Insurance: other; reporting requirements; provide for, the official text

Act
No. 25

Public
Acts of 2025

Approved
by the Governor

October
7, 2025

Filed
with the Secretary of State

October
7, 2025

EFFECTIVE
DATE:  October 7, 2025

state of michigan

103rd Legislature

Regular session of 2025

Introduced by Rep. VanWoerkom

ENROLLED HOUSE BILL No. 4968

AN ACT to amend 2018 PA 175,
entitled “An act to impose an assessment on certain insurance providers; to impose
certain duties and obligations on certain insurance providers, state
departments, agencies, and officials; to create certain funds; to authorize
certain expenditures; and to impose certain remedies and penalties,” by
amending sections 7, 11, and 17 (MCL 550.1757, 550.1761, and 550.1767).

The People of the State of
Michigan enact:

Sec.
7. (1) Beginning on the first day of the calendar quarter in which the director
of the department of health and human services notifies the secretary of state
and the department in writing that the federal Centers for Medicare and
Medicaid Services has approved its request for a waiver of the broad-based and
uniformity provisions of section 1903(w)(3)(B) and (C) of title XIX of the
social security act, 42 USC 1396b, for implementation of this act or October 1,
2018, whichever is later, there is levied and imposed an annual assessment on
the number of member months for each insurance provider reported on its annual
financial statement filed with the department of insurance and financial
services or the department of health and human services, whichever is
applicable, for the previous calendar year at the following rates in the
following circumstances:

(a) For tier 1, a Medicaid contracted health plan’s member
months supported with federal funds authorized under subchapter XIX of the
social security act, 42 USC 1396 to 1396w-8, as follows:

(i) For the number of member months and the
dollar amount necessary per member month, as determined each year by the
department of health and human services, to achieve a result of between 1.00
and 1.02 on the statistical test imposed by the federal Centers for Medicare
and Medicaid Services according to 42 CFR 433.68(e).

(ii) For each remaining member month not
assessed under subparagraph (i), $1.20 per
member month.

(b) For tier 2, a health insurer’s member months not
supported with federal funds authorized under subchapter XIX of the social
security act, 42 USC 1396 to 1396w-8, $2.40 per member month.

(c) For tier 3, a specialty prepaid health plan’s member
months supported with federal funds authorized under subchapter XIX of the
social security act, 42 USC 1396 to 1396w-5, $1.20 per member month.

(2) If the federal waiver under subsection (1) is approved on
an ongoing basis, the department of health and human services may use
information in the waiver approval instead of updating the tax on an annual
basis.

(3) The department of health and human services may continue
with the tax structure that was approved by the federal Centers for Medicare
and Medicaid Services on December 20, 2024, and in place on July 4, 2025,
unless the federal Centers for Medicare and Medicaid Services end dates the
waiver.

(4) If the waiver that was approved on December 20, 2024 is
ended by the federal Centers for Medicare and Medicaid Services, the department
of health and human services shall propose to the federal Centers for Medicare
and Medicaid Services a tax structure that is compliant with updated
broad-based and uniform requirements under federal law and regulation.
Beginning on approval from the federal Centers for Medicare and Medicaid
Services of a revised insurance provider assessment tax structure, there is levied
and imposed an annual assessment on the number of member months for each
insurance provider reported on its annual financial statement filed with the
department of insurance and financial services or the department of health and
human services, whichever is applicable, for the previous calendar year. The
tax rate must be determined each year by the department of health and human
services for the dollar amount necessary per member month to achieve a total
revenue not to exceed the total revenue due for the tax year of April 1, 2024
through March 31, 2025. The per member month tax rate must be the same for all
tiers described in subsection (1).

(5) By May 15 of each year, the department of insurance and
financial services and the department of health and human services shall make
available to the department the number of member months for each insurance
provider and the necessary assessment information for the department to
calculate the assessment due under this act, including the number of member
months and the rate to be imposed in accordance with subsection (1)(a)(i) to satisfy the statistical test.

(6) For the initial year of implementation only, the
department shall notify each insurance provider after June 15, 2018 but
before October 15, 2018, of the number of member months and the rate imposed on
these member months in accordance with subsection (1)(a)(i) and of its assessment, prorated for 2 quarters, due based
on the insurance provider’s member months for the previous calendar year. The
initial assessment is payable in 2 equal installments. Each insurance provider
shall submit the payments to the department by January 30, 2019 and April 30,
2019.

(7) The department shall notify each insurance provider after
June 1, but before June 15 each year after implementation, of the number of
member months and the rate imposed on these member months under subsection
(1)(a)(i) and of its annual assessment due under
this act based on the insurance provider’s member months for the previous
calendar year, or in the federal waiver approval in accordance with subsection
(2). The assessment is payable on a quarterly basis and each insurance provider
shall submit quarterly payments on July 30, October 30, January 30, and
April 30 to the department for the amount of the assessment imposed under this
act with respect to the number of member months reported on its financial
statements for the previous calendar year, or in the federal waiver approval in
accordance with subsection (2).

(8) If a due date falls on a Saturday, Sunday, state holiday,
or legal banking holiday, the payments are due on the next succeeding business
day.

(9) The department may require that payment of the assessment
be made by an electronic funds transfer method approved by the department.

Sec.
11. (1) The department shall administer the assessment imposed under this act
under 1941 PA 122, MCL 205.1 to 205.31, and this act. If 1941 PA 122, MCL
205.1 to 205.31, and this act conflict, the provisions of this act apply. The
assessment imposed under this act is a tax for the purpose of 1941 PA 122, MCL
205.1 to 205.31.

(2) The department may promulgate rules to implement this act
under the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to
24.328.

(3) The assessment imposed under this act is not considered
an assessment or burden for purposes of the tax, or as a credit toward or
payment instead of the tax under section 476a of the insurance code of 1956,
1956 PA 218, MCL 500.476a.

(4) The department shall submit an annual report to the state
budget director, the senate and house of representatives standing committees on
appropriations and insurance, and the senate and house fiscal agencies not
later than 120 days after May 15 that states the amount of revenue collected
from insurance providers under this act for the preceding state fiscal year and
the costs incurred for administration and compliance requirements under this
act for the preceding state fiscal year.

Sec.
17. The department shall provide the director of the department of insurance
and financial services with written notice of any final determination that an
insurance provider has failed to pay an assessment, interest, or penalty when
due. The director of the department of insurance and financial services may
suspend or revoke, after notice and hearing, the certificate of authority to
transact insurance in this state, or the license to operate in this state, of
any insurance provider that fails to pay an assessment, interest, or penalty
due under this act. The director of the department of insurance and financial
services shall not withdraw a suspension of a certificate of authority to
transact insurance in this state or a license to operate in this state under
this section unless any delinquent assessment, interest, or penalty has been
paid. If the director of the department of insurance and financial services
issues a suspension under this section, the director of the department of
insurance and financial services shall provide written notice to the standing
committees on insurance not later than 10 days after the suspension is issued.

Enacting section 1. This amendatory act does not
take effect unless all of the following bills of the 103rd Legislature are
enacted into law:

(a) House Bill
No. 4183.

(b) House Bill
No. 4951.

(c) House Bill No.
4961.

This
act is ordered to take immediate effect.

Clerk of the House of
Representatives

Secretary of the Senate

Approved___________________________________________

____________________________________________________

Governor