HB-4281,As Passed House,Jun 5, 2003

SUBSTITUTE FOR

HOUSE BILL NO. 4281

                                                                             A bill to amend 1980 PA 350, entitled                                             

"The nonprofit health care corporation reform act,"                         

(MCL 550.1101 to 550.1704) by adding section 401i.                          

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

1   Sec. 401i.  (1) Beginning January 1, 2004, a health care                    

2   corporation shall establish and offer to provide or include                 

3   prescription drug coverage in at least 1 nongroup and group                 

4   conversion certificate as a pilot project under this section.               

5   This pilot project shall continue through July 1, 2006 and, while           

6   in pilot project status, is not subject to the guaranteed                   

7   renewability provisions of section 401e.                                    

8       (2) A certificate that includes prescription drug coverage                  

9   under subsection (1) shall include all of the following:                    

10  (a) At a minimum, a prescription drug benefit that includes a               

11  co-pay of no more than 50% of the health care corporation's                 

1   approved amount for the payment of prescription drugs, with a               

2   minimum co-pay of $10.00 and a maximum co-pay of $100.00 per                

3   prescription.                                                               

4       (b) An annual per person benefit maximum of no less than                    

5   $2,500.00.                                                                  

6       (c) A provision that members will be entitled to purchase                   

7   prescription drugs at a discount under the affinity program                 

8   offered by the health care corporation once their annual per                

9   person prescription drug benefit maximum has been reached.                  

10      (3) Not later than July 1, 2005, the health care corporation                

11  shall issue an interim report to the commissioner regarding the             

12  claims experience of the market segment under this section and              

13  the ongoing viability of the pilot project.  Not later than July            

14  1, 2006, the health care corporation shall issue a final report             

15  to the commissioner regarding the claims experience of the market           

16  segment under this section and the ongoing viability of the pilot           

17  project.  By September 30, 2006, the commissioner shall determine           

18  if the nongroup and group conversion certificate providing the              

19  prescription drug benefit under this section provides a useful              

20  benefit to its subscribers.  If the commissioner determines that            

21  the certificate does not provide a useful benefit to its                    

22  subscribers, the commissioner may order the termination of the              

23  pilot program under this section and terminate the offering of              

24  prescription drug coverage in the nongroup and group conversion             

25  certificates.  If the commissioner determines that the                      

26  certificate does provide a useful benefit to its subscribers, the           

27  commissioner may order the termination of the pilot project                 

1   designation and order that the program continue indefinitely.  If           

2   the program is continued beyond September 30, 2006, then the                

3   certificate is subject to the guaranteed renewability provisions            

4   of section 401e.

5       Enacting section 1.  This amendatory act does not take effect               

6   unless House Bill No. 4279 of the 92nd Legislature is enacted               

7   into law.