Michigan Health Insurance Guide
Michigan Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As a Michigan resident you have a variety of private health insurance plans to choose from including individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for Michigan State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
Michigan laws are different from those of most other states in regard to individual policies and guarantee issue. Blue Cross Blue Shield of Michigan (BCBSM) is required by Michigan law to guarantee issue of individual HMO health insurance policies during the annual open enrollment period. Guarantee issue means you cannot be denied coverage because of your past or current health. All other Michigan insurers can underwrite individual policies. That means you can be turned down for any number of reasons including your age, past or current health and number of people applying for coverage under a particular plan If you are accepted, the insurer has the right to impose an exclusionary period up to 12 months for any pre-existing conditions. Michigan also allows insurance companies to a six-month look-back period and does not require that they grant you credit for prior coverage. While BCBSM must community rate the individual health insurance products they offer and cannot raise your premiums because of your health, Michigan does not place rating caps on any other individual health insurance companies.
Michigan is also a guarantee issue state for group health plans issued to small businesses. If your Michigan health insurance is provided through an employer, coverage cannot be denied because of the past or current health of anyone in the group. However, with the exception of BCBSM, a 12-month exclusionary period and 6-month look-back period for pre-existing conditions can be applied if you don’t have proof of prior creditable coverage. Employers are permitted to impose a waiting period for new hires. Michigan law allows group health insurance issuers except BCBSM to medically underwrite policies. They may charge higher premiums (not to exceed 45% of the standard published rate) based on a group’s past or current health status. BCBSM may adjust its rates by a factor of 35%, based on location.
Michigan is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. Insurers are also prohibited from raising the premiums on individual plans at renewal to offset the cost of any claims or new risks you represent.
Michigan Mandated Health Benefits
Michigan laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism and Drug Abuse Treatment
- Breast Reconstruction
- Diabetes Supplies
- Emergency Services
- Hospice Care
- Mammography
- Maternity Stays
- Off-Label Drugs
- Orthotics
- Prosthetics
- Coverage for newborn under parent's policy
- Coverage for handicapped dependents under parent's policy
- Coverage for dependent students under their parent’s policy
- Coverage for conversion to non-groups.
Types Health Insurance Plans Available in Michigan
The following major medical health insurance plans are generally available in Michigan. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Michigan
- MIChild
Up to age 19, the uninsured resident children of working families can participate in MIChild, an affordable health insurance program with rates based on family income. Comprehensive medical services are provided through many of the state’s HMOs and other health care plans throughout the state. Families who don’t select a plan during application will be assigned one, but can change during the first 30 days of the program. MIChild is open enrollment.
Regulating Agency
The Michigan Office of Financial and Insurance Regulations is responsible for regulating Maine’s health insurance industry.
Get access to Michigan health insurance quotes from http://www.einsurance.com/health-insurance.
Michigan Office of Financial and Insurance Regulation
PO Box 30220
Lansing, MI 48909
(517) 241-6228 or (877) 999-6442
http://www.michigan.gov/dleg/0,1607,7-154-10555---,00.html
Michigan Department of Community Health MIChild
Capitol View Building
201 Townsnd Street
Lansing, MI 48913
http://www.michigan.gov/mdch/0,1607,7-132-2943_4845_4931---,00.html
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/