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1 chapters · 1,672 sections in this title.
Mich. Comp. Laws § 500.3521 Prepayment rates; filing and approval of methodology; schedule.
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Sec. 3521. (1) The methodology used to determine prepayment rates by category rates charged by the health maintenance organization and any changes to either the methodology or the rates shall be filed with and approved by the commissioner before becoming effective. (2) A health m…
Mich. Comp. Laws § 500.3525 Proposal to revise contract or rate; approval of commissioner; approval with modifications; hearing; disposition; exception; notice.
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Sec. 3525. (1) Except as otherwise provided in subsection (2), if a health maintenance organization desires to change a contract it offers to enrollees or desires to change a rate charged, a copy of the proposed revised contract or rate shall be filed with the commissioner and sh…
Mich. Comp. Laws § 500.3528 Health maintenance organization; credentialing verification; accreditation by nationally recognized accredited body.
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Sec. 3528. (1) A health maintenance organization shall establish written policies and procedures for credentialing verification of all health professionals with whom the health maintenance organization contracts. A health maintenance organization shall apply these standards consi…
Mich. Comp. Laws § 500.3529 Affiliated provider contracts; collection of payments from enrollees; contract provisions; waiver of requirement under subsection (2); contract format; evidence of sufficient number of providers.
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Sec. 3529. (1) A health maintenance organization may contract with or employ health professionals on the basis of cost, quality, availability of services to the membership, conformity to the administrative procedures of the health maintenance organization, and other factors relev…
Mich. Comp. Laws § 500.3530 Availability of covered services; assurance; establishment and maintenance of proximity.
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Sec. 3530. (1) A health maintenance organization shall maintain contracts with those numbers and those types of affiliated providers that are sufficient to assure that covered services are available to its enrollees without unreasonable delay. The commissioner shall determine wha…
Mich. Comp. Laws § 500.3531 Contracts with health care providers to become affiliated providers; requirements; standards; filing; duplicative standards; notice procedures; provider application period; approval or rejection as affiliated provider; termination of contract; providing information to insurer.
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Sec. 3531. (1) This section applies if a health maintenance organization contracts with health care providers to become affiliated providers or offers a prudent purchaser contract. (2) A health maintenance organization may enter into a contract with 1 or more health care provider…
Mich. Comp. Laws § 500.3533 Prudent purchaser contracts; reimbursement for unauthorized services or services by nonaffiliated providers.
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Sec. 3533. Subject to section 3405, a health maintenance organization may offer prudent purchaser contracts to groups or individuals and in conjunction with those contracts a health maintenance organization may pay or may reimburse enrollees, or may contract with another person t…
Mich. Comp. Laws § 500.3535 Solicitation or advertising.
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Sec. 3535. Solicitation of enrollees or advertising of the services, charges, or other nonprofessional aspects of the health maintenance organization's operation under this section is not in violation of laws relating to solicitation or advertising by health professionals. A heal…
Mich. Comp. Laws § 500.3544 Noninsured benefit plan; processing and payment of claims.
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Sec. 3544. (1) A health maintenance organization may process and pay claims on behalf of a noninsured benefit plan only after the health maintenance organization has received adequate money from the noninsured benefit plan sponsor to fully cover the claim payments. (2) As used in…
Mich. Comp. Laws § 500.3545 Acquisition of obligations from another managed care entity.
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Sec. 3545. With the director's prior approval, a health maintenance organization may acquire obligations from another managed care entity. The director shall not grant prior approval unless the director determines that the transaction will not jeopardize the health maintenance or…
Mich. Comp. Laws § 500.3547 Health care service operations; visitation or examination by director; consultation with enrollees; authority; access to information relating to delivery of services; submission of information regarding proposed contract.
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Sec. 3547. (1) The director at any time may visit or examine the health care service operations of a health maintenance organization and consult with enrollees to the extent necessary to carry out the intent of this act. (2) The director has the authority granted under chapter 2 …
Mich. Comp. Laws § 500.3548 Maintenance of books, records, files, and financial records; funds and assets.
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Sec. 3548. (1) A health maintenance organization shall keep all of its books, records, and files at or under the control of its principal place of doing business in this state, and shall keep a record of all of its securities, notes, mortgages, or other evidences of indebtedness,…
Mich. Comp. Laws § 500.3551 Health maintenance organization; net worth.
