MI HB5842

Health care corporations offering dental coverage cannot require dentists to charge fees set by the corporation, except for services covered under the certificate.

Health care corporations are prohibited from imposing deductibles, copayments, coinsurance, or other requirements designed to provide minimal reimbursement and circumvent this provision.

"Covered services" include services with available reimbursement and services not reimbursed only due to waiting periods, annual/lifetime limits, or frequency limitations.

Covered services exclude: (a) patient-selected services using materials with higher costs than covered materials if the dentist requests additional payment and patient agrees; (b) services with copayments exceeding 50%; and (c) services with deductibles greater than $20 per service or annual deductibles not expected to be met by at least 50% of covered individuals.

The commissioner shall investigate and issue rulings on all complaints arising under this section; the provision applies to certificates entered into after enactment and to existing certificates upon their next extension, renewal, or modification.