Michigan Health Insurance Enforcement and Consumer Protections Grant Award

Cycle I Grant Application Summary

Michigan Grantee: Department of Insurance and Financial Services

Award Date: October 31, 2016

Total Award: $1,295,342.33

Baseline Award: $476,998

Selected Market Reforms Amount: $540,000

Workload Award Amount: $278,344.33

• Section 2707- The Michigan Department of Insurance and Financial Services will enhance its form review process for prescription drug benefits, including hiring a pharmacist to assist in reviewing formulary tiers, drug access requirements, and other areas related to prescription drug benefits to ensure that plans are free from potentially discriminatory requirements.

• Section 2713 - The Michigan Department of Insurance and Financial Services will evaluate the current forms review process for preventive services benefits in the individual, small and large group markets to ensure compliance with federal statutes, regulations, and informal guidance. The Department will create a process for reviewing large group market forms’ preventive services benefits language.

• Section 2719 - The Michigan Department of Insurance and Financial Services will create and implement an online form through which consumers may submit requests for external review. The Department will also run a paid media campaign to raise consumer awareness of their external review rights and ability to file a complaint. The Department will also develop a consumer-friendly print publication on the external review process, and produce a long and short form explanatory video for consumers on the process for filing complaints or filing an external review request.

• Section 2726 - The Michigan Department of Insurance and Financial Services will research the impact of parity in mental health and substance use disorder benefits coverage, including the minimum requirements, and how they are measured against medical benefits, and will identify new requirements. The Department will identify the health insurance issuers that are having difficulty complying, and provide direction. The Department will also evaluate and enhance its current forms review process for mental health and substance use disorder benefits in the individual, small and large group markets to ensure compliance with federal statutes, regulations, and informal guidance. And finally, the Department will update filing directions and requirements in System for Electronic Rate and Form Filing (SERFF), and publish directives via bulletin and on the Department’s website.