Michigan Compiled Laws 218-1956-34 Chapter 34 Disability Insurance Policies (500.3400...500.3480)

• Section 500.3400 Policy Of Disability Insurance; Scope Of Chapter, Exemptions, Exceptions.
  (1) The term “policy of disability insurance” as used in this chapter includes any policy or contract of insurance against loss resulting from sickness...
• Section 500.3401 Purpose Of Chapter; Short Title, Uniform Disability Insurance Policy Provisions Law.
  (1) The purpose of this chapter is to provide for a new set of standard provisions applicable to disability insurance policies, which it is...
• Section 500.3402 Disability Insurance Policy; Provisions Required.
  No policy of disability insurance, as defined in section 3400 (1), shall be delivered or issued for delivery to any person in this state...
• Section 500.3403 Individual Disability Insurance Policy; Coverage For Newly Born Children; Notice Of Birth; Payment Of Premium.
  (1) Individual disability insurance policies providing coverage on an expense incurred basis which provide coverage for a family member of the insured shall, as...
• Section 500.3404 Disability Insurance Policies Issued For Delivery To Nonresident.
  If any policy is issued by an insurer domiciled in this state for delivery to a person residing in another state, and if the...
• Section 500.3405 Prudent Purchaser Agreements With Providers Of Hospital, Nursing, Medical, Surgical, Or Sick-care Services; Disability Insurance Policies; Rates; Discrimination Prohibited; Prior Contracts And Renewal; Optometry, Chiropractic, And Physical Therapy Service.
  (1) For the purpose of doing business as an organization under the prudent purchaser act, 1984 PA 233, MCL 550.51 to 550.63, an insurer...
• Section 500.3405a Use Of Favored Nation Clause.
  (1) Notwithstanding any provision of this act to the contrary, this section applies to the use of a most favored nation clause in a...
• Section 500.3406 Disability Insurance Policy; Provisions Required, Captions, Omissions, Substitutions.
  (1) Except as provided in subsection (2) of this section, each such policy delivered or issued for delivery to any person in this state...
• Section 500.3406a Hospital, Medical, Or Surgical Expense Incurred Policy; Mastectomy Benefit Coverage Required.
  A hospital, medical or surgical expense incurred policy shall offer benefits for prosthetic devices to maintain or replace the body parts of an individual...
• Section 500.3406b Coverage For Mental Health Services By Mental Health Care Provider.
  A policy or certificate which provides coverage for mental health services shall provide coverage for mental health services provided to an individual by a...
• Section 500.3406c Hospice Care; Definition; Description Of Coverage.
  (1) An insurer that delivers, issues for delivery, or renews in this state an expense-incurred hospital, medical, or surgical policy that provides coverage for...
• Section 500.3406d Coverage For Breast Cancer Diagnostic Services, Breast Cancer Outpatient Treatment Services, And Breast Cancer Rehabilitative Services; Coverage For Breast Cancer Screening Mammography; Definitions; Effective Date Of Section.
  (1) Subject to dollar limits, deductibles, and coinsurance provisions that are not less favorable than those for physical illness generally, an insurer which delivers,...
• Section 500.3406e Coverage For Drug Used In Antineoplastic Therapy And Cost Of Its Administration; Conditions.
  An insurer which delivers, issues for delivery, or renews in this state a hospital, medical, or surgical expense incurred policy shall provide coverage in...
• Section 500.3406f Excluded Or Limited Coverage; “group” Defined; Applicability Of Section; Crediting Prior Continuous Health Care Coverage; Examination By Commissioner And Director; Report.
  (1) An insurer may exclude or limit coverage for a condition as follows: (a) For an individual covered under an individual policy or certificate...
• Section 500.3406g Policy Or Certificate Offering Dependent Coverage To Child; Denial Of Enrollment On Certain Grounds Prohibited.
  An insurer that delivers, issues for delivery, or renews in this state an expense-incurred hospital, medical, or surgical policy or certificate that offers dependent...
• Section 500.3406h Eligibility Of Parent For Dependent Coverage; Health Coverage Of Child Through Noncustodial Parent; Duties Of Insurer; Court Or Administrative Order And Notice Required.
