Michigan Laws 500.3403 – Health insurance policy offering dependent coverage; required provisions; denial prohibited; grounds
Current as of: 2024 | Check for updates
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Terms Used In Michigan Laws 500.3403
- Dependent: A person dependent for support upon another.
- Health insurance policy: means an expense-incurred hospital, medical, or surgical policy, certificate, or contract. See Michigan Laws 500.608
- insured: as used in this chapter , shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits and rights provided therein. See Michigan Laws 500.3462
- 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
- Rate: means the cost of insurance per payroll before adjustment for an individual insured's size, exposure, or loss experience. See Michigan Laws 500.2402
- Service area: means that term as defined in section 3501, unless the context requires otherwise. See Michigan Laws 500.116
- 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 that makes dependent coverage available under the health insurance policy shall do all of the following:
(a) Make available dependent coverage, at the option of the policyholder, until the dependent has attained 26 years of age.
(b) Provide the same health insurance benefits to a dependent child that are available to any other covered dependent.
(c) Provide health insurance benefits to a dependent child at the same rate or premium applicable to any other covered dependent.
(d) Include both of the following provisions in the health insurance policy:
(i) That the health insurance benefits applicable for children are payable with respect to a newly born child of the insured from the moment of birth.
(ii) That the coverage for newly born children consists of coverage of injury or sickness including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities.
(2) A health insurance policy that offers dependent coverage shall not deny enrollment to an insured’s child on any of the following grounds:
(a) The child was born out of wedlock.
(b) The child is not claimed as a dependent on the insured’s federal income tax return.
(c) The child does not reside with the insured or in the insurer’s service area.
(3) This section does not require an insurer or plan to make coverage available for a child of a child receiving dependent coverage.