reglab/statecodes huggingface dataset:
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406d - Coverage for Breast Cancer Diagnostic Services, Breast Cancer Outpatient Treatment Services, and Breast Cancer Rehabilitative Services; Coverage for Breast Cancer Screening Mammography; Definitions.

500.3406d Coverage for breast cancer diagnostic services, breast cancer outpatient treatment services, and breast cancer rehabilitative services; coverage for breast cancer screening mammography; definitions.
Sec. 3406d.
(1) Subject to dollar limits, deductibles, and coinsurance provisions that are not less favorable than those for physical illness generally, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall offer or include coverage for breast cancer diagnostic services, breast cancer outpatient treatment services, and breast cancer rehabilitative services.
(2) Subject to dollar limits, deductibles, and coinsurance provisions that are not less favorable than those for physical illness generally, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall offer or include the following coverage for breast cancer screening mammography:
(a) If performed on a woman 35 years of age or older and under 40 years of age, coverage for 1 screening mammography examination during that 5-year period.
(b) If performed on a woman 40 years of age or older, coverage for 1 screening mammography examination every calendar year.
(3) As used in this section:
(a) "Breast cancer diagnostic services" means a procedure intended to aid in the diagnosis of breast cancer, delivered on an inpatient or outpatient basis, including but not limited to mammography, surgical breast biopsy, and pathologic examination and interpretation.
(b) "Breast cancer rehabilitative services" means a procedure intended to improve the result of, or ameliorate the debilitating consequences of, treatment of breast cancer, delivered on an inpatient or outpatient basis, including but not limited to reconstructive plastic surgery, physical therapy, and psychological and social support services.
(c) "Breast cancer screening mammography" means a standard 2-view per breast, low-dose radiographic examination of the breasts, using equipment designed and dedicated specifically for mammography, in order to detect unsuspected breast cancer.
(d) "Breast cancer outpatient treatment services" means a procedure intended to treat cancer of the human breast, delivered on an outpatient basis, including but not limited to surgery, radiation therapy, chemotherapy, hormonal therapy, and related medical follow-up services.
History:
Add. 1989, Act 59, Eff. Nov. 1, 1989 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406e - Coverage for Drug Used in Antineoplastic Therapy and Cost of Its Administration; Conditions.

500.3406e Coverage for drug used in antineoplastic therapy and cost of its administration; conditions.
Sec. 3406e.
An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall provide coverage in each policy for a drug used in antineoplastic therapy and the reasonable cost of its administration. Coverage must be provided for any United States Food and Drug Administration approved drug regardless of whether the specific neoplasm for which the drug is being used as treatment is the specific neoplasm for which the drug has received approval by the United States Food and Drug Administration if all of the following conditions are met:
(a) The drug is ordered by a physician for the treatment of a specific type of neoplasm.
(b) The drug is approved by the United States Food and Drug Administration for use in antineoplastic therapy.
(c) The drug is used as part of an antineoplastic drug regimen.
(d) Current medical literature substantiates its efficacy and recognized oncology organizations generally accept the treatment.
(e) The physician has obtained informed consent from the patient for the treatment regimen that includes United States Food and Drug Administration approved drugs for off-label indications.
History:
Add. 1989, Act 59, Imd. Eff. June 16, 1989 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406f - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

500.3406f Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Compiler's Notes:
The repealed section pertained to excluded or limited coverage and examination of issue of crediting prior continuous health care coverage.
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406g - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

500.3406g Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Compiler's Notes:
The repealed section pertained to prohibition against denying coverage to dependent child under certain conditions.
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406h - Eligibility of Parent for Dependent Coverage; Health Coverage of Child Through Noncustodial Parent; Duties of Insurer; Court or Administrative Order and Notice Required.

