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1 chapters · 1,672 sections in this title.
Mich. Comp. Laws § 500.3402d Blanket disability insurance; coverage.
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Sec. 3402d. (1) For purposes of this chapter, blanket disability insurance is disability insurance that covers special groups of individuals, as follows: (a) A policy issued to a common carrier as the policyholder and that covers a group defined as all individuals who are passeng…
Mich. Comp. Laws § 500.3402e Blanket disability insurance policies; issuance.
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Sec. 3402e. (1) An insurer authorized to write disability insurance in this state may issue blanket disability insurance policies. (2) An insurer shall not deliver or issue for delivery in this state a blanket disability insurance policy unless a copy of the form of the policy is…
Mich. Comp. Laws § 500.3402f Blanket disability insurance policy; provisions.
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Sec. 3402f. An insurer shall include in a blanket disability insurance policy the applicable provisions of sections 3406 to 3466 and all of the following provisions: (a) That the policy and the application signed by the policyholder constitute the entire contract between the part…
Mich. Comp. Laws § 500.3402g Blanket disability insurance policy; certificate; payment of benefits.
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Sec. 3402g. (1) An insurer shall not require an individual application from an individual covered under a blanket disability insurance policy. The director may require the insurer to furnish a certificate to each individual insured under a blanket disability policy. (2) Except as…
Mich. Comp. Laws § 500.3402h Legal liability of policyholder.
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Sec. 3402h. Sections 3402d to 3402g do not affect the legal liability of a policyholder for the death of or injury to an employee, member, or other individual insured under the blanket disability insurance policy.
Mich. Comp. Laws § 500.3403 Health insurance policy offering dependent coverage; required provisions; denial prohibited; grounds.
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Sec. 3403. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that makes dependent coverage available under the health insurance policy shall do all of the following: (a) Make available dependent coverage, at the option of the pol…
Mich. Comp. Laws § 500.3404 Insurance policy issued for delivery to nonresident.
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Sec. 3404. The director may require that a policy issued by an insurer domiciled in this state for delivery to a person residing in another state meet the standards prescribed in sections 2212a, 3402, and 3406 to 3466 if the official that is responsible for the administration of …
Mich. Comp. Laws § 500.3405 Prudent purchaser agreements with providers of hospital, nursing, medical, surgical, or sick-care services; rates; discrimination prohibited; optometry, chiropractic, and physical therapy service.
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Sec. 3405. (1) For the purpose of doing business as an organization under the prudent purchaser act, 1984 PA 233, MCL 550.51 to 550.63, an insurer authorized in this state to write health insurance may enter into prudent purchaser agreements with providers of hospital, nursing, m…
Mich. Comp. Laws § 500.3405a Use of most favored nation clause.
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Sec. 3405a. (1) Notwithstanding any provision of this act to the contrary, this section applies to the use of a most favored nation clause in a provider contract on and after February 1, 2013. (2) Subject to subsection (3), beginning February 1, 2013, an insurer or a health maint…
Mich. Comp. Laws § 500.3406 Disability insurance policy; provisions required, captions, omissions, substitutions.
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Sec. 3406. (1) Except as provided in subsection (2) of this section, each such policy delivered or issued for delivery to any person in this state shall contain the provisions specified in sections 3407 through 3424 in the words in which the same appear in such sections: Provided…
Mich. Comp. Laws § 500.3406a Reconstructive surgery following mastectomy; prosthetic device.
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Sec. 3406a. An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall offer benefits for prosthetic devices to maintain or replace the body parts of an individual who has undergone a mastectomy. This coverage must provide that reasonab…
Mich. Comp. Laws § 500.3406aa Third party access; dental provider network; requirements; exceptions; definitions.
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Sec. 3406aa. (1) A contracting entity may grant a third party access to a provider network contract, or a provider's dental services or contractual discounts provided under a provider network contract, if both of the following requirements are met: (a) At the time the provider ne…
Mich. Comp. Laws § 500.3406b Coverage for mental health services by mental health care provider.
