April 29, 2014, Introduced by Senators KAHN and PAPPAGEORGE and referred to the Committee on Appropriations.
A bill to amend 2011 PA 142, entitled
"Health insurance claims assessment act,"
by amending section 3 (MCL 550.1733).
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3. (1) For dates of service beginning on or after January
1, 2012 and ending on June 30, 2014, subject to subsections (2),
(3), and (4), there is levied upon and there shall be collected
from every carrier and third party administrator an assessment of
1% on that carrier's or third party administrator's paid claims.
For dates of service beginning on or after July 1, 2014, subject to
this subsection and subsections (2), (3), and (4), there is levied
upon and there shall be collected from every carrier and third
party administrator an assessment of 0.75% on that carrier's or
third party administrator's paid claims. For dates of service
beginning on or after July 1, 2014, subject to subsections (2),
(3), and (4), the assessment levied under this subsection will
increase to 1.0% if the federal government informs this state that
the use tax revenues assessed on entities under section 3f of the
use tax act, 1937 PA 94, MCL 205.93f, will not be federally
reimbursed.
(2) A carrier with a suspension or exemption under section
3717 of the insurance code of 1956, 1956 PA 218, MCL 500.3717, on
the
effective date of this act September
20, 2011 is subject to an
assessment of 0.1%.
(3) All of the following apply to a group health plan that
uses the services of a third party administrator or excess loss or
stop loss insurer:
(a)
A group health plan sponsor shall is not be responsible
for
an assessment under this subsection section for a paid claim
where
if the assessment on that claim has been paid by a
third
party administrator or excess loss or stop loss insurer, except as
otherwise provided in section 3a(2).
(b) Except as otherwise provided in subdivision (d), the third
party
administrator shall be is responsible for all assessments on
paid claims paid by the third party administrator.
(c) Except as otherwise provided in subdivision (d), the
excess
loss or stop loss insurer shall be is responsible for all
assessments on paid claims paid by the excess loss or stop loss
insurer.
(d) If there is both a third party administrator and an excess
loss or stop loss insurer servicing the group health plan, the
third
party administrator shall be is
responsible for all
assessments for paid claims that are not reimbursed by the excess
loss or stop loss insurer and the excess loss or stop loss insurer
shall
be is responsible for all assessments for paid claims that
are reimbursable to the excess loss or stop loss insurer.
(4) The assessment under this section shall not exceed
$10,000.00 per insured individual or covered life annually.
(5) To the extent an assessment paid under this section for
paid claims for a group health plan or individual subscriber is
inaccurate due to subsequent claim adjustments or recoveries,
subsequent filings shall be adjusted to accurately reflect the
correct assessment based on actual claims paid.
(6) If the assessment under this section collects revenue in
an amount greater than $400,000,000.00, adjusted annually by the
medical inflation rate, each carrier and third party administrator
that paid the assessment shall receive a proportional credit
against the carrier's or third party administrator's assessment in
the immediately succeeding year. The department shall send a notice
of credit to each carrier or third party administrator entitled to
a credit under this subsection not later than July 1. A carrier or
third party administrator entitled to a credit under this
subsection shall apply that credit to the July 30 payment. Any
unused credit shall be carried forward and applied to subsequent
payments. If a carrier or third party administrator entitled to a
credit under this subsection has no liability under this act in the
immediately succeeding year or if this act is no longer in effect,
the department shall issue that carrier or third party
administrator a refund in the amount of any unused credit. If a
third party administrator receives a credit or refund under this
subsection, the third party administrator shall apply that credit
or refund to the benefit of the entity for which it processed the
claims under a service contract.
Enacting section 1. This amendatory act does not take effect
unless Senate Bill No. 893 of the 97th Legislature is enacted into
law.