reglab/housing_qa huggingface dataset:
MI Comp L § 500.3830a (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)|Section 500.3830a - Termination of Contract or Agreement; Notice to Individual.

500.3830a Termination of contract or agreement; notice to individual. Sec. 3830a.  (1) At the time of an event described in section 3830(2) because of which an individual loses coverage or benefits due to the termination of a contract or agreement, policy, or plan, the organization that terminates the contract or agreement, the insurer terminating the policy, or the administrator of the plan being terminated, respectively, shall notify the individual of his or her rights under section 3830 and of the obligations of insurers of medicare supplement policies under section 3830(1). The notice shall be communicated contemporaneously with the notification of termination.  (2) At the time of an event described in section 3830(2) because of which an individual ceases enrollment under a contract or agreement, policy, or plan, the organization that offers the contract or agreement, regardless of the basis for the cessation of enrollment, the insurer offering the policy, or the administrator of the plan, respectively, shall notify the individual of his or her rights under section 3830 and of the obligations of insurers of medicare supplement policies under section 3830(1). The notice shall be communicated within 10 working days of the insurer receiving notification of disenrollment. History: Add. 2002, Act 304, Imd. Eff. May 10, 2002 Popular Name: Act 218
MI Comp L § 500.3833 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)|Section 500.3833 - Replacement Policy; Waiver of Certain Time Periods.

500.3833 Replacement policy; waiver of certain time periods. Sec. 3833.  If a medicare supplement policy or certificate replaces another medicare supplement policy, certificate, or contract, the replacing insurer shall waive any time periods applicable to preexisting conditions, waiting periods, elimination periods, and probationary periods in the new medicare supplement policy for similar benefits to the extent such time was spent under the original coverage. History: Add. 1992, Act 84, Imd. Eff. June 2, 1992 Popular Name: Act 218
MI Comp L § 500.3835 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)|Section 500.3835 - Marketing Procedures; Determining Appropriateness of Recommended Purchase or Replacement; More Than 1 Policy Prohibited; Individual Enrolled in Medicare Advantage; "Notice to Buyer" Displayed.

500.3835 Marketing procedures; determining appropriateness of recommended purchase or replacement; more than 1 policy prohibited; individual enrolled in medicare advantage; "notice to buyer" displayed.Sec. 3835.  (1) An insurer that markets Medicare supplement insurance coverage in this state directly or through its agents shall do all of the following:  (a) Establish marketing procedures to ensure that any comparison of policies by its agents will be fair and accurate.  (b) Establish marketing procedures to ensure excessive insurance is not sold or issued.  (c) Inquire and otherwise make every reasonable effort to identify whether a prospective applicant for Medicare supplement insurance already has health coverage.   (d) Establish auditable procedures for verifying compliance with this subsection.  (2) In recommending the purchase or replacement of any Medicare supplement coverage, an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement.  (3) Any sale of Medicare supplement coverage that will provide an individual with more than 1 Medicare supplement policy, certificate, or contract is prohibited.  (4) An insurer shall not issue a Medicare supplement policy or certificate to an individual enrolled in Medicare advantage unless the effective date of the coverage is after the termination date of the individual's Medicare advantage coverage.   (5) A medical supplement policy must display prominently by type, stamp, or other appropriate means, on the first page of the policy the following: "Notice to buyer: This policy may not cover all of your medical expenses.". History: Add. 1992, Act 84, Imd. Eff. June 2, 1992 ;-- Am. 2006, Act 462, Imd. Eff. Dec. 20, 2006 ;-- Am. 2018, Act 429, Eff. Mar. 20, 2019 Popular Name: Act 218
MI Comp L § 500.3837 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)|Section 500.3837 - Repealed. 2002, Act 304, Imd. Eff. May 10, 2002.

