Michigan’s auto insurance laws changed in 2020, giving drivers more flexibility when selecting Personal Injury Protection (PIP) medical coverage.
Your available PIP medical options and eligibility may depend on your household, health coverage, and the documentation required by your auto insurance carrier. Reviewing these choices carefully can help you make an informed decision based on your individual circumstances.
Qualified Health Coverage and Coordination of Benefits
Qualified Health Coverage (QHC) is a standard under Michigan law that may help establish eligibility for certain PIP medical coverage selections. Depending on the option selected, your auto insurer may require documentation showing that you, or other eligible household members, have qualifying health coverage.
Coordination of benefits generally addresses which coverage pays first for eligible medical expenses following an auto accident. A coordination-of-benefits arrangement may be available with certain health plans and auto insurers. It does not, by itself, establish that a health plan meets Michigan’s QHC requirements.
PIP Medical Coverage Options
Michigan drivers may select Unlimited, $500,000, or $250,000 in PIP medical coverage without establishing QHC eligibility.
Other selections have additional eligibility and documentation requirements:
- The $250,000 PIP medical option with exclusions may be available when qualifying individuals have health coverage that meets applicable requirements.
- The $50,000 PIP medical option is generally available only to named insureds enrolled in Medicaid and is subject to additional household eligibility requirements.
- The PIP medical opt-out may be available to qualifying individuals enrolled in Medicare Parts A and B, subject to additional household eligibility requirements.
Eligibility requirements can be detailed and may depend on the named insured, spouse, resident relatives, other available PIP coverage, and the type of health coverage in place. Your auto insurer determines whether the documentation submitted supports the requested PIP medical selection.
QHC Documentation
When QHC documentation is required, the auto insurer may request a letter or other documentation from the health insurer or employer.
Documentation may need to include:
- The full names and dates of birth of each person covered by the health plan
- Confirmation that the plan meets Michigan’s QHC requirements
- Confirmation that the plan does not exclude or limit coverage for injuries resulting from motor vehicle accidents
- Information regarding the plan’s applicable individual deductible, when required
- Any other information requested by the auto insurance carrier
Medicare and Medicaid elections may require different documentation than a QHC letter. For example, an insurer may request proof of current Medicare or Medicaid enrollment. Documentation requirements and acceptable forms may vary by carrier.
Review Documentation at Renewal
If you rely on QHC, Medicare, or Medicaid to select a PIP medical option that requires eligibility documentation, updated documentation is generally required at renewal.
You should also notify your insurance professional if there is a change in:
- Your health plan or employer-sponsored coverage
- Medicare or Medicaid enrollment
- Household members or residency
- Coverage available through another auto insurance policy
A change in health coverage or household circumstances may affect your eligibility for a PIP medical selection. If current documentation is not provided, your insurer may be unable to process the requested selection.
Consider Your Coverage Carefully
PIP medical coverage and health insurance are not the same. Health plans may have deductibles, copays, provider-network requirements, prior authorization rules, limitations, and exclusions that differ from auto insurance coverage.
Before selecting a lower PIP medical limit, excluding an eligible individual, or opting out of PIP medical coverage, consider:
- Your health plan’s deductible, copays, and out-of-pocket costs
- Whether your preferred providers participate in your health plan’s network
- Whether your health plan has requirements or limitations that could affect accident-related care
- Whether all members of your household meet the eligibility requirements for the selected option
- The potential impact if your health coverage changes in the future
Your insurance professional can help explain the PIP medical selections available through your carrier. They cannot determine whether a particular health plan will cover a specific treatment or predict how a claim will be handled.
How Mason-McBride Can Help
As an independent Michigan insurance agency, Mason-McBride helps drivers review policy options, understand PIP medical selections, and identify documentation that may be required by their insurance carrier.
If you would like a second opinion on your current insurance protection, our team can review your existing policies and help you better understand your options.
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This information is provided for general educational purposes only. It is not legal advice and is not a recommendation to select, reduce, exclude, or opt out of any particular coverage or limit. Eligibility, coverage availability, policy terms, conditions, exclusions, documentation requirements, and claim outcomes vary by insurer and individual circumstances. Please review your policy documents and consult your insurance professional, health plan administrator, or legal adviser, as appropriate.