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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3823 - Covered Benefits More Restrictive Than Benefits Under Medicare and Required Under State Law Prohibited; Benefits for Outpatient Prescription Drugs.

500.3823 Covered benefits more restrictive than benefits under medicare and required under state law prohibited; benefits for outpatient prescription drugs.
Sec. 3823.
(1) An insurance policy shall not be titled, advertised, solicited, or issued for delivery in this state as a medicare supplement policy unless the definitions and terms contained in the policy are such that covered benefits under the policy are not more restrictive than covered benefits under medicare and those required to be provided under state law.
(2) A medicare supplement policy with benefits for outpatient prescription drugs in existence prior to January 1, 2006 shall be renewed for current policyholders who do not enroll in part D at the option of the policyholder.
(3) A medicare supplement policy with benefits for outpatient prescription drugs shall not be issued after December 31, 2005.
(4) After December 31, 2005, a medicare supplement policy with benefits for outpatient prescription drugs may not be renewed after the policyholder enrolls in medicare part D unless:
(a) The policy is modified to eliminate outpatient prescription coverage for expenses of outpatient prescription drugs incurred after the effective date of the individual's coverage under a part D plan.
(b) Premiums are adjusted to reflect the elimination of outpatient prescription drug coverage at the time of medicare part D enrollment, accounting for any claims paid, if applicable.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992 ;-- Am. 2006, Act 462, Imd. Eff. Dec. 20, 2006
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3825 - Preexisting Diseases or Conditions; Waiver Prohibited.

500.3825 Preexisting diseases or conditions; waiver prohibited.
Sec. 3825.
A medicare supplement policy shall not use waivers to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3830a - Termination of Contract or Agreement; Notice to Individual.

500.3830a Termination of contract or agreement; notice to individual.
Sec. 3830a.
(1) At the time of an event described in section 3830(2) because of which an individual loses coverage or benefits due to the termination of a contract or agreement, policy, or plan, the organization that terminates the contract or agreement, the insurer terminating the policy, or the administrator of the plan being terminated, respectively, shall notify the individual of his or her rights under section 3830 and of the obligations of insurers of medicare supplement policies under section 3830(1). The notice shall be communicated contemporaneously with the notification of termination.
(2) At the time of an event described in section 3830(2) because of which an individual ceases enrollment under a contract or agreement, policy, or plan, the organization that offers the contract or agreement, regardless of the basis for the cessation of enrollment, the insurer offering the policy, or the administrator of the plan, respectively, shall notify the individual of his or her rights under section 3830 and of the obligations of insurers of medicare supplement policies under section 3830(1). The notice shall be communicated within 10 working days of the insurer receiving notification of disenrollment.
History:
Add. 2002, Act 304, Imd. Eff. May 10, 2002
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3833 - Replacement Policy; Waiver of Certain Time Periods.

500.3833 Replacement policy; waiver of certain time periods.
Sec. 3833.
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 time was spent under the original coverage.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3835 - Marketing Procedures; Determining Appropriateness of Recommended Purchase or Replacement; More Than 1 Policy Prohibited; Individual Enrolled in Medicare Advantage; "Notice to Buyer" Displayed.

500.3835 Marketing procedures; determining appropriateness of recommended purchase or replacement; more than 1 policy prohibited; individual enrolled in medicare advantage; "notice to buyer" displayed.
Sec. 3835.
(1) An insurer that markets Medicare supplement insurance coverage in this state directly or through its agents shall do all of the following:
(a) Establish marketing procedures to ensure that any comparison of policies by its agents will be fair and accurate.
(b) Establish marketing procedures to ensure excessive insurance is not sold or issued.
(c) Inquire and otherwise make every reasonable effort to identify whether a prospective applicant for Medicare supplement insurance already has health coverage.
(d) Establish auditable procedures for verifying compliance with this subsection.
(2) In recommending the purchase or replacement of any Medicare supplement coverage, an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement.
(3) Any sale of Medicare supplement coverage that will provide an individual with more than 1 Medicare supplement policy, certificate, or contract is prohibited.
(4) An insurer shall not issue a Medicare supplement policy or certificate to an individual enrolled in Medicare advantage unless the effective date of the coverage is after the termination date of the individual's Medicare advantage coverage.
(5) A medical supplement policy must display prominently by type, stamp, or other appropriate means, on the first page of the policy the following: "Notice to buyer: This policy may not cover all of your medical expenses.".
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992 ;-- Am. 2006, Act 462, Imd. Eff. Dec. 20, 2006 ;-- Am. 2018, Act 429, Eff. Mar. 20, 2019
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3837 - Repealed. 2002, Act 304, Imd. Eff. May 10, 2002.

