Vote Smart's Synopsis:

Vote to pass a bill that amends requirements for health care corporations operating within Michigan.

Highlights:

• Prohibits a health care corporation from forming within the state.

• Authorizes a health care corporation to establish, operate, or merge with a nonprofit mutual disability insurer.

• Specifies that the merger between a health care corporation and a nonprofit disability insurer is effective upon the completion of the following:
• Adoption of a plan of merger by the health care corporation and the nonprofit mutual disability insurer;
• Contribution of $1.5 billion to the Michigan Health and Wellness Foundation, distributed over 18 years beginning on April 2014 in order to continue the social mission; and
• Approval of the plan by the Commissioner within 90 days of the receipt of the plan.

• Prohibits health care corporations from using or enforcing a “most favored nation clause” in any health provider contract after February 1, 2013 unless approved by the Commissioner.

• Specifies that the “most favored nation clause” authorizes a health care corporation to require all of the following from a health provider:
• Prohibit a health care provider from contracting with another party to provide health care services at a lower rate than specified within their contract with the health care corporation;
• Require a health care provider to accept lower payment or reimbursement than specified within their contract with the health care corporation;
• Require the termination or renegotiation of an existing contract if the provider agrees to provide health care services to any other party at a lower rate than the payment or reimbursement rate specified in the contract with the health care corporation; and
• Require the health care provider to disclose their payment or reimbursement plans with “other parties” to the health care corporation.

• Requires all health care corporations established, maintained, and operated within Michigan to continue offering health care benefits to all residents regardless of health status until January 1, 2014.

• Prohibits a health care corporation from discontinuing a particular plan or product unless the corporation meets all of the following conditions:
• Provides at least a 90 day notice of the discontinuation to the Commissioner and to each covered individual under the plan or product;
• Offers the option to purchase another plan or product without a waiting period, exclusion of coverage for a preexisting condition, or limitation of coverage for a preexisting condition; and
• Decides to discontinue coverage or offer different products without basing the decision on the individual’s health status.

• Prohibits a health care corporation from discontinuing all coverage unless they have met the following guidelines:
• Provides notice to the Commissioner and each person under the coverage at least 180 days before the date of discontinuing all coverage;
• Discontinues all health benefit plans in the insurance market from which the health care corporation is withdrawing and does not renew coverage for these plans.

• Prohibits a health care corporation that discontinues all coverage from issuing any health benefit plans in the insurance market it withdrew from for at least 5 years starting from the date the last plan was discontinued or not renewed.

• Requires health care corporations to maintain enough contracts with health providers and facilities to ensure that all covered health care services are accessible to members without “unreasonable” delay, beginning January 1, 2014.

• Requires the Michigan Health and Wellness Foundation to give 60 percent of funds eligible for disbursal to subsidize the cost of MediGap coverage for eligible senior citizens, effective January 1, 2016.

Full Bill Text