SENATE BILL NO. 60


   January 26, 1999, Introduced by Senators SHUGARS, SCHWARZ 
        and HAMMERSTROM and referred to the Committee on Health 
        Policy.



        A bill to amend 1980 PA 350, entitled

   "The nonprofit health care corporation reform act,"

   by amending section 402b (MCL 550.1402b), as added by 1996

   PA 516.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 1         Sec. 402b.  (1) For an individual covered under a nongroup

 2    certificate or under a certificate not covered under subsection

 3    (2), a health care corporation may exclude or limit coverage for

 4    a condition only if the exclusion or limitation relates to a con-

 5    dition for which medical advice, diagnosis, care, or treatment

 6    was recommended or received within 6 months before enrollment and

 7    the exclusion or limitation does not extend for more than 6

 8    months after the effective date of the certificate.






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 1         (2) A health care corporation shall not exclude or limit

 2    coverage for a preexisting condition for an individual covered

 3    under a group certificate.

 4          (3) The commissioner and the director of community
             health

 5     shall examine the issue of crediting prior continuous health
                       care

 6     coverage to reduce the period of time imposed by a
                       preexisting

 7     condition limitation or exclusion under subsection (1) and
                       shall

 8     report to the governor and the senate and the house of
                       represen-

 9     tatives standing committees on insurance and health policy
                       issues

10     by May 15, 1997.  The report shall include the
                       commissioner's and

11     director's findings and shall propose alternative mechanisms
                       or a

12     combination of mechanisms to credit prior continuous health
                       care

13     coverage towards the period of time imposed by a preexisting
                       con-

14     dition limitation or exclusion.  The report shall address at
                       a

15     minimum all of the following:

16          (a) Cost of crediting prior continuous health care

17     coverages.

18          (b) Period of lapse or break in coverage, if any,
                       permitted

19     in a prior health care coverage.

20          (c) Types and scope of prior health care coverages that
                       are

21     permitted to be credited.

22          (d) Any exceptions or exclusions to crediting prior
                       health

23     care coverage.

24          (e) Uniform method of certifying periods of prior
                       creditable

25     coverage. 

26         (3) NOTWITHSTANDING SUBSECTION (1), A HEALTH CARE

27    CORPORATION SHALL NOT ISSUE A CERTIFICATE TO A PERSON ELIGIBLE



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 1    FOR NONGROUP COVERAGE OR ELIGIBLE FOR A CERTIFICATE NOT COVERED

 2    UNDER SUBSECTION (2) THAT EXCLUDES OR LIMITS COVERAGE FOR A PRE-

 3    EXISTING CONDITION OR PROVIDES A WAITING PERIOD IF ALL OF THE

 4    FOLLOWING APPLY:

 5         (A) THE PERSON'S MOST RECENT HEALTH COVERAGE PRIOR TO APPLY-

 6    ING FOR COVERAGE WITH THE HEALTH CARE CORPORATION WAS UNDER A

 7    GROUP HEALTH PLAN.

 8         (B) THE PERSON WAS CONTINUOUSLY COVERED PRIOR TO THE APPLI-

 9    CATION FOR COVERAGE WITH THE HEALTH CARE CORPORATION UNDER 1 OR

10    MORE HEALTH PLANS FOR AN AGGREGATE OF AT LEAST 18 MONTHS WITH NO

11    BREAK IN COVERAGE THAT EXCEEDED 62 DAYS.

12         (C) THE PERSON IS NO LONGER ELIGIBLE FOR GROUP COVERAGE.

13         (D) THE PERSON DID NOT LOSE ELIGIBILITY FOR COVERAGE FOR

14    FAILURE TO PAY ANY REQUIRED CONTRIBUTION OR FOR AN ACT TO DEFRAUD

15    THE HEALTH CARE CORPORATION.

16         (4) As used in this section, "group" means a group of 2 or

17    more subscribers.

18         Enacting section 1.  This amendatory act takes effect

19    October 1, 1999.



















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