HB 6035 Summary

• Creates Chapter 37A regulating individual health benefit plans, establishing definitions for carriers, health benefit plans, and related terms, with applicability limited to plans subject to commissioner policy form or premium approval.

• Prohibits carriers from excluding or limiting coverage for preexisting conditions for individuals transitioning from group health plans with 18+ months continuous coverage and no break exceeding 62 days, with certain exceptions.

• Establishes the Michigan Catastrophic Protection Plan (MI-CaPP) Board with 7 members (commissioner plus 6 appointees representing carriers, health care corporations, economists, and the public) to administer a Michigan Claims Fund for reimbursing carriers 90% of eligible claims between $80,000-$800,000 annually.

• Requires carriers to file premium rates with 60-day review period, prohibits health-based underwriting differentials after policy issuance, and mandates guaranteed renewal except for fraud, nonpayment, or service area changes; prevents carriers from exiting the individual market for 5 years after discontinuing all coverage.

• Imposes annual assessments on all carriers proportional to their individual market share to fund the catastrophic claims reimbursement program, with board reporting to governor and legislature required by October 1, 2011 and annually thereafter.