Michigan Laws 333.5659 – Life insurer, health insurer, or health care payment or benefits plan; prohibited acts
Current as of: 2023 | Check for updates
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A life insurer, a health insurer, or a health care payment or benefits plan shall not do 1 or more of the following because a patient with reduced life expectancy due to advanced illness, the patient’s patient surrogate, or the patient advocate has made a decision to refuse or discontinue a medical treatment as a result of information received as required under this part:
(a) Refuse to provide or continue coverage or benefits to the patient within the scope and level of coverage or benefits of an existing policy, certificate, or contract.
Terms Used In Michigan Laws 333.5659
- Advanced illness: except as otherwise provided in this subdivision, means a medical or surgical condition with significant functional impairment that is not reversible by curative therapies and that is anticipated to progress toward death despite attempts at curative therapies or modulation, the time course of which may or may not be determinable through reasonable medical prognostication. See Michigan Laws 333.5653
- Care: includes treatment, control, transportation, confinement, and isolation in a facility or other location. See Michigan Laws 333.5101
- Contract: A legal written agreement that becomes binding when signed.
- Medical treatment: means a treatment including, but not limited to, palliative care treatment, or a procedure, medication, surgery, a diagnostic test, or a hospice plan of care that may be ordered, provided, or withheld or withdrawn by a health professional or a health facility under generally accepted standards of medical practice and that is not prohibited by law. See Michigan Laws 333.5653
- Patient: means an individual who is under the care of a physician. See Michigan Laws 333.5653
- Patient advocate: means that term as described and used in sections 5506 to 5515 of the estates and protected individuals code, 1998 PA 386, MCL 700. See Michigan Laws 333.5653
- Patient surrogate: means the parent or legal guardian of a patient who is a minor or a member of the immediate family, the next of kin, or the legal guardian of a patient who has a condition other than minority that prevents the patient from giving consent to medical treatment. See Michigan Laws 333.5653
(b) Limit the amount of coverage or benefits available to the patient within the scope and level of coverage or benefits of an existing policy, certificate, or contract.
(c) Charge the patient a different rate for coverage or benefits under an existing policy, certificate, or contract.
(d) Consider the terms of an existing policy, certificate, or contract to have been breached or modified.
(e) Invoke a suicide or intentional death exemption or exclusion in a policy, certificate, or contract covering the patient.