Sec. 3537.
(1) After the initial 24 months of operation, a health maintenance organization shall have an open enrollment period of not less than 30 days at least once during each consecutive 12-month period. During each enrollment period, the health maintenance organization shall accept up to its capacity as determined by the organization and submitted to the commissioner not less than 60 days before the commencement of the enrollment period, individuals in the order in which they apply for enrollment in a manner that does not unfairly discriminate on the basis of age, sex, race, health, or economic status. The commissioner may waive compliance by the organization with this open enrollment requirement for any 12-month period for which the organization demonstrates to the commissioner's satisfaction that either of the following will occur:
(a) It has enrolled, or will be compelled to enroll, a disproportionate number of individuals who are likely to utilize its services more often than an actuarially determined average as determined under rules promulgated by the commissioner, and enrollment during an open enrollment period of an additional number of those individuals will jeopardize its economic viability.
(b) If it maintained an open enrollment period, it would not be able to comply with the rules promulgated under this chapter.
(2) A health maintenance organization providing health maintenance services to specified groups of individuals may accept members of the groups before accepting other individuals in the order in which they apply.
(3) A health maintenance organization which, under this section, enrolls individuals who are not members of a group may rate this nongroup membership on the basis of actual and credible loss experience.
History: Add. 2000, Act 252, Imd. Eff. June 29, 2000
Popular Name: Act 218
Popular Name: HMO
Last modified: October 10, 2016