Michigan Laws 500.3406z – Essential health benefit coverage; annual and lifetime dollar limits; prohibition; applicability to grandfathered health plan coverage
Current as of: 2024 | Check for updates
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Terms Used In Michigan Laws 500.3406z
- Health insurance policy: means an expense-incurred hospital, medical, or surgical policy, certificate, or contract. See Michigan Laws 500.608
- Insurer: means an individual, corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyds organization, fraternal benefit society, or other legal entity, engaged or attempting to engage in the business of making insurance or surety contracts. See Michigan Laws 500.106
- state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories belonging to the United States; and the words "United States" shall be construed to include the district and territories. See Michigan Laws 8.3o
(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 C.F.R. § 147.140, or to a short-term or 1-time limited duration policy or certificate of not longer than 6 months.