September 27, 2005, Introduced by Senators VAN WOERKOM and ALLEN and referred to the Committee on Health Policy.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending section 3406f (MCL 500.3406f), as added by 1996 PA 517.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3406f. (1) An insurer may exclude or limit coverage for a
condition as follows:
(a)
For an individual covered under an individual policy or
certificate
or any other policy or certificate not covered under
subdivision
(b) or (c), only if the exclusion or limitation relates
to
a condition for which medical advice, diagnosis, care, or
treatment
was recommended or received within 6 months before
enrollment
and the exclusion or limitation does not extend for more
than
12 months after the effective date of the policy or
certificate.
(a) (b)
For an individual covered under a
group policy or
certificate covering 2 to 50 individuals, only if the exclusion or
limitation relates to a condition for which medical advice,
diagnosis, care, or treatment was recommended or received within 6
months before enrollment and the exclusion or limitation does not
extend for more than 12 months after the effective date of the
policy or certificate.
(b) (c)
For an individual covered under a
group policy or
certificate covering more than 50 individuals, only if the
exclusion or limitation relates to a condition for which medical
advice, diagnosis, care, or treatment was recommended or received
within 6 months before enrollment and the exclusion or limitation
does not extend for more than 6 months after the effective date of
the policy or certificate.
(2) As used in this section, "group" means a group health plan
as defined in section 2791(a)(1) and (2) of part C of title XXVII
of
the public health service act, chapter 373, 110 Stat.~1972, 42
U.S.C.
USC 300gg-91, and includes government plans that are not
federal government plans.
(3) This section applies only to an insurer that delivers,
issues for delivery, or renews in this state an expense-incurred
hospital, medical, or surgical policy or certificate. This section
does not apply to any policy or certificate that provides coverage
for specific diseases or accidents only, or to any hospital
indemnity, medicare supplement, long-term care, disability income,
or 1-time limited duration policy or certificate of no longer than
6 months.
(4)
The commissioner and the director of community health
shall
examine the issue of crediting prior continuous health care
coverage
to reduce the period of time imposed by preexisting
condition
limitations or exclusions under subsection (1)(a), (b),
and
(c) and shall report to the governor and the senate and the
house
of representatives standing committees on insurance and
health
policy issues by May 15, 1997. The report shall include the
commissioner's
and director's findings and shall propose
alternative
mechanisms or a combination of mechanisms to credit
prior
continuous health care coverage towards the period of time
imposed
by a preexisting condition limitation or exclusion. The
report
shall address at a minimum all of the following:
(a)
Cost of crediting prior continuous health care coverages.
(b)
Period of lapse or break in coverage, if any, permitted in
a
prior health care coverage.
(c)
Types and scope of prior health care coverages that are
permitted
to be credited.
(d)
Any exceptions or exclusions to crediting prior health
care
coverage.
(e)
Uniform method of certifying periods of prior creditable
coverage.