SB 1293 Summary

• Prohibits insurers and health maintenance organizations from using "most favored nation" clauses in provider contracts beginning February 1, 2013, with a complete ban effective January 1, 2014.

• Restricts qualified health plans offered through health benefit exchanges from covering elective abortion, except through optional riders purchased with additional premiums outside the exchange.

• Establishes rating restrictions for health insurance in individual and small group markets effective January 1, 2014, limiting premium variation to age (3:1 ratio), tobacco use (1.5:1 ratio), rating area, and family vs. individual coverage.

• Creates framework for nonprofit mutual disability insurers to merge with nonprofit health care corporations while maintaining nonprofit status, preventing conversion to stock insurers and requiring asset distribution to Michigan health endowment fund in certain transactions.

• Requires insurers to establish provider networks meeting federal network adequacy standards and implement open enrollment periods with commissioner-approved minimum standards beginning January 1, 2014.