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Sec. 3551. (1) A health maintenance organization shall determine its minimum net worth using accounting procedures approved by the director. The accounting procedures must ensure that a health maintenance organization is financially and actuarially sound. (2) To obtain or maintai…
Mich. Comp. Laws § 500.3553 Certificate of authority; deposit requirements.
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Sec. 3553. (1) To obtain or maintain a certificate of authority in this state, a health maintenance organization shall possess and maintain a deposit in an amount determined adequate by the director to continue to comply with section 403 but not less than $100,000.00 plus 5% of a…
Mich. Comp. Laws § 500.3555 Financial plan.
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Sec. 3555. A health maintenance organization shall maintain a financial plan evaluating, at a minimum, cash flow needs and adequacy of working capital. The plan under this subsection must do all of the following: (a) Demonstrate compliance with all health maintenance organization…
Mich. Comp. Laws § 500.3557 Notice of changes in operations.
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Sec. 3557. A health maintenance organization shall file notice with the director of any substantive changes in operations within 30 days after the substantive change in operations occurs. A substantive change in operations includes, but is not limited to, any of the following: (a…
Mich. Comp. Laws § 500.3559 Reinsurance contract or plan of self-insurance; purpose; filing; approval; coverage.
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Sec. 3559. (1) Subject to subsection (2), a health maintenance organization shall obtain a reinsurance contract or establish a plan of self-insurance as necessary to ensure solvency or to protect subscribers in the event of insolvency. A reinsurance contract must be with an insur…
Mich. Comp. Laws § 500.3561 Insolvency; continuation of benefits.
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Sec. 3561. A health maintenance organization shall have a plan for handling insolvency that allows for continuation of benefits for the duration of the health maintenance contract period for which premiums have been paid and continuation of benefits to any enrollee who is confine…
Mich. Comp. Laws § 500.3563 Insolvency; offer of enrollment by health insurers participating in enrollment process; allocation of group coverage to health maintenance organizations or insurers within service area; nongroup coverage; reassignment of enrollees of insolvent organization contracting with state funded health care program; substitute coverage under American health benefit exchange.
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Sec. 3563. (1) If a health maintenance organization becomes insolvent, upon the director's order all other health insurers that participated in the enrollment process with the insolvent health maintenance organization at a group's last regular enrollment period shall offer the in…
Mich. Comp. Laws § 500.3569 Assumption of financial risk.
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Sec. 3569. (1) Except as provided in section 3515(2), a health maintenance organization shall assume full financial risk on a prospective basis for the provision of health services under a health maintenance organization contract. A health maintenance organization may do any of t…
Mich. Comp. Laws § 500.3571 State or federal health programs.
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Sec. 3571. A health maintenance organization that participates in a state or federal health program shall meet the solvency and financial requirements of this act, unless the health maintenance organization is in receivership or under supervision. Notwithstanding any provision of…
Mich. Comp. Laws § 500.3573 Operation of health care delivery system not meeting requirements of act; permitted conduct; limitations.
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Sec. 3573. (1) A person that proposes to operate a system of health care delivery and financing to be offered to individuals, whether or not as members of groups, in exchange for a fixed payment and to be organized so that providers and the organization are in some part at risk f…
Mich. Comp. Laws § 500.3701 Definitions.
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Sec. 3701. As used in this chapter: (a) "Actuarial certification" means a written statement by a member of the American Academy of Actuaries or another individual acceptable to the director that a small employer carrier is in compliance with section 3705, based on the individual'…
Mich. Comp. Laws § 500.3703 Scope of chapter.
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Sec. 3703. (1) This chapter applies to any health benefit plan that provides coverage to 2 or more employees of a small employer. (2) This chapter does not apply to individual health insurance policies that are subject to policy form and premium approval by the director.
Mich. Comp. Laws § 500.3705 Geographic areas; adjustment and determination of premiums; conditions; additional premium; small employer; rating factors.
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Sec. 3705. (1) For adjusting premiums for health benefit plans subject to this chapter, a carrier shall use the defined geographic areas established by the director and allowed under federal law. (2) Premiums for a health benefit plan under this chapter are subject to the followi…
Mich. Comp. Laws § 500.3707 Health benefit plan; marketing; affiliation period.
