500.3406z Essential health benefit coverage; annual and lifetime dollar limits; prohibition; applicability to grandfathered health plan coverage.
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500.3406z Essential health benefit coverage; annual and lifetime dollar limits; prohibition; applicability to grandfathered health plan coverage.
Sec. 3406z.
(1)An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not institute either of the following:
(a)Lifetime limits on the dollar value of essential health benefit coverage under section 3406bb(1).
(b)Annual limits on the dollar value of essential health benefit coverage under section 3406bb(1).
(2)This section does not prevent an insurer from placing annual or lifetime dollar limits with respect to any individual on specific covered benefits that are not essential health benefits to the extent that the limits are otherwise permitted under applicable federal or state law.
(3)This section does not apply to grandfathered health plan coverage, as that term is defined in 45 CFR 147.140, or to a short-term or 1-time limited duration policy or certificate of not longer than 6 months.
History: Add. 2023, Act 159 , Eff. Feb. 13, 2024
Popular Name: Act 218