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Michigan Legislature
Michigan Compiled Laws Complete Through PA 48 of 2019
House: Adjourned until Tuesday, October 15, 2019 1:30:00 PM
Senate: Adjourned until Tuesday, October 15, 2019 10:00:00 AM


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350-1980-4
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THE NONPROFIT HEALTH CARE CORPORATION REFORM ACT (EXCERPT)
Act 350 of 1980
Part 4


DocumentTypeDescription
Section 550.1400SectionUse of most favored nation clause in provider contract.
Section 550.1401SectionOffering of health care benefits; limiting benefits; division of benefits into classes or kinds; prohibited conduct; grounds for denial of coverage; coordination of benefits, subrogation, and nonduplication of benefits; health care corporation as party in interest; limiting or denying coverage or participation status; requirements for participation and reimbursement; determination by commissioner; definitions.
Section 550.1401aSectionHealth care service rendered by dentist; benefits or reimbursement; “dentist” defined; certificates to which section applicable.
Section 550.1401bSectionCertificate providing benefits for mental health services; requirements.
Section 550.1401cSectionReplacement group certificate with preexisting condition limitation; elimination, reduction, or limitation of benefits; “disability coverage” defined.
Section 550.1401dSectionServices performed by physician's assistant; reimbursement; conditions; applicability of section; supervision by physician; definitions.
Section 550.1401eSectionGroup certificate issued by health care corporation; renewal or continuation; guaranteed renewal; discontinuing plan, product, or coverage in nongroup or group market; conditions.
Section 550.1401fSectionHealth care corporation; access to obstetrician-gynecologist.
Section 550.1401gSectionHealth care corporation; access to pediatric care services.
Section 550.1401hSectionHealth care corporation providing prescription drug coverage; formulary restrictions.
Section 550.1401iSectionPrescription drug coverage; pilot project; provisions; interim report; determination; evaluation.
Section 550.1401jSectionPrescription drug coverage; rate differentials; filing.
Section 550.1401kSectionTelemedicine services; provisions; definition; applicability.
Section 550.1401mSectionOffer of health care benefits to all residents regardless of health status.
Section 550.1402SectionHealth care corporation; prohibited conduct; commission or compensation; new preexisting condition limitation waiting period; readjusting rates; participation in trade practice conference for disability insurers; provider class plan not altered or superseded; probable cause to believe provisions violated; notice; disposition of matter by agreement of parties; action for damages; hearing; issuance of cease and desist order; violation of cease and desist order; civil fine; action for actual monetary damage; attorneys' fees.
Section 550.1402aSectionTerms and conditions of certificate; form; description; requested information; written request; “board certified” defined.
Section 550.1402bSectionPreexisting condition limitation or exclusion; prohibition; exception; “group” defined.
Section 550.1402cSectionTermination of participation between primary care physician and health care corporation; notice to member; effect of termination; definitions.
Section 550.1402dSectionApplicability of MCL 500.2212c to health care corporation.
Section 550.1403SectionPayment of benefits; interest; claim form; exception.
Section 550.1403aSectionBenefits paid by check or written instrument; escheat.
Section 550.1403bSectionAdvertising material prohibited.
Section 550.1404SectionViolation of MCL 550.1402 or MCL 550.1403; private informal managerial-level conference; review by commissioner; internal procedures; determination by commissioner; expedited grievance procedure; procedural rules; hearing matter as contested case; authorization to act on behalf of member.
Section 550.1405SectionSingle billing form; development; explanation of total bill for services.
Section 550.1406SectionConfidentiality of records; disclosures; consent; policy regarding protection of privacy and confidentiality of personal data; violation as misdemeanor; penalty; civil action for damages; effect of section on governmental agencies; compliance with federal law and regulations; "health care operations" defined.
Section 550.1407SectionComplaint system; procedures; response to complaint; access to complaints and responses; record of complaints; annual report; other legal remedies.
Section 550.1408SectionFalse, dishonest, or fraudulent claim for payment as misdemeanor; penalty; civil action; prosecution.
Section 550.1409SectionCivil action for negligence.
Section 550.1409aSectionCoverage for children who are full-time or part-time students; continuing coverage if dependent student takes leave of absence due to illness or injury; eligibility; requirements.
Section 550.1410SectionCertificate providing coverage of dependent terminating at specified age; exceptions.
Section 550.1410aSectionProvisions of group certificate; electing coverage under group conversion certificate; notice of conversion privilege; requirements of group conversion certificate; premium; issuance; compliance.
Section 550.1410bSectionPremium for group conversion certificate after January 1, 2014; determination; rating factors.
Section 550.1411-550.1413aSectionRepealed. 1994, Act 40, Imd. Eff. Mar. 14, 1994.
Section 550.1414SectionExpired. 1980, Act 430, Eff. Jan. 1, 1982.
Section 550.1414aSectionTreatment of substance abuse; contracts; qualifications of provider; coverage for intermediate and outpatient care for substance abuse required; demonstration projects; substance abuse advisory committee; report; contracts based on final report; reimbursement; group and nongroup certificates; exceptions; option to decline coverage; charges, terms, and conditions; reduction of coverage; deductibles and copayment provision; minimum coverage; adjustment; definitions; effective date of section.
Section 550.1414bSectionOffer of wellness coverage by health care corporation.
Section 550.1415SectionBenefits for prosthetic devices.
Section 550.1416SectionCoverage for breast cancer diagnostic services, breast cancer outpatient services, and breast cancer rehabilitative services; coverage for breast cancer screening mammography; definitions; effective date of section.
Section 550.1416aSectionCoverage for drug used in antineoplastic therapy and cost of its administration; conditions.
Section 550.1416bSectionEstablishment of program to prevent onset of clinical diabetes required; report; coverages; “diabetes” defined.
Section 550.1416cSectionOff-label use of approved drug; coverage; conditions; compliance; use of copayment, deductible, sanction, or utilization control; limitation; definitions.
Section 550.1416dSectionCoverage for obstetrical and gynecological services by physician or nurse midwife.
Section 550.1416eSectionDiagnosis 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; prescription drug plan; coordinated benefits; definitions.
Section 550.1417SectionHospice care; contracts with health care corporation; description of benefit.
Section 550.1418SectionEmergency health services; medical coverage required; “stabilization” defined.
Section 550.1419SectionCertificate offering dependent coverage to child; denial of enrollment on certain grounds prohibited.
Section 550.1419aSectionEligibility of parent for dependent coverage; health coverage of child through noncustodial parent; court or administrative order and notice required.
Section 550.1419bSectionIndividual eligible under title XIX of social security act; assignment of rights of subscriber to department of social services.
Section 550.1420-550.1430SectionRepealed. 2006, Act 441, Imd. Eff. Oct. 19, 2006.
Section 550.1435Section“Program” defined.
Section 550.1436SectionMichigan caring programs for children; creation; contribution requirements; rating methodologies; supersedure of inconsistent provisions.
Section 550.1437SectionEligibility of child for enrollment in program.
Section 550.1438SectionLimitation of benefits; provision of other health care benefits.
Section 550.1439SectionFees prohibited; exception; funding; enrollment of children.
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