Insurance: third-party administrators; health care benefits that require certain deductibles or copays; provide for certain restrictions. Amends 1984 PA 218 (MCL 550.901 - 550.960) by adding sec. 33.
If enacted, HB 5972 will directly affect the way third-party administrators manage health care benefits related to copayments and coinsurance. This amendment would ensure that individuals do not face high out-of-pocket costs that may otherwise deter them from seeking necessary medical care. The bill's provisions would come into effect for service contracts established after the enactment of the law, as well as for existing contracts upon their subsequent renewal or extension.
House Bill 5972 aims to amend the 1984 Public Act 218, known as the Third Party Administrator Act, in Michigan. Specifically, the bill introduces a new section that prohibits third-party administrators from entering into service contracts for benefit plans that include health care services with copayments or coinsurance exceeding 50% of the total cost of those services. This legislative proposal seeks to limit the financial burden placed on individuals when accessing health care benefits, thereby enhancing consumer protection in health insurance matters.
One of the notable points of contention regarding HB 5972 may stem from the potential pushback from third-party administrators and insurance providers who could argue that such restrictions could lead to increased overall costs for health insurance plans. Some stakeholders might contend that limiting copayment structures could complicate the flexibility of plan designs that cater to diverse consumer needs. Additionally, there might be debates around balancing consumer protections with maintaining economic viability for administrators within the healthcare market.