Michigan Laws 500.3711 – Small employer carrier; guaranteed renewal; exceptions; modification
Current as of: 2023 | Check for updates
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Terms Used In Michigan Laws 500.3711
- Carrier: means a person that provides health benefits, coverage, or insurance in this state. See Michigan Laws 500.3701
- Fraud: Intentional deception resulting in injury to another.
- Geographic area: means an area in this state that includes not less than 1 entire county, is established by a carrier under section 3705, and is used for adjusting premiums for a health benefit plan subject to this chapter. See Michigan Laws 500.3701
- plan: means an expense-incurred hospital, medical, or surgical policy or certificate, or health maintenance organization contract. See Michigan Laws 500.3701
- Small employer: means any person actively engaged in business that, on at least 50% of its working days during the preceding and current calendar years, employed not fewer than 2 and not more than 50 eligible employees. See Michigan Laws 500.3701
- Small employer carrier: means a carrier that offers health benefit plans covering the employees of a small employer. See Michigan Laws 500.3701
- 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) Except as otherwise provided in this section, a small employer carrier that offers health coverage in the small employer group market in connection with a health benefit plan shall renew or continue in force the plan at the option of the small employer.
(2) Guaranteed renewal under subsection (1) is not required in any of the following circumstances:
(a) There is fraud or intentional misrepresentation by the small employer.
(b) For coverage of an insured individual, there is fraud or misrepresentation by the insured individual or the individual’s representative.
(c) Lack of payment.
(d) Noncompliance with minimum contribution requirements.
(e) Noncompliance with minimum participation requirements.
(f) The small employer carrier no longer offers that particular type of coverage in the market.
(g) The small employer moves outside the geographic area.
(3) A small employer carrier that offers health coverage in the small employer group market may modify a health benefit plan if the modification is consistent with state law and effective on a uniform basis among all small employers with coverage under the health benefit plan.