500.3837 Repealed. 2002, Act 304, Imd. Eff. May 10, 2002.
Compiler's Notes:
The repealed section pertained to report to commissioner.
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3839 - Renewal or Continuation Provision; Effect of Termination or Replacement; Elimination of Outpatient Prescription Drug Benefit.

500.3839 Renewal or continuation provision; effect of termination or replacement; elimination of outpatient prescription drug benefit.
Sec. 3839.
(1) Each medicare supplement policy shall include a renewal or continuation provision. The provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state the term of coverage for which the policy is issued and for which it may be renewed. The provision shall include any reservation by the insurer of the right to change premiums and any automatic renewal premium increases based on the policyholder's age.
(2) If a medicare supplement policy is terminated by the group policyholder and is not replaced as provided under subsection (4), the issuer shall offer certificate holders an individual medicare supplement policy that at the option of the certificate holder provides for continuation of the benefits contained in the group policy or provides for such benefits as otherwise meet the requirements of section 3819 or 3819a.
(3) If an individual is a certificate holder in a group medicare supplement policy and the individual terminates membership in the group, the issuer shall offer the certificate holder the conversion opportunity described in subsection (2) or (4) or at the option of the group policyholder, offer the certificate holder continuation of coverage under the group policy.
(4) If a group medicare supplement policy is replaced by another group medicare supplement policy purchased by the same policyholder, the succeeding issuer shall offer coverage to all persons covered under the old group policy on its date of termination. Coverage under the new policy shall not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced.
(5) If a medicare supplement policy eliminates an outpatient prescription drug benefit as a result of requirements imposed by the medicare prescription drug, improvement, and modernization act of 2003, Public Law 108-173, the modified policy shall be considered to satisfy the guaranteed renewal requirements of this section.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992 ;-- Am. 2006, Act 462, Imd. Eff. Dec. 20, 2006 ;-- Am. 2009, Act 220, Imd. Eff. Jan. 5, 2010
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3843 - Health Insurance; Notice; Contents; Applicability of Subsection (1).

500.3843 Health insurance; notice; contents; applicability of subsection (1).
Sec. 3843.
(1) A policy or certificate of health insurance issued for delivery in this state to persons eligible for Medicare by reason of age must notify insureds under the policy or certificate that the policy is not a Medicare supplement policy. The notice must either be printed or attached to the first page of the coverage outline delivered to insureds under the policy or certificate or, if a coverage outline is not delivered, to the first page of the policy or certificate delivered to insureds. The notice must be in not less than 12-point type, and must contain the following language:
"This (policy or certificate) is not a Medicare supplement (policy or certificate). It is not designed to fit with Medicare. It may not fit all of the gaps in Medicare and it may duplicate some Medicare benefits. If you are eligible for Medicare, review the Medicare supplement buyer's guide available from the company. If you decide to consider buying this policy or certificate, be sure you understand what it covers, what it does not cover, and whether it duplicates coverage you already have."
(2) Subsection (1) does not apply to any of the following:
(a) A Medicare supplement policy or certificate.
(b) A disability income policy or certificate.
(c) A single premium nonrenewable policy or certificate.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992 ;-- Am. 2018, Act 429, Eff. Mar. 20, 2019
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3847 - Advertising; Filing Copy With Director.

