REQUIRED INFORMATION ON EXPLANATION

OF BENEFITS FOR DENTAL SERVICES

House Bill 5776

Sponsor:  Rep. Joe Hune

Committee:  Insurance

Complete to 9-15-08

A SUMMARY OF HOUSE BILL 5776 AS INTRODUCED 2-20-08

The bill would amend Chapter 22 of the Insurance Code to require that certain information be included in the explanation of benefits for dental services sent to consumers, in cases where an insurance company or health maintenance organization (HMO) is paying the maximum covered benefit.

The explanation of benefits provided to an insured or enrolled person would have to specify:

**That the amount paid or to be paid is the maximum amount that the insurance company or HMO is obligated to pay under the policy, certificate, or contract.

** That the amount paid or to be paid is not a determination as to the reasonableness of the amount billed.

** That the amount paid or to be paid is not a determination as to whether the amount billed is or is not a customary or usual fee or charge for the service provided.

These statements would have to be in boldfaced and uppercase type and be in a conspicuous location on the explanation of benefits or similar communication.

The bill would apply to commercial insurers and HMOs that provide coverage for dental services.

MCL 500.2212c

FISCAL IMPACT:

The bill does not appear to have any fiscal impact on state or local government.

                                                                                           Legislative Analyst:   Chris Couch

                                                                                                  Fiscal Analyst:   Mark Wolf

■ This analysis was prepared by nonpartisan House staff for use by House members in their deliberations, and does not constitute an official statement of legislative intent.