Michigan Health Study Guide

Three numbers carry the Michigan health exam, and each is a departure from what national prep material teaches: a prompt-pay clock with no electronic-versus-paper split, an external-review window that carries two different published figures, and a state continuation statute that does not exist. Learn those first. Long-term care is the rest of the chapter, and it is where Michigan gets specific about dollars and about your own credential.

Prompt pay — one clock, and a second rule that looks like it

MCL 500.2006(8)(a) gives a health plan 45 days after it receives a clean claim to pay it, then charges 12% per annum on what is late. The trap is what is missing. Most states run two tiers — a shorter clock for electronic claims, a longer one for paper. Michigan draws no electronic-versus-paper distinction anywhere in MCL 500.2006(7) to (14). Forty-five days, however the claim arrived.

What Michigan does have is a second interest rule that candidates merge with the first. MCL 500.2006(4) is more general — it runs across lines, not just health plans — and charges 12% simple interest per annum from a date 60 days after satisfactory proof of loss. Different clock, different starting event, different scope. Read the stem for whether it is a health plan and a clean claim before deciding which rule you are in.

External review — two numbers, and you need both

An enrollee who loses the internal appeal may request external review from DIFS under the Patient’s Right to Independent Review Act. Learn this one as a pair, because the state publishes two figures and they measure from different events. MCL 550.1911(1) gives 120 days from receipt of the notice of adverse or final adverse determination — that is the statutory answer, and the one to give when a question cites the Act. DIFS tells consumers 127 days, adding a seven-day allowance for receipt. Neither is wrong; a candidate who knows only the consumer figure will be caught by a statutory question, and one who knows only the statute will think DIFS’s page is a mistake.

Upstream, DIFS publishes internal decision deadlines of 30 days pre-service and 60 days post-service. Downstream, the process is fast: an expedited review must be requested within 10 days (MCL 550.1913(1)), after which the independent review organisation reports within 36 hours and the director decides within 24 hours of that (550.1913(8), (10)) — which DIFS publishes to consumers as a 72-hour turnaround. On a reversal the carrier immediately shall approve the coverage (MCL 550.1911(19)), and DIFS’s orders routinely add a duty to prove implementation within seven days. Judicial review lies in circuit court within 60 days.

And 2006 PA 495 (MCL 550.1951 et seq.) extends the same process to governmental self-funded plans, which normally sit outside a state’s reach.

Continuation — the statute that is not there

Michigan has no mini-COBRA — no state continuation statute at all. DIFS’s consumer materials describe federal COBRA only, which attaches at employers with 20 or more employees.

That absence is the question. A stem describing a fifteen-employee firm and asking what the departing employee may do is testing whether you know there is no state backstop underneath the federal threshold — not whether you can recall a Michigan election period, because there is none to recall. Everywhere else you have studied, a small-employer answer exists. Here, federal COBRA’s 20-employee threshold is the only one in play.

Long-term care — the dollar mandates and your own credential

Two Michigan content rules are easy to test because they are arithmetic. A policy sold as comprehensive must cover home care at at least half the dollar amount available for nursing-home benefits — a $100/day nursing-home benefit requires at least $50/day of home care. And the insurer must offer inflation protection compounding annually at not less than 5%, which need not be re-offered once declined. Note the verb: the mandate is an offer, not a coverage requirement. Partnership policies add dollar-for-dollar asset disregard against the Medicaid resource limit, and the policy carries a 30-day free look.

Then the credential, at MCL 500.1204f. To sell, solicit or negotiate long-term care you need an Accident & Health or Life license, a one-time 8-hour course before you sell, and 4 hours every two-year CE compliance period thereafter (1204f(1)(a), (2)(a)). Two details ride along: it binds non-resident producers too — an exception to Michigan’s otherwise complete CE reciprocity — and the insurer must verify it before permitting a sale (1204f(5), (8)).

Finally, the public-program frame. Michigan’s marketplace is federally-facilitated — there is no state-based exchange — though DIFS certifies qualified health plans and rates. Medicaid was expanded through the Healthy Michigan Plan (2013 PA 107), effective April 1, 2014, up to 133% of the federal poverty level; CHIP is MIChild. Both run through MDHHS.