Bill
HB 4464
HB 4464 exempts retiree-only and certain transitional plans from Michigan's ACA protections, allowing preexisting-condition denials and limits on benefits for those plans.
Status and timeline
- Bill: House Bill 4464 (sponsored by Rep. Mike Harris); companion SB 2990.
- Enacted: Passed Legislature; signed by the Governor 6/20/2025.
- Effective date: September 1, 2025.
- Amends: Insurance Code of 1956 — sections 3403, 3406z, 3406bb, 3406hh, 3406ii (MCL 500.3403 et seq.).
- Fiscal impact: Reported as none for state or local government.
Purpose / intent
- The bill narrowly changes Michigan law that had codified certain Patient Protection and Affordable Care Act (ACA) market reform protections, by exempting specified insurance products (primarily retiree-only coverage and certain transitional individual/small-group plans) from several of those state-law ACA-derived requirements.
Key provisions and changes
- Exemption for retiree-only coverage:
- The requirement to offer dependent coverage to age 26 (MCL 500.3403) does not apply to retiree-only health insurance.
- Prohibitions on lifetime and annual dollar limits for essential health benefits (EHBs) (MCL 500.3406z) are made inapplicable to retiree-only coverage.
- Mandated coverage of certain services (EHB list in MCL 500.3406bb), including mental health and substance use disorder services, is made not applicable to retiree-only coverage.
- Treatment of “non-grandfathered health plan coverage”:
- The bill defines (for the purposes of these statutory provisions) “non-grandfathered health plan coverage” to include certain individual and small‑group transitional insurance plans that have been given extra time to comply with ACA market reforms, as specified annually by the director of the Department of Insurance and Financial Services (DIFS), until CMS requires full compliance. For those plans, the statute’s protections prohibiting denial for preexisting conditions would no longer apply (the existing law already exempts retiree-only plans from that prohibition).
- Grandfathered-plan definition expanded:
- The bill adds that a “fixed indemnity” (per 45 CFR 148.220(b)(4)) and a short‑term or one‑time limited duration policy/certificate of not longer than six months (per MCL 500.2213b) are to be treated as grandfathered for purposes of the preexisting condition provisions — effectively excluding those products from certain ACA-derived protections.
Who is affected
- Individuals covered by retiree-only health insurance (often employer-sponsored retiree plans) — potentially losing state-level protections that had mirrored ACA consumer protections.
- Consumers in certain transitional individual and small-group plans designated annually by DIFS (the bill’s “non‑grandfathered” transitional plans) — may be excluded from preexisting condition protections under state law.
- Insurers and issuers of retiree-only, fixed indemnity, and short‑term limited-duration policies — gain statutory exemptions from several mandated benefit and consumer-protection provisions.
- DIFS — gains a role to specify annually which transitional plans fit the bill’s definition until CMS compliance.
Practical impact and considerations
- For exempted plans, carriers may be able to impose annual or lifetime dollar limits on EHBs, deny coverage or exclude preexisting conditions (for the designated transitional plans), and omit specified mandated benefits (including some mental-health/SUD coverage) that otherwise would be required under the state codification of ACA provisions.
- The bill relies in part on federal definitions and CMS timing; DIFS determinations and CMS actions will affect which plans remain exempt and for how long.
Source references
- MCL 500.3403, 500.3406z, 500.3406bb, 500.3406hh, 500.3406ii; 45 CFR 148.220(b)(4); MCL 500.2213b.
Compiled from official sources — confirm details with the bill’s official record.
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