  (1) If a parent is eligible for dependent coverage through an insurer, the insurer shall: (a) Permit the parent to enroll, under the dependent...
• Section 500.3406i Individual Eligible Under Title XIX Of Social Security Act; Assignment Of Rights Of Insured To Department Of Social Services.
  (1) An insurer shall not consider whether an individual is eligible for or has available medical assistance under title XIX of the social security...
• Section 500.3406j Insured Or Applicant For Expense-incurred Hospital, Medical, Or Surgical Policy Or Certificate As Victim Of Domestic Abuse; Refusal To Provide Coverage Prohibited; Exception; Liability; Applicability To Policies Or Certificates On Or After June 1, 1998; “domestic Violence” Defined.
  (1) An insurer that delivers, issues for delivery, or renews in this state an expense-incurred hospital, medical, or surgical policy or certificate shall not...
• Section 500.3406k Emergency Health Services; Medical Services Coverage; “stabilization” Defined.
  (1) An expense-incurred hospital, medical, or surgical policy or certificate delivered, issued for delivery, or renewed in this state that provides coverage for emergency...
• Section 500.3406l Medical Transportation Services; Reimbursement.
  (1) Except as otherwise provided in subsections (2) and (3), an expense-incurred hospital, medical, or surgical policy or certificate that provides benefits for emergency...
• Section 500.3406m Access By Insured To Obstetrician-gynecologist.
  (1) An insurer that delivers, issues for delivery, or renews in this state an expense-incurred hospital, medical, or surgical policy or certificate that requires...
• Section 500.3406n Access To Pediatric Services.
  (1) An insurer that delivers, issues for delivery, or renews in this state an expense-incurred hospital, medical, or surgical policy or certificate that requires...
• Section 500.3406o Insurer Providing Prescription Drug Coverage; Formulary Restrictions.
  An insurer that delivers, issues for delivery, or renews in this state an expense-incurred hospital, medical, or surgical policy or certificate that provides coverage...
• Section 500.3406p Establishment Of Program To Prevent Onset Of Clinical Diabetes Required; Report; Coverages; “diabetes” Defined.
  (1) An insurer providing an expense-incurred hospital, medical, or surgical policy or certificate delivered or issued for delivery in this state and a health...
• Section 500.3406q Off-label Use Of Approved Drug; Coverage; Conditions; Compliance; Use Of Copayment, Deductible, Sanction, Or Utilization Control; Limitation; Definitions.
  (1) An expense-incurred hospital, medical, or surgical policy or certificate delivered, issued for delivery, or renewed in this state that provides pharmaceutical coverage and...
• Section 500.3406r Coverage For Obstetrical And Gynecological Services By Physician Or Nurse Midwife.
  (1) As used in this section, "nurse midwife" means an individual licensed as a registered professional nurse under article 15 of the public health...
• Section 500.3406s 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; Short-term Or 1-time Limited Duration Policy Or Certificate; Prescription Drug Plan; Coordinated Benefits; Definitions.
  (1) Except as otherwise provided in this section, an expense-incurred hospital, medical, or surgical group or individual policy or certificate delivered, issued for delivery,...
• Section 500.3407 Entire Contract; Changes.
  There shall be a provision as follows: ENTIRE CONTRACT; CHANGES: This policy, including the endorsements and the attached papers, if any, constitutes the entire...
• Section 500.3407a Conduct On Behalf Of Or Information Provided To Insured By Health Care Provider; Prohibition Or Discouragement By Disability Insurer.
  A disability insurer shall not prohibit or discourage a health care provider from advocating on behalf of an insured for appropriate medical treatment options...
• Section 500.3407b Undergoing Genetic Testing As Condition Of Issuing, Renewing, Or Continuing Policy Or Certificate; Disclosure Of Genetic Testing Or Genetic Information; Prohibitions; “genetic Information” And “genetic Test” Defined.
  (1) An expense-incurred hospital, medical, or surgical policy or certificate delivered, issued for delivery, or renewed in this state shall not require an insured...
• Section 500.3408 Time Limit On Certain Defenses; Incontestability.