500.3406h Eligibility of parent for dependent coverage; health coverage of child through noncustodial parent; duties of insurer; court or administrative order and notice required.
Sec. 3406h.
(1) If a parent is eligible for dependent coverage through an insurer, the insurer shall:
(a) Permit the parent to enroll, under the dependent coverage, a child who is otherwise eligible for coverage without regard to any enrollment season restrictions.
(b) If the parent is enrolled but fails to make application to obtain coverage for the child, enroll the child under dependent coverage upon application by the friend of the court or by the child's other parent through the friend of the court.
(c) Not eliminate the child's coverage unless premiums have not been paid as required by the policy or certificate or the insurer is provided with satisfactory written evidence of either of the following:
(i) The court or administrative order is no longer in effect.
(ii) The child is or will be enrolled in comparable health coverage through another insurer, health care corporation, health maintenance organization, or self-funded health coverage plan that will take effect not later than the effective date of the cancellation of the existing coverage.
(2) If a child has health coverage through an insurer of a noncustodial parent, that insurer shall do all of the following:
(a) Provide the custodial parent with information necessary for the child to obtain benefits through that coverage.
(b) Permit the custodial parent or, with the custodial parent's approval, the provider to submit a claim for covered services without the noncustodial parent's approval.
(c) Make payment on claims submitted under subdivision (b) directly to the custodial parent or medical provider.
(3) This section applies only if a parent is required by a court or administrative order to provide health coverage for a child and the insurer is notified of that court or administrative order.
History:
Add. 1995, Act 237, Eff. Mar. 28, 1996
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406i - Individual Eligible Under Title XIX of Social Security Act; Assignment of Rights of Insured to Department of Social Services.

500.3406i Individual eligible under title XIX of social security act; assignment of rights of insured to department of social services.
Sec. 3406i.
(1) An insurer shall not consider whether an individual is eligible for or has available medical assistance under title XIX of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1396 to 1396g and 1396i to 1396v, in this or another state when considering eligibility for coverage or making payments under its plan for eligible insureds.
(2) If an insurer has a legal liability to make payments, and payment for covered expenses for medical goods or services furnished to an individual has been made under the medical assistance program established under section 105 of the social welfare act, Act No. 280 of the Public Acts of 1939, being section 400.105 of the Michigan Compiled Laws, the department of social services has the rights of the individual to payment by the insurer to the extent payment was made by the department of social services's medical assistance program for those medical goods or services.
(3) If the department of social services has been assigned the rights of an insured who is eligible for medical assistance under section 105 of Act No. 280 of the Public Acts of 1939 and is covered by an insurer, the insurer shall not impose requirements on the department of social services that are different from requirements that apply to an agent or assignee of any other covered insured.
History:
Add. 1995, Act 237, Eff. Mar. 28, 1996
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406j - Insured or Applicant as Victim of Domestic Violence; Refusal to Provide Coverage Prohibited; Liability; "Domestic Violence" Defined.

500.3406j Insured or applicant as victim of domestic violence; refusal to provide coverage prohibited; liability; "domestic violence" defined.
Sec. 3406j.
(1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not rate, cancel coverage on, refuse to provide coverage for, or refuse to issue or renew a health insurance policy solely because an insured or applicant for insurance is or has been a victim of domestic violence.
(2) An insurer is not civilly liable for any cause of action that may result from compliance with this section.
(3) As used in this section, "domestic violence" means inflicting bodily injury on, causing serious emotional injury or psychological trauma to, or placing in fear of imminent physical harm by threat or force a person who is a spouse or former spouse of, has or has had a dating relationship with, resides or has resided with, or has a child in common with the person committing the violence.
History:
Add. 1998, Act 136, Imd. Eff. June 24, 1998 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406k - Emergency Health Services; Medically Necessary Coverage; "Stabilization" Defined.

500.3406k Emergency health services; medically necessary coverage; "stabilization" defined.
Sec. 3406k.
(1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for emergency health services shall provide coverage for medically necessary services provided to an insured for the sudden onset of a medical condition that manifests itself by signs and symptoms of sufficient severity, including severe pain, such that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in serious jeopardy to the individual's health or to a pregnancy in the case of a pregnant woman, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. An insurer shall not require a physician to transfer a patient before the physician determines that the patient has reached the point of stabilization. An insurer shall not deny payment for emergency health services up to the point of stabilization provided to an insured under this subsection because of either of the following:
(a) The final diagnosis.
(b) Prior authorization not being given by the insurer before emergency health services were provided.
(2) As used in this section, "stabilization" means the point at which no material deterioration of a condition is likely, within reasonable medical probability, to result from or occur during transfer of the patient.
History:
Add. 1998, Act 125, Imd. Eff. June 10, 1998 ;-- Am. 2004, Act 7, Imd. Eff. Feb. 20, 2004 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406l - Medical Transportation Services; Reimbursement; Exception.

