February 20, 2008, Introduced by Reps. Hune and Gaffney and referred to the Committee on Insurance.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
(MCL 500.100 to 500.8302) by adding section 2212c.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 2212c. (1) An insurer that delivers, issues for delivery,
or renews in this state an expense-incurred hospital, medical, or
surgical policy or certificate that provides for coverage for
dental services and a health maintenance organization that issues a
health maintenance organization contract that provides for coverage
for dental services shall include on any explanation of benefits or
similar communication to an insured or enrollee for dental service
where the insurer or health maintenance organization is paying the
maximum covered benefit amount all of the following:
(a) That the amount paid or to be paid is the maximum amount
the insurer or health maintenance organization is obligated to pay
under the terms of the policy, certificate, or contract.
(b) That the amount paid or to be paid is not a determination
as to the reasonableness of the amount billed.
(c) 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 specified service provided.
(2) The statements required under subsection (1) shall be in
boldfaced and uppercase type and shall be placed in a conspicuous
location on the explanation of benefits form or similar
communication.