  There shall be a provision as follows: TIME LIMIT ON CERTAIN DEFENSES: (a) After 3 years from the date of issue of this policy...
• Section 500.3409 Disability Insurance; Mandatory Notices As To Cancellation And Refund Of Premium.
  (1) Except as provided in subsection (2), a disability insurance, other than group and blanket insurance, delivered or issued for delivery to a person...
• Section 500.3410 Grace Period; Provision Required.
  There shall be a provision as follows: GRACE PERIOD: A grace period of ................ (insert a number not less than “7” for weekly premium...
• Section 500.3411 Reinstatement; Provision Required.
  There shall be a provision as follows: REINSTATEMENT: If any renewal premium be not paid within the time granted the insured for payment, a...
• Section 500.3412 Notice Of Claim; Provision Required.
  There shall be a provision as follows: NOTICE OF CLAIM: Written notice of claim must be given to the insurer within 20 days after...
• Section 500.3413 Claim Forms; Provision Required.
  There shall be a provision as follows: CLAIM FORMS: The insurer, upon receipt of a notice of claim, will furnish to the claimant such...
• Section 500.3414 Proofs Of Loss; Provision Required.
  There shall be a provision as follows: PROOFS OF LOSS: Written proof of loss must be furnished to the insurer at its said office...
• Section 500.3416 Time Of Payment Of Claims; Provision Required.
  There shall be a provision as follows: TIME OF PAYMENT OF CLAIMS: Indemnities payable under this policy for any loss other than loss for...
• Section 500.3418 Payment Of Claims Provision Required.
  There shall be a provision as follows: PAYMENT OF CLAIMS: Indemnity for loss of life will be payable in accordance with the beneficiary designation...
• Section 500.3420 Physical Examinations And Autopsy; Provision Required.
  There shall be a provision as follows: PHYSICAL EXAMINATIONS AND AUTOPSY: The insurer at its own expense shall have the right and opportunity to...
• Section 500.3422 Legal Actions; Provision Required.
  There shall be a provision as follows: LEGAL ACTIONS: No action at law or in equity shall be brought to recover on this policy...
• Section 500.3424 Change Of Beneficiary; Provision Required.
  There shall be a provision as follows: CHANGE OF BENEFICIARY: Unless the insured makes an irrevocable designation of beneficiary, the right to change of...
• Section 500.3425 Health Insurance Policies; Coverage For Intermediate And Outpatient Care For Substance Abuse Required; Option To Decline; Charges, Terms And Conditions; Reduction Of Coverage; Deductibles And Copayment Provisions; Minimum Coverage; Adjustment; Definitions; Effective Date Of Section.
  (1) Each insurer offering health insurance policies in this state shall provide coverage for intermediate and outpatient care for substance abuse, upon issuance or...
• Section 500.3426 Offer Of Wellness Coverage By Insurer.
  (1) Each insurer providing a group expense-incurred hospital, medical, or surgical certificate delivered, issued for delivery, or renewed in this state and each health...
• Section 500.3428 Provider Network.
  Beginning January 1, 2014, an insurer shall establish and maintain a provider network that, at a minimum, satisfies any network adequacy requirements imposed by...
• Section 500.3430 Optional Policy Provisions; Insurance Commissioner's Approval.
  Except as provided in subsection (2) of section 3406 (inapplicable or inconsistent provisions), no such policy delivered or issued for delivery to any person...
• Section 500.3432 Change Of Occupation; Optional Provision.
  There may be a provision as follows: CHANGE OF OCCUPATION: If the insured be injured or contract sickness after having changed his occupation to...
• Section 500.3434 Misstatement Of Age; Optional Provision.
  There may be a provision as follows: MISSTATEMENT OF AGE: If the age of the insured has been misstated, all amounts payable under this...
• Section 500.3436 Other Insurance With Same Insurer; Optional Provision.
  There may be a provision as follows: OTHER INSURANCE IN THIS INSURER: If an accident or sickness or accident and sickness policy or policies...
• Section 500.3438 Insurance With Other Insurers; Optional Provision.