500.3847 Advertising; filing copy with director.
Sec. 3847.
An insurer that provides Medicare supplement insurance coverage in this state shall file with the director for review a copy of any written, radio, or television advertisement for Medicare supplement insurance intended for use in this state at least 30 days before the date the insurer desires to use the advertising. The filing must include a sample or photocopy of all applicable Medicare supplement policies and related forms and the approval status of the policies and forms.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992 ;-- Am. 2018, Act 429, Eff. Mar. 20, 2019
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3851 - Aggregate Benefits; Rates, Rating Schedules, and Rate Revisions.

500.3851 Aggregate benefits; rates, rating schedules, and rate revisions.
Sec. 3851.
(1) A medicare supplement policy form or certificate form shall not be delivered or issued for delivery unless the policy form or certificate form can be expected, as estimated for the entire period for which rates are computed to provide coverage, to return to policyholders and certificate holders in the form of aggregate benefits, not including anticipated refunds or credits, the following:
(a) For group policies at least 75% of the aggregate amount of premiums earned calculated on the basis of incurred claims experience and earned premiums for the entire period for which rates are computed and in accordance with accepted actuarial principles and practices.
(b) For individual policies at least 65% of the aggregate amount of premium earned calculated on the basis of incurred claims experience and earned premiums for the entire period for which rates are computed and in accordance with accepted actuarial principles and practices.
(2) All filings of rates and rating schedules shall demonstrate that expected claims in relation to premiums comply with the requirements of this section when combined with actual experience to date. Filings of rate revisions shall also demonstrate that the anticipated loss ratio over the entire future period for which the revised rates are computed to provide coverage can be expected to meet the appropriate loss ratio standards.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3852 - Benchmark Ratio.

500.3852 Benchmark ratio.
Sec. 3852.
An insurer shall file by May 31 of each year a reporting form for the calculation of benchmark ratio since inception in a format prescribed by the commissioner for each type in a standard medicare supplement benefit plan.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3853 - Refund or Credit Calculation; Form; Interest; Due Date.

500.3853 Refund or credit calculation; form; interest; due date.
Sec. 3853.
If on the basis of the experience as reported by an insurer under section 3852 the benchmark ratio since inception (ratio 1) exceeds the adjusted experienced ratio since inception (ratio 3), then a refund or credit calculation is required. The refund calculation shall be done on a statewide basis on a refund calculation form in a format prescribed by the commissioner for each type in a standard medicare supplement benefit plan. For purposes of the refund or credit calculation, only experience on policies issued within the reporting year shall be excluded. A refund or credit shall be made only where the benchmark loss ratio exceeds the adjusted experienced loss ratio and the amount to be refunded or credited exceeds the minimum level. The refund shall include interest from the end of the calendar year to the date of the refund or credit at a rate specified by the secretary of health and human services, but not less than the average rate of interest for 13-week treasury notes. A refund or credit against premiums due shall be made by September 30 following the experience year upon which the refund or credit is based.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3855 - Annual Filing of Rates, Rating Schedule, and Supporting Documentation; Premium Adjustments; Public Hearing for Rate Increase; Failure to Make Premium Adjustments.

500.3855 Annual filing of rates, rating schedule, and supporting documentation; premium adjustments; public hearing for rate increase; failure to make premium adjustments.
Sec. 3855.
(1) Each insurer that issues medicare supplement policies for delivery in this state shall file annually with the commissioner, on a form and in the manner prescribed by the commissioner, its rates, rating schedule, and supporting documentation including all claims experience of the insurer for medicare supplement coverage. The filings and schedules shall demonstrate that the actual and expected losses in relation to premiums are in compliance with the applicable loss ratio standards of this state. The supporting documentation shall also be in accordance with actuarial standards of practice using reasonable assumptions that the appropriate loss ratio standards can be expected to be met over the entire period for which rates are computed excluding active life reserves. An expected third-year loss ratio that is greater than or equal to the applicable percentage under section 3851 shall be demonstrated for policies or certificates in force less than 3 years.
(2) An insurer shall make such premium adjustments as are necessary to produce an expected loss ratio under the medicare supplement policy as will conform with minimum loss ratio standards for medicare supplement policies and certificates and that are expected to result in a loss ratio at least as great as that originally anticipated in the rates used to produce current premiums by the insurer for such medicare supplement insurance policies. A premium adjustment that would modify the loss ratio experience under the policy shall not be made with respect to a policy at any time other than upon its renewal date or anniversary date.
(3) The commissioner may conduct a public hearing to gather information concerning a request by a medicare supplement insurer for an increase in a rate for a medicare supplement policy form or certificate form issued before or after the effective date of this chapter if the experience of the form for the previous reporting period is not in compliance with the applicable loss ratio standard. The determination of compliance shall be made without consideration of any refund or credit for the reporting period. Public notice of the hearing shall be furnished in a manner considered appropriate by the commissioner.
(4) If a medicare supplement insurer fails to make premium adjustments acceptable to the commissioner, the commissioner may order premium adjustments, refunds, or premium credits considered necessary to achieve the loss ratio required by this section.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3857 - Duties of Insurer; Certification of Compliance With Subsection (1)(a).