500.3406l Medical transportation services; reimbursement; exception.
Sec. 3406l.
(1) Except as otherwise provided in subsections (2) and (3), an insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides benefits for emergency services shall provide for direct reimbursement to any provider of covered medical transportation services or shall provide that payment be made jointly to the insured and the provider, if the provider has not received payment for those services from any other source.
(2) Subsection (1) does not apply to a transaction between an insurer and a medical transportation service provider if the parties have entered into a contract providing for direct payment.
(3) An insurer for a policy issued under section 3405 does not have to provide for direct reimbursement to any nonaffiliated or nonparticipating provider for medical transportation services that were not emergency health services as described in section 3406k.
(4) This section does not apply to a health maintenance organization contract.
History:
Add. 2004, Act 171, Imd. Eff. June 24, 2004 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406m - Access by Insured to Obstetrician-Gynecologist.

500.3406m Access by insured to obstetrician-gynecologist.
Sec. 3406m.
(1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that requires an insured to designate a participating primary care provider and provides for annual well-woman examinations and routine obstetrical and gynecologic services shall permit a female insured to access an obstetrician-gynecologist for annual well-woman examinations and routine obstetrical and gynecologic services.
(2) An insurer shall not require prior authorization or referral for access under subsection (1) to an obstetrician-gynecologist who is participating with the insurer. An insurer may require prior authorization or referral for access to a nonparticipating obstetrician-gynecologist.
(3) An insurer shall include a description of the coverage required under this section in a communication sent to the insured or group purchaser of coverage.
History:
Add. 1998, Act 402, Eff. Mar. 23, 1999 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406n - Access to Pediatric Care Services.

500.3406n Access to pediatric care services.
Sec. 3406n.
(1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that requires an insured to designate a participating primary care provider and provides for dependent care coverage shall permit a dependent minor insured to select and access a pediatrician for general pediatric care services.
(2) An insurer shall not require prior authorization or referral for access under subsection (1) to a pediatrician who participates with the insurer. An insurer may require prior authorization or referral for access to a nonparticipating pediatrician.
History:
Add. 1999, Act 179, Imd. Eff. Nov. 16, 1999 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406o - Insurer Providing Prescription Drug Coverage; Formulary Restrictions; Expedited Review of Coverage for Nonformulary Alternative; Determination; Subject to 500.3406w.

500.3406o Insurer providing prescription drug coverage; formulary restrictions; expedited review of coverage for nonformulary alternative; determination; subject to 500.3406w.
Sec. 3406o.
(1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription drugs and limits those benefits to drugs included in a formulary shall do all of the following:
(a) Provide for participation of participating physicians, dentists, and pharmacists in the development of the formulary.
(b) Disclose to health care providers and upon request to insureds the nature of the formulary restrictions.
(c) Provide for exceptions from the formulary limitation when a nonformulary alternative is a medically necessary and appropriate alternative. This subdivision does not prevent an insurer from establishing prior authorization requirements or another process for consideration of coverage or higher cost-sharing for nonformulary alternatives.
(2) On a request for an expedited review of coverage for a nonformulary alternative based on exigent circumstances, an insurer shall make a determination and notify the enrollee or the enrollee's designee and the prescribing physician, or other prescriber, as appropriate, of the determination within 24 hours after the insurer receives all information necessary to determine whether the exception should be granted. For purposes of this subsection, exigent circumstances exist when an enrollee is suffering from a health condition that may seriously jeopardize the enrollee's life, health, or ability to regain maximum function or when an enrollee is undergoing a current course of treatment using a nonformulary drug.
(3) If subsection (2) does not apply, an insurer shall make a determination on coverage for a nonformulary alternative and notify the enrollee or the enrollee's designee and the prescribing physician, or other prescriber, as appropriate, of the determination within 72 hours after the insurer receives all information necessary to determine whether the exception should be granted.
(4) This section is subject to section 3406w.
History:
Add. 1999, Act 177, Imd. Eff. Nov. 16, 1999 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 ;-- Am. 2020, Act 322, Imd. Eff. Dec. 29, 2020
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406r - Coverage for Obstetrical and Gynecological Services by Physician or Nurse Midwife.

