™Your Policy Risk Impact Agent
1 chapters · 1,672 sections in this title.
Mich. Comp. Laws § 500.3408 Time limit on certain defenses; incontestable policy.
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Sec. 3408. (1) An insurer shall include in a disability insurance policy, other than a health insurance policy, a provision that consists of both of the following: (a) One of the following, as applicable: (i) TIME LIMIT ON CERTAIN DEFENSES: After 3 years from the date of issue of…
Mich. Comp. Laws § 500.3409 Disability insurance policy; mandatory notices as to cancellation and refund of premium.
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Sec. 3409. (1) Except as otherwise provided in this section, an insurer that delivers, issues for delivery, or renews in this state a disability insurance policy, other than a policy that provides group or blanket insurance, shall include the following notice, in substance printe…
Mich. Comp. Laws § 500.3410 Grace period; provision required.
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Sec. 3410. There shall be a provision as follows: GRACE PERIOD: A grace period of ................ (insert a number not less than "7" for weekly premium policies, "10" for monthly premium policies and "31" for all other policies) days will be granted for the payment of each premi…
Mich. Comp. Laws § 500.3411 Reinstatement; provision required.
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Sec. 3411. (1) Subject to subsection (2), an insurer shall include the following provision in a disability insurance policy other than a health insurance policy: REINSTATEMENT: If any renewal premium is not paid within the time granted the insured for payment, a subsequent accept…
Mich. Comp. Laws § 500.3412 Notice of claim; provision required.
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Sec. 3412. (1) Except as otherwise provided in subsection (2), an insurer shall include in a disability insurance policy, other than a health insurance policy, a provision as follows: NOTICE OF CLAIM: Written notice of claim must be given to the insurer within 20 days after the o…
Mich. Comp. Laws § 500.3413 Claim forms; provision required.
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Sec. 3413. An insurer shall include in a disability insurance policy, other than a health insurance policy, a provision as follows: CLAIM FORMS: The insurer, upon receipt of a notice of claim, will furnish to the claimant the forms that are usually furnished for filing proofs of …
Mich. Comp. Laws § 500.3414 Proofs of loss; provision required.
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Sec. 3414. An insurer shall include in a disability insurance policy, other than a health insurance policy, a provision as follows: PROOFS OF LOSS: Written proof of loss must be furnished to the insurer at its designated office. Proof of loss for a claim for loss for which this p…
Mich. Comp. Laws § 500.3416 Time of payment of claims; provision required.
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Sec. 3416. An insurer shall include in a disability insurance policy, other than a health insurance policy, a provision as follows: TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy for a loss other than loss for which this policy provides a periodic payment will b…
Mich. Comp. Laws § 500.3418 Payment of claims; provision required.
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Sec. 3418. (1) Except as otherwise provided in subsection (2), an insurer shall include in a disability insurance policy, other than a health insurance policy, a provision as follows: PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance with the beneficiary…
Mich. Comp. Laws § 500.3420 Physical examinations and autopsy; provision required.
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Sec. 3420. An insurer shall include in a disability insurance policy, other than a health insurance policy, a provision as follows: PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its own expense has the right and must be given the opportunity to examine the insured at reasonab…
Mich. Comp. Laws § 500.3422 Legal actions; provision required.
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Sec. 3422. An insurer shall include in a disability insurance policy, other than a health insurance policy, a provision as follows: LEGAL ACTIONS: An insured must not bring an action at law or in equity to recover on this policy before the expiration of 60 days after written proo…
Mich. Comp. Laws § 500.3424 Change of beneficiary; provision required.
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Sec. 3424. (1) Except as otherwise provided in subsection (2), an insurer shall include in a disability insurance policy, other than a health insurance policy, a provision as follows: CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation of beneficiary, the i…
Mich. Comp. Laws § 500.3425 Health insurance policy; coverage for intermediate and outpatient care for substance use disorder required; charges, terms, and conditions; reduction of coverage; deductibles and copayment provisions; definitions.
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Sec. 3425. (1) Except as otherwise provided in this subsection, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall provide coverage for intermediate and outpatient care for substance use disorder. This section does not apply to …
Mich. Comp. Laws § 500.3426 Offer of wellness coverage by insurer.
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Sec. 3426. (1) An insurer that delivers, issues for delivery, or renews in this state a group health insurance policy may offer group wellness coverage. An insurer may provide for an appropriate rebate or reduction in premiums or for reduced copayments, coinsurance, or deductible…
Mich. Comp. Laws § 500.3428 Provider network.
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Sec. 3428. An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall establish and maintain a provider network that, at a minimum, satisfies any network adequacy requirements imposed by the director under federal law.
Mich. Comp. Laws § 500.3430 Optional policy provisions; insurance commissioner's approval.
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Sec. 3430. Except as provided in subsection (2) of section 3406 (inapplicable or inconsistent provisions), no such policy delivered or issued for delivery to any person in this state shall contain provisions respecting the matters set forth in sections 3432 through 3454 unless su…
Mich. Comp. Laws § 500.3432 Change of occupation; optional provision.