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Sec. 3707. (1) As a condition of transacting business in this state with small employers, every small employer carrier shall make available to small employers all health benefit plans it markets to small employers in this state. A small employer carrier shall be considered to be …
Mich. Comp. Laws § 500.3708 Special enrollment period.
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Sec. 3708. (1) A health benefit plan offered to a small employer by a small employer carrier shall provide for the acceptance of late enrollees subject to this chapter. (2) A small employer carrier shall permit an employee or a dependent of the employee, who is eligible, but not …
Mich. Comp. Laws § 500.3709 Minimum participation rules.
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Sec. 3709. (1) Except as provided in this section, requirements used by a small employer carrier in determining whether to provide coverage to a small employer shall be applied uniformly among all small employers applying for coverage or receiving coverage from the small employer…
Mich. Comp. Laws § 500.3711 Small employer carrier; guaranteed renewal; exceptions; modification.
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Sec. 3711. (1) Except as otherwise provided in this section, a small employer carrier that offers health coverage in the small employer group market in connection with a health benefit plan shall renew or continue in force the plan at the option of the small employer. (2) Guarant…
Mich. Comp. Laws § 500.3712 Decision to discontinue plan in geographic area.
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Sec. 3712. (1) If a small employer carrier decides to discontinue offering all small employer health benefit plans in a geographic area, all of the following apply: (a) The small employer carrier shall provide notice to the commissioner and to each small employer covered by the s…
Mich. Comp. Laws § 500.3713 Information offered upon request.
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Sec. 3713. Each small employer carrier shall provide all of the following to a small employer upon request and upon entering into a contract with the small employer: (a) The extent to which premiums for a specific small employer are established or adjusted due to any permitted ch…
Mich. Comp. Laws § 500.3715 Information and documentation; retention at principal place of business.
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Sec. 3715. (1) Each small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practi…
Mich. Comp. Laws § 500.3716 Archer medical savings account; exception.
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Sec. 3716. This chapter does not apply to a health benefit plan sponsored by a small employer that is an Archer medical savings account that meets all requirements of section 220 of the internal revenue code of 1986.
Mich. Comp. Laws § 500.3717 Suspension; exemption; conditions; exception.
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Sec. 3717. (1) Upon a request for suspension by the small employer carrier and a finding by the commissioner after consulting with the attorney general that the suspension is reasonable in light of the financial condition of the carrier and that the suspension would enhance the e…
Mich. Comp. Laws § 500.3718 Applicability of MCL 550.1619.
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Sec. 3718. A nonprofit health care corporation is subject to section 619 of the nonprofit health care corporation reform act, 1980 PA 350, MCL 550.1619.
Mich. Comp. Laws § 500.3723 Applicability of chapter; date of health benefit plan.
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Sec. 3723. This chapter applies to a health benefit plan for a small employer that is delivered, issued for delivery, renewed, or continued in this state after January 22, 2004. For purposes of this section, the date a health benefit plan is continued is the first rating period t…
Mich. Comp. Laws § 500.3801 Chapter; definitions.
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Sec. 3801. As used in this chapter: (a) "Applicant" means: (i) For an individual Medicare supplement policy, the person who seeks to contract for benefits. (ii) For a group Medicare supplement policy or certificate, the proposed certificate holder. (b) "Bankruptcy" means, with re…
Mich. Comp. Laws § 500.3803 Applicability of chapter.
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Sec. 3803. (1) Except as provided in subsections (2) and (3), this chapter applies to a Medicare supplement policy delivered, issued for delivery, or renewed in this state. (2) Sections 3807, 3809, 3811, and 3819 apply to a Medicare supplement policy delivered or issued for deliv…
Mich. Comp. Laws § 500.3805 Medicare supplement policy; definitions.
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Sec. 3805. As used in a medicare supplement policy: (a) The definition of "accident", "accidental injury", or "accidental means" shall not include words that establish an accidental means test or use words such as "external, violent, visible wounds" or similar words of descriptio…
Mich. Comp. Laws § 500.3807 Basic core package of benefits; standards for plans K and L; applicability of section.