500.3406r Coverage for obstetrical and gynecological services by physician or nurse midwife.
Sec. 3406r.
(1) As used in this section, "nurse midwife" means an individual licensed as a registered professional nurse under article 15 of the public health code, 1978 PA 368, MCL 333.16101 to 333.18838, who has been issued a specialty certification in the practice of nurse midwifery by the Michigan board of nursing under section 17210 of the public health code, 1978 PA 368, MCL 333.17210.
(2) An insurer that delivers, issues for delivery, or renews in this state a policy of health insurance that provides coverage for obstetrical and gynecological services shall include coverage for obstetrical and gynecological services whether performed by a physician or a nurse midwife acting within the scope of his or her license or specialty certification or shall do 1 or both of the following:
(a) Offer to provide coverage for obstetrical and gynecological services whether performed by a physician or a nurse midwife acting within the scope of his or her license or specialty certification.
(b) Offer to provide coverage for maternity services and gynecological services rendered during pre- and post-natal care whether performed by a physician or a nurse midwife acting within the scope of his or her license or specialty certification.
History:
Add. 2004, Act 375, Imd. Eff. Oct. 11, 2004 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406u - Coverage for Prescription Eyedrops; Requirements; "Prescriber" Defined.

500.3406u Coverage for prescription eyedrops; requirements; "prescriber" defined.
Sec. 3406u.
(1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription eyedrops shall not deny coverage for a refill of the prescription if all of the following apply:
(a) For a 30-day supply, the amount of time has passed within which the insured should have used 75% of the dosage units of the drug according to the prescriber's instructions, or 23 days have passed after either of the following:
(i) The original date the prescription was distributed to the insured.
(ii) The date the most recent refill was distributed to the insured.
(b) The prescriber indicates on the original prescription that additional quantities are needed.
(c) The prescription eye drops prescribed by the prescriber are covered under the health insurance policy.
(2) As used in this section, "prescriber" means that term as defined in section 17708 of the public health code, 1978 PA 368, MCL 333.17708.
History:
Add. 2019, Act 139, Imd. Eff. Dec. 5, 2019
Compiler's Notes:
Enacting section 1 of Act 139 of 2019 provides:"Enacting section 1. This amendatory act applies to health insurance policies delivered, executed, issued, amended, adjusted, or renewed in this state, or outside of this state if covering residents of this state, beginning 90 days after the date this amendatory act is enacted into law."Ninety days after the enactment date of Act 139 of 2019 is March 4, 2020.
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406v - Coverage for Emergency Supply of Insulin.

500.3406v Coverage for emergency supply of insulin.
Sec. 3406v.
Beginning on the effective date of the amendatory act that added this section, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription drugs shall provide coverage for any emergency supply of insulin that is covered under an insured's health insurance policy and that is dispensed to the insured by a pharmacist as provided in section 17744f of the public health code, 1978 PA 368, MCL 333.17744f.
History:
Add. 2021, Act 37, Imd. Eff. July 1, 2021
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406w - Temporary Emergency and Early Refills for Prescription Drugs; Inapplicable After March 31, 2021.

500.3406w Temporary emergency and early refills for prescription drugs; inapplicable after March 31, 2021.
Sec. 3406w.
(1) Beginning on the effective date of the amendatory act that added this section, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription drugs shall do both of the following:
(a) Provide coverage for an emergency refill of up to a 60-day supply of any covered maintenance prescription drug.
(b) Provide coverage for an early refill of any 30-day or 60-day covered maintenance prescription drug to allow for up to a 90-day supply, without regard to whether the pharmacy is mail order or in person.
(2) This section does not apply after March 31, 2021.
(3) As used in this section:
(a) "Emergency refill" means a refill where, in the pharmacist's professional judgment, failure to refill the prescription may interrupt the patient's ongoing care and have a significant adverse effect on the patient's well-being as provided in section 17713 of the public health code, 1978 PA 368, MCL 333.17713.
(b) "Maintenance prescription drug" means a prescription drug that meets the requirements under section 3406t(1)(b)(i) to (iii).
History:
Add. 2020, Act 322, Imd. Eff. Dec. 29, 2020
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406x - Nonopioid Directive Form; Website.

