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NOTE: Dates reflect any modification to item, not necessarily a change in law.
Act 350 of 1980
- THE NONPROFIT HEALTH CARE CORPORATION REFORM ACT (550.1101 - 550.1704)
Section 550.1201 ‑
Health care corporation; incorporation; number of persons; payment of cash or other material benefit to subscriber; applicable laws; charitable and benevolent institution; exemption from taxation; certificate of authority; health care benefits and certificates.
Section 550.1201a ‑
Formation of health care corporation after January 1, 2014; prohibition.
Section 550.1202 ‑
Articles of incorporation; contents; number; forms; examination and certification by attorney general; fees.
Section 550.1204 ‑
Filing of statements and documents; examination; investigation; additional information; conditions; duties of commissioner.
Section 550.1206 ‑
Funds, property, and business of health care corporation; investments; insurance; prepaid health care benefits.
Section 550.1207 ‑
Powers of health care corporation; interests of senior citizens; validity of corporate acts.
Section 550.1209 ‑
Action by member; discontinuance, compromise, or settlement; notice; expense.
Section 550.1211 ‑
Administrative services only and cost-plus arrangements; service contracts; fees; administrative costs; marketing policy; notice; coverage, rights, and obligations under collective bargaining agreement; liability of individual; report; “noninsured benefit plan” defined.
Section 550.1211a ‑
Definitions; prohibited acts by corporation; processing claims for benefits on timely basis; claim form; notice to covered individuals; notice to corporation of complaint and proceedings contemplated; hearing; findings; order; violation of order; penalty; action and award of actual monetary damages; review; stay of enforcement.
Section 550.1212 ‑
Action without notice or lapse of time periods; waiver; attorney-in-fact.
Section 550.1215 ‑
Health care corporation as shareholder in other nonprofit corporation; rights, powers, privileges, and liabilities.
Section 550.1220 ‑
Merger of health care corporation with nonprofit mutual disability insurer.
Section 550.1301 ‑
Board of directors; powers and duties generally; appointment, qualifications, and terms of members; vacancy; officer or employee as voting or nonvoting director; method of selection; definitions; prohibition.
Section 550.1303 ‑
Meetings; required provisions in bylaws; notice; waiver; participation by conference telephone or similar communications equipment; quorum; action by board; actions requiring majority vote; record roll call vote; recording vote in minutes.
Section 550.1304 ‑
Books, records, and minutes; copy of minutes; disclosure, publication, and dissemination of minutes; compelling production of books or records.
Section 550.1305 ‑
Establishment and composition of corporate body; service of members on committees; membership on board of directors.
Section 550.1306 ‑
Effect of common directorship, officership, or interest on validity of contract or other transaction; burden of establishing validity of contract; exclusion of common or interested directors in determination of quorum; compensation of directors; bylaws regarding conflict of interest.
Section 550.1307 ‑
Advisory councils; committees of board of directors; bylaws regarding membership and emergency meetings and actions.
Section 550.1308 ‑
Committees of board of directors; powers and authority; prohibited activities; emergency actions.
Section 550.1309 ‑
Officers and assistants; selection; restriction; authority and duties; removal; contractual rights; bond; vacancies; compensation; pension.
Section 550.1310 ‑
Fiduciary duties; scope and manner of discharge; removal of director for breach of fiduciary duty; notice and hearing.
Section 550.1311 ‑
Liability for misapplication or misuse of corporate money or property.
Section 550.1313 ‑
False statement as misdemeanor; liability for false statement or report; commencement of action for civil liability.
Section 550.1401 ‑
Offering 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 550.1401a ‑
Health care service rendered by dentist; benefits or reimbursement; “dentist” defined; certificates to which section applicable.
Section 550.1401b ‑
Certificate providing benefits for mental health services; requirements.
Section 550.1401c ‑
Replacement group certificate with preexisting condition limitation; elimination, reduction, or limitation of benefits; “disability coverage” defined.
Section 550.1401d ‑
Services performed by physician's assistant; reimbursement; conditions; applicability of section; supervision by physician; definitions.
Section 550.1401e ‑
Group certificate issued by health care corporation; renewal or continuation; guaranteed renewal; discontinuing plan, product, or coverage in nongroup or group market; conditions.
Section 550.1401h ‑
Health care corporation providing prescription drug coverage; formulary restrictions.
Section 550.1401i ‑
Prescription drug coverage; pilot project; provisions; interim report; determination; evaluation.
