Michigan Compiled Laws 350-1980-4 Part 4 (550.1400...550.1439)

• Section 550.1400 Use Of Most Favored Nation Clause In Provider Contract.
  (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 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.
  (1) A health care corporation established, maintained, or operating in this state shall offer health care benefits to all residents of this state, and...
• Section 550.1401a Health Care Service Rendered By Dentist; Benefits Or Reimbursement; “dentist” Defined; Certificates To Which Section Applicable.
  (1) If a group or nongroup certificate of a health care corporation provides for health care benefits for a health care service, those benefits...
• Section 550.1401b Certificate Providing Benefits For Mental Health Services; Requirements.
  A certificate issued by a corporation which provides benefits for mental health services shall provide benefits for mental health services provided to an individual...
• Section 550.1401c Replacement Group Certificate With Preexisting Condition Limitation; Elimination, Reduction, Or Limitation Of Benefits; “disability Coverage” Defined.
  (1) If existing group disability coverage is replaced by a group certificate with a preexisting condition limitation and insuring 10 or more members, coverage...
• Section 550.1401d Services Performed By Physician's Assistant; Reimbursement; Conditions; Applicability Of Section; Supervision By Physician; Definitions.
  (1) Subject to subsections (2) and (3), if a health care corporation group or nongroup certificate provides for health care benefits for services performed...
• 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.
  (1) Except as otherwise provided in this section, a health care corporation that has issued a nongroup certificate shall renew or continue in force...
• Section 550.1401f Health Care Corporation; Access To Obstetrician-gynecologist.
  (1) A health care corporation certificate that requires a member to designate a participating primary care provider and provides for annual well-woman examinations and...
• Section 550.1401g Health Care Corporation; Access To Pediatric Care Services.
  (1) A health care corporation certificate that requires a member to designate a participating primary care provider and provides for dependent care coverage shall...
• Section 550.1401h Health Care Corporation Providing Prescription Drug Coverage; Formulary Restrictions.
  A health care corporation that provides coverage for prescription drugs and limits those benefits to drugs included in a formulary shall do all of...
• Section 550.1401i Prescription Drug Coverage; Pilot Project; Provisions; Interim Report; Determination; Evaluation.
  (1) Beginning January 1, 2004, a health care corporation shall establish and offer to provide or include prescription drug coverage in at least 1...
• Section 550.1401j Prescription Drug Coverage; Rate Differentials; Filing.
  The rates charged to nongroup and group conversion subscribers for a certificate that includes prescription drug coverage pursuant to section 401i may include rate...
• Section 550.1401k Telemedicine Services; Provisions; Definition; Applicability.
  (1) A group or nongroup health care corporation certificate shall not require face-to-face contact between a health care professional and a patient for services...
• Section 550.1401m Offer Of Health Care Benefits To All Residents Regardless Of Health Status.
  Until January 1, 2014, a health care corporation established, maintained, or operating in this state shall offer health care benefits to all residents of...
• 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.
  (1) A health care corporation shall not do any of the following: (a) Misrepresent pertinent facts or certificate provisions relating to coverage. (b) Fail...
• Section 550.1402a Terms And Conditions Of Certificate; Form; Description; Requested Information; Written Request; “board Certified” Defined.
  (1) A health care corporation shall provide a written form in plain English to subscribers upon enrollment that describes the terms and conditions of...
• Section 550.1402b Preexisting Condition Limitation Or Exclusion; Prohibition; Exception; “group” Defined.
  (1) For an individual covered under a nongroup certificate or under a certificate not covered under subsection (2), a health care corporation may exclude...
• Section 550.1402c Termination Of Participation Between Primary Care Physician And Health Care Corporation; Notice To Member; Effect Of Termination; Definitions.
  (1) If participation between a primary care physician and a health care corporation terminates, the physician may provide written notice of this termination within...
• Section 550.1402d Applicability Of Mcl 500.2212c To Health Care Corporation.
  Section 2212c of the insurance code of 1956, 1956 PA 218, MCL 500.2212c, applies to a health care corporation. History: Add. 2013, Act 31,...
• Section 550.1403 Payment Of Benefits; Interest; Claim Form; Exception.
  (1) A health care corporation, on a timely basis, shall pay to a member benefits as are entitled and provided under the applicable certificate....
• Section 550.1403a Benefits Paid By Check Or Written Instrument; Escheat.
  Benefits paid by a health care corporation to a subscriber or provider by way of a check or other similar written instrument for the...
• Section 550.1403b Advertising Material Prohibited.
  A health care corporation shall not include in any bill for services or products any advertising material for any other service or product sold...
• 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.
  (1) A person who has reason to believe that a health care corporation has violated section 402 or 403, if the violation was with...
• Section 550.1405 Single Billing Form; Development; Explanation Of Total Bill For Services.
  (1) A health care corporation, in consultation with the department of social services, shall develop a single billing form to be used for the...
• 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.
  (1) A health care corporation shall, in order to ensure the confidentiality of records containing personal data that may be associated with identifiable members,...
• Section 550.1407 Complaint System; Procedures; Response To Complaint; Access To Complaints And Responses; Record Of Complaints; Annual Report; Other Legal Remedies.
  (1) A health care corporation shall establish and maintain a complaint system which affords adequate and reasonable procedures for the expeditious resolution of written...
• Section 550.1408 False, Dishonest, Or Fraudulent Claim For Payment As Misdemeanor; Penalty; Civil Action; Prosecution.
  Any provider, member, or other person who knowingly makes, presents, or causes to be presented to a health care corporation any false, dishonest, or...