500.3406x Nonopioid directive form; website.
Sec. 3406x.
An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall make available to the insurer's insureds a nonopioid directive form on the insurer's internet website. As used in this section, "nonopioid directive form" means that term as defined in section 9145 of the public health code, 1978 PA 368, MCL 333.9145.
History:
Add. 2022, Act 43, Imd. Eff. Mar. 23, 2022
Compiler's Notes:
Enacting section 1 of Act 43 of 2022 provides:"Enacting section 1. This amendatory act applies to policies delivered, executed, issued, amended, adjusted, or renewed in this state, or outside of this state if covering residents of this state, after March 31, 2022."
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406y - Nonopioid Directive Form; Enrollment.

500.3406y Nonopioid directive form; enrollment.
Sec. 3406y.
An insurer that delivers, issues for delivery, or renews in this state a policy of health insurance shall provide a nonopioid directive form to insureds upon enrollment. As used in this section, "nonopioid directive form" means that term as defined in section 9145 of the public health code, 1978 PA 368, MCL 333.9145.
History:
Add. 2022, Act 42, Imd. Eff. Mar. 23, 2022
Compiler's Notes:
Enacting section 1 of Act 42 of 2022 provides:"Enacting section 1. This amendatory act applies to policies delivered, executed, issued, amended, adjusted, or renewed in this state, or outside of this state if covering residents of this state, after June 30, 2022."
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406z - Essential Health Benefit Coverage; Annual and Lifetime Dollar Limits; Prohibition; Applicability to Grandfathered Health Plan Coverage.

500.3406z Essential health benefit coverage; annual and lifetime dollar limits; prohibition; applicability to grandfathered health plan coverage.
Sec. 3406z.
(1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not institute either of the following:
(a) Lifetime limits on the dollar value of essential health benefit coverage under section 3406bb(1).
(b) Annual limits on the dollar value of essential health benefit coverage under section 3406bb(1).
(2) This section does not prevent an insurer from placing annual or lifetime dollar limits with respect to any individual on specific covered benefits that are not essential health benefits to the extent that the limits are otherwise permitted under applicable federal or state law.
(3) This section does not apply to grandfathered health plan coverage, as that term is defined in 45 CFR 147.140, or to a short-term or 1-time limited duration policy or certificate of not longer than 6 months.
History:
Add. 2023, Act 159, Eff. Feb. 13, 2024
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406z[1] - Disability Insurance Policies; Discrimination Against Living Donors; Prohibition; Definitions.

500.3406z[1] Disability insurance policies; discrimination against living donors; prohibition; definitions.
Sec. 3406z.
(1) This section applies to disability insurance policies or certificates delivered or issued for delivery after December 31, 2023.
(2) Unless there is an additional actuarial risk, as determined in accordance with sound actuarial principles as well as the individual's actual and reasonably anticipated experience, an insurer shall not do any of the following with respect to a disability insurance policy or certificate based solely on the individual's status as a living donor:
(a) Deny coverage.
(b) Cancel coverage.
(c) Refuse to issue the policy or certificate.
(d) Determine the price or premium for the policy or certificate.
(e) Otherwise vary a term or condition of the policy or certificate.
(3) As used in this section:
(a) "Living donor" means an individual who is not deceased and has donated any of the following:
(i) All or part of an organ.
(ii) A tissue.
(b) "Organ" means a human kidney, liver, heart, lung, pancreas, esophagus, stomach, or small or large intestine, a portion of the human gastrointestinal tract, or another part of the human body designated by the department by rule.
(c) "Tissue" means a portion of the human body other than an organ, including, but not limited to, an eye, skin, bone, bone marrow, a heart valve, a spermatozoon, an ova, an artery, a vein, a tendon, a ligament, blood, blood derivatives, a pituitary gland, or fluid.
History:
Add. 2023, Act 192, Imd. Eff. Nov. 7, 2023
Compiler's Notes:
Section 3406z, as added by Act 192 of 2023, was compiled as 500.3406z[1] to distinguish it from another section 3406z, deriving from Act 159 of 2023 and pertaining to a prohibition on lifetime and annual dollar limits.
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406ff - Financial Parity for Orally Administered, Intravenously Administered and Injected Antineoplastic (Anticancer) Medications.

