HB-5348, As Passed House, June 8, 2006
October 20, 2005, Introduced by Reps. Green, Byrnes, Ball, Kahn, Vander Veen, Shaffer, Zelenko, Hopgood, Polidori, Byrum and Hansen and referred to the Committee on Senior Health, Security, and Retirement.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending section 3901 (MCL 500.3901), as added by 1992 PA 84,
and by adding section 3902; and to repeal acts and parts of acts.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3901. As used in this chapter:
(a) "Acute condition" means that the individual is medically
unstable, requiring frequent monitoring by medical professionals in
order to maintain his or her health status.
(b) "Applicant" means:
(i) For an individual long-term care insurance policy, the
person who seeks to contract for long-term care benefits.
(ii) For a group long-term care insurance certificate, the
proposed certificate holder.
(c) "Group long-term care insurance" means a long-term care
insurance certificate that is delivered or issued for delivery in
this state and issued to any of the following:
(i) One or more employers or labor organizations, or to a trust
or the trustees of a fund established by 1 or more employers or
labor organizations for employees or former employees or members or
former members of the labor organization.
(ii) A professional, trade, or occupational association for its
members or former or retired members if the association is composed
of individuals who were all actively engaged in the same
profession, trade, or occupation and the association has been
maintained in good faith for purposes other than obtaining
insurance unless waived by the commissioner.
(iii) Subject to section 3903(2), an association or to a trust
or to the trustees of a fund established, created, or maintained
for the benefit of members of 1 or more associations.
(iv) A group other than that described in subparagraphs (i),
(ii), or (iii) if the commissioner determines all of the following:
(A) The issuance of the group certificate is not contrary to
the best interests of the public.
(B) The issuance of the group certificate would result in
economies of acquisition or administration.
(C) The benefits are reasonable in relation to the premiums
charged.
(d) "Guaranteed renewable" means the insured has the right to
continue the long-term care insurance in force by the timely
payment of premiums and the insurer does not have a unilateral
right to make any change in any provision of the policy or rider
while the insurance is in force and cannot decline to renew, except
that rates may be revised by the insurer on a class basis.
(e) "Home care services" means 1 or more of the following
medically
prescribed services or assessment team recommended
services for the long-term care and treatment of an insured that
are to be provided in a noninstitutional setting according to a
written diagnosis and plan of care or individual assessment and
plan of care:
(i) Nursing services under the direction of a registered nurse,
including the service of a home health aide.
(ii) Physical therapy.
(iii) Speech therapy.
(iv) Respiratory therapy.
(v) Occupational therapy.
(vi) Nutritional services provided by a registered dietitian.
(vii) Personal care services, homemaker services, adult day
care, and similar nonmedical services.
(viii) Medical social services.
(ix) Other similar medical services and health-related support
services.
(f) "Home health or care agency" means a person certified by
medicare whose business is to provide to individuals in their
places of residence other than in a hospital, nursing home, or
county medical care facility, 1 or more of the following services:
nursing services, therapeutic services, social work services,
homemaker services, home health aide services, or other related
services.
(g) "Intermediate care facility" means a facility, or distinct
part
of a facility, certified by the department of public
community health to provide intermediate care, custodial care, or
basic care that is less than skilled nursing care but more than
room and board.
(h) "Long-term care insurance" means an individual or group
insurance policy, certificate, or rider advertised, marketed,
offered, or designed to provide coverage for at least 12
consecutive months for each covered person on an expense-incurred,
indemnity, prepaid, or other basis for 1 or more necessary or
medically necessary diagnostic, preventive, therapeutic,
rehabilitative, maintenance, personal, or custodial care services
provided
in a setting, other than including an assisted living
facility operating legally in this state, but not including an
acute care unit of a hospital. Long-term care insurance includes
individual or group annuities and life insurance policies or riders
that provide directly or supplement long-term care insurance. Long-
term care insurance does not include a life insurance policy that
accelerates the death benefit specifically for 1 or more of the
qualifying events of terminal illness or medical conditions
requiring extraordinary medical intervention or permanent
institutional confinement and that provide the option of a lump-sum
payment for those benefits and in which neither the benefits nor
the eligibility for the benefits is conditioned upon the receipt of
long-term care. Long-term care insurance does not include an
insurance policy offered primarily to provide coverage for
rehabilitative and convalescent care and is not offered,
advertised, or marketed as a long-term care policy, or offered
primarily to provide basic medicare supplemental coverage, hospital
confinement indemnity coverage, basic hospital expense coverage,
basic medical-surgical expense coverage, major medical expense
coverage, disability income protection coverage, catastrophic
coverage, comprehensive coverage, accident only coverage, specific
disease or specified accident coverage, or limited benefit health
coverage.
(i)
"Medicare" means title XVIII of the social security act,
chapter
531, 49 Stat. 620, 42 U.S.C. 1395 to 1395b, 1395b-2, 1395c
to
1395i, 1395i-2 to 1395i-4, 1395j to 1395t, 1395u to 1395w-2,
1395w-4
to 1395zz, and 1395bbb to 1395ccc 42
USC 1395 to 1395ggg.
(j) "Nonprofit health care corporation" means a nonprofit
health care corporation operating pursuant to the nonprofit health
care corporation reform act, 1980 PA 350, MCL 550.1101 to 550.1704.
(k) (j)
"Preexisting condition" means a condition
for which
medical advice or treatment was recommended by, or received from, a
provider of health care services within the 6 months immediately
before the effective date of coverage of an insured person.
(l) (k)
"Policy" means an insurance policy or
certificate,
rider, or endorsement delivered or issued for delivery in this
state by an insurer or subsidiary of a nonprofit health care
corporation.
(m) (l) "Skilled nursing facility" means a
facility, or a
distinct
part of a facility, certified by the department of public
community health to provide skilled nursing care.
Sec. 3902. A nonprofit health care corporation shall only
offer long-term care coverage through a subsidiary of the health
care corporation and as provided in this chapter. If a health care
corporation subsidiary offers long-term care coverage in this
state, the sale of that coverage is not exempt from taxation by
this state or any political subdivision of this state.
Enacting section 1. Sections 420 to 430 of the nonprofit
health care corporation reform act, 1980 PA 350, MCL 550.1420 to
550.1430, are repealed.