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Michigan Compiled Laws Complete Through PA 19 of 2024
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Senate: Adjourned until Tuesday, March 19, 2024 10:00:00 AM


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218-1956-35
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THE INSURANCE CODE OF 1956 (EXCERPT)
Act 218 of 1956
Chapter 35
HEALTH MAINTENANCE ORGANIZATIONS

DocumentTypeDescription
Section 500.3501SectionDefinitions.
Section 500.3503SectionApplicability of provisions to health maintenance organization.
Section 500.3505SectionHealth maintenance contract; use of descriptive words; restrictions.
Section 500.3507SectionAuthorizing and regulating health maintenance organization; establishment of system by director.
Section 500.3508SectionQuality assessment program; quality improvement program.
Section 500.3509SectionCertificate of authority; application; form; limitation; change of service area.
Section 500.3511SectionGoverning body; election of enrollee board members; requirements; meetings.
Section 500.3513SectionHealth maintenance organization operations; regulation by director; incorporation as legal entity.
Section 500.3515SectionAdditional health services; deductibles; copayments; "preventive health care services" defined; partial payment from government or private person.
Section 500.3517SectionHealthy lifestyle programs; emergency or out-of-area service; payment of expenses or fees.
Section 500.3519SectionContract and contract rates; fairness; rate differential; basic health services to large employers required.
Section 500.3521SectionPrepayment rates; filing and approval of methodology; schedule.
Section 500.3523SectionRepealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3525SectionProposal to revise contract or rate; approval of commissioner; approval with modifications; hearing; disposition; exception; notice.
Section 500.3527SectionRepealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3528SectionHealth maintenance organization; credentialing verification; accreditation by nationally recognized accredited body.
Section 500.3529SectionAffiliated provider contracts; collection of payments from enrollees; contract provisions; waiver of requirement under subsection (2); contract format; evidence of sufficient number of providers.
Section 500.3530SectionAvailability of covered services; assurance; establishment and maintenance of proximity.
Section 500.3531SectionContracts 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.
Section 500.3533SectionPrudent purchaser contracts; reimbursement for unauthorized services or services by nonaffiliated providers.
Section 500.3535SectionSolicitation or advertising.
Section 500.3537SectionRepealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3539SectionRepealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3541SectionRepealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3542SectionRepealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3543SectionRepealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3544SectionNoninsured benefit plan; processing and payment of claims.
Section 500.3545SectionAcquisition of obligations from another managed care entity.
Section 500.3547SectionHealth 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.
Section 500.3548SectionMaintenance of books, records, files, and financial records; funds and assets.
Section 500.3549SectionRepealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3551SectionHealth maintenance organization; net worth.
Section 500.3553SectionCertificate of authority; deposit requirements.
Section 500.3555SectionFinancial plan.
Section 500.3557SectionNotice of changes in operations.
Section 500.3559SectionReinsurance contract or plan of self-insurance; purpose; filing; approval; coverage.
Section 500.3561SectionInsolvency; continuation of benefits.
Section 500.3563SectionInsolvency; 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.
Section 500.3565SectionRepealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3567SectionRepealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3569SectionAssumption of financial risk.
Section 500.3571SectionState or federal health programs.
Section 500.3573SectionOperation of health care delivery system not meeting requirements of act; permitted conduct; limitations.
Section 500.3580SectionRepealed. 2016, Act 276, Imd. Eff. July 1, 2016.
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