500.3406ff Financial parity for orally administered, intravenously administered and injected antineoplastic (anticancer) medications.
Sec. 3406ff.
(1) A health insurance policy delivered, issued for delivery, or renewed in this state that provides coverage for prescribed orally administered antineoplastic medications and intravenously administered or injected antineoplastic medications must ensure either of the following:
(a) That financial requirements applicable to prescribed orally administered antineoplastic medications are not more restrictive than the financial requirements that apply to intravenously administered or injected antineoplastic medications that are covered by the health insurance policy.
(b) That the co-pay or coinsurance for orally administered antineoplastic medication does not exceed $250.00 per 30-day supply. Beginning January 1, 2026, and each January 1 after that date, the department shall adjust the financial requirement described in this subdivision by an amount determined by the state treasurer that reflects the cumulative annual change in the prescription drug index of the medical care component of the United States Consumer Price Index.
(2) An insurer cannot achieve compliance with this section by increasing cost-sharing requirements, reclassifying benefits with respect to antineoplastic medications, or imposing more restrictive treatment limitations on prescribed orally administered antineoplastic medications or intravenously administered or injected antineoplastic medications covered under a health insurance policy described in subsection (1).
(3) This section does not prohibit an insurer from applying utilization management techniques, including prior authorization, step therapy, limits on quantity dispensed, and days' supply per fill for any administered antineoplastic medication.
(4) As used in this section:
(a) "Antineoplastic medication" means a medication used to kill, slow, or prevent the growth of cancerous cells.
(b) "Cost-sharing requirement" means deductibles, copayments, coinsurance, out-of-pocket expenses, aggregate lifetime limits, and annual limits.
(c) "Treatment limitation" means limits on the frequency of treatment, days of coverage, or other similar limits on the scope or duration of treatment. Treatment limitation does not include the application of utilization management techniques described in subsection (3).
History:
Add. 2023, Act 170, Eff. Feb. 13, 2024
Compiler's Notes:
Enacting section 1 of Act 170 of 2023 provides:"Enacting section 1. This amendatory act applies to health insurance policies delivered, issued for delivery, or renewed in this state after December 31, 2025."
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3406ii - Prohibition on the Limitation or Exclusion of Benefits Based on Preexisting Condition; Exceptions.

500.3406ii Prohibition on the limitation or exclusion of benefits based on preexisting condition; exceptions.
Sec. 3406ii.
(1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not limit or exclude coverage for an individual by imposing a preexisting condition exclusion on the individual.
(2) This section does not apply to any of the following:
(a) Grandfathered health plan coverage, as that term is defined in 45 CFR 147.140.
(b) Insurance coverage that provides benefits for any of the following:
(i) Hospital confinement indemnity.
(ii) Disability income.
(iii) Accident only.
(iv) Long-term care.
(v) Medicare supplemental.
(vi) Limited benefit health.
(vii) Specified disease indemnity.
(viii) Sickness or bodily injury, or death by accident, or both.
(ix) Retiree-only health insurance coverage.
(x) Stand-alone dental plans.
(xi) Stand-alone vision plans.
(xii) Other limited benefit policies.
(3) As used in this section, "preexisting condition exclusion" means a limitation or exclusion of benefits or a denial of coverage based on the fact that a physical or mental condition was present before the effective date of coverage or before the date coverage is denied, whether or not any medical advice, diagnosis, care, or treatment was recommended or received for the condition before the date of coverage or denial of coverage.
History:
Add. 2023, Act 157, Eff. Feb. 13, 2024
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3407 - Entire Contract; Changes.

