Michigan Laws 500.3712 – Decision to discontinue plan in geographic area
Current as of: 2023 | Check for updates
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Terms Used In Michigan Laws 500.3712
- Carrier: means a person that provides health benefits, coverage, or insurance in this state. See Michigan Laws 500.3701
- Commissioner: means the director. See Michigan Laws 500.102
- 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
- Waiting period: means , with respect to a health benefit plan and an individual who is a potential enrollee in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan. See Michigan Laws 500.3701
(1) If a small employer carrier decides to discontinue offering all small employer health benefit plans in a geographic area, all of the following apply:
(a) The small employer carrier shall provide notice to the commissioner and to each small employer covered by the small employer carrier in the geographic area of the discontinuation at least 180 days prior to the date of the discontinuation of the coverage.
(b) All small employer health benefit plans issued or delivered for issuance in the geographic area are discontinued and all current health benefit plans in the geographic area are not renewed.
(c) The small employer carrier shall not issue or deliver for issuance any small employer health benefit plans in the geographic area for 5 years beginning on the date the last small employer health benefit plan in the geographic area is not renewed under subdivision (b).
(d) The small employer carrier shall not issue or deliver for issuance for 5 years any small employer health benefit plans in an area that was not a geographic area where the small employer carrier was issuing or delivering for issuance small employer health benefit plans on the date notice was given under subdivision (a). The 5-year period under this subdivision begins on the date notice was given under subdivision (a).
(2) A small employer carrier shall not discontinue offering a particular plan or product in the small employer group market unless the small employer carrier does all of the following:
(a) Provides notice to the commissioner and to each small employer provided coverage under the plan or product of the discontinuation at least 90 days before the date of the discontinuation.
(b) Offers to each small employer provided coverage under the plan or product the option to purchase any other plan or product currently being offered in the small employer group market by that small employer carrier without excluding or limiting coverage for a preexisting condition or providing a waiting period.
(c) Acts uniformly without regard to any health status factor of enrolled individuals or individuals who may become eligible for coverage in making the determination to discontinue coverage and in offering other plans or products.