SENATE BILL No. 992

 

 

June 12, 2014, Introduced by Senators MARLEAU, JONES, GREEN, KAHN, BOOHER and NOFS and referred to the Committee on Insurance.

 

 

 

     A bill to amend 1956 PA 218, entitled

 

"The insurance code of 1956,"

 

by amending sections 3801 and 3833 (MCL 500.3801 and 500.3833),

 

section 3801 as amended by 2009 PA 220 and section 3833 as added by

 

1992 PA 84.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 3801. As used in this chapter:

 

     (a) "Applicant" means:

 

     (i) For an individual medicare supplement policy, the person

 

who seeks to contract for benefits.

 

     (ii) For a group medicare supplement policy or certificate, the

 

proposed certificate holder.

 


     (b) "Bankruptcy" means when that a medicare advantage

 

organization that is not an insurer has filed, or has had filed

 

against it, a petition for declaration of bankruptcy and has ceased

 

doing business in this state.

 

     (c) "Certificate" means any certificate delivered or issued

 

for delivery in this state under a group medicare supplement

 

policy.

 

     (d) "Certificate form" means the form on which the certificate

 

is delivered or issued for delivery by the insurer.

 

     (e) "Continuous period of creditable coverage" means the

 

period during which an individual was covered by creditable

 

coverage, if during the period of the coverage the individual had

 

no breaks in coverage greater than 63 days.

 

     (f) "Creditable coverage" means coverage of an individual

 

provided under any of the following:

 

     (i) A group health plan.

 

     (ii) Health insurance coverage.

 

     (iii) Part A or part B of medicare.

 

     (iv) Medicaid other than coverage consisting solely of benefits

 

under section 1928 of medicaid, 42 USC 1396s.

 

     (v) Chapter 55 of title 10 of the United States Code, Medical

 

and dental care under 10 USC 1071 to 1110.1110b.

 

     (vi) A medical care program of the Indian health service or of

 

a tribal organization.

 

     (vii) A state health benefits risk pool.

 

     (viii) A health plan offered under chapter 89 of title 5 of the

 

United States Code, 5 USC 8901 to 8914.

 


     (ix) A public health plan as defined in federal regulation.

 

     (x) Health care under section 5(e) of title I of the peace

 

corps act, 22 USC 2504.

 

     (xi) Medicare advantage.

 

     (g) "Direct response solicitation" means solicitation in which

 

an insurer representative does not contact the applicant in person

 

and explain the coverage available, such as, but not limited to,

 

solicitation through direct mail or through advertisements in

 

periodicals and other media.

 

     (h) "Employee welfare benefit plan" means a plan, fund, or

 

program of employee benefits that term as defined in section 3 of

 

subtitle A of title I of the employee retirement income security

 

act of 1974, 29 USC 1002.

 

     (i) "Insolvency" means when that an insurer licensed to

 

transact the business of insurance in this state has had a final

 

order of liquidation entered against it with a finding of

 

insolvency by a court of competent jurisdiction in the insurer's

 

state of domicile.

 

     (j) "Insurer" includes any entity , including a health care

 

corporation operating pursuant to the nonprofit health care

 

corporation reform act, 1980 PA 350, MCL 550.1101 to 550.1704,

 

delivering or issuing for delivery in this state medicare

 

supplement policies.

 

     (k) "Medicaid" means title XIX of the social security act, 42

 

USC 1396 to 1396v.1396w-5.

 

     (l) "Medicare" means title XVIII of the social security act, 42

 

USC 1395 to 1395hhh.1395kkk.

 


     (m) "Medicare advantage" means a plan of coverage for health

 

benefits under medicare part C as defined described in section 12-

 

2859 of part C of medicare, 42 USC 1395w-28, and includes any of

 

the following:

 

     (i) Coordinated care plans that provide health care services,

 

including, but not limited to, health maintenance organization

 

plans with or without a point-of-service option, plans offered by

 

provider-sponsored organizations, and preferred provider

 

organization plans.

 

     (ii) Medical savings account plans coupled with a contribution

 

into a medicare advantage medical savings account.

 

     (iii) Medicare advantage private fee-for-service plans.

 

     (n) "Medicare supplement buyer's guide" means the document

 

entitled, "guide to health insurance for people with medicare",

 

developed by the national association of insurance commissioners

 

and the United States department of health and human services or a

 

substantially similar document as approved by the commissioner.

 

     (o) "Medicare supplement policy" means an individual,

 

nongroup, or group policy or certificate that is advertised,

 

marketed, or designed primarily as a supplement to reimbursements

 

under medicare for the hospital, medical, or surgical expenses of

 

persons eligible for medicare and medicare select policies and

 

certificates under section 3817. Medicare supplement policy does

 

not include a policy, certificate, or contract of 1 or more

 

employers or labor organizations, or of the trustees of a fund

 

established by 1 or more employers or labor organizations, or both,

 

for employees or former employees, or both, or for members or

 


former members, or both, of the labor organizations. Medicare

 

supplement policy does not include medicare advantage, plans

 

established under medicare part C, outpatient prescription drug

 

plans established under medicare part D, or any health care

 

prepayment plan that provides benefits pursuant to an agreement

 

under section 1833(a)(1)(A) of the social security act, 42 USC

 

1395l.

 

     (p) "PACE" means a program of all-inclusive care for the

 

elderly as described in the social security act.42 USC 1396u-4.

 

     (q) "Prestandardized medicare supplement benefit plan",

 

"prestandardized benefit plan", or "prestandardized plan" means a

 

group or individual policy of medicare supplement insurance issued

 

prior to before June 2, 1992.

 

     (r) "1990 standardized medicare supplement benefit plan",

 

"1990 standardized benefit plan", or "1990 plan" means a group or

 

individual policy of medicare supplement insurance issued on or

 

after June 2, 1992 with an effective date for coverage prior to

 

before June 1, 2010 and includes medicare supplement insurance

 

policies and certificates renewed on or after that date which that

 

are not replaced by the issuer at the request of the insured.

 

     (s) "2010 standardized medicare supplement benefit plan",

 

"2010 standardized benefit plan", or "2010 plan" means a group or

 

individual policy of medicare supplement insurance with an

 

effective date for coverage on or after June 1, 2010.

 

     (t) "Policy form" means the form on which the policy or

 

certificate is delivered or issued for delivery by the insurer.

 

     (u) "Secretary" means the secretary of the United States

 


department of health and human services.

 

     (v) "Social security act" means the social security act, 42

 

USC 301 to 1397jj.1397mm.

 

     Sec. 3833. (1) If a medicare supplement policy or certificate

 

replaces another medicare supplement policy, certificate, or

 

contract, the replacing insurer shall waive any time periods

 

applicable to preexisting conditions, waiting periods, elimination

 

periods, and probationary periods in the new medicare supplement

 

policy for similar benefits to the extent such the time was spent

 

under the original coverage.

 

     (2) If a medicare supplement policy replaces a medicare

 

advantage policy, the replacing insurer shall waive any time

 

periods applicable to preexisting conditions, waiting periods,

 

elimination periods, and probationary periods in the new medicare

 

supplement policy for similar benefits to the extent the time was

 

spent under the coverage provided by the medicare advantage policy.