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Sec. 3406b. A policy or certificate which provides coverage for mental health services shall provide coverage for mental health services provided to an individual by a mental health care provider operated by or under contract with the department of mental health or a county commu…
Mich. Comp. Laws § 500.3406bb Health insurance policy; minimum required coverage; use of in-network and out-of-network providers; use of reasonable medical management techniques; applicability to short-term or 1-time limited duration policies; effective date.
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Sec. 3406bb. (1) An insurer that delivers, issues for delivery, or renews in the individual or small group market in this state a health insurance policy shall provide coverage for all of the following: (a) Ambulatory patient services. (b) Emergency services. (c) Hospitalization.…
Mich. Comp. Laws § 500.3406c Hospice care; definition; description of coverage.
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Sec. 3406c. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for inpatient hospital care shall offer to include coverage for hospice care. As used in this section, "hospice" means a health care program tha…
Mich. Comp. Laws § 500.3406d Coverage for breast cancer diagnostic services, breast cancer outpatient treatment services, and breast cancer rehabilitative services; coverage for breast cancer screening mammography; definitions.
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Sec. 3406d. (1) Subject to dollar limits, deductibles, and coinsurance provisions that are not less favorable than those for physical illness generally, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall offer or include coverag…
Mich. Comp. Laws § 500.3406e Coverage for drug used in antineoplastic therapy and cost of its administration; conditions.
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Sec. 3406e. An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall provide coverage in each policy for a drug used in antineoplastic therapy and the reasonable cost of its administration. Coverage must be provided for any United Sta…
Mich. Comp. Laws § 500.3406ee Health insurance policies; individual or small group markets; mandatory levels of coverage; actuarial value; compliance; applicability.
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Sec. 3406ee. (1) An insurer that delivers, issues for delivery, or renews in this state in the individual or small group market a health insurance policy shall offer health insurance policies that provide at least 1 of the following levels of coverage: (a) Coverage designed to pr…
Mich. Comp. Laws § 500.3406ff Financial parity for orally administered, intravenously administered and injected antineoplastic (anticancer) medications.
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Sec. 3406ff. (1) A health insurance policy delivered, issued for delivery, or renewed in this state that provides coverage for prescribed orally administered antineoplastic medications and intravenously administered or injected antineoplastic medications must ensure either of the…
Mich. Comp. Laws § 500.3406h Eligibility of parent for dependent coverage; health coverage of child through noncustodial parent; duties of insurer; court or administrative order and notice required.
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Sec. 3406h. (1) If a parent is eligible for dependent coverage through an insurer, the insurer shall: (a) Permit the parent to enroll, under the dependent coverage, a child who is otherwise eligible for coverage without regard to any enrollment season restrictions. (b) If the par…
Mich. Comp. Laws § 500.3406hh Coverage for mental health and substance use disorder services.
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Sec. 3406hh. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall provide coverage for mental health and substance use disorder services. All of the following apply to the coverage required under this subsection: (a) Any finan…
Mich. Comp. Laws § 500.3406i Individual eligible under title XIX of social security act; assignment of rights of insured to department of social services.
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Sec. 3406i. (1) An insurer shall not consider whether an individual is eligible for or has available medical assistance under title XIX of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1396 to 1396g and 1396i to 1396v, in this or another state when considering eli…
Mich. Comp. Laws § 500.3406ii Prohibition on the limitation or exclusion of benefits based on preexisting condition; exceptions.
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Sec. 3406ii. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not limit or exclude coverage for an individual by imposing a preexisting condition exclusion on the individual. (2) This section does not apply to any of the f…
Mich. Comp. Laws § 500.3406j Insured or applicant as victim of domestic violence; refusal to provide coverage prohibited; liability; "domestic violence" defined.