500.3857 Duties of insurer; certification of compliance with subsection (1)(a).
Sec. 3857.
(1) An insurer shall do all of the following:
(a) Accept a notice from a medicare carrier on dually assigned claims submitted by participating physicians and suppliers as a claim for benefits in place of any other claim form otherwise required and make a payment determination on the basis of the information contained in that notice.
(b) Notify the participating physician or supplier and the beneficiary of the payment determination.
(c) Pay the participating physician or supplier directly.
(d) Furnish, at the time of enrollment, each enrollee with a card listing the policy name, number, and a central mailing address to which notices from a medicare carrier may be sent.
(e) Pay user fees for claim notices that are transmitted electronically or otherwise.
(f) Provide to the secretary of health and human services, at least annually, a central mailing address to which all claims may be sent by medicare carriers.
(2) Compliance with the requirements set forth in subsection (1)(a) shall be certified on the medicare supplement insurance experience reporting form.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3859 - Prohibited Conduct; Violation as Misdemeanor; Penalty.

500.3859 Prohibited conduct; violation as misdemeanor; penalty.
Sec. 3859.
(1) A person shall not knowingly sell a health insurance policy or certificate to an individual entitled to benefits under part A or enrolled under part B of medicare with knowledge that the policy or certificate substantially duplicates health benefits to which the individual is otherwise entitled, other than benefits to which the individual is entitled under a requirement of state or federal law other than medicare. A person who violates this subsection is guilty of a misdemeanor punishable by imprisonment for not more than 2 years, or a fine of not more than $10,000.00, or both. The court may order a person convicted under this subsection to pay restitution to individuals for expenses incurred as a result of violation of this subsection. For purposes of this subsection, benefits that are payable to or on behalf of an individual without regard to other health benefit coverage of the individual shall not be considered as duplicative. The selling of a group certificate or contract of the trustees of a fund established by 1 or more employers, labor organizations, or both, for employees, former employees, or both, or for members or former members, or both, of labor organizations, shall not be considered to be a violation of this subsection.
(2) A person shall not falsely assume or pretend to be acting or misrepresent in any way that he or she is acting under the authority of or in association with medicare or any state or federal agency, for the purpose of selling or attempting to sell insurance or, in such a pretended character, demand or obtain money, paper, documents, or any thing of value. A person who violates this subsection is guilty of a misdemeanor punishable by imprisonment for not more than 2 years, or a fine of not more than $10,000.00, or both.
(3) A person shall not solicit, offer for sale, or deliver a medicare supplement policy in this state, unless the policy has been approved by the commissioner. A person who violates this subsection is guilty of a misdemeanor punishable by imprisonment for not more than 1 year, or a fine of not more than $5,000.00, or both.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992
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) › 218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861) › Section 500.3861 - Probable Cause of Violation; Notice of Hearing; Opportunity to Confer and Discuss; Hearing; Applicability of MCL 500.2038 to 500.2040; Violation; Penalty.