Section 550.1401m ‑
Offer of health care benefits to all residents regardless of health status.
Section 550.1402 ‑
Health 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 550.1402a ‑
Terms and conditions of certificate; form; description; requested information; written request; “board certified” defined.
Section 550.1402b ‑
Preexisting condition limitation or exclusion; prohibition; exception; “group” defined.
Section 550.1402c ‑
Termination of participation between primary care physician and health care corporation; notice to member; effect of termination; definitions.
Section 550.1404 ‑
Violation 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 550.1405 ‑
Single billing form; development; explanation of total bill for services.
Section 550.1406 ‑
Confidentiality 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 550.1407 ‑
Complaint system; procedures; response to complaint; access to complaints and responses; record of complaints; annual report; other legal remedies.
Section 550.1408 ‑
False, dishonest, or fraudulent claim for payment as misdemeanor; penalty; civil action; prosecution.
Section 550.1409a ‑
Coverage 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 550.1410 ‑
Certificate providing coverage of dependent terminating at specified age; exceptions.
Section 550.1410a ‑
Provisions of group certificate; electing coverage under group conversion certificate; notice of conversion privilege; requirements of group conversion certificate; premium; issuance; compliance.
Section 550.1410b ‑
Premium for group conversion certificate after January 1, 2014; determination; rating factors.
Section 550.1414a ‑
Treatment 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 550.1416 ‑
Coverage 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 550.1416a ‑
Coverage for drug used in antineoplastic therapy and cost of its administration; conditions.
Section 550.1416b ‑
Establishment of program to prevent onset of clinical diabetes required; report; coverages; “diabetes” defined.
Section 550.1416c ‑
Off-label use of approved drug; coverage; conditions; compliance; use of copayment, deductible, sanction, or utilization control; limitation; definitions.
Section 550.1416d ‑
Coverage for obstetrical and gynecological services by physician or nurse midwife.
Section 550.1416e ‑
Diagnosis 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 550.1417 ‑
Hospice care; contracts with health care corporation; description of benefit.
Section 550.1418 ‑
Emergency health services; medical coverage required; “stabilization” defined.
Section 550.1419 ‑
Certificate offering dependent coverage to child; denial of enrollment on certain grounds prohibited.
Section 550.1419a ‑
Eligibility of parent for dependent coverage; health coverage of child through noncustodial parent; court or administrative order and notice required.
Section 550.1419b ‑
Individual eligible under title XIX of social security act; assignment of rights of subscriber to department of social services.
Section 550.1436 ‑
Michigan caring programs for children; creation; contribution requirements; rating methodologies; supersedure of inconsistent provisions.
Section 550.1438 ‑
Limitation of benefits; provision of other health care benefits.
PART 4A MEDICARE SUPPLEMENT CERTIFICATES (550.1451...550.1499a)
Section 550.1501a ‑
Special participating contracts with health care providers for provision of primary health care benefits to children enrolled in Michigan caring program.
Section 550.1501b ‑
Conduct on behalf of or information provided to subscriber by health care provider; prohibition or discouragement by health care corporation.
Section 550.1502 ‑
Contracts for reimbursement with professional health care providers; private provider-patient relationship; methods of diagnosis or treatment not to be restricted; refusal to reimburse for overutilized services; choice of providers; list of providers; recommendation of provider as misdemeanor; symbol of participation; health maintenance organization not impeded; contracts subject to MCL 550.1504 to 550.1518; participation of freestanding surgical outpatient facility; optometric services; status of license or registration.
Section 550.1502a ‑
Prudent purchaser agreements; group contracts; options; group contracts under which financial or other advantage realized; additional option; applicability of subsection (5); individual contracts; rates; contracts subject to MCL 550.1504 to 550.1518; discrimination against class of health care providers; provisions inapplicable to certain contracts or renewals; optometric and chiropractic services; status of license or registration.
Section 550.1504 ‑
Reimbursement arrangements; goals; definitions; supplemental efforts.
Section 550.1505 ‑
Provider class plan; development, modification, implementation, or review; procedures to obtain advice and consultation.
Section 550.1506 ‑
Provider class plan; transmitting to commissioner; examination; determination; notice; placing plan into effect; retention of plan for commissioner's records.
Section 550.1507 ‑
Provider class plan; inclusion and transmittal of items omitted.
Section 550.1509 ‑
Achievement of goals and objectives; determinations by commissioner.
Section 550.1511 ‑
Provider class plan; transmittal to commissioner; preparation by commissioner.
