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1 chapters · 1,672 sections in this title.
Mich. Comp. Laws § 500.3819a Medicare supplement policies or certificates with effective date for coverage on or after June 1, 2010; minimum standards.
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Sec. 3819a. (1) This section applies to all Medicare supplement policies or certificates delivered or issued for delivery with an effective date for coverage on or after June 1, 2010. (2) An insurance policy must not be titled, advertised, solicited, or issued for delivery in thi…
Mich. Comp. Laws § 500.3821 Issuance of policy to person not enrolled in medicare parts A and B prohibited; refund; interest.
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Sec. 3821. (1) An insurer shall not issue an individual medicare supplement policy to a person who has not applied for or enrolled in medicare, parts A and B. If it is later determined that a person has not applied for or enrolled in medicare, parts A and B, an insurer shall refu…
Mich. Comp. Laws § 500.3823 Covered benefits more restrictive than benefits under medicare and required under state law prohibited; benefits for outpatient prescription drugs.
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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 th…
Mich. Comp. Laws § 500.3825 Preexisting diseases or conditions; waiver prohibited.
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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.
Mich. Comp. Laws § 500.3827 Duplicate benefits prohibited; application; statements and questions whether another policy in force; list of policies sold to applicant; notice regarding replacement coverage.
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Sec. 3827. (1) A Medicare supplement insurance policy or certificate must not be delivered or issued for delivery in this state if the policy or certificate provides benefits that duplicate benefits provided by Medicare. (2) Application forms or a supplementary application or oth…
Mich. Comp. Laws § 500.3829 Denying or conditioning issuance based on health status, claims experience, receipt of health care, or medical condition of applicant prohibited; condition; exclusion of benefits based on preexisting conditions; reduction; creditable coverage.
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Sec. 3829. (1) An insurer shall not deny or condition the issuance or effectiveness of a Medicare supplement policy available for sale in this state, or discriminate in the pricing of such a policy, because of the health status, claims experience, receipt of health care, or medic…
Mich. Comp. Laws § 500.3829a Medicare supplement policies or certificates delivered, issued for delivery, or renewed on or after May 21, 2009; genetic test; definitions.
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Sec. 3829a. (1) This section applies to all medicare supplement policies or certificates delivered, issued for delivery, or renewed on or after May 21, 2009. (2) An insurer of a medicare supplement policy or certificate shall not do either of the following: (a) Deny or condition …
Mich. Comp. Laws § 500.3830 Eligible person; requirements.
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Sec. 3830. (1) An eligible person is an individual described in subsection (2) who applies to enroll under a medicare supplement policy during the period described in subsection (3), and who submits evidence of the date of termination or disenrollment or medicare part D enrollmen…
Mich. Comp. Laws § 500.3830a Termination of contract or agreement; notice to individual.
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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 t…
Mich. Comp. Laws § 500.3831 Individual or group expense incurred hospital, medical, or surgical policies; right of continuation or conversion to medicare supplemental plan; request for coverage; exclusion from preexisting conditions; notice of availability of coverage; utilization of another insurer to write coverage.
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Sec. 3831. (1) Each insurer offering group expense incurred hospital, medical, or surgical policies or certificates in this state shall make available without restriction, to any person who requests coverage from an insurer and has been insured with an insurer, if the person lose…
Mich. Comp. Laws § 500.3833 Replacement policy; waiver of certain time periods.
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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…
Mich. Comp. Laws § 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.
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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) Esta…
Mich. Comp. Laws § 500.3839 Renewal or continuation provision; effect of termination or replacement; elimination of outpatient prescription drug benefit.
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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 whic…
Mich. Comp. Laws § 500.3841 Riders or endorsements; signed acceptance or agreement; additional premium; use of certain standards, terms, and words; filing of changes in medicare benefits; elimination of duplicate benefits; notice of modifications; notice requirements of medicare prescription drug, improvement, and modernization act of 2003.
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Sec. 3841. (1) Except for riders or endorsements by which the insurer effectuates a request made in writing by the insured, exercises a specifically reserved right under a medicare supplement policy, or as required to reduce or eliminate benefits to avoid duplication of medicare …
Mich. Comp. Laws § 500.3843 Health insurance; notice; contents; applicability of subsection (1).
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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 print…
Mich. Comp. Laws § 500.3847 Advertising; filing copy with director.