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Sec. 3432. An insurer may include in a disability insurance policy, other than a health insurance policy, a provision as follows: CHANGE OF OCCUPATION: If the insured is injured or contracts an illness after changing his or her occupation to 1 classified by the insurer as more ha…
Mich. Comp. Laws § 500.3434 Misstatement of age; optional provision.
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Sec. 3434. There may be a provision as follows: MISSTATEMENT OF AGE: If the age of the insured has been misstated, all amounts payable under this policy shall be such as the premium paid would have purchased at the correct age.
Mich. Comp. Laws § 500.3436 Other insurance with same insurer; optional provision.
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Sec. 3436. There may be a provision as follows: OTHER INSURANCE IN THIS INSURER: If an accident or sickness or accident and sickness policy or policies previously issued by the insurer to the insured be in force concurrently herewith, making the aggregate indemnity for ..........…
Mich. Comp. Laws § 500.3438 Insurance with other insurers; optional provision; expense incurred benefits.
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Sec. 3438. (1) An insurer may include in an individual disability insurance policy a provision as follows: INSURANCE WITH OTHER INSURERS: If this insurer has not been given written notice before the occurrence or commencement of loss that the insured under this policy has other v…
Mich. Comp. Laws § 500.3440 Insurance with other insurers; other benefits.
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Sec. 3440. (1) An insurer may include in an individual disability insurance policy a provision as follows: INSURANCE WITH OTHER INSURERS: If this insurer has not been given written notice before the occurrence or commencement of loss that the insured under this policy has other v…
Mich. Comp. Laws § 500.3444 Relation of earnings to insurance; optional provision.
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Sec. 3444. There may be a provision as follows: RELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss of time benefits promised for the same loss under all valid loss of time coverage upon the insured, whether payable on a weekly or monthly basis, shall exceed th…
Mich. Comp. Laws § 500.3446 Unpaid premium; optional provision.
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Sec. 3446. There may be a provision as follows: UNPAID PREMIUM: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom.
Mich. Comp. Laws § 500.3448 Cancellation; optional provision.
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Sec. 3448. There may be a provision as follows: CANCELLATION: The insurer may cancel this policy at any time by written notice delivered to the insured, or mailed to the insured, stating when, not less than 5 days thereafter, the cancellation shall be effective; and after the pol…
Mich. Comp. Laws § 500.3450 Conformity with state statutes; optional provision.
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Sec. 3450. There may be a provision as follows: CONFORMITY WITH STATE STATUTES: Any provision of this policy which, on its effective date, is in conflict with the statutes of the state in which the insured resides on such date is hereby amended to conform to the minimum requireme…
Mich. Comp. Laws § 500.3452 Illegal occupation or criminal activity; optional provision; definitions.
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Sec. 3452. (1) An insurer may include in a disability insurance policy a provision as follows: ILLEGAL OCCUPATION OR CRIMINAL ACTIVITY: The insurer is not liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony or to which a…
Mich. Comp. Laws § 500.3460 Order of certain policy provisions.
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Sec. 3460. The provisions which are the subject of sections 3406 through 3454, or any corresponding provisions which are used in lieu thereof in accordance with such sections, shall be printed in the consecutive order of the provisions in such sections or, at the option of the in…
Mich. Comp. Laws § 500.3462 Third party ownership of policy.
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Sec. 3462. The word "insured", as used in this chapter, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any ind…
Mich. Comp. Laws § 500.3464 Foreign or alien insurers; provision required by other state law; domestic insurers; provision required by other state or country.
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Sec. 3464. (1) Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any provision which is not less favorable to the insured or the beneficiary than the provisions of this chapter and which is prescribed or requi…
Mich. Comp. Laws § 500.3466 Filing procedure; insurance commissioner, regulatory powers.
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Sec. 3466. The commissioner may make such reasonable rules and regulations concerning the procedure for the filing or submission of policies subject to this chapter as are necessary, proper or advisable to the administration of this chapter. This provision shall not abridge any o…
Mich. Comp. Laws § 500.3468 Provisions violating code; construction of noncomplying policies and provisions.
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Sec. 3468. (1) No policy provision which is not subject to sections 3406 through 3454 shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to this chapter. (2) A policy delivered…
Mich. Comp. Laws § 500.3470 Age of insured; provision regulations.
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Sec. 3470. If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accep…
Mich. Comp. Laws § 500.3471 Provision and nondisclosure of large employer group claims utilization and cost information; civil liability immunity; definitions.
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Sec. 3471. (1) On request of a large employer group, an insurer shall provide the large employer group with claims utilization and cost information as provided in subsection (3) on presentation of a signed nondisclosure agreement to the insurer. In signing the nondisclosure agree…
Mich. Comp. Laws § 500.3472 Open enrollment period; prohibitions; establishment of reasonable periods for health insurance policies; minimum standards for frequency and duration of open enrollment periods; denial of coverage.
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Sec. 3472. (1) During an applicable open enrollment period, an insurer that offers, delivers, issues for delivery, or renews in this state a health insurance policy shall not deny or condition the issuance or effectiveness of the policy and shall not discriminate in the pricing o…
Mich. Comp. Laws § 500.3474 Risk classification; rates; filing requirements.