500.3861 Probable cause of violation; notice of hearing; opportunity to confer and discuss; hearing; applicability of MCL 500.2038 to 500.2040; violation; penalty.
Sec. 3861.
(1) If the commissioner has probable cause to believe that an insurer or agent has violated or is violating this chapter and that a hearing by the commissioner would be in the public interest, the commissioner shall give notice in writing to the person involved pursuant to the administrative procedures act of 1969, Act No. 306 of the Public Acts of 1969, being sections 24.201 to 24.328 of the Michigan Compiled Laws, setting forth the general nature of the complaint against him or her, and the proceedings contemplated. Before the issuance of a notice of hearing, the commissioner shall give the person an opportunity to confer and discuss the possible complaint and proceedings in person with the commissioner or his or her representative, and the matter may be disposed of summarily upon agreement of the parties.
(2) The provisions of section 2030 shall apply with respect to a hearing held pursuant to subsection (1), except that the use of an independent hearing officer shall not be allowed.
(3) If, after opportunity for a hearing held pursuant to Act No. 306 of the Public Acts of 1969, the commissioner determines that the insurer or agent has violated this chapter, the provisions of sections 2038 to 2040 shall apply. Each medicare supplement policy issued or delivered in violation of any of the provisions contained in this chapter shall constitute a separate violation for purposes of assessing a civil fine.
(4) In addition to any other applicable penalties for violations of this act, the commissioner may require insurers violating this chapter to cease marketing any medicare supplement policy or certificate in this state that is related directly or indirectly to a violation or may require the insurer to take such actions as are necessary to comply with this chapter.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992
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) › 218-1956-39 - Chapter 39 Long-Term Care Insurance (500.3901...500.3955) › Section 500.3901a - Long-Term Care Insurance Policies; Discrimination Against Living Donors; Prohibition; Definitions.

500.3901a Long-term care insurance policies; discrimination against living donors; prohibition; definitions.
Sec. 3901a.
(1) This section applies to all long-term care 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 long-term care 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 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
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) › 218-1956-39 - Chapter 39 Long-Term Care Insurance (500.3901...500.3955) › Section 500.3902 - Offer of Long-Term Care Coverage by Subsidiary of Health Care Corporation.

500.3902 Offer of long-term care coverage by subsidiary of health care corporation.
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.
History:
Add. 2006, Act 441, Imd. Eff. Oct. 19, 2006
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) › 218-1956-39 - Chapter 39 Long-Term Care Insurance (500.3901...500.3955) › Section 500.3903 - Group Long-Term Care Insurance; Coverage Offered to Groups Described in MCL 500.3901(c)(iv) and 500.3901(c)(iii).

500.3903 Group long-term care insurance; coverage offered to groups described in MCL 500.3901(c)(iv) and 500.3901(c)(iii).
Sec. 3903.
(1) Group long-term care insurance coverage shall not be offered to a resident of this state under a group certificate issued in another state to a group described in section 3901(c)(iv), unless this state or another state which the commissioner determines has and enforces statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this state has made a determination that those requirements have been met.
(2) Before advertising, marketing, or offering a group long-term care insurance certificate within this state to a group described in section 3901(c)(iii), the group or the insurer shall file evidence with the commissioner that the group meets all of the following requirements:
(a) Consists of at least 100 members.
(b) Has been in active existence for at least 1 year.
(c) Holds regular meetings at least annually.
(d) Except for credit unions, the group collects dues or solicits contributions from members.
(e) The members have voting privileges and representation on the governing board and committees.
(f) Has been organized and maintained in good faith for purposes other than obtaining insurance unless the commissioner waives this requirement.
(3) Thirty days after making the filing under this section, the group described in section 3901(c)(iii) shall be considered to satisfy subsection (2) organizational requirements, unless the commissioner makes a finding that the group does not satisfy those organizational requirements.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992
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) › 218-1956-39 - Chapter 39 Long-Term Care Insurance (500.3901...500.3955) › Section 500.3905 - Long-Term Care Coverage; Requirements; Certain Coverages Requiring Care Recommendations.

