MI SB1205

Public employers with 50 or more employees in medical benefit plans must receive detailed claims utilization and cost information from carriers in electronic, spreadsheet-compatible format.

Carriers must compile annual claims data including census information (birth year, gender, zip code, coverage type), incurred and paid claims, and administrative fees and expenses, with separate reporting for medical, prescription drug, dental, and optical benefits.

Public employers may request claims utilization and cost information up to 4 times per calendar year, with compilation required within 30 days of each request.

Information must cover a 24-month relevant period (or shorter if plan is newer) and include high-cost individual data for those exceeding $25,000 in annual claims, presented as de-identified health information compliant with HIPAA.

Public employers must disclose compiled claims information to carriers or administrators submitting bids and to employee representatives upon request within a reasonable timeframe.