Insurance: health benefits; application of amount paid by the insured or other certain parties when calculating the insured’s co-pay for a prescription drug; require under certain conditions. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406nn.

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SENATE BILL NO. 914

A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
(MCL 500.100 to 500.8302) by adding section 3406nn.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3406nn. (1) Subject to section 4 of the health care false 1
claim act, 1984 PA 323, MCL 752.1004, a health insurance policy 2
that is not a high deductible health plan that is delivered, issued 3
for delivery, or renewed in this state that provides coverage for 4
prescription drugs must include any amount paid by the enrollee or 5
April 22, 2026, Introduced by Senators CHANG, BAYER, IRWIN, GEISS and MCMORROW
and referred to Committee on Finance, Insurance, and Consumer Protection.
2

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paid on behalf of the enrollee by another person when calculating 1
the insured's overall contribution to any out-of-pocket maximum or 2
any cost-sharing requirement. 3
(2) Subject to section 4 of the health care false claim act, 4
1984 PA 323, MCL 752.1004, a health insurance policy that is a high 5
deductible health plan that is delivered, issued for delivery, or 6
renewed in this state that provides coverage for prescription drugs 7
must include any amount paid by the enrollee or paid on behalf of 8
the enrollee by another person when calculating the insured's 9
overall contribution to any out-of-pocket maximum or any cost-10
sharing requirement. However, if the application of payment by the 11
enrollee or on behalf of the enrollee would cause the enrollee's 12
health savings account to be considered ineligible under section 13
223 of the internal revenue code of 1986, 26 USC 223, the health 14
insurance policy must apply the payment after the minimum 15
deductible under section 223(c)(2)(A) of the internal revenue code 16
of 1986, 26 USC 223, has been satisfied. The health insurance plan 17
must apply the payment described in this subsection for payment of 18
preventive care described in section 223(c)(2)(C) of the internal 19
revenue code of 1986, 26 USC 223, regardless of whether the minimum 20
deductible under section 223(c)(2)(C) of the internal revenue code 21
of 1986, 26 USC 223, has been satisfied. 22
(3) This section applies to a health insurance policy 23
delivered, issued for delivery, or renewed in this state after 24
December 31, 2025. 25
(4) If any provision of this section conflicts with a federal 26
law, the federal law prevails. 27
(5) As used in this section: 28
(a) "Cost-sharing requirement" means any copayment, 29
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Final Page
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coinsurance, deductible, or annual limitation on cost sharing, 1
including, but not limited to, a limitation subject to 42 USC 2
18022(c) and 300gg-6(b), required by or on behalf of an insured in 3
order to receive a specific health care service, including a 4
prescription drug, covered by a health insurance policy. 5
(b) "Health savings account" means that term as defined in 6
section 223 of the internal revenue code of 1986, 26 USC 223. 7
(c) "High deductible health plan" means that term as defined 8
in section 223 of the internal revenue code of 1986, 26 USC 223. 9
(d) "Prescription drug" means that term as defined in section 10
17708 of the public health code, 1978 PA 368, MCL 333.17708. 11
However, prescription drug does not include a drug with an AB-rated 12
generic equivalent unless the insured obtains access to the drug 13
through any of the following: 14
(i) Prior authorization. 15
(ii) A step therapy protocol. 16
(iii) The insurer's exception process. 17