Section 550.1512 ‑
Extension of 6-month period provided in MCL 550.511(1); determination.
Section 550.1513 ‑
Provider class plan; examination; automatic retention; placing plan into effect; preparation of plan by commissioner; notice.
Section 550.1514 ‑
Appeal; selection and qualifications of hearing officer; consolidation; annual report.
Section 550.1515 ‑
Appeal; parties; request; time; relief; transmittal of provider class plan to hearing officer; determinations.
Section 550.1601 ‑
Regulation and supervision of health care corporation; delegation of authority.
Section 550.1602 ‑
Statement of condition; statistical, financial, and other reports.
Section 550.1603 ‑
Visitation and examination; access to books, papers, and documents; witnesses; expenses; disclosure of information; reporting violation; action by attorney general; ex parte order directing compliance.
Section 550.1603a ‑
Health care corporation subject to MCL 500.224 and 500.225; costs and expenses.
Section 550.1605 ‑
Certificate of authority; suspension or limitation; circumstances; order; hearing; notice.
Section 550.1606 ‑
Authority of commissioner regarding officers and directors; authority as to dissolution, taking over, or liquidation of corporations; insolvency defined.
Section 550.1607 ‑
Submission of new or revised certificate and applicable proposed rates; approval or disapproval; exemption; circumstances and conditions; notice; implementation of certificates and rates.
Section 550.1608 ‑
Rates charged to nongroup subscribers for certificate; methodology and definitions of rating system, formula, component, and factor used to calculate rates for group subscribers for certificate; filing; approval, disapproval, or modification; standard; burden of proof; effective date of proposed rate; rate adjustments; implementation prior to approval; examination of financial arrangement; formulae, and factors.
Section 550.1609 ‑
Excessive rate; administrative expense budget; equitable rate; adequate rate; line of business to be self-sustaining; cost transfers for benefit of senior citizens and group conversion subscribers.
Section 550.1610 ‑
Filing of information and materials relative to proposed rate; notice; approval, approval with modifications, or disapproval; additional information and materials; determination; notice; visitation and examination; expenses; order; effect of inability to approve 1 or more rating classes of business within line of business; information in support of nongroup rate filing; public inspection of information; forms and instructions for filing proposed rates.
Section 550.1612 ‑
Notice of rate filing; contents of request for hearing; advertisements; limitation on fee for copy of rate filing; waiver or reduction of fee; calculation of costs.
Section 550.1613 ‑
Request for hearing; standing of person; access to filing; confidentiality; penalty; appointment and qualifications of independent hearing officer; commencement of hearing; discovery; conducting hearing; burden of proving compliance; factors in rendering proposal for decision; order rendering decision; withdrawal of order.
Section 550.1614 ‑
Interim rates; petition; determination; granting interim rate; final rate determination; refunds or adjustments; limitation on order establishing interim rate adjustment; rates to which section applicable.
Section 550.1616 ‑
Endorsing, filing, and indexing documents; notice of refusal to file; judicial review; certificate of correction; persons adversely affected by correction; documents to which section inapplicable.
Section 550.1619 ‑
Injunction; declaratory and equitable relief; enforcement of act or rules.
Section 550.1620 ‑
Certificate subject to policy and certificate issuance and rate filing requirements; establishment of reasonable open enrollment periods; frequency and duration; denial, condition, or discrimination.
PART 6A HEALTH ENDOWMENT FUND CORPORATIONS (550.1651...550.1655)
Section 550.1652 ‑
Health endowment fund corporation; incorporation; conflict of interest; appointment of board members; vacancy; terms; quorum; vote; business open to public; notice; meeting in closed session; minutes; compensation.
Section 550.1653 ‑
Charitable purpose nonprofit corporation; receipt and administration of funds; articles of incorporation; grants; conflict with other provisions of law; social mission contributions; fund as private, nonprofit corporation.
Section 550.1655 ‑
Disbursement, expenditure, and investment of money by fund; system of financial accounting, controls, audits, and reports; appointment of audit committee; duties of executive director; requirement to keep accurate accounting; cooperation with investigation.
Section 550.1701 ‑
Formal reorganization not required; duties of health care corporation; amendments to articles and bylaws; description of board restructuring; review; certification; statement of reasons for disapproval; judicial remedies; effect of noncompliance; extension of corporate existence; powers undiminished.
Section 550.1702 ‑
Discontinuation of certain rules; continuation of certain orders and approvals.