January 22, 2007, Introduced by Rep. Hune and referred to the Committee on Insurance.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending sections 3107, 3109, and 3109a (MCL 500.3107, 500.3109,
and 500.3109a), section 3107 as amended by 1991 PA 191, and by
adding chapter 21A.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
CHAPTER 21A MANAGED CARE
Sec. 2151. As used in this chapter, "managed care option"
means an optional coverage selected by an insured at the time a
policy is issued that includes, but is not limited to, the
monitoring and adjudication of an injured person's care, the use of
a preferred provider program or other network, or other similar
option.
Sec. 2153. This chapter applies to all automobile insurance
whether written on an individual, group, franchise, blanket policy,
or similar basis.
Sec. 2155. An automobile insurer may offer a managed care
option that shall provide for allowable expenses consisting of all
reasonable charges incurred for reasonably necessary products,
services, and accommodations for an injured person's care,
recovery, or rehabilitation. This managed care option is subject to
all of the following:
(a) Shall be uniformly offered in all areas where the managed
care option is available.
(b) Shall provide a discount that reflects reasonably
anticipated reductions in losses or expenses.
(c) Shall not apply to emergency care. Emergency care
includes, but is not limited to, all care necessary to the point
where no material deterioration of a condition is likely, within
reasonable medical probability, to result from or occur during
transfer of the patient.
Sec. 2156. An automobile insurer that offers a managed care
option under this chapter shall also offer personal protection
insurance benefits under section 3107(1)(a) that are not subject to
the managed care option.
Sec. 2157. The managed care option applies to the insured who
selects the managed care option and any person who resides in an
area where the managed care option is available and who is claiming
personal protection insurance benefits under the policy with the
managed care option.
Sec. 2161. A managed care option may provide for deductibles,
co-pays, or both deductibles and co-pays.
Sec. 2163. A managed care option shall provide for all of the
following:
(a) That personal protection insurance benefits are primary
and will not be coordinated with other health and accident coverage
on the individual claiming personal protection insurance benefits
under the policy with the managed care option.
(b) That personal protection insurance benefits must be
exhausted by the individual claiming those benefits under the
policy with the managed care option before the individual may seek
benefits from another health or accident coverage provider.
(c) That deductibles, co-pays, or other similar sanctions
shall not be assessed or collected from other health and accident
coverage providers for the individual claiming personal protection
insurance benefits under the policy with the managed care option.
Sec. 2165. At the time of the initial selection of the managed
care option by the insured, an automobile insurer shall obtain a
signed acknowledgment that the insured received a written
disclosure statement approved by the commissioner or a written
disclosure statement that includes all of the following:
(a) A summary of the provisions of the managed care option.
(b) The estimated range of the percentage of the discount
provided by the managed care option.
(c) A general description of the differences between a managed
care option under this chapter and personal protection insurance
benefits under section 3107(1)(a) that are not subject to the
managed care option, including any procedural differences in
seeking treatment and filing a claim.
(d) The consequences for violating any provisions of the
managed care option, including the possibility of a claim denial,
the payment of a deductible and the amount of that deductible, and
any additional out-of-pocket expenses that may be incurred.
(e) An explanation of whether the insurer offers an opt-out
provision that would enable the insured to change his or her policy
from a managed care option to personal protection insurance
benefits under section 3107(1)(a) that are not subject to the
managed care option and any restrictions placed upon the insured in
regard to opting out of the managed care option.
Sec. 2167. The disclosure statement under section 2165 shall
include a postal mailing address and either a toll-free telephone
number or an internet website address that insureds or applicants
for insurance may write, call, or otherwise access for information
on the managed care option.
Sec.
3107. (1) Except as provided in subsection (2), personal
Personal protection insurance benefits are payable for the
following:
(a)
Allowable Except as
provided in section 2155, allowable
expenses consisting of all reasonable charges incurred for
reasonably necessary products, services, and accommodations for an
injured person's care, recovery, or rehabilitation. Allowable
expenses within personal protection insurance coverage shall not
include charges for a hospital room in excess of a reasonable and
customary charge for semiprivate accommodations except if the
injured person requires special or intensive care, or for funeral
and burial expenses in the amount set forth in the policy which
shall not be less than $1,750.00 or more than $5,000.00.
(b)
Work Except as provided in
subsection (2), work loss
consisting of loss of income from work an injured person would have
performed during the first 3 years after the date of the accident
if he or she had not been injured. Work loss does not include any
loss after the date on which the injured person dies. Because the
benefits received from personal protection insurance for loss of
income are not taxable income, the benefits payable for such loss
of income shall be reduced 15% unless the claimant presents to the
insurer in support of his or her claim reasonable proof of a lower
value of the income tax advantage in his or her case, in which case
the
lower value shall apply. Beginning March 30, 1973 For the
period beginning October 1, 2006 through September 30, 2007, the
benefits payable for work loss sustained in a single 30-day period
and the income earned by an injured person for work during the same
period
together shall not exceed $1,000.00 $4,589.00, which maximum
shall apply pro rata to any lesser period of work loss. Beginning
October
1, 1974 2007, the maximum shall be adjusted annually to
reflect changes in the cost of living under rules prescribed by the
commissioner but any change in the maximum shall apply only to
benefits arising out of accidents occurring subsequent to the date
of change in the maximum.
(c) Expenses not exceeding $20.00 per day, reasonably incurred
in obtaining ordinary and necessary services in lieu of those that,
if he or she had not been injured, an injured person would have
performed during the first 3 years after the date of the accident,
not for income but for the benefit of himself or herself or of his
or her dependent.
(2) A person who is 60 years of age or older and in the event
of an accidental bodily injury would not be eligible to receive
work loss benefits under subsection (1)(b) may waive coverage for
work loss benefits by signing a waiver on a form provided by the
insurer. An insurer shall offer a reduced premium rate to a person
who waives coverage under this subsection for work loss benefits.
Waiver of coverage for work loss benefits applies only to work loss
benefits payable to the person or persons who have signed the
waiver form.
Sec. 3109. (1) Benefits provided or required to be provided
under the laws of any state or the federal government shall be
subtracted from the personal protection insurance benefits
otherwise payable for the injury.
(2) An injured person is a natural person suffering accidental
bodily injury.
(3) An insurer providing personal protection insurance
benefits may offer, at appropriately reduced premium rates, a
deductible
of a specified dollar amount which that does not exceed
$300.00 per accident. This deductible may be applicable to all or
any specified types of personal protection insurance benefits but
shall apply only to benefits payable to the person named in the
policy, his or her spouse, and any relative of either domiciled in
the same household. Any other deductible provisions require the
prior approval of the commissioner. This subsection does not apply
to a managed care option offered under chapter 21A.
Sec. 3109a. An insurer providing personal protection insurance
benefits shall offer, at appropriately reduced premium rates,
deductibles and exclusions reasonably related to other health and
accident coverage on the insured. The deductibles and exclusions
required to be offered by this section shall be subject to prior
approval by the commissioner and shall apply only to benefits
payable to the person named in the policy, the spouse of the
insured, and any relative of either domiciled in the same
household. This section does not apply to a managed care option
offered under chapter 21A.
Enacting section 1. This amendatory act takes effect 6 months
after the date it is enacted.