HOUSE BILL No. 5328


     February 9, 2000, Introduced by Reps. Ruth Johnson, Gieleghem, Birkholz, Vander Roest, Van Woerkom, Faunce, Bovin,
Brater, Voorhees, Martinez, DeWeese, Green, Scranton and Spade and referred to the Committee on Insurance and Financial Services.


        A bill to amend 1980 PA 350, entitled

   "The nonprofit health care corporation reform act,"

   (MCL 550.1101 to 550.1704) by adding section 416c.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

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           SEC. 416C.  (1) A HEALTH CARE CORPORATION SHALL PROVIDE BEN-

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      EFITS IN EACH GROUP AND NONGROUP CERTIFICATE FOR GENERAL ANESTHE-

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      SIA AND ASSOCIATED FACILITY CHARGES FOR DENTAL PROCEDURES

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      RENDERED IN A HOSPITAL OR SURGICAL CARE SETTING IF ALL OF THE

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      FOLLOWING ARE MET:

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           (A) THE CLINICAL STATUS OR UNDERLYING MEDICAL CONDITION OF

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      THE MEMBER PATIENT, AS DETERMINED BY THE MEMBER PATIENT'S PRIMARY

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      CARE PHYSICIAN, PEDIATRICIAN, OR DENTIST, REQUIRES DENTAL PROCE-

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      DURES THAT ORDINARILY WOULD NOT REQUIRE GENERAL ANESTHESIA TO BE

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      RENDERED IN A HOSPITAL OR SURGICAL CARE SETTING.




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           (B) THE MEMBER PATIENT MEETS 1 OR MORE OF THE FOLLOWING:

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           (i) IS UNDER 7 YEARS OF AGE.

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           (ii) IS DEVELOPMENTALLY DISABLED, REGARDLESS OF AGE.

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           (iii) HAS HEALTH THAT IS COMPROMISED AND FOR WHOM GENERAL

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      ANESTHESIA REGARDLESS OF AGE IS MEDICALLY NECESSARY AS DETERMINED

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      BY THE MEMBER PATIENT'S PRIMARY CARE PROVIDER, PEDIATRICIAN, OR

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      DENTIST.

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           (2) A HEALTH CARE CORPORATION MAY REQUIRE PRIOR AUTHORIZA-

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      TION OF GENERAL ANESTHESIA AND ASSOCIATED FACILITY CHARGES FOR

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      DENTAL CARE PROCEDURES IN THE SAME MANNER THAT PRIOR AUTHORIZA-

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      TION IS REQUIRED FOR OTHER COVERED BENEFITS.  COVERAGE FOR ANES-

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      THESIA AND ASSOCIATED FACILITY CHARGES UNDER THIS SECTION IS

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      SUBJECT TO ALL OTHER TERMS AND CONDITIONS OF THE CERTIFICATE THAT

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      APPLY GENERALLY TO OTHER BENEFITS.

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           (3) THIS SECTION DOES NOT REQUIRE A CERTIFICATE TO PROVIDE

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      COVERAGE FOR THE DENTAL PROCEDURE ITSELF, INCLUDING, BUT NOT

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      LIMITED TO, THE DENTIST'S PROFESSIONAL FEE.























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