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Michigan Compiled Laws Complete Through PA 249 of 2016
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Senate: Adjourned until Wednesday, August 3, 2016 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 500.3505SectionCertificate of authority; use of descriptive words; restrictions.
Section 500.3507SectionAuthorizing and regulating health maintenance organization; establishment of system by commissioner.
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; terms; vacancy; meetings.
Section 500.3513SectionHealth delivery and business and financial operations; regulation by commissioner.
Section 500.3515SectionAdditional health maintenance services; copayments; limitation; report on increase of employer and employee numbers; "preventive health care services" defined; partial payment from government or private person.
Section 500.3515.amendedSectionAdditional health maintenance services; copayments; limitation; "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 required.
Section 500.3521SectionPrepayment rates; filing and approval of methodology; schedule.
Section 500.3523SectionHealth maintenance contract; provisions.
Section 500.3525SectionProposal to revise contract or rate; approval of commissioner; approval with modifications; hearing; disposition; exception; notice.
Section 500.3527SectionHealth maintenance contract; performance; violation of terms.
Section 500.3528SectionHealth maintenance organization; duties.
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; rate and operating requirements; maintenance of financial records by health maintenance organization.
Section 500.3535SectionSolicitation or advertising.
Section 500.3537SectionOpen enrollment period; acceptance of group members; rating nongroup membership.
Section 500.3539SectionNongroup contract; exclusion or limitation; preexisting condition; renewal or continuation of nongroup contract or group contract; guaranteed renewal; healthy lifestyle program; "group" defined.
Section 500.3541SectionAdvocation by health professional.
Section 500.3542SectionInducement to health professional prohibited; exception.
Section 500.3543SectionThird party administrator.
Section 500.3545SectionAcquisition of obligations from another managed care entity.
Section 500.3547SectionHealth care service operations; visitation or examination by commissioner; consultation with enrollees; additional authority.
Section 500.3548SectionMaintenance of books, records, and files; funds and assets.
Section 500.3549SectionDisciplinary action; notice to board.
Section 500.3551SectionHealth maintenance organization; net worth.
Section 500.3553SectionMinimum deposit requirements.
Section 500.3555SectionFinancial plan.
Section 500.3557SectionNotice of changes in operations.
Section 500.3559SectionReinsurance contract or plan; purpose; filing; approval; coverage.
Section 500.3561SectionInsolvency; continuation of benefits.
Section 500.3563SectionInsolvency; allocation of group coverage to health maintenance organizations and 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.
Section 500.3565SectionCancellation of contract by nongroup subscriber.
Section 500.3567SectionCancellation of contract with nongroup enrollee by health maintenance organization.
Section 500.3569SectionAssumption of financial risk; “requiring an affiliated provider to assume financial risk” defined.
Section 500.3571SectionState and federal health programs.
Section 500.3573SectionOperation of health care delivery system not meeting requirements of act; permitted conduct; limitations.
Section 500.3580SectionConsumer guide to health maintenance organizations; publication; contents; data; writing, presentation, promotion, and distribution of guide; access through internet.
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