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Sec. 3406j. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not rate, cancel coverage on, refuse to provide coverage for, or refuse to issue or renew a health insurance policy solely because an insured or applicant for in…
Mich. Comp. Laws § 500.3406jj Medical loss ratio rebates; applicability.
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Sec. 3406jj. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall issue rebates to its insured in accordance with 42 USC 300gg-18 and the regulations promulgated under that section of law if the insurer does not meet the medic…
Mich. Comp. Laws § 500.3406jj[1] Prohibition on discrimination against health professionals.
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Sec. 3406jj. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not discriminate with respect to participation under the health insurance policy against a health professional who is acting within the scope of the health prof…
Mich. Comp. Laws § 500.3406k Emergency health services; medically necessary coverage; "stabilization" defined.
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Sec. 3406k. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for emergency health services shall provide coverage for medically necessary services provided to an insured for the sudden onset of a medical c…
Mich. Comp. Laws § 500.3406kk Coverage for blood pressure monitors.
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Sec. 3406kk. An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall cover a blood pressure monitor for a pregnant or postpartum insured subject to applicable cost-sharing including deductible, co-insurance, or co-pay provisions.
Mich. Comp. Laws § 500.3406l Medical transportation services; reimbursement; exception.
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Sec. 3406l. (1) Except as otherwise provided in subsections (2) and (3), an insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides benefits for emergency services shall provide for direct reimbursement to any provider of covere…
Mich. Comp. Laws § 500.3406m Access by insured to obstetrician-gynecologist.
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Sec. 3406m. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that requires an insured to designate a participating primary care provider and provides for annual well-woman examinations and routine obstetrical and gynecologic ser…
Mich. Comp. Laws § 500.3406n Access to pediatric care services.
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Sec. 3406n. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that requires an insured to designate a participating primary care provider and provides for dependent care coverage shall permit a dependent minor insured to select a…
Mich. Comp. Laws § 500.3406o Insurer providing prescription drug coverage; formulary restrictions; expedited review of coverage for nonformulary alternative; determination; subject to 500.3406w.
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Sec. 3406o. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription drugs and limits those benefits to drugs included in a formulary shall do all of the following: (a) Provide for participation o…
Mich. Comp. Laws § 500.3406oo Coverage for mental health screenings during postpartum period.
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Sec. 3406oo. An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall provide coverage for mental health screenings during the postpartum period as described in section 9137 of the public health code, 1978 PA 368, MCL 333.9137.
Mich. Comp. Laws § 500.3406p Establishment of program to prevent onset of clinical diabetes required; survey; coverages; "diabetes" defined.
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Sec. 3406p. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall establish and provide to insureds, enrollees, and affiliated providers a program to prevent the onset of clinical diabetes. This program for affiliated providers…
Mich. Comp. Laws § 500.3406q Off-label use of approved drug; coverage; conditions; compliance; use of copayment, deductible, sanction, or utilization control; limitation; definitions.
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Sec. 3406q. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides pharmaceutical coverage shall provide coverage for an off-label use of a United States Food and Drug Administration approved drug and the reasonable cost…
Mich. Comp. Laws § 500.3406r Coverage for obstetrical and gynecological services by physician or nurse midwife.
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Sec. 3406r. (1) As used in this section, "nurse midwife" means an individual licensed as a registered professional nurse under article 15 of the public health code, 1978 PA 368, MCL 333.16101 to 333.18838, who has been issued a specialty certification in the practice of nurse mid…
Mich. Comp. Laws § 500.3406s Diagnosis and treatment of autism spectrum disorders; coverage; prohibition; availability of other benefits; conditions; qualified health plan offered through American health benefit exchange pursuant to federal law; short-term or 1-time limited duration policy or certificate; prescription drug plan; coordinated benefits; definitions.
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Sec. 3406s. (1) Except as otherwise provided in this section, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall provide coverage for the diagnosis of autism spectrum disorders and treatment of autism spectrum disorders. An insu…
Mich. Comp. Laws § 500.3406ss Dental payment reimbursement methods.