500.3905 Long-term care coverage; requirements; certain coverages requiring care recommendations.
Sec. 3905.
(1) Long-term care coverage shall meet all of the following requirements:
(a) Shall include coverage for intermediate/basic care, which shall not be significantly less than the coverage provided for skilled nursing care.
(b) Shall not limit or exclude coverage by type of illness, type of provider, territorial limitations, treatment, medical condition, or accident other than a motor vehicle accident, except as follows:
(i) Preexisting conditions.
(ii) Mental or nervous disorders; however, this shall not be defined to include more than neurosis, psychoneurosis, psychopathy, psychosis, or mental or emotional disease or disorder and shall not permit exclusion or limitation of benefits on the basis of Alzheimer's disease or related disorders.
(iii) Alcoholism or drug addiction.
(iv) Illness, treatment, or medical condition arising out of any of the following:
(A) War or act of war, whether declared or undeclared.
(B) Participation in a felony, riot, or insurrection.
(C) Service in the armed forces or units auxiliary to the armed forces.
(D) Suicide, whether or not the individual was sane or insane at the time of the suicide, attempted suicide, or intentionally self-inflicted injury.
(2) Long-term care coverage other than home care coverage may provide that before certain coverages in the policy take effect, care must first be recommended by a person or persons as provided in the policy and approved by the commissioner or prescribed by a licensed treating physician. Long-term care coverage for home care may provide that before coverage for home care in the policy takes effect, care must first be prescribed or recommended by a person or persons as provided in the policy and approved by the commissioner.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992
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) › 218-1956-39 - Chapter 39 Long-Term Care Insurance (500.3901...500.3955) › Section 500.3907 - Individual Long-Term Care Policy; Guaranteed Renewable Provision; Conversion; New Limitation Period; Intermediate Care Facility or Skilled Nursing Facility; Home Care Services.

500.3907 Individual long-term care policy; guaranteed renewable provision; conversion; new limitation period; intermediate care facility or skilled nursing facility; home care services.
Sec. 3907.
(1) Each individual long-term care policy shall contain a guaranteed renewable provision. An insurer shall not cancel or otherwise terminate a long-term care insurance policy on the grounds of the age or the deterioration of the mental or physical health of the insured.
(2) Each group long-term care certificate shall contain a conversion provision permitting an individual entitled to benefits under the group certificate to elect to convert from the group certificate to an individual long-term care policy with the option of receiving benefits substantially similar to the prior coverage. An individual shall be entitled to convert to the individual policy at all times except under the following circumstances:
(a) Termination of the individual's group coverage resulted from the individual's failure to make any required payment of premium when due.
(b) The terminating coverage is replaced by other group coverage effective on the day following the termination of the other group coverage.
(3) If existing coverage is converted to or replaced by a long-term care insurance policy with the same insurer, the long-term care insurance policy shall not contain a provision establishing a new limitation period except with respect to an increase in benefits voluntarily selected by the insured. The premium for the converted policy shall be calculated on the basis of the insured's age at inception of coverage under the group certificate.
(4) A long-term care insurance policy that provides coverage for care in an intermediate care facility or a skilled nursing facility shall also provide coverage for home care services that is a dollar amount equivalent to at least 1/2 of 1 year's coverage available for nursing home benefits under the policy at the time covered home health services are being received.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992
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) › 218-1956-39 - Chapter 39 Long-Term Care Insurance (500.3901...500.3955) › Section 500.3908 - Long-Term Care Partnership Program Policy; Conversion or Replacement.

500.3908 Long-term care partnership program policy; conversion or replacement.
Sec. 3908.
(1) Subject to subsection (2), long-term care insurance that is delivered or issued for delivery in this state after December 31, 2007, and before long-term care partnership program policies are approved for sale in this state, may be converted to or replaced with a long-term care partnership program policy.
(2) Before converting the long-term care insurance to, or replacing the long-term care insurance with, a long-term care partnership program policy under this section, the insured and the insurer shall both agree to the conversion or the replacement.
(3) As used in this section, "long-term care partnership program policy" means that term as defined in section 3957.
History:
Add. 2015, Act 198, Eff. Feb. 22, 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) › 218-1956-39 - Chapter 39 Long-Term Care Insurance (500.3901...500.3955) › Section 500.3909 - Option to Purchase Inflation Protection; Summary of Coverage; Applicability of Section.

