The web Browser you are currently using is unsupported, and some features of this site may not work as intended. Please update to a modern browser such as Chrome, Firefox or Edge to experience all features Michigan.gov has to offer.
Bulletin No. 98-04
Excluding or limiting coverage under a health insurance contract for preexisting conditions
Issued and entered December 28, 1998 by E.L. Cox, Commissioner of Insurance
INFORMATIONAL STATEMENT AND PROCEDURAL GUIDELINES ISSUED PURSUANT TO ACT 306 OF THE PUBLIC ACTS OF 1969 AS AMENDED
Public Act 517 of 1996 was signed into law on January 13, 1997. Many insurers have inquired about the practical application of Section 500.3406f which was added to the Insurance Code by this Act. The purpose of this bulletin is to provide information to insurers for use in determining the parameters of permissible preexisting condition exclusions and limitations for group and individual expense-incurred hospital, medical, or surgical policies or certificates under 3406f.
Section 3406f restricts an insurer's ability to "exclude or limit coverage for a condition" on and after October 1, 1997. That section reads in pertinent part:
MCL 500.3406f (1) (bracketed reference added).
As an example, assume an individual policy was first effective on September 1, 1997. On or after October 1, 1997, an insurer violates section 3406f when it excludes or limits coverage for a preexisting condition beyond September 1, 1998 (12 months from the effective date), because to do so would be contrary to the restrictions contained in section 3406f. (In addition, under this same example, an insurer violates section 3406f when it excludes or limits coverage for a preexisting condition on or after October 1, 1997 if the exclusion or limitation relates to a condition for which medical advice, diagnosis, care, or treatment was recommended or received more than 6 months before enrollment.)
Insurers are advised to review all claim denials and all policy/certificate exclusions and limitations on and after October 1, 1997 for consistency with the requirements of code section 3406f. Questions regarding this bulletin or code section 3406f should be directed to the Michigan Insurance Bureau, Commercial Market Standards Division, P.O. Box 30220, Lansing, MI 48909, or call (517) 373-0242.