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HB 5938

Insurance: health insurers; methods of payments and reimbursements for dental benefits; provide for. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406kk).

2023-2024 Regular Session

Health plans and nonprofit dental plans must offer at least one payment method that pays dentists 100% of the amount due with no access fees.

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Bill Summary · HB 5938

Summary — HB 5938 (House Bill 5938 / Substitute H‑2)

Main purpose

Require health plans and nonprofit dental care corporations that provide dental benefits to offer at least one payment or reimbursement method that delivers 100% of the amount payable to the dentist without charging the dentist a fee to access that payment.

Key provisions

  • Adds section 3406kk to the Insurance Code (1956 PA 218, MCL 500.100–500.8302).
  • Requires a health plan or a nonprofit dental care corporation (operating under 1963 PA 125, MCL 550.351–550.373) that provides dental benefits to provide one or more payment/reimbursement methods that:
    • Provide the dentist with 100% of the amount payable; and
    • Do not require the dentist to incur a fee to access the payment or reimbursement.
  • Exemption: fees imposed by the dentist’s financial institution are not prohibited.
  • Opt‑out: if a dentist elects to opt out of a payment method, that opt‑out remains in effect until the dentist opts back in or a new contract is executed.
  • “Health plan” is defined by reference to section 2006 of the Insurance Code (as noted in analysis, that term is broadly interpreted to include insurers offering health policies and certain multiple employer welfare arrangements).

Scope and applicability

  • Applies to dental benefits policies delivered, issued for delivery, or renewed in Michigan after the bill’s effective date.
  • The House Fiscal Agency analysis clarifies that, in practice, “health plan” would include insurers that provide various health policies (including limited policies such as vision/dental-only, hospital indemnity, Medicare supplement, long‑term care, etc.) and multiple employer welfare arrangements regulated under Chapter 70; it would not apply to payments under administrative‑services‑only (ASO) or cost‑plus arrangements.

Who is affected

  • Dentists (the adopted House substitute H‑2 refers specifically to “dentist”; the original introduced draft also referenced “dental therapists”).
  • Health insurers and issuers of dental benefit plans, and nonprofit dental care corporations covered by 1963 PA 125.
  • Potentially multiple employer welfare arrangements that offer dental benefits.

Fiscal and enforcement considerations

  • Fiscal impact: indeterminate.
  • Enforcement: violations of the Insurance Code can lead to administrative hearings and civil fines under section 150 — typically $1,000 per violation (or $5,000 if the violator knew or should have known). Fine collections are capped (e.g., $50,000 cap under cited provisions) and deposited to the state general fund; enforcement also may generate state administrative costs.

Legislative status / timeline (selected)

  • Introduced: Sep 17, 2024 (Rep. Sharon MacDonell).
  • Substitute (H‑2) adopted and passed the Michigan House: Dec 12, 2024 (immediate effect granted by the House).
  • Referred to Committee on Government Operations: Dec 18, 2024.
  • Referred to Joint Committee on Energy and Technology: Jan 22, 2025.
  • Not enacted as of the latest action; further committee and chamber action would be required before becoming law.

Notes: The bill text references the Insurance Code definition of “health plan” (MCL 500.2006); readers should consult that section and the House Fiscal Agency analysis for the specific inclusion/exclusion of plan types (e.g., ASO arrangements).

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

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