500.3909 Option to purchase inflation protection; summary of coverage; applicability of section.
Sec. 3909.
(1) An insurer shall not offer a long-term care insurance policy unless the insurer also offers to the policyholder, in addition to any other inflation protection, the option to purchase a policy that provides for benefit levels to increase with benefit maximums or reasonable durations that are meaningful to account for reasonably anticipated increases in the costs of long-term care services covered by the policy. Insurers shall offer to each policyholder, at the time of purchase, the option to purchase a policy with an inflation protection feature no less favorable than 1 of the following:
(a) Increases benefit levels annually in a manner so that the increases are compounded annually at a rate not less than 5%.
(b) Guarantees the insured individual the right to periodically increase benefit levels without providing evidence of insurability or health status so long as the option for the previous period has not been declined. The amount of the additional benefit shall be not less than the difference between the existing policy benefit and that benefit compounded annually at a rate of at least 5% for the period beginning with the purchase of the existing benefit and extending until the year in which the offer is made.
(c) Covers a specified percentage of actual or reasonable charges and does not include a maximum specified indemnity amount or limit.
(2) If the policy is issued to a group, the required offer in subsection (1) shall be made to the group policyholder. However, if the policy is issued to a group defined in section 3901(c)(iv) other than to a continuing care retirement community, the offering shall be made to each proposed certificate holder.
(3) Insurers shall include all of the following information in or with the summary of coverage:
(a) A graphic comparison of the benefit levels of a policy that increases benefits over the policy period with a policy that does not increase benefits. The graphic comparison shall show benefit levels over at least a 20-year period.
(b) Any expected premium increases or additional premiums to pay for automatic or optional benefit increases. If premium increases or additional premiums will be based on the attained age of the applicant at the time of the increase, the insurer shall also disclose the magnitude of the potential premiums the applicant would need to pay at ages 75 and 85 for benefit increases. An insurer may use a reasonable hypothetical, or a graphic demonstration, for the purposes of this disclosure.
(4) This section does not apply to life insurance products that accelerate the death benefit to provide long-term care benefits.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992
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) › 218-1956-39 - Chapter 39 Long-Term Care Insurance (500.3901...500.3955) › Section 500.3910 - Option of Purchasing Policy or Certificate Including Nonforfeiture Benefits; Offer.

500.3910 Option of purchasing policy or certificate including nonforfeiture benefits; offer.
Sec. 3910.
(1) This section does not apply to life insurance policies or riders containing accelerated benefits for long-term care.
(2) Except as provided in subsection (3), a long-term care insurance policy shall not be delivered or issued for delivery in this state unless the policyholder or certificateholder has been offered the option of purchasing a policy or certificate including a nonforfeiture benefit. An offer shall be in writing if the nonforfeiture benefit is not otherwise described in the outline of coverage or other materials given to the prospective policyholder or certificateholder. The offer of a nonforfeiture benefit may be in the form of a rider that is attached to the policy. If the policyholder or certificateholder declines the nonforfeiture benefit, the insurer shall provide a contingent benefit upon lapse that shall be available for a specified period of time following a substantial increase in premium rates.
(3) When a group long-term care insurance policy is issued, the offer required in subsection (2) shall be made to the group policyholder. However, if the policy is issued as group long-term care insurance as defined in section 3901(c)(iv), other than to a continuing care retirement community or other similar entity, the offering shall be made to each proposed certificateholder.
History:
Add. 2006, Act 442, Imd. Eff. Oct. 19, 2006
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) › 218-1956-39 - Chapter 39 Long-Term Care Insurance (500.3901...500.3955) › Section 500.3910b - Reduction Options; Applicability of Section to Long-Term Care Policies and Certificates Issued on or After June 1, 2007.

