Title 550, GENERAL INSURANCE LAWS

Sec. 14. (1) The commissioner shall issue a certificate of authority to operate as a TPA if the commissioner is satisfied that the TPA has adequate facilities, personnel, and managers to act as a third party administrator. (2) If the commissioner disapproves an application for a …

Sec. 18. (1) The commissioner shall collect, and the persons affected shall pay to the commissioner, the following fees: (a) Filing fee to accompany application for third party administrator's certificate of authority $ 200.00. (b) Certificate of authority for a third party admin…

Sec. 19. (1) A TPA advisory board is created. The board shall consist of 7 members appointed by the commissioner, at least 4 of whom shall be individuals employed by TPAs who are not in the employ of a carrier and who do not have a significant ownership interest in a carrier. The…

Sec. 20. The commissioner shall have the same authority with respect to a TPA or manager as he or she does with respect to an insurance agency or agent under the insurance code of 1956, Act No. 218 of the Public Acts of 1956, being sections 500.100 to 500.8302 of the Michigan Com…

Sec. 22. The commissioner may designate 1 or more persons to conduct hearings provided for under this act, hearings required by the administrative procedures act of 1969, Act No. 306 of the Public Acts of 1969, being sections 24.201 to 24.315 of the Michigan Compiled Laws, and he…

Sec. 24. The commissioner is authorized to destroy or otherwise dispose of all records, books, papers, and other data on file with the department which in his or her opinion and on the advice of the attorney general, are of no further material value to the state of Michigan; but …

Sec. 26. (1) A carrier or third party administrator that is a pharmacy benefit manager shall not prohibit a 340B Program entity or a pharmacy that has a license in good standing in this state under contract with a 340B Program entity from participating in the carrier's or third p…

Sec. 27. A contract between a carrier or third party administrator that is a pharmacy benefit manager and a pharmacy must not prohibit the pharmacy from disclosing the current selling price of a drug in accordance with section 17757 of the public health code, 1978 PA 368, MCL 333…

Sec. 30. (1) A TPA may only provide administrative services pursuant to a written service contract. For the duration of the service contract, a TPA shall maintain at its principal administrative office the TPA's books and records of all transactions under the service contract in …

Sec. 32. (1) A TPA, in connection with a benefit plan, shall provide in its service contract a provision that the person contracting for the services shall provide written notice to each individual covered by the plan, which written notice shall contain the following information:…

Sec. 34. (1) A TPA shall provide for the confidentiality of personal data identifying an individual covered by a plan. A TPA shall not disclose records containing personal information that may be associated with an identifiable individual covered by a plan to a person other than …

Sec. 36. By July 1, 2022 and each July 1 after that date, a third party administrator shall prepare under oath and file with the director a statement concerning the third party administrator's affairs on a form provided by the director. A third party administrator shall file the …

Sec. 40. A TPA or manager, in processing claims, shall not do any of the following: (a) Misrepresent pertinent facts relating to coverage. (b) Fail to make a good faith effort to acknowledge promptly or to act reasonably and promptly upon communications with respect to a claim fo…

Sec. 42. A manager or TPA, in order to induce a person to contract or to continue to contract with the TPA; to induce a person to lapse, forfeit, or surrender a service contract entered into with a TPA; or to induce a person to secure or terminate coverage with a carrier or other…

Sec. 44. (1) A TPA shall not refuse to enter into a service contract or provide administrative services other than processing claims because of race, color, creed, marital status, sex, national origin, residence, age, disability, or lawful occupation. (2) A TPA or manager shall n…

Sec. 50. (1) When the commissioner has probable cause to believe that a TPA or manager is violating, or has violated section 40, indicating a persistent tendency to engage in conduct prohibited by that section, or has probable cause to believe that a TPA or manager is violating, …

Sec. 52. (1) If a TPA or manager violates a cease and desist order under this act and has been given notice and an opportunity for a hearing held under the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328, the director may order a civil fine of not more th…

Sec. 54. The commissioner may at any time, by order, after notice and opportunity for hearing, reopen and alter, modify, or set aside, in whole or in part, an order issued by him or her under this act, when in his or her opinion conditions of fact or of law have so changed as to …

Sec. 56. (1) Any final order or decision made, issued, or executed by the commissioner under this act shall be subject to review, after hearing had before the commissioner or a deputy commissioner without leave by the circuit court of Ingham county or the circuit court of the cou…

Sec. 58. (1) A person shall not be excused from attending and testifying, or producing any books, papers, or other documents before any court or magistrate, arbitrator or board of arbitrators, upon any investigation, proceeding, or trial, for a violation of any of the provisions …

Sec. 60. (1) The commissioner, after notice and hearing, may promulgate rules pursuant to the administrative procedures act of 1969, Act No. 306 of the Public Acts of 1969, being sections 24.201 to 24.315 of the Michigan Compiled Laws, as necessary to effectuate the purposes of t…