR

16    LIMITS, AND THIS EXEMPTION SHALL BE EXPLICITLY PROVIDED FOR IN

17    THE CONTRACT.

18         SEC. 21053E.  (1) EFFECTIVE JANUARY 1, 1998, A HEALTH MAIN-

19    TENANCE ORGANIZATION GROUP OR INDIVIDUAL CONTRACT THAT OFFERS

20    DEPENDENT COVERAGE SHALL PROVIDE OR OFFER TO PROVIDE THAT THE

21    DEPENDENT COVERAGE APPLICABLE TO CHILDREN INCLUDE COVERAGE FOR

22    WELL-CHILD EXAMINATIONS FROM THE MOMENT OF BIRTH UNTIL 18 YEARS

23    OF AGE OR GRADUATION FROM HIGH SCHOOL, WHICHEVER COMES LATER.

24    EACH SUCH CONTRACT SHALL PROVIDE COVERAGE, AT A MINIMUM, FOR

25    WELL-CHILD EXAMINATIONS AT APPROXIMATELY THE FOLLOWING AGE

26    INTERVALS:  FIRST WEEK, 1 MONTH, 2 MONTHS, 4 MONTHS, 6 MONTHS, 9

27    MONTHS, 12 MONTHS, 15 MONTHS, 18 MONTHS, 24 MONTHS, 3 YEARS, 4



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 1    YEARS, 5 YEARS, 6 YEARS, 7 YEARS, 8 YEARS, 10 YEARS, 12 YEARS, 14

 2    YEARS, 16 YEARS, AND 18 YEARS OR GRADUATION FROM HIGH SCHOOL,

 3    WHICHEVER COMES LATER.  A CONTRACT MAY PROVIDE THAT WELL-CHILD

 4    EXAMINATIONS THAT ARE RENDERED DURING A PERIODIC REVIEW ARE ONLY

 5    COVERED TO THE EXTENT THAT THOSE SERVICES ARE PROVIDED BY OR

 6    UNDER THE SUPERVISION OF A SINGLE PHYSICIAN DURING THE COURSE OF

 7    1 VISIT.

 8         (2) AS USED IN THIS SECTION, "WELL-CHILD EXAMINATIONS" MEANS

 9    THE PERIODIC REVIEW OF A CHILD'S MEDICAL STATUS BY A PHYSICIAN OR

10    PURSUANT TO A PHYSICIAN'S SUPERVISION.  A REVIEW INCLUDES A HIS-

11    TORY, COMPLETE PHYSICAL EXAMINATION, GROWTH AND DEVELOPMENT

12    ASSESSMENT, DIET AND NUTRITION GUIDANCE, APPROPRIATE IMMUNIZA-

13    TIONS, AND LABORATORY TESTS IN KEEPING WITH PREVAILING MEDICAL

14    STANDARDS.

15         (3) COVERAGE UNDER SUBSECTION (1) IS NOT SUBJECT TO ANY

16    COPAYMENTS, COINSURANCE PROVISIONS, DEDUCTIBLE, OR DOLLAR LIMITS,

17    AND THIS EXEMPTION SHALL BE EXPLICITLY PROVIDED FOR IN THE

18    CONTRACT.





















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