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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 …
Mich. Comp. Laws § 500.3849 Filing and approval requirements; deletion of outpatient prescription drug benefits; issuance of policy; use and change in premium rates; additional forms; availability; conditions and effect of discontinuance; combining forms for purposes of refund or credit calculation; compliance with federal law; “type” defined.
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Sec. 3849. (1) An insurer shall not deliver or issue for delivery a medicare supplement policy to a resident of this state unless the policy form or certificate form has been filed with and approved by the commissioner in accordance with filing requirements and procedures prescri…
Mich. Comp. Laws § 500.3851 Aggregate benefits; rates, rating schedules, and rate revisions.
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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 policyh…
Mich. Comp. Laws § 500.3852 Benchmark ratio.
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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.
Mich. Comp. Laws § 500.3853 Refund or credit calculation; form; interest; due date.
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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 …
Mich. Comp. Laws § 500.3855 Annual filing of rates, rating schedule, and supporting documentation; premium adjustments; public hearing for rate increase; failure to make premium adjustments.
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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 exp…
Mich. Comp. Laws § 500.3857 Duties of insurer; certification of compliance with subsection (1)(a).
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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 determ…
Mich. Comp. Laws § 500.3859 Prohibited conduct; violation as misdemeanor; penalty.
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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 in…
Mich. Comp. Laws § 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.
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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 pursuan…
Mich. Comp. Laws § 500.3901 Long-term care insurance; definitions.
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Sec. 3901. As used in this chapter: (a) "Acute condition" means that the individual is medically unstable, requiring frequent monitoring by medical professionals in order to maintain his or her health status. (b) "Applicant" means: (i) For an individual long-term care insurance p…
Mich. Comp. Laws § 500.3901a Long-term care insurance policies; discrimination against living donors; prohibition; definitions.
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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 ind…
Mich. Comp. Laws § 500.3902 Offer of long-term care coverage by subsidiary of health care corporation.
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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 cove…
Mich. Comp. Laws § 500.3903 Group long-term care insurance; coverage offered to groups described in MCL 500.3901(c)(iv) and 500.3901(c)(iii).
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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 enfo…
Mich. Comp. Laws § 500.3905 Long-term care coverage; requirements; certain coverages requiring care recommendations.
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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 …
Mich. Comp. Laws § 500.3906 Designation of person to receive notice of termination; reinstatement of coverage; effective date of section.
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Sec. 3906. (1) An individual long-term care policy or certificate shall not be issued until the insurer has received from the applicant either a written designation of at least 1 person, in addition to the applicant, who is to receive notice of lapse or termination of the policy …
Mich. Comp. Laws § 500.3907 Individual long-term care policy; guaranteed renewable provision; conversion; new limitation period; intermediate care facility or skilled nursing facility; home care services.
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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…
Mich. Comp. Laws § 500.3908 Long-term care partnership program policy; conversion or replacement.
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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 lo…
Mich. Comp. Laws § 500.3909 Option to purchase inflation protection; summary of coverage; applicability of section.
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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 rea…
Mich. Comp. Laws § 500.3910 Option of purchasing policy or certificate including nonforfeiture benefits; offer.
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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 p…
Mich. Comp. Laws § 500.3910a Nonforfeiture benefits; coverage elements, eligibility, benefit triggers, and benefit length; contingent benefit; premium increase; notification; duties of insurer; limitation on maximum benefits; effective date of section; premiums subject to loss ratio requirements; conditions for offering nonforfeiture benefit.
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Sec. 3910a. (1) This section does not apply to life insurance policies or riders containing accelerated benefits for long-term care. (2) A policy or certificate offered with nonforfeiture benefits shall have coverage elements, eligibility, benefit triggers, and benefit length tha…
Mich. Comp. Laws § 500.3910b Reduction options; applicability of section to long-term care policies and certificates issued on or after June 1, 2007.
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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 bene…
Mich. Comp. Laws § 500.3911 Preexisting condition; limitation period; definition.
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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 …
Mich. Comp. Laws § 500.3913 Home health care benefits.
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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.…
Mich. Comp. Laws § 500.3915 Certain conditions prohibited.
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Sec. 3915. A long-term care insurance policy sold before, on, or after June 2, 1992 shall not condition benefits on any of the following: (a) The prior institutionalization of the insured. (b) Prior receipt of a higher level of institutional care.