• Section 550.1409 Civil Action For Negligence.
  A civil action for negligence based upon, or arising out of, the health care provider-patient relationship shall not be maintained against a health care...
• 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.
  (1) Any certificate delivered, issued for delivery, or renewed in this state that provides for coverage for dependent children who are full-time or part-time...
• Section 550.1410 Certificate Providing Coverage Of Dependent Terminating At Specified Age; Exceptions.
  Any certificate issued by a health care corporation that provides that coverage of a dependent of the subscriber terminates at a specified age shall...
• 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.
  (1) A group certificate that is issued or renewed in this state after December 31, 1990 shall include provisions consistent with this section. (2)...
• Section 550.1410b Premium For Group Conversion Certificate After January 1, 2014; Determination; Rating Factors.
  Notwithstanding section 410a(8), for a certificate delivered, issued for delivery, or renewed in this state on or after January 1, 2014, the premium for...
• Section 550.1411-550.1413a Repealed. 1994, Act 40, Imd. Eff. Mar. 14, 1994.
  Compiler's Notes: The repealed sections pertained to supplemental medicare benefits certificate without preexisting condition exclusion or limitation, medicare supplemental buyer's guide, certificate to complement federal...
• Section 550.1414 Expired. 1980, Act 430, Eff. Jan. 1, 1982.
  Compiler's Notes: The expired section pertained to treatment of alcoholism and drug abuse.Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
• 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.
  (1) A health care corporation shall offer benefits for the inpatient treatment of substance abuse by a licensed allopathic physician or a licensed osteopathic...
• Section 550.1414b Offer Of Wellness Coverage By Health Care Corporation.
  (1) A health care corporation may offer group wellness coverage. Wellness coverage may provide for an appropriate rebate or reduction in premiums or for...
• Section 550.1415 Benefits For Prosthetic Devices.
  (1) Not later than 12 months after the effective date of this act, a health care corporation shall offer or include coverage, in all...
• 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.
  (1) Subject to dollar limits, deductibles, and coinsurance provisions that are not less favorable than those for physical illness generally, a health care corporation...
• Section 550.1416a Coverage For Drug Used In Antineoplastic Therapy And Cost Of Its Administration; Conditions.
  A health care corporation shall provide coverage in each group and nongroup certificate for a federal food and drug administration approved drug used in...
• Section 550.1416b Establishment Of Program To Prevent Onset Of Clinical Diabetes Required; Report; Coverages; “diabetes” Defined.
  (1) A health care corporation shall establish and provide to members and participating providers a program to prevent the onset of clinical diabetes. This...
• Section 550.1416c Off-label Use Of Approved Drug; Coverage; Conditions; Compliance; Use Of Copayment, Deductible, Sanction, Or Utilization Control; Limitation; Definitions.
  (1) A health care corporation group or nongroup certificate that provides pharmaceutical coverage shall provide coverage for an off-label use of a federal food...
• Section 550.1416d 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 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.
  (1) Except as otherwise provided in this section, a health care corporation group or nongroup certificate shall provide coverage for the diagnosis of autism...
• Section 550.1417 Hospice Care; Contracts With Health Care Corporation; Description Of Benefit.
  (1) A health care corporation shall offer to include benefits for hospice care in each certificate that provides benefits for inpatient hospital care. (2)...
• Section 550.1418 Emergency Health Services; Medical Coverage Required; “stabilization” Defined.
  (1) A health care corporation certificate that provides coverage for emergency health services shall provide coverage for medically necessary services provided to a member...
• Section 550.1419 Certificate Offering Dependent Coverage To Child; Denial Of Enrollment On Certain Grounds Prohibited.
  A health care corporation certificate that offers dependent coverage shall not deny enrollment to a subscriber's child on any of the following grounds: (a)...
• Section 550.1419a Eligibility Of Parent For Dependent Coverage; Health Coverage Of Child Through Noncustodial Parent; Court Or Administrative Order And Notice Required.
  (1) If a parent is eligible for dependent coverage through a health care corporation, the health care corporation shall: (a) Permit the parent to...
• Section 550.1419b Individual Eligible Under Title XIX Of Social Security Act; Assignment Of Rights Of Subscriber To Department Of Social Services.
  (1) A health care corporation shall not consider whether an individual is eligible for or has available medical assistance under title XIX of the...
• Section 550.1420-550.1430 Repealed. 2006, Act 441, Imd. Eff. Oct. 19, 2006.
  Compiler's Notes: The repealed sections pertained to individual and group long-term care coverage.Popular Name: Act 218
• Section 550.1435 “program” Defined.
  As used in sections 436 to 439, “program” means the Michigan caring program created in section 436. History: Add. 1991, Act 60, Imd. Eff....
• Section 550.1436 Michigan Caring Programs For Children; Creation; Contribution Requirements; Rating Methodologies; Supersedure Of Inconsistent Provisions.
  There may be created within each health care corporation a Michigan caring program for children. The program shall provide primary health care coverage for...
• Section 550.1437 Eligibility Of Child For Enrollment In Program.
  A child is eligible for enrollment in the program if the child meets all of the following: (a) Is less than 19 years of...
• Section 550.1438 Limitation Of Benefits; Provision Of Other Health Care Benefits.
  (1) Notwithstanding any other provision of this act, a health care corporation may limit the benefits it will furnish to an eligible child enrolled...
• Section 550.1439 Fees Prohibited; Exception; Funding; Enrollment Of Children.
  The program shall not charge any fee to an enrolled eligible child or the child's parents or legal guardians except that if prescription drug...

Last modified: October 10, 2016