Michigan Health Insurance (MI)

Michigan (MI)
Individual Health Insurance Regulations

Learn more about Michigan Individual Health Insurance

With the exception of policies written by Blue Cross Blue Shield of Michigan, all individual health insurance policies in Michigan may be underwritten by the health insurance carriers. Blue Cross Blue Shield of Michigan individual health insurance policies must be issued on a guarantee issue basis. HMO individual health insurance policies written during the annual open enrollment period must also be offered on a guarantee issue basis. Guarantee issue polices provide individual health insurance coverage, despite the applicants past or current health history. All medically underwritten polices are subject to carrier approval, with the insurance carrier being allowed to 1) offer full coverage as provided under the health plan 2)offer coverage under the health plan with specific limitations and exclusions regarding pre-existing conditions or 3)denying coverage altogether based upon past and current health history. Under the medically underwritten policies, health insurance carriers are permitted to add a 12 month exclusionary period limit on pre-existing health conditions, with credit for prior coverage not being required. Blue Cross Blue Shield of Michigan is required to community rate their line of individual health insurance products, with no rating restriction placed on any of the other individual health insurance carriers.

Michigan (MI)
Small Group Health Insurance Regulations

Small group health insurance is defined as a group of employees with numbers between 2 and 50 and is written on a guaranteed issue basis. Guarantee issue health insurance policies demand that no group may be declined coverage due to past or current medical history of its employees. With the exclusion of Blue Cross Blue Shield of Michigan and HMO plans, health insurance carriers may impose a 12 month exclusionary period for pre-existing conditions on those applicants who do not have proof of prior creditable coverage. Once eligible to join the group health plan, an employer may impose a waiting period prior to allowing you to sign up for health care coverage under the group health plan. Michigan provides for group health insurance premium rates to be medically underwritten with a rate adjustment of 45%. This means that the insurance companies may charge a higher premium to small groups with a history or current status of medical conditions, but may not charge those higher risk groups more than 45% of the standard published rate. Blue Cross Blue Shield may not medically underwrite for rate adjustments, but may alter rates based on the geographical location of the business with a rate adjustment factor of 35%.

Michigan COBRA and Continuation Coverage

Groups of 20 or more employees must abide by federal COBRA regulations. Michigan does not have a state mini-COBRA law. Individuals opting out of a group health insurance plan, who do not have COBRA benefits available to them may obtain guaranteed issue coverage through Blue Cross Blue Shield of Michigan. Because guaranteed issue coverage is available, Michigan does not have a high-risk health insurance pool.

Additional Michigan Resources

• MIChild
  Provides health insurance coverage to children of low-income families who are under the age of 19 and residents of the State of Michigan.
• Michigan Department of Community Health (MDCH)
  The Michigan Department of Community Health offers information and assistance about the health care programs available through Medicaid and how to qualify.

MI Medical Insurance Statistics

Total Population: 9,982,000
With Health Insurance: 8,848,000 / 88.6%
Without Health Insurance: 1,133,000 / 11.4%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: The percentage of Michigan residents without health insurance has decreased by .2% since 2004.

Michigan Office of Financial and Insurance Services
Phone: 517-373-1820
The Office of Financial and Insurance Services (OFIS) provides information regarding financial institutions, insurance and securities.

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