Mich. Comp. Laws § 500.3917 Replacement policy; waiver of time periods applicable to preexisting conditions and probationary periods.
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Sec. 3917. If a long-term care insurance policy or certificate replaces another long-term care policy or certificate, the replacing insurer shall waive any time periods applicable to preexisting conditions and probationary periods for similar benefits in the new long-term care po…
Mich. Comp. Laws § 500.3919 Institutionalization; extension of benefits; limitations.
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Sec. 3919. Termination of long-term care insurance shall be without prejudice to any benefits payable for institutionalization if such institutionalization began while the long-term care coverage was in force and continues without interruption after termination. An extension of b…
Mich. Comp. Laws § 500.3921 Application; questions relating to health condition; delivery; record of policy rescissions; annual report to commissioner.
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Sec. 3921. (1) All applications for long-term care insurance policies except those that are guaranteed issue shall contain clear and unambiguous questions designed to ascertain the applicant's health condition. (2) If an application for long-term care insurance contains a questio…
Mich. Comp. Laws § 500.3923 Riders or endorsements; certain changes in benefits or premiums; definition, explanation, description, and labeling of certain terms.
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Sec. 3923. (1) Except for riders or endorsements by which the insurer effectuates a request made in writing by the insured under an individual long-term care insurance policy, all riders or endorsements added to a long-term care insurance policy after date of issue or at reinstat…
Mich. Comp. Laws § 500.3925 Applicability of section to long-term care policy or certificate issued on or after June 1, 2007; information to be provided on forms; acknowledgment of disclosure; notice of premium rate schedule increase; personal worksheet; availability of free and independent insurance purchasing and public benefits counseling.
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Sec. 3925. (1) Except as provided in subsection (2), this section applies to any long-term care policy or certificate issued in this state on or after June 1, 2007. (2) For a long-term care certificate issued on or after June 1, 2007 under a group long-term care insurance policy …
Mich. Comp. Laws § 500.3926 Applicability of section to long-term care policy or certificate issued on or after June 1, 2007; information to be provided to commissioner; premium rate schedule; statement; request by commissioner for actuarial demonstration; additional information.
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Sec. 3926. (1) This section applies to any long-term care policy or certificate issued in this state on or after June 1, 2007. (2) An insurer shall provide all of the following information to the commissioner 30 days prior to making a long-term care insurance policy or certificat…
Mich. Comp. Laws § 500.3926a Applicability of section to long-term care policy or certificate issued on or after June 1, 2007; notice of pending premium rate schedule increase; requirements; review and approval by commissioner; eligibility for contingent benefit upon lapse; applicability of subsections to certain policies or certificates; exceptional increases; definitions.
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Sec. 3926a. (1) Except as provided in subsection (2), this section applies to any long-term care policy or certificate issued in this state on or after June 1, 2007. (2) For certificates issued on or after June 1, 2007 under a group long-term care insurance policy described in se…
Mich. Comp. Laws § 500.3927 Reasonableness of benefits relative to premiums; expected loss ratio; evaluation of factors; applicability of section.
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Sec. 3927. (1) Benefits under individual long-term care insurance policies shall be considered reasonable in relation to premiums provided the expected loss ratio is at least 60%, calculated in a manner that provides for adequate reserving of the long-term care insurance risk. In…
Mich. Comp. Laws § 500.3928 Fixed indivisible premium life insurance policy funding long-term care benefits by accelerating death benefit; reasonableness of benefits relative to premiums; provisions.
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Sec. 3928. A fixed indivisible premium life insurance policy that funds long-term care benefits entirely by accelerating the death benefit is considered to provide reasonable benefits in relation to premiums provided that the policy complies with all of the following provisions: …
Mich. Comp. Laws § 500.3929 Increasing premiums prohibited; conditions.
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Sec. 3929. The premiums charged to an insured for long-term care insurance shall not increase due to either of the following: (a) The increasing age of the insured at ages beyond 65. (b) The duration the insured has been covered under the policy.
Mich. Comp. Laws § 500.3930 Acceleration of benefits under group or individual life policies or riders; determination of policy reserves.
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Sec. 3930. (1) If long-term care benefits are provided through the acceleration of benefits under group or individual life policies or riders to those policies, policy reserves for the benefits must be determined in accordance with section 834(1)(g). Claim reserves must also be e…