March 15, 2006, Introduced by Senator OLSHOVE and referred to the Committee on Health Policy.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
by amending sections 2243, 3405, and 3631 (MCL 500.2243, 500.3405,
and 500.3631), as amended by 1994 PA 438; and to repeal acts and
parts of acts.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 2243. (1) Notwithstanding any provision of a policy or
contract of group accident, group health, or group accident and
health insurance, executed after July 23, 1965, if the policy or
contract provides for reimbursement for any optometric service that
is within the lawful scope of practice of a duly licensed
optometrist, a subscriber to such group accident, group health, or
group accident and group health insurance policy or contract shall
be entitled to reimbursement for such service, whether the service
is performed by a physician or a duly licensed optometrist. Unless
the policy or contract of group accident, group health, or group
accident and health insurance otherwise provides, there shall be no
reimbursement for ophthalmic materials, lenses, spectacles,
eyeglasses, or appurtenances.
(2) If a subscriber contract provides for and offers
optometric services, the subscriber shall have freedom of choice to
select either a physician or an optometrist to render the services.
Unless the subscriber contract otherwise provides, there shall be
no reimbursement for ophthalmic materials, lenses, spectacles,
eyeglasses, or appurtenances.
(3)
This section does not require coverage or reimbursement
for
a practice of optometric service unless that service was
included
in the definition of practice of optometry under section
17401
of the public health code, Act No. 368 of the Public Acts of
1978,
being section 333.17401 of the Michigan Compiled Laws, as of
May 20, 1992.
Sec. 3405. (1) For the purpose of doing business as an
organization
under the prudent purchaser act, Act No. 233 of the
Public
Acts of 1984, being sections 550.51 to 550.63 of the
Michigan Compiled Laws 1984 PA 233, MCL 550.51 to 550.63, an
insurer authorized in this state to write disability insurance that
provides coverage for hospital, nursing, medical, surgical, or
sick-care benefits may enter into prudent purchaser agreements with
providers of hospital, nursing, medical, surgical, or sick-care
services
pursuant to this section and Act No. 233 of the Public
Acts
of 1984 the prudent
purchaser act, 1984 PA 233, MCL 550.51 to
550.63.
(2) An insurer may offer disability insurance policies under
which the insured persons shall be required, as a condition of
coverage, to obtain hospital, nursing, medical, surgical, or sick-
care services exclusively from health care providers who have
entered into prudent purchaser agreements. A person to whom such a
policy is offered shall also be offered a policy that:
(a) Does not, as a condition of coverage, require insured
persons to obtain services exclusively from health care providers
who have entered into prudent purchaser agreements.
(b) Does not give a financial advantage or other advantage to
an insured person who elects to obtain services from health care
providers who have entered into prudent purchaser agreements.
(3) An insurer may offer disability insurance policies under
which insured persons who elect to obtain hospital, nursing,
medical, surgical, or sick-care services from health care providers
who have entered into prudent purchaser agreements shall realize a
financial advantage or other advantage by selecting such providers.
Policies offered pursuant to this subsection shall not, as a
condition of coverage, require insured persons to obtain such
services exclusively from health care providers who have entered
into prudent purchaser agreements. A person to whom such a policy
is offered shall also be offered a policy that:
(a) Does not, as a condition of coverage, require insured
persons to obtain services exclusively from health care providers
who have entered into prudent purchaser agreements.
(b) Does not give a financial advantage or other advantage to
an insured person who elects to obtain services from health care
providers who have entered into prudent purchaser agreements.
(4) The rates charged by an insurer for coverage under
policies issued under this section shall not be unreasonably lower
than what is necessary to meet the expenses of the insurer for
providing this coverage and shall not have an anticompetitive
effect or result in predatory pricing in relation to prudent
purchaser agreement coverages offered by other organizations.
(5) An insurer shall not discriminate against a class of
health care providers when entering into prudent purchaser
agreements with health care providers for its provider panel. This
subsection does not:
(a) Prohibit the formation of a provider panel consisting of a
single class of providers when a service provided for in the
specifications of a purchaser may legally be provided only by a
single class of providers.
(b) Prohibit the formation of a provider panel that conforms
to the specifications of a purchaser of the coverage authorized by
this section so long as the specifications do not exclude any class
of health care providers who may legally perform the services
included in the coverage.
(c) Require an organization that has uniformly applied the
standards
filed pursuant to section 3(3) of
Act No. 233 of the
Public
Acts of 1984, being section 550.53 of the Michigan Compiled
Laws
the prudent purchaser act,
1984 PA 233, MCL 550.53, to
contract with any individual provider.
(6) Nothing in this 1984 amendatory act applies to any
contract that is in existence before December 20, 1984, or the
renewal of such contract.
(7)
Notwithstanding any other provision of this act, if
coverage
under a prudent purchaser agreement provides for benefits
for
services that are within the scope of practice of optometry, an
insurer
is not required to provide coverage or reimburse for a
practice
of optometric service unless that service was included in
the
definition of practice of optometry under section 17401 of the
public
health code, Act No. 368 of the Public Acts of 1978 , being
section
333.17401 of the Michigan Compiled Laws, as of May 20,
1992.