500.3407 Entire contract; changes.
Sec. 3407.
Except as otherwise provided in this act, an insurer shall include the following provision in a disability insurance policy:
ENTIRE CONTRACT; CHANGES: This policy, including the applicable riders and endorsements; the application for coverage if specified by the insurer; the identification card if specified by the insurer; and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy is valid until approved by an executive officer of the insurer and unless the approval is endorsed on this policy or attached to this policy. An insurance producer does not have authority to change this policy or to waive any of its provisions.
History:
1956, Act 218, Eff. Jan. 1, 1957 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3407a - Conduct on Behalf of or Information Provided to Insured by Health Care Provider; Prohibition or Discouragement by Disability Insurer.

500.3407a Conduct on behalf of or information provided to insured by health care provider; prohibition or discouragement by disability insurer.
Sec. 3407a.
A disability insurer shall not prohibit or discourage a health care provider from advocating on behalf of an insured for appropriate medical treatment options pursuant to the grievance procedure in section 2213 or from discussing with an insured or provider any of the following:
(a) Health care treatments and services.
(b) Quality assurance plans required by law, if applicable.
(c) The financial relationships between the insurer and the health care provider including all of the following as applicable:
(i) Whether a fee-for-service arrangement exists, under which the provider is paid a specified amount for each covered service rendered to the participant.
(ii) Whether a capitation arrangement exists, under which a fixed amount is paid to the provider for all covered services that are or may be rendered to each covered individual or family.
(iii) Whether payments to providers are made based on standards relating to cost, quality, or patient satisfaction.
History:
Add. 1997, Act 66, Imd. Eff. July 15, 1997
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3407b - Undergoing Genetic Testing as Condition of Issuing, Renewing, or Continuing Policy; Disclosure of Genetic Testing or Genetic Information; Definitions.

500.3407b Undergoing genetic testing as condition of issuing, renewing, or continuing policy; disclosure of genetic testing or genetic information; definitions.
Sec. 3407b.
(1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not require an insured or his or her dependent or an asymptomatic applicant for insurance or his or her asymptomatic dependent to do either of the following:
(a) Undergo genetic testing before issuing, renewing, or continuing the policy in this state.
(b) Disclose whether genetic testing has been conducted or the results of genetic testing or genetic information.
(2) As used in this section:
(a) "Clinical purposes" includes all of the following:
(i) Predicting risk of diseases.
(ii) Identifying carriers for single-gene disorders.
(iii) Establishing prenatal and clinical diagnosis or prognosis.
(iv) Prenatal, newborn, and other carrier screening, as well as testing in high-risk families.
(v) Testing for metabolites if undertaken with high probability that an excess or deficiency of the metabolite indicates or suggests the presence of heritable mutations in single genes.
(vi) Other testing if the intended purpose is diagnosis of a presymptomatic genetic condition.
(b) "Genetic information" means information about a gene, gene product, or inherited characteristic derived from a genetic test.
(c) "Genetic test" means the analysis of human DNA, RNA, chromosomes, and those proteins and metabolites used to detect heritable or somatic disease-related genotypes or karyotypes for clinical purposes. A genetic test must be generally accepted in the scientific and medical communities as being specifically determinative for the presence, absence, or mutation of a gene or chromosome to qualify under this definition. Genetic test does not include a routine physical examination or a routine analysis, including, but not limited to, a chemical analysis, of body fluids, unless conducted specifically to determine the presence, absence, or mutation of a gene or chromosome.
(d) After December 31, 2017, "insurer" includes a nonprofit dental care corporation operating under 1963 PA 125, MCL 550.351 to 550.373.
History:
Add. 2000, Act 27, Imd. Eff. Mar. 15, 2000 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 ;-- Am. 2017, Act 223, Imd. Eff. Dec. 20, 2017
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3408 - Time Limit on Certain Defenses; Incontestable Policy.

