MI HB5841

Third party administrators cannot enter into service contracts requiring dentists to provide services at benefit plan-set fees, except for services covered under the benefit plan.

Third party administrators cannot structure deductibles, copayments, coinsurance, or other requirements to provide minimal reimbursement and circumvent this section's protections.

"Covered services" include services with available reimbursement or those unavailable only due to waiting periods, annual/lifetime limits, or frequency limitations, but exclude patient-selected services with higher costs and services with copayments exceeding 50%.

Services subject to deductibles greater than $20 per service or annual deductibles not expected to be met by at least 50% of covered individuals are not considered covered services.

The insurance commissioner must investigate and rule on all complaints arising under this section, with the amendment applying to service contracts entered into after enactment and to existing contracts upon their next extension, renewal, or modification.