HOUSE BILL No. 5783


     March 12, 2002, Introduced by Rep. Spade and referred to the Committee on Insurance and Financial Services.


        A bill to amend 1956 PA 218, entitled

   "The insurance code of 1956,"

   (MCL 500.100 to 500.8302) by adding section 3406l.

               THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

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             SEC. 3406l.  (1) AN INSURER THAT DELIVERS, ISSUES FOR DELIV-

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        ERY, OR RENEWS IN THIS STATE ON OR AFTER JANUARY 1, 2003 AN

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        EXPENSE-INCURRED HOSPITAL, MEDICAL, OR SURGICAL POLICY OR CERTIF-

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        ICATE THAT PROVIDES PRESCRIPTION COVERAGE AND A HEALTH MAINTE-

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        NANCE ORGANIZATION THAT ISSUES OR RENEWS A GROUP OR INDIVIDUAL

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        CONTRACT ON OR AFTER JANUARY 1, 2003 SHALL PROVIDE COVERAGE FOR

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        LOW-PROTEIN MODIFIED FOOD PRODUCTS SUBJECT TO BOTH OF THE

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        FOLLOWING:

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             (A) THE LOW-PROTEIN MODIFIED FOOD PRODUCTS ARE PRESCRIBED

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        FOR THE THERAPEUTIC TREATMENT OF AMINO ACID DISORDERS.




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             (B) THE LOW-PROTEIN MODIFIED FOOD PRODUCTS ARE ADMINISTERED

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        UNDER THE DIRECTION OF A PHYSICIAN.

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             (2) COVERAGE UNDER THIS SECTION SHALL NOT HAVE DEDUCTIBLES

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        AND COPAYMENT PROVISIONS THAT ARE LESS FAVORABLE THAN THOSE FOR

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        PRESCRIPTION COVERAGE GENERALLY.  COVERAGE UNDER THIS SECTION MAY

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        BE LIMITED TO A CAP OF $4,000.00 PER PLAN YEAR ON BOTH INDIVIDUAL

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        MEDICAL FOOD EXPENDITURES AND MEDICAL FORMULAS.  THIS $4,000.00

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        CAP SHALL BE ADJUSTED ANNUALLY BY THE COMMISSIONER PURSUANT TO

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        THE CONSUMER PRICE INDEX.

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             (3) AS USED IN THIS SECTION:

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             (A) "CONSUMER PRICE INDEX" MEANS THE PERCENTAGE OF CHANGE IN

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        THE CONSUMER PRICE INDEX FOR ALL URBAN CONSUMERS IN THE UNITED

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        STATES CITY AVERAGE FOR ALL ITEMS FOR THE PRIOR 12-MONTH PERIOD

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        AS REPORTED BY THE UNITED STATES DEPARTMENT OF LABOR, BUREAU OF

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        LABOR STATISTICS, AND AS CERTIFIED BY THE COMMISSIONER.

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             (B) "LOW-PROTEIN MODIFIED FOOD PRODUCT" MEANS A FOOD PRODUCT

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        THAT IS SPECIALLY FORMULATED TO HAVE LESS THAN 1 GRAM OF PROTEIN

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        PER SERVING.  LOW-PROTEIN MODIFIED FOOD PRODUCT DOES NOT INCLUDE

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        A NATURAL FOOD THAT IS NATURALLY LOW IN PROTEIN.



















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