HOUSE BILL No. 5008


     July 10, 2001, Introduced by Reps. Caul and Sanborn 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,"

   by amending section 401f (MCL 550.1401f), as added by 1998 PA

   412.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

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           Sec. 401f.  (1) A health care corporation certificate that

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      requires a member to designate a participating primary care pro-

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      vider and provides for annual well-woman examinations and routine

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      obstetrical and gynecologic services shall permit a female member

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      to access an obstetrician-gynecologist for annual well-woman

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      examinations and routine obstetrical and gynecologic services.

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           (2) A health care corporation shall not require prior autho-

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      rization or referral for access under subsection (1) to an

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      obstetrician-gynecologist who participates with the health care

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      corporation.  A health care corporation may require prior


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      authorization or referral for access to a nonparticipating

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      obstetrician-gynecologist.

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           (3) IF AN OBSTETRICIAN-GYNECOLOGIST REFERS A MEMBER TO

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      ANOTHER OBSTETRICIAN-GYNECOLOGIST FOR OBSTETRICAL-GYNECOLOGIC

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      SERVICES OR TO A PERINATALOGIST OR OTHER PROVIDER OF PRENATAL

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      CARE FOR PRENATAL CARE DURING A PREGNANCY, THE HEALTH CARE CORPO-

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      RATION SHALL NOT REQUIRE THAT THE REFERRAL MUST COME FROM THE

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      MEMBER'S PRIMARY CARE PROVIDER IF BOTH OF THE FOLLOWING APPLY:

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           (A) THE REFERRING OBSTETRICIAN-GYNECOLOGIST PARTICIPATES

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      WITH THE HEALTH CARE CORPORATION.

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           (B) THE REFERRED OBSTETRICIAN-GYNECOLOGIST OR PERINATALOGIST

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      OR OTHER PROVIDER OF PRENATAL CARE PARTICIPATES WITH THE HEALTH

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      CARE CORPORATION.

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           (4)  (3)  A description of the benefit provided by this sec-

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      tion shall be included by the health care corporation in a commu-

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      nication sent to the individual or group purchaser of coverage.

























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