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SB 976

Insurance: health insurers; health insurance policy; include provision related to Michigan health insurance exchange act. Amends sec. 2212a of 1956 PA 218 (MCL 500.2212a). TIE BAR WITH: SB 0973'26

2025-2026 Regular Session Introduced by Darrin Camilleri and 9 co-sponsors

Requires Michigan health insurers to provide a plain-English, standardized policy summary plus on-demand network, formulary, and credentialing disclosures.

referred to Committee on Insurance
#insurance:exchanges #insurance:healthinsurers
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Bill Summary · SB 976

Summary of SB 976 (2025-2026) – Michigan

Main purpose and intent

SB 976 proposes to amend the Michigan Insurance Code to require health insurers that issue or renew health insurance policies in Michigan to provide a comprehensive, plain-English written summary of the policy. The summary would cover standard definitions, coverage details, cost sharing, renewability, and other key aspects. The bill also expands disclosure requirements to include information about provider networks, drug formularies, and other details, and it aligns some disclosures with federal guidance and the Michigan health insurance exchange act. The measure ties its effective date to the passage of SB 973, indicating a coordinated package.

Key provisions and changes

  • Mandatory written policy summary (new Sec. 2212a(1))

    • Insurers must deliver a written summary in plain English to insureds.
    • The summary must include:
    • (a) Uniform definitions of standard and medical terms to help consumers compare coverage.
    • (b) Description of coverage and cost sharing for each benefits category.
    • (c) Any exceptions, reductions, and limitations.
    • (d) Cost-sharing details (deductibles, coinsurance, copayments).
    • (e) Renewability and continuation of coverage.
    • (f) Coverage examples.
    • (g) Whether the policy provides minimum essential coverage under the ACA and whether cost-sharing meets applicable requirements.
    • (h) A statement that the summary is a summary and the policy should govern.
    • (i) Contact information for questions.
    • (j) Internet URL to review or obtain the actual policy or certificate.
    • (k) Instructions to obtain a list of network providers (for insurers with provider networks).
    • (l) Instructions to obtain information on prescription drug coverage (if a formulary is used).
    • (m) Instructions for obtaining the uniform glossary and a contact number to obtain a paper copy (if available).
    • (n) Any other information required by the Michigan health insurance exchange act, as directed by the department.

  • Timing and delivery of the summary (Sec. 2212a(2))

    • (a) To applicant within 7 business days after receiving the application.
    • (b) By the first date of coverage if information at application has changed.
    • (c) To the insured within 30 days after the policy renewal.
    • (d) On request, within 7 days.

  • On-request disclosure (Sec. 2212a(3))

    • Insurers must provide, upon request, written information about:
    • (a) Current provider network details (names, locations, specialties, access limitations, and which providers will not accept new subscribers).
    • (b) Provider credentials (including board certifications, relevant degrees, certification dates, and facilities with privileges).
    • (c) Licensing verification contact for disciplinary actions or complaints within the prior 3 years.
    • (d) Prior authorization requirements, limitations, exclusions, formulary restrictions.
    • (e) Financial relationships with closed provider panels (e.g., fee-for-service, capitation, performance-based payments).
    • (f) Contact information to obtain additional information.

  • Electronic provision (Sec. 2212a(6))

    • Information required under subsection (3) may be provided electronically.

  • Definitions (Sec. 2212a(7))

    • “Board certified” aligns with standards from the American Board of Medical Specialties, American Osteopathic Association, or equivalent national bodies.

  • Policy formatting requirements (Sec. 2212a(5))

    • Policies must be presented in a clear, non-unduly prominent style.
    • Required to print exceptions and reductions with relevant benefits or under clear headings.
    • Form number must appear on the first page (lower left corner of each form).
    • Policy cannot incorporate insurer bylaws or charter provisions unless fully stated in the policy (with certain exceptions for filed rates and classifications).

  • Effective date linkage

    • The act’s enactment is contingent on the passage of SB 973 of the 103rd Legislature (i.e., tied to another measure in the package).

Who would be affected

  • Health insurers in Michigan delivering, issuing, or renewing health insurance policies in the state.
  • Applicants and insured individuals who would receive standardized, plain-English policy summaries and on-demand disclosures.
  • Policyholders with provider networks and those with prescription drug formularies, as additional network and formulary information would be accessible.
  • Providers and professional credentialing data publishers (to the extent insurer disclosures require sharing provider credentials and related information).
  • State department and health exchange administrators responsible for implementing and enforcing the disclosure requirements.

Procedural and timeline aspects

  • The bill would take effect only if SB 973 (another related measure) is enacted.
  • Implementation would require insurers to establish processes for producing and delivering the summary and handling on-request disclosures, both in writing and electronically.
  • Timelines for delivery align with application, policy issuance, renewal, and on-demand requests, aiming to improve consumer access to policy terms and costs.

Potential impact

  • Enhanced transparency around health insurance policy terms, coverage limitations, and cost-sharing.
  • Easier comparison shopping for consumers through standardized definitions and structured summarization.
  • Increased consumer access to information about networks, credentials, prior authorizations, and formulary details.
  • Greater alignment with federal guidance on consumer-facing explanations of health coverage.

Note: This summary reflects the provisions as written in SB 976 and its stated linkage to SB 973. For full applicability, the companion SB 973’s text and enacted language would be required.

Compiled from official sources — confirm details with the bill’s official record.

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