  There may be a provision as follows: INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this insurer, providing benefits for...
• Section 500.3439 Insurance With Other Insurers; Allowable Provisions; Report To Legislature.
  (1) There may be a provision as follows: Insurance with other insurers: Benefits payable by this policy may be limited if there is other...
• Section 500.3440 Insurance With Other Insurers; Other Benefits; Optional Provision.
  There may be a provision as follows: INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this insurer, providing benefits for...
• Section 500.3444 Relation Of Earnings To Insurance; Optional Provision.
  There may be a provision as follows: RELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss of time benefits promised for...
• Section 500.3446 Unpaid Premium; Optional Provision.
  There may be a provision as follows: UNPAID PREMIUM: Upon the payment of a claim under this policy, any premium then due and unpaid...
• Section 500.3448 Cancellation; Optional Provision.
  There may be a provision as follows: CANCELLATION: The insurer may cancel this policy at any time by written notice delivered to the insured,...
• Section 500.3450 Conformity With State Statutes; Optional Provision.
  There may be a provision as follows: CONFORMITY WITH STATE STATUTES: Any provision of this policy which, on its effective date, is in conflict...
• Section 500.3452 Illegal Occupation; Optional Provision.
  There may be a provision as follows: ILLEGAL OCCUPATION: The insurer shall not be liable for any loss to which a contributing cause was...
• Section 500.3454 Repealed. 1980, Act 429, Eff. Mar. 31, 1981.
  Compiler's Notes: The repealed section pertained to intoxicants and narcotics.Popular Name: Act 218
• Section 500.3460 Order Of Certain Policy Provisions.
  The provisions which are the subject of sections 3406 through 3454, or any corresponding provisions which are used in lieu thereof in accordance with...
• Section 500.3462 Third Party Ownership Of Policy.
  The word “insured”, as used in this chapter, shall not be construed as preventing a person other than the insured with a proper insurable...
• Section 500.3464 Foreign Or Alien Insurers; Provision Required By Other State Law; Domestic Insurers; Provision Required By Other State Or Country.
  (1) Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this state, may contain any...
• Section 500.3466 Filing Procedure; Insurance Commissioner, Regulatory Powers.
  The commissioner may make such reasonable rules and regulations concerning the procedure for the filing or submission of policies subject to this chapter as...
• Section 500.3468 Provisions Violating Code; Construction Of Noncomplying Policies And Provisions.
  (1) No policy provision which is not subject to sections 3406 through 3454 shall make a policy, or any portion thereof, less favorable in...
• Section 500.3470 Age Of Insured; Provision Regulations.
  If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy...
• Section 500.3472 Open Enrollment Period; Prohibitions; Establishment Of Reasonable Periods For Disability Policies; Minimum Standards For Frequency And Duration Of Open Enrollment Periods.
  (1) Beginning January 1, 2014, during an applicable open enrollment period, an insurer shall not deny or condition the issuance or effectiveness of a...
• Section 500.3474 Risk Classification; Rates; Filing Requirements.
  No policy of insurance against loss or expense from the sickness, or from the bodily injury or death from accident of the insured, nor...
• Section 500.3474a Premium Rate After January 1, 2014; Basis; Factors.
  The premium rate charged by an insurer, health maintenance organization, or nonprofit health care corporation for health insurance coverage offered through a policy or...
• Section 500.3475 Reimbursement For Services By Licensed Psychologist, Podiatrist, Or Chiropractor; Section Inapplicable To Policy Or Certificate Involving Prudent Purchaser Agreement.
  (1) Notwithstanding any provision of any policy of insurance or certificate, if an insurance policy or certificate provides for reimbursement for any service that...
• Section 500.3476 Telemedicine Services; Provisions; Definition; Applicability.
  (1) An expense-incurred hospital, medical, or surgical group or individual policy or certificate delivered, issued for delivery, or renewed in this state and a...
• Section 500.3480 Repealed. 1963, Act 127, Eff. Sept. 6, 1963.
  Compiler's Notes: The section imposed penalties for violation of disability insurance provisions.Popular Name: Act 218

Last modified: October 10, 2016