SENATE BILL No. 1257

May 11, 2000, Introduced by Senators SCHWARZ, YOUNG, BENNETT, EMERSON,

SHUGARS, HAMMERSTROM, GOSCHKA, BYRUM and DE BEAUSSAERT and

referred to the Committee on Health Policy.

A bill to amend 1956 PA 218, entitled

"The insurance code of 1956,"

by amending section 3406k (MCL 500.3406k), as added by 1998

PA 125.

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

1 Sec. 3406k. (1) An expense-incurred hospital, medical, or

2 surgical policy or certificate delivered, issued for delivery, or

3 renewed in this state that provides coverage for emergency health

4 services shall provide coverage for medically necessary services

5 provided to an insured for the sudden onset of a medical condi-

6 tion that manifests itself by signs and symptoms of sufficient

7 severity, including severe pain, such that the absence of immedi-

8 ate medical attention could reasonably be expected to result in

9 serious jeopardy to the individual's health or to a pregnancy in

10 the case of a pregnant woman, serious impairment to bodily

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1 functions, or serious dysfunction of any bodily organ or part.

2 An insurer shall not deny payment for emergency health services

3 up to the point of stabilization provided to an insured under

4 this subsection because of either of the following:

5 (a) The final diagnosis.

6 (b) Prior authorization was not given by the insurer before

7 emergency health services were provided.

8 (2) AN INSURER SUBJECT TO THIS SECTION SHALL NOT ENCOURAGE

9 OR DIRECT AN INSURED TO AN EMERGENCY HEALTH SERVICES RESPONSE AND

10 TRANSPORTATION SYSTEM IN COMPETITION WITH OR IS A SUBSTITUTION

11 FOR THE 9-1-1 EMERGENCY HEALTH SERVICES SYSTEM OR OTHER STATE OR

12 LOCAL UNIT OF GOVERNMENT EMERGENCY HEALTH SERVICES SYSTEM.

13 (3) SUBSECTION (2) DOES NOT PROHIBIT AN INSURER FROM USING

14 OR REQUIRING TRANSPORTATION OUTSIDE THE 9-1-1 EMERGENCY HEALTH

15 SERVICES SYSTEM OR OTHER STATE OR LOCAL UNIT OF GOVERNMENT EMER-

16 GENCY HEALTH SERVICES SYSTEM FOR NONEMERGENCY HEALTH SERVICES.

17 (4) AN INSURER SHALL NOT REQUIRE AN INSURED TO OBTAIN PRIOR

18 AUTHORIZATION BEFORE ACCESSING THE 9-1-1 SYSTEM OR OTHER STATE OR

19 LOCAL UNIT OF GOVERNMENT EMERGENCY HEALTH SERVICES SYSTEM FOR

20 EMERGENCY HEALTH SERVICES.

21 (5) AN INSURER SHALL NOT USE FALSE OR MISLEADING LANGUAGE IN

22 ANY MATERIALS PROVIDED TO INSUREDS TO DISCOURAGE OR PROHIBIT AN

23 INSURED FROM ACCESSING THE 9-1-1 SYSTEM FOR EMERGENCY HEALTH

24 SERVICES.

25 (6) (2) As used in this section, "stabilization" means the

26 point at which no material deterioration of a condition is

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1 likely, within reasonable medical probability, to result from or

2 occur during transfer of the patient.

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