(8)
Notwithstanding any other provision of this act, if
coverage
under a prudent purchaser agreement provides for benefits
for
services that are within the scope of practice of chiropractic,
an
insurer is not required to provide coverage or reimburse for the
use
of therapeutic sound or electricity, or both, for the reduction
or
correction of spinal subluxations in a chiropractic service.
This
subsection shall not take effect unless Senate Bill No. 493 of
the
87th Legislature is enacted into law.
Sec. 3631. (1) For the purpose of doing business as an
organization
under the prudent purchaser act, Act No. 233 of the
Public
Acts of 1984, being sections 550.51 to 550.63 of the
Michigan Compiled Laws 1984 PA 233, MCL 550.51 to 550.63, an
insurer authorized to write group disability insurance or family
expense insurance that provides coverage for hospital, nursing,
medical, surgical, or sick-care benefits may enter into prudent
purchaser agreements with providers of hospital, nursing, medical,
surgical,
or sick-care services pursuant to this section and Act
No.
233 of the Public Acts of 1984 the
prudent purchaser act, 1984
PA 233, MCL 550.51 to 550.63.
(2) An insurer may offer group disability insurance policies
or family expense policies under which the insured persons shall be
required, as a condition of coverage, to obtain hospital, nursing,
medical, surgical, or sick-care services exclusively from health
care providers who have entered into prudent purchaser agreements.
(3) An individual who is a member of a group who is offered
the option of being under a policy pursuant to subsection (2) shall
also be offered the option of being insured under a policy pursuant
to subsection (4). This subsection applies only if the group in
which the individual is a member has 25 or more members or if the
provider panel that is providing the services under the group
policy is limited by the organization to a specific number pursuant
to
section 3(1) of Act No. 233 of the Public Acts of 1984, being
section
550.53 of the Michigan Compiled Laws the prudent purchaser
act, 1984 PA 233, MCL 550.53.
(4) An insurer may offer group disability insurance policies
or family expense policies under which insured persons who elect to
obtain hospital, nursing, medical, surgical, or sick-care services
from health care providers who have entered into prudent purchaser
agreements shall realize a financial advantage or other advantage
by selecting such a provider. Policies offered pursuant to this
subsection shall not, as a condition of coverage, require insured
persons to obtain such services exclusively from health care
providers who have entered into prudent purchaser agreements.
(5) An individual who is a member of a group who is offered
the option of being insured under a policy pursuant to subsection
(2) or (4) shall also be offered the option of being insured under
a policy that:
(a) Does not, as a condition of coverage, require insured
persons to obtain services exclusively from health care providers
who have entered into prudent purchaser agreements.
(b) Does not give a financial advantage or other advantage to
an insured person who elects to obtain services from health care
providers who have entered into prudent purchaser agreements.
(6) Subsection (5) applies only if the group in which the
individual is a member has 25 or more members and if the group on
December 20, 1984 had health care coverage through the group
sponsor.
(7) The rates charged by an insurer for coverage under
policies issued under this section shall not be unreasonably lower
than what is necessary to meet the expenses of the insurer for
providing this coverage and shall not have an anticompetitive
effect or result in predatory pricing in relation to prudent
purchaser agreement coverages offered by other organizations.
(8) An insurer shall not discriminate against a class of
health care providers when entering into prudent purchaser
agreements with health care providers for its provider panel. This
subsection does not:
(a) Prohibit the formation of a provider panel consisting of a
single class of providers when a service provided for in the
specifications of a purchaser may legally be provided only by a
single class of providers.
(b) Prohibit the formation of a provider panel that conforms
to the specifications of a purchaser of the coverage authorized by
this section so long as the specifications do not exclude any class
of health care providers who may legally perform the services
included in the coverage.
(c) Require an organization that has uniformly applied the
standards
filed pursuant to section 3(3) of
Act No. 233 of the
Public
Acts of 1984, being section 550.53 of the Michigan Compiled
Laws
the prudent purchaser act,
1984 PA 233, MCL 550.53, to
contract with any individual provider.
(9) Nothing in this 1984 amendatory act applies to any
contract that is in existence before December 20, 1984, or the
renewal of such contract.
(10)
Notwithstanding any other provision of this act, if
coverage
under a prudent purchaser agreement provides for benefits
for
services that are within the scope of practice of optometry, an
insurer
is not required to provide coverage or reimburse for a
practice
of optometric service unless that service was included in
the
definition of practice of optometry under section 17401 of the
public
health code, Act No. 368 of the Public Acts of 1978 , being
section
333.17401 of the Michigan Compiled Laws, as of May 20,
1992.
(11)
Notwithstanding any other provision of this act, if
coverage
under a prudent purchaser agreement provides for benefits
for
services that are within the scope of practice of chiropractic,
an
insurer is not required to provide coverage or reimburse for the
use
of therapeutic sound or electricity, or both, for the reduction
or
correction of spinal subluxations in a chiropractic service.
This
subsection shall not take effect unless Senate Bill No. 493 of
the
87th Legislature is enacted into law.
Enacting section 1. Section 3107b of the insurance code of
1956, 1956 PA 218, MCL 500.3107b, is repealed.