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Sec. 3406ss. (1) A health plan or nonprofit dental care corporation operating under 1963 PA 125, MCL 550.351 to 550.373, that provides dental benefits shall provide 1 or more methods of payments or reimbursements that provide the dentist with 100% of the amount payable and do not…
Mich. Comp. Laws § 500.3406t Synchronizing insured's or enrollee's multiple maintenance prescription drugs.
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Sec. 3406t. (1) An insurer that delivers, issues for delivery, or renews in this state an expense-incurred hospital, medical, or surgical group or individual policy or certificate that provides prescription drug coverage, or a health maintenance organization that offers a group o…
Mich. Comp. Laws § 500.3406tt Coverage for certain hormonal contraceptives.
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Sec. 3406tt. In addition to any coverage requirements under state or federal law, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription drugs shall provide coverage for a hormonal contraception pat…
Mich. Comp. Laws § 500.3406u Coverage for prescription eyedrops; requirements; "prescriber" defined.
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Sec. 3406u. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription eyedrops shall not deny coverage for a refill of the prescription if all of the following apply: (a) For a 30-day supply, the a…
Mich. Comp. Laws § 500.3406v Coverage for emergency supply of insulin.
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Sec. 3406v. Beginning on the effective date of the amendatory act that added this section, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription drugs shall provide coverage for any emergency suppl…
Mich. Comp. Laws § 500.3406w Temporary emergency and early refills for prescription drugs; inapplicable after March 31, 2021.
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Sec. 3406w. (1) Beginning on the effective date of the amendatory act that added this section, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription drugs shall do both of the following: (a) Provid…
Mich. Comp. Laws § 500.3406x Nonopioid directive form; website.
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Sec. 3406x. An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall make available to the insurer's insureds a nonopioid directive form on the insurer's internet website. As used in this section, "nonopioid directive form" means that…
Mich. Comp. Laws § 500.3406y Nonopioid directive form; enrollment.
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Sec. 3406y. An insurer that delivers, issues for delivery, or renews in this state a policy of health insurance shall provide a nonopioid directive form to insureds upon enrollment. As used in this section, "nonopioid directive form" means that term as defined in section 9145 of …
Mich. Comp. Laws § 500.3406z Essential health benefit coverage; annual and lifetime dollar limits; prohibition; applicability to grandfathered health plan coverage.
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Sec. 3406z. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not institute either of the following: (a) Lifetime limits on the dollar value of essential health benefit coverage under section 3406bb(1). (b) Annual limits on…
Mich. Comp. Laws § 500.3406z[1] Disability insurance policies; discrimination against living donors; prohibition; definitions.
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Sec. 3406z. (1) This section applies to disability insurance policies or certificates delivered or issued for delivery after December 31, 2023. (2) Unless there is an additional actuarial risk, as determined in accordance with sound actuarial principles as well as the individual'…
Mich. Comp. Laws § 500.3407 Entire contract; changes.
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Sec. 3407. Except as otherwise provided in this act, an insurer shall include the following provision in a disability insurance policy: ENTIRE CONTRACT; CHANGES: This policy, including the applicable riders and endorsements; the application for coverage if specified by the insure…
Mich. Comp. Laws § 500.3407a Conduct on behalf of or information provided to insured by health care provider; prohibition or discouragement by disability insurer.
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Sec. 3407a. A disability insurer shall not prohibit or discourage a health care provider from advocating on behalf of an insured for appropriate medical treatment options pursuant to the grievance procedure in section 2213 or from discussing with an insured or provider any of the…
Mich. Comp. Laws § 500.3407b Undergoing genetic testing as condition of issuing, renewing, or continuing policy; disclosure of genetic testing or genetic information; definitions.
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Sec. 3407b. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not require an insured or his or her dependent or an asymptomatic applicant for insurance or his or her asymptomatic dependent to do either of the following: (a)…