Michigan Compiled Laws Act 218 Of 1984 Third Party Administrator Act (550.901 - 550.962)

AN ACT to provide for the regulation of third party administrators; to provide for the licensure of administrative service managers; to provide for certain powers and duties for certain state agencies and officers; to provide for the confidentiality of certain personal data; and to prescribe penalties for a violation of this act.

History: 1984, Act 218, Eff. Jan. 1, 1985

Compiler's Notes: For transfer of the Department of Insurance and Office of the Commissioner on Insurance from the Department of Licensing and Regulation to the Department of Commerce, see E.R.O. No. 1991-9, compiled at MCL 338.3501 of the Michigan Compiled Laws. For transfer of authority, powers, duties, functions, and responsibilities of the insurance bureau and the commissioner of insurance to the commissioner of the office of financial and insurance services and the office of financial and insurance services, see E.R.O. No. 2000-2, compiled at MCL 445.2003 of the Michigan compiled laws.

Section 550.901 Short Title.
This act shall be known and may be cited as the “third party administrator act”. History: 1984, Act 218, Eff. Jan. 1, 1985 Compiler's...
Section 550.902 Definitions.
As used in this act: (a) “Administrative services manager” or “manager” means an individual responsible for conducting the daily operations of a third party...
Section 550.910 Third Party Administrator; Certificate Required; Requirements; Instances In Which Tpa Subject To Act; Name.
(1) A person shall not operate as a third party administrator without obtaining and maintaining a certificate of authority pursuant to this act. (2)...
Section 550.912 Application For Certificate Of Authority; Form, Verification, And Contents; Filing Notice Of Modification.
(1) An application for a certificate of authority to operate as a TPA shall be in a form prescribed by the commissioner, shall be...
Section 550.914 Certificate Of Authority; Issuance; Notice Of Disapproval; Continued Compliance With Subsection (1).
(1) The commissioner shall issue a certificate of authority to operate as a TPA if the commissioner is satisfied that the TPA has adequate...
Section 550.916 Repealed. 2002, Act 74, Imd. Eff. Mar. 15, 2002.
Compiler's Notes: The repealed section pertained to license as administrative services manager.
Section 550.918 Fees; Payment; Collection; And Designation.
(1) The commissioner shall collect, and the persons affected shall pay to the commissioner, the following fees: (a) Filing fee to accompany application for...
Section 550.919 Tpa Advisory Board; Creation; Appointment, Qualifications, And Terms Of Members; Expenses; Duty Of Board; Report.
(1) A TPA advisory board is created. The board shall consist of 7 members appointed by the commissioner, at least 4 of whom shall...
Section 550.920 Authority Of Commissioner.
The commissioner shall have the same authority with respect to a TPA or manager as he or she does with respect to an insurance...
Section 550.922 Hearings.
The commissioner may designate 1 or more persons to conduct hearings provided for under this act, hearings required by the administrative procedures act of...
Section 550.924 Destruction Or Disposal Of Records, Books, Papers, And Other Data.
The commissioner is authorized to destroy or otherwise dispose of all records, books, papers, and other data on file with the department which in...
Section 550.930 Provision Of Administrative Services Pursuant To Written Service Contract; Maintenance Of Books And Records; Tpa And Manager As Fiduciary.
(1) A TPA may only provide administrative services pursuant to a written service contract. For the duration of the service contract, a TPA shall...
Section 550.932 Benefit Plan; Notice; Plan Covering Less Than 500 Individuals; Service Contract Between Tpa And Governmental Entity Not Subject To Erisa; Construction Of Act.
(1) A TPA, in connection with a benefit plan, shall provide in its service contract a provision that the person contracting for the services...
Section 550.934 Confidentiality.
(1) A TPA shall provide for the confidentiality of personal data identifying an individual covered by a plan. A TPA shall not disclose records...
Section 550.936 Annual Statement; Report.
(1) Each TPA acting within this state shall annually, on or before March 1, prepare under oath and deposit with the commissioner a statement...
Section 550.940 Prohibited Conduct Generally.
A TPA or manager, in processing claims, shall not do any of the following: (a) Misrepresent pertinent facts relating to coverage. (b) Fail to...
Section 550.942 Additional Prohibited Conduct.
A manager or TPA, in order to induce a person to contract or to continue to contract with the TPA; to induce a person...
Section 550.944 Additional Prohibited Conduct.
(1) A TPA shall not refuse to enter into a service contract or provide administrative services other than processing claims because of race, color,...
Section 550.950 Violation; Probable Cause; Notice; Conference; Disposition Of Matter Upon Agreement Of Parties; Action For Damages; Hearing; Findings And Decision; Cease And Desist Order; Additional Order.
(1) When the commissioner has probable cause to believe that a TPA or manager is violating, or has violated section 40, indicating a persistent...
Section 550.952 Civil Fine; Suspension Or Revocation Of Certificate Or License.
If a TPA or manager violates a cease and desist order under this act and has been given notice and an opportunity for a...
Section 550.954 Alteration, Modification, Or Setting Aside Of Order.
The commissioner may at any time, by order, after notice and opportunity for hearing, reopen and alter, modify, or set aside, in whole or...
Section 550.956 Judicial Review; Petition For Review; Transcript Of Record And Copy Of Order Or Decision; Hearing Cause As Civil Case In Equity; Evidence; Duty Of Court; Incomplete Record; Stay Of Order Or Decision; Jurisdiction.
(1) Any final order or decision made, issued, or executed by the commissioner under this act shall be subject to review, after hearing had...
Section 550.958 Self-incrimination; False Oath Or Affirmation.
(1) A person shall not be excused from attending and testifying, or producing any books, papers, or other documents before any court or magistrate,...
Section 550.960 Rules.
(1) The commissioner, after notice and hearing, may promulgate rules pursuant to the administrative procedures act of 1969, Act No. 306 of the Public...
Section 550.962 Repealed. 2002, Act 74, Imd. Eff. Mar. 15, 2002.
Compiler's Notes: The repealed section pertained to effective date of act.

Last modified: October 10, 2016