HB 4464 — Insurance: health insurers; compliance with affordable care act coverage; modify. Amends secs. 3403, 3406z, 3406bb, 3406hh & 3406ii of 1956 PA 218 (MCL 500.3403 et seq.).

HB-4464, As Passed House, June 5, 2025 HOUSE BILL NO.

(1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that makes DAW H02956'25_HB4464_INTR_1H02956'25_HB4464_APH_1 pchuotr1udab 1 dependent coverage available under the health insurance policy shall do all of the following:

(4) This section does not apply to retiree-only health DAW H02956'25_HB4464_INTR_1H02956'25_HB4464_APH_1 pchuotr1udab 1 insurance coverage.

DAW H02956'25_HB4464_INTR_1H02956'25_HB4464_APH_1 pchuotr1udab 1 (h) Laboratory services.

(2) Except as otherwise allowed under 45 CFR 147.130 (a)(2)(i),(ii), and (iii), an insurer that delivers, issues for DAW H02956'25_HB4464_INTR_1H02956'25_HB4464_APH_1 pchuotr1udab 1 delivery, or renews in this state a health insurance policy shall not impose any cost-sharing requirements for benefits provided under subsection (1)(i).

(7) This section does not require an insurer to cover items of DAW H02956'25_HB4464_INTR_1H02956'25_HB4464_APH_1 pchuotr1udab 1 the United States Preventive Services Task Force that have been downgraded to a "D" rating, or any item or service during the plan year that is subject to a safety recall or is otherwise determined to pose a significant safety concern by a federal agency authorized to regulate the item or service.

DAW H02956'25_HB4464_INTR_1H02956'25_HB4464_APH_1 pchuotr1udab 1 (a) Any financial requirements or quantitative treatment limitations applicable to mental health and substance use disorder benefits in any classification must be no more restrictive than the predominant financial requirements or quantitative treatment limitations applied to substantially all benefits provided for medical/surgical benefits in the same classification and there must be no separate cumulative financial requirements that are applicable only with respect to mental health or substance use disorder benefits.

(2) Benefits provided under subsection (1) must meet all applicable federal parity requirements, including, but not limited to, 42 USC 300gg-26 and the regulations promulgated under that DAW H02956'25_HB4464_INTR_1H02956'25_HB4464_APH_1 pchuotr1udab 1 section.

(4) If a health insurance policy applies different levels of financial requirements to different tiers of prescription drug benefits that are based on reasonable factors determined in accordance with the requirements for nonquantitative treatment limits limitations and without regard to whether a drug is generally prescribed with respect to medical and surgical benefits or with respect to mental health or substance use disorder DAW H02956'25_HB4464_INTR_1H02956'25_HB4464_APH_1 pchuotr1udab 1 benefits, the health plan satisfies the parity requirements of this section with respect to prescription drug benefits.

(e) "Quantitative treatment limitations" includes limitations that are expressed numerically, such as limits on benefits based on the frequency of treatment, number of visits, days of coverage, DAW H02956'25_HB4464_INTR_1H02956'25_HB4464_APH_1 pchuotr1udab 1 days in a waiting period, or other similar limits on the scope or duration of treatment, and includes, but is not limited to, the limitations described under 45 CFR 146.136.

DAW H02956'25_HB4464_INTR_1H02956'25_HB4464_APH_1 pchuotr1udab 1 (xiii) A short-term or 1-time limited duration policy or certificate of not longer than 6 months as described in section 2213b.

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