***** 500.3910b SEE SUBSECTION (7) FOR APPLICABILITY *****
500.3910b Reduction options; applicability of section to long-term care policies and certificates issued on or after June 1, 2007.
Sec. 3910b.
(1) A long-term care insurance policy or certificate shall provide that a policyholder or certificateholder who wishes to reduce coverage and lower the policy or certificate premium may choose at least 1 of the following options:
(a) Reducing the lifetime maximum benefit.
(b) Reducing the daily, weekly, or monthly benefit amount.
(2) In addition to the reduction options listed in subsection (1), a long-term care insurer may offer additional reduction options that are consistent with the policy or certificate design or the insurer's administrative processes.
(3) A long-term care insurer shall include in the long-term care insurance policy or certificate a description of the ways in which coverage may be reduced and the process for requesting and implementing a reduction in coverage.
(4) The age to determine the premium for reduced coverage shall be based on the age used to determine the premiums for the coverage currently in force.
(5) A long-term care insurer may limit any reduction in coverage to plans available for that policy form and to those for which benefits will be available after consideration of claims paid or payable.
(6) If a long-term care insurance policy or certificate is about to lapse, the insurer shall provide written notice to the insured of the options in subsection (1) to lower the premium by reducing coverage and of the premiums applicable to the reduced coverage options. The insurer may include in the notice additional options to those required in subsection (1). The notice shall provide the insured at least 30 days in which to elect to reduce coverage, and the policy or certificate shall be reinstated without underwriting if the insured elects the reduced coverage.
(7) This section applies to long-term care policies and certificates issued on or after June 1, 2007.
History:
Add. 2006, Act 442, Imd. Eff. Oct. 19, 2006
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) › 218-1956-39 - Chapter 39 Long-Term Care Insurance (500.3901...500.3955) › Section 500.3911 - Preexisting Condition; Limitation Period; Definition.

500.3911 Preexisting condition; limitation period; definition.
Sec. 3911.
(1) A preexisting condition limitation period in a long-term care insurance policy, other than a group long-term care certificate described in section 3901(c)(i), shall not exceed 1 of the following:
(a) Six months after the effective date of coverage.
(b) A period of time set by the commissioner if the commissioner has found that a longer limitation period than provided for in subdivision (a) is justified because the group is specially limited by age, group categories, or other specific policy provisions and that the longer limitation period will be in the best interest of the public.
(2) A long-term care insurance policy, other than a group long-term care certificate described in section 3901(c)(i) , shall not use a definition of preexisting condition that is more restrictive than the definition in section 3901.
(3) The definition of preexisting condition does not prohibit an insurer from using an application form designed to elicit the complete health history of an applicant and, on the basis of the answers on that application, underwrite in accordance with that insurer's established underwriting standards.
(4) Unless otherwise provided in the policy, a preexisting condition, regardless of whether it is disclosed on the application, need not be covered until after the limitation period. A long-term care insurance policy shall not exclude or use waivers or riders of any kind to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting conditions beyond the limitation period.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992
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) › 218-1956-39 - Chapter 39 Long-Term Care Insurance (500.3901...500.3955) › Section 500.3913 - Home Health Care Benefits.

500.3913 Home health care benefits.
Sec. 3913.
(1) A long-term care insurance policy shall not limit or exclude services for home health care benefits in any of the following ways:
(a) By requiring that the insured would need skilled care in a skilled nursing facility if home health care services were not provided.
(b) By requiring that the insured first or simultaneously receive nursing or therapeutic services in a home or community setting before home health care services are covered.
(c) By limiting eligible services to services provided by registered nurses or licensed practical nurses.
(d) By requiring that a nurse or therapist provide services covered by the policy that can be provided by a home health aide or other licensed or certified home care worker acting within the scope of his or her licensure or certification.
(e) By requiring that the insured have an acute condition before home health care services are covered.
(f) By limiting benefits to services provided by medicare-certified agencies or providers.
(2) Home health care coverage may be applied to the nonhome health care benefits provided in the policy when determining maximum coverage under the terms of the policy.
(3) A long-term care insurance policy that provides coverage for home care services or assisted living services shall define and provide a detailed explanation in plain English of what home care services or assisted living services are covered. A long-term care insurance policy that provides coverage for assisted living facility stays shall define in plain English what assisted living facilities are covered.
History:
Add. 1992, Act 84, Imd. Eff. June 2, 1992 ;-- Am. 2001, Act 4, Imd. Eff. Mar. 30, 2001
Popular Name:
Act 218