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Sec. 3807. (1) Every insurer issuing a medicare supplement insurance policy in this state shall make available a medicare supplement insurance policy that includes a basic core package of benefits to each prospective insured. An insurer issuing a medicare supplement insurance pol…
Mich. Comp. Laws § 500.3807a Medicare supplement policies or certificates with effective date for coverage on or after June 1, 2010; basic core package of benefits.
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Sec. 3807a. (1) This section applies to all medicare supplement policies or certificates delivered or issued for delivery with an effective date for coverage on or after June 1, 2010. A policy or certificate shall not be advertised, solicited, delivered, or issued for delivery in…
Mich. Comp. Laws § 500.3809 Additional benefits; reimbursement for preventive screening tests and services; definitions; applicability of section.
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Sec. 3809. (1) In addition to the basic core package of benefits required under section 3807, the following benefits may be included in a medicare supplement insurance policy and if included shall conform to section 3811(5)(b) to (j): (a) Medicare part A deductible: coverage for …
Mich. Comp. Laws § 500.3809a Medicare supplement policies or certificates with effective date for coverage on or after June 1, 2010; additional benefits.
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Sec. 3809a. (1) This section applies to all medicare supplement policies or certificates delivered or issued for delivery with an effective date for coverage on or after June 1, 2010. (2) In addition to the basic core package of benefits required under section 3807a, the followin…
Mich. Comp. Laws § 500.3811 Basic core benefits; availability; sale of certain benefits prohibited; designations, structure, language, and format; other designations; requirements; applicability of section.
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Sec. 3811. (1) An insurer shall make available to each prospective medicare supplement policyholder and certificate holder a policy form or certificate form containing only the basic core benefits as provided in section 3807. (2) Groups, packages, or combinations of medicare supp…
Mich. Comp. Laws § 500.3811a Medicare supplement policies or certificates with effective date for coverage on or after June 1, 2010; basic core benefits; availability; sale of certain benefits prohibited; structure, language, designation, and format; other designations; requirements.
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Sec. 3811a. (1) This section applies to all Medicare supplement policies or certificates delivered or issued for delivery with an effective date for coverage on or after June 1, 2010. A policy or certificate must not be advertised, solicited, delivered, or issued for delivery in …
Mich. Comp. Laws § 500.3811b Medicare supplement policies or certificates for newly eligible individuals after December 31, 2019; exceptions to standards and requirements.
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Sec. 3811b. (1) This section applies to all Medicare supplement policies or certificates delivered or issued for delivery in this state to individuals newly eligible for Medicare after December 31, 2019. A policy or certificate that provides coverage of the Medicare part B deduct…
Mich. Comp. Laws § 500.3813 Disability coverage; medicare supplement buyer's guide; applicability of section.
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Sec. 3813. An insurer that issues a policy that provides health insurance coverage to a person eligible for Medicare by reason of age shall provide the prospective policyholder with a Medicare supplement buyer's guide in written or electronic format, which must be furnished at th…
Mich. Comp. Laws § 500.3815 Outline of coverage; acknowledgment of receipt; compliance with notice requirements; substitute; language, written or electronic format, and required items.
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Sec. 3815. (1) An insurer that offers a Medicare supplement policy shall provide to the applicant at the time of application an outline of coverage in written or electronic format and, except for direct response solicitation policies, shall obtain an acknowledgment of receipt of …
Mich. Comp. Laws § 500.3817 Medicare select policies and certificates; definitions; requirements for issuance; plan of operation; filing, format, and contents; proposed changes; updated list of network providers; payment for covered services not available through network providers; disclosure; receipt of information; grievance procedure; report; availability of comparable or lesser benefits; continuation of coverage; requests for data by state or federal agencies.
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Sec. 3817. (1) This section applies to medicare select policies and certificates. (2) As used in this section: (a) "Complaint" means any dissatisfaction expressed by an individual concerning a medicare select insurer or its network providers. (b) "Grievance" means a dissatisfacti…
Mich. Comp. Laws § 500.3819 Minimum standards; suspension of benefits and premiums; notice; reinstitution; offer to exchange 1990 standardized plan to 2010 plan.
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Sec. 3819. (1) An insurance policy shall not be titled, advertised, solicited, or issued for delivery in this state as a medicare supplement policy if the policy does not meet the minimum standards prescribed in this section. These minimum standards are in addition to all other r…