500.3408 Time limit on certain defenses; incontestable policy.
Sec. 3408.
(1) An insurer shall include in a disability insurance policy, other than a health insurance policy, a provision that consists of both of the following:
(a) One of the following, as applicable:
(i) TIME LIMIT ON CERTAIN DEFENSES: After 3 years from the date of issue of this policy, the insurer will not use a misstatement, except a fraudulent misstatement, made by the applicant in the application for the policy to void the policy or to deny a claim for loss incurred or disability, as defined in the policy, beginning after the expiration of the 3-year period. This policy provision does not affect a legal requirement for avoidance of a policy or denial of a claim during the initial 3-year period, and does not limit the application of sections 3432, 3434, 3436, 3438, and 3440 if a misstatement with respect to age or occupation or other insurance is made.
(ii) Instead of the provision required under subparagraph (i), for a policy that the insured has the right to continue in force subject to its terms by the timely payment of premium until at least age 50 or, for a policy issued after age 44, for at least 5 years after its date of issue, an insurer may include the following in the policy, under the caption "INCONTESTABLE":
After this policy has been in force for a period of 3 years during the lifetime of the insured (excluding any period during which the insured is disabled), it becomes incontestable as to the statements contained in the application.
(b) A claim for a loss incurred or disability, as defined in the policy, beginning after 3 years from the date of issue of this policy will not be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss existed before the effective date of coverage of this policy.
(2) For the purpose of permitting insurers to use a uniform policy in several states, the insurer may print in the policy form in the provisions required under subsection (1)(a) and (b) the term of "3 years". Notwithstanding any provision of the contract or law to the contrary, the time limits for the defenses described in this section and included in a disability insurance policy, not including a health insurance policy, that is delivered or issued for delivery in this state must not exceed 2 years.
History:
1956, Act 218, Eff. Jan. 1, 1957 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3410 - Grace Period; Provision Required.

500.3410 Grace period; provision required.
Sec. 3410.
There shall be a provision as follows:
GRACE PERIOD: A grace period of ................ (insert a number not less than "7" for weekly premium policies, "10" for monthly premium policies and "31" for all other policies) days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force.
(A policy which contains a cancellation provision may add, at the end of the above provision, "subject to the right of the insurer to cancel in accordance with the cancellation provision hereof." A policy in which the insurer reserves the right to refuse any renewal shall have, at the beginning of the above provision, "unless not less than 5 days prior to the premium due date the insurer has delivered to the insured or has mailed to his last address as shown by the records of the insurer written notice of its intention not to renew this policy beyond the period for which the premium has been accepted,").
History:
1956, Act 218, Eff. Jan. 1, 1957
Popular Name:
Act 218
2023 Michigan Compiled Laws › Chapter 500 - Insurance Code of 1956 › Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302) › 218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480) › Section 500.3411 - Reinstatement; Provision Required.

500.3411 Reinstatement; provision required.
Sec. 3411.
(1) Subject to subsection (2), an insurer shall include the following provision in a disability insurance policy other than a health insurance policy:
REINSTATEMENT: If any renewal premium is not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by an agent duly authorized by the insurer to accept the premium, without requiring in connection with the acceptance of the premium an application for reinstatement, is a reinstatement of the policy. However, if the insurer or its agent requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy is reinstated upon approval of the application by the insurer or, if not approved by the insurer, on the forty-fifth day after the date of the conditional receipt unless the insurer has previously notified the insured in writing of its disapproval of the application. Under the reinstated policy, the insurer will cover only loss resulting from accidental injury that is sustained after the date of reinstatement and loss due to sickness that begins more than 10 days after that date. In all other respects, the insured and insurer have the same rights under the policy as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions endorsed on the policy or attached to the policy in connection with the reinstatement. The insurer will apply any premium accepted in connection with a reinstatement to a period for which premium has not been previously paid, but not to any period more than 60 days before the date of reinstatement.
(2) An insurer may omit the last sentence of the provision required under subsection (1) from a policy that the insured has the right to continue in force subject to its terms by the timely payment of premium until at least age 50 or, for a policy issued after age 44, for at least 5 years after its date of issue.
History:
1956, Act 218, Eff. Jan. 1, 1957 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016
Popular Name:
Act 218