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Sec. 3474. No policy of insurance against loss or expense from the sickness, or from the bodily injury or death from accident of the insured, nor any application, rider or endorsement to be used in connection therewith, shall be delivered or issued for delivery to any person in t…
Mich. Comp. Laws § 500.3474a Premium rate after January 1, 2014; basis; factors.
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Sec. 3474a. The premium rate charged by an insurer, health maintenance organization, or nonprofit health care corporation for health insurance coverage offered through a policy or certificate delivered, issued for delivery, or renewed in this state on or after January 1, 2014 in …
Mich. Comp. Laws § 500.3475 Reimbursement for services by licensed psychologist, podiatrist, or chiropractor; section inapplicable to policy involving prudent purchaser agreement.
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Sec. 3475. (1) Notwithstanding any provision of a disability insurance policy, if the disability insurance policy provides for reimbursement for any service that is legally performed by a person fully licensed as a psychologist under part 182 of the public health code, 1978 PA 36…
Mich. Comp. Laws § 500.3476 Telemedicine services; provisions; definitions.
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Sec. 3476. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the i…
Mich. Comp. Laws § 500.3477 Use of financial incentive or payment to act as inducement to deny, reduce, limit, or delay services; prohibition; exception.
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Sec. 3477. (1) An insurer shall not use any financial incentive or make any payment to a health professional that acts directly or indirectly as an inducement to deny, reduce, limit, or delay specific medically necessary and appropriate services. (2) Subsection (1) does not prohi…
Mich. Comp. Laws § 500.3501 Definitions.
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Sec. 3501. As used in this chapter: (a) "Affiliated provider" means a health professional, licensed hospital, licensed pharmacy, or any other institution, organization, or person that has entered into a participating provider contract, directly or indirectly, with a health mainte…
Mich. Comp. Laws § 500.3503 Applicability of provisions to health maintenance organization.
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Sec. 3503. (1) Unless specifically excluded, or otherwise specifically provided for in this chapter, all of the provisions of this act that apply to a domestic insurer authorized to issue a health insurance policy apply to a health maintenance organization. (2) Sections 408, 410,…
Mich. Comp. Laws § 500.3505 Health maintenance contract; use of descriptive words; restrictions.
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Sec. 3505. (1) A health maintenance organization shall not issue a health maintenance contract before it receives a certificate of authority under this act. (2) A person shall not use the term health maintenance organization to describe or refer to a person, and a person shall no…
Mich. Comp. Laws § 500.3507 Authorizing and regulating health maintenance organization; establishment of system by director.
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Sec. 3507. The director shall establish a system of authorizing and regulating health maintenance organizations in this state to protect and promote the public health through the assurance that the organizations provide all of the following: (a) An acceptable quality of health ca…
Mich. Comp. Laws § 500.3508 Quality assessment program; quality improvement program.
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Sec. 3508. (1) A health maintenance organization shall develop and maintain a quality assessment program that includes, at a minimum, systematic collection, analysis, and reporting of relevant data in accordance with statutory and regulatory requirements. (2) A health maintenance…
Mich. Comp. Laws § 500.3509 Certificate of authority; application; form; limitation; change of service area.
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Sec. 3509. (1) An application to the director for a certificate of authority must be on a form prescribed and provided by the director. (2) A certificate of authority issued to a health maintenance organization under this act is limited to the service area described in the applic…
Mich. Comp. Laws § 500.3511 Governing body; election of enrollee board members; requirements; meetings.
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Sec. 3511. (1) A health maintenance organization's governing body must include no less than 1 individual who represents the health maintenance organization's membership. (2) A health maintenance organization that is under a contract with this state to provide medical services aut…
Mich. Comp. Laws § 500.3513 Health maintenance organization operations; regulation by director; incorporation as legal entity.
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Sec. 3513. (1) The director shall regulate health delivery aspects of health maintenance organization operations to ensure that health maintenance organizations are capable of providing care and services promptly, appropriately, and in a manner that ensures continuity and accepta…
Mich. Comp. Laws § 500.3515 Additional health services; deductibles; copayments; "preventive health care services" defined; partial payment from government or private person.
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Sec. 3515. (1) A health maintenance organization may provide additional health services or any other related health care service or treatment not required under this act. (2) A health maintenance organization may have health maintenance contracts with deductibles. A health mainte…
Mich. Comp. Laws § 500.3517 Healthy lifestyle programs; emergency or out-of-area service; payment of expenses or fees.
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Sec. 3517. (1) A health maintenance contract shall not provide for payment of cash or other material benefit to an enrollee other than as permitted under the law of this state or as approved by the director under section 2236. (2) Subsection (1) does not prohibit a health mainten…
Mich. Comp. Laws § 500.3519 Contract and contract rates; fairness; rate differential; basic health services to large employers required.
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Sec. 3519. (1) A health maintenance organization contract and the contract's rates, including any deductibles, copayments, and coinsurances, between the organization and its subscribers must be fair, sound, and reasonable in relation to the services provided, and the procedures f…