What does the Michigan
law say about coverages for newborns?
Insurance Bulletin
86-8 states that maternity or pregnancy benefits are medical benefits
which cover care arising from pregnancy and childbirth. Medical
or hospital care for a healthy infant following delivery is considered
part of the care for pregnancy and delivery and should be covered
the same as the care for the mother. Well baby care is covered under
the mother's coverage even if the baby has not been added to the
mother's coverage. Michigan law also requires that an employer must
offer to add a newborn to a health benefit plan that includes family
coverage. The employer or insurer can require that they receive
notice within 31 days of the birth if the parents want to add the
child to the coverage.
What does the Michigan
law say about coverage for mammograms?
Michigan
law requires that health insurance companies, Blue Cross Blue Shield
of Michigan, and HMOs provide or offer to provide coverage for breast
cancer screening mammography. The coverage must include one mammogram
in a five-year period for a woman at least 35 years of age and less
than 40 years of age. For women 40 years of age and older, they
must pay for one mammogram per year. The law requires that this
coverage must be offered, however, a group, such as an employer,
is allowed to choose not to purchase the mammography coverage.
What does the Michigan
law say about coverage for chemotherapy (antineoplastic) drugs?
Michigan
law requires health insurance companies, Blue Cross Blue Shield
of Michigan and HMOs to pay for FDA approved drugs used in antineoplastic
therapy (chemotherapy) and the reasonable cost to administer them.
When the FDA approves a drug to be used in chemotherapy, it does
so for the treatment of a specific type of cancer. Since the drug
is FDA approved, it can be used for the treatment of other types
of cancer. This is known as an "off label" use of a drug.
The FDA will not review or approve these multiple uses for drugs.
There have been problems with third party payers denying payment
for "off label" chemotherapy drugs. Michigan law provides
that an antineoplastic (chemotherapy) drug is covered if it is FDA
approved, the current medical literature substantiates its efficacy
to treat the type of cancer and the patient is informed that the
treatment is an "off label" use.
What does the Michigan
law say about coverage of diabetes?
Michigan law requires
health insurance companies, health maintenance organizations, and
Blue Cross Blue Shield of Michigan to provide benefits for blood
glucose monitors, visual reading and urine testing strips, lancets,
spring-powered lancets, syringes, insulin pumps and medical supplies
required for use of an insulin pump. They must also provide payment
for self-management training and education if prescribed by an allopathic
or osteopathic physician and determined to be medically necessary.
There are some limitations on the educational training reimbursements.
A health insurance company
and a health maintenance organization that provides a benefit plan
including outpatient prescription coverage must also pay for insulin,
nonexperimental medication for controlling blood sugar, medications
used for foot ailments, infections, and other medical conditions
of the foot, ankle, or nails associated with diabetes. Blue Cross
Blue Shield must cover these same medications regardless of whether
outpatient prescription drugs are otherwise provided in the health
benefit plan.
Individuals who receive
their health insurance coverage through a self-insured employer
may have different benefits for diabetes treatments and education
than those listed above. Self-insured employers are regulated under
federal laws and do not have to meet the requirements of Michigan
law.