500.3837 Repealed. 2002, Act 304, Imd. Eff. May 10, 2002. Compiler's Notes: The repealed section pertained to report to commissioner.Popular Name: Act 218
MI Comp L § 500.3839 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)|Section 500.3839 - Renewal or Continuation Provision; Effect of Termination or Replacement; Elimination of Outpatient Prescription Drug Benefit.

500.3839 Renewal or continuation provision; effect of termination or replacement; elimination of outpatient prescription drug benefit.Sec. 3839.  (1) Each medicare supplement policy shall include a renewal or continuation provision. The provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state the term of coverage for which the policy is issued and for which it may be renewed. The provision shall include any reservation by the insurer of the right to change premiums and any automatic renewal premium increases based on the policyholder's age.  (2) If a medicare supplement policy is terminated by the group policyholder and is not replaced as provided under subsection (4), the issuer shall offer certificate holders an individual medicare supplement policy that at the option of the certificate holder provides for continuation of the benefits contained in the group policy or provides for such benefits as otherwise meet the requirements of section 3819 or 3819a.  (3) If an individual is a certificate holder in a group medicare supplement policy and the individual terminates membership in the group, the issuer shall offer the certificate holder the conversion opportunity described in subsection (2) or (4) or at the option of the group policyholder, offer the certificate holder continuation of coverage under the group policy.  (4) If a group medicare supplement policy is replaced by another group medicare supplement policy purchased by the same policyholder, the succeeding issuer shall offer coverage to all persons covered under the old group policy on its date of termination. Coverage under the new policy shall not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced.  (5) If a medicare supplement policy eliminates an outpatient prescription drug benefit as a result of requirements imposed by the medicare prescription drug, improvement, and modernization act of 2003, Public Law 108-173, the modified policy shall be considered to satisfy the guaranteed renewal requirements of this section. History: Add. 1992, Act 84, Imd. Eff. June 2, 1992 ;-- Am. 2006, Act 462, Imd. Eff. Dec. 20, 2006 ;-- Am. 2009, Act 220, Imd. Eff. Jan. 5, 2010 Popular Name: Act 218
MI Comp L § 500.3843 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)|Section 500.3843 - Health Insurance; Notice; Contents; Applicability of Subsection (1).

500.3843 Health insurance; notice; contents; applicability of subsection (1).Sec. 3843.  (1) A policy or certificate of health insurance issued for delivery in this state to persons eligible for Medicare by reason of age must notify insureds under the policy or certificate that the policy is not a Medicare supplement policy. The notice must either be printed or attached to the first page of the coverage outline delivered to insureds under the policy or certificate or, if a coverage outline is not delivered, to the first page of the policy or certificate delivered to insureds. The notice must be in not less than 12-point type, and must contain the following language:  "This (policy or certificate) is not a Medicare supplement (policy or certificate). It is not designed to fit with Medicare. It may not fit all of the gaps in Medicare and it may duplicate some Medicare benefits. If you are eligible for Medicare, review the Medicare supplement buyer's guide available from the company. If you decide to consider buying this policy or certificate, be sure you understand what it covers, what it does not cover, and whether it duplicates coverage you already have."  (2) Subsection (1) does not apply to any of the following:  (a) A Medicare supplement policy or certificate.  (b) A disability income policy or certificate.  (c) A single premium nonrenewable policy or certificate. History: Add. 1992, Act 84, Imd. Eff. June 2, 1992 ;-- Am. 2018, Act 429, Eff. Mar. 20, 2019 Popular Name: Act 218
MI Comp L § 500.3847 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)|Section 500.3847 - Advertising; Filing Copy With Director.

500.3847 Advertising; filing copy with director.Sec. 3847.  An insurer that provides Medicare supplement insurance coverage in this state shall file with the director for review a copy of any written, radio, or television advertisement for Medicare supplement insurance intended for use in this state at least 30 days before the date the insurer desires to use the advertising. The filing must include a sample or photocopy of all applicable Medicare supplement policies and related forms and the approval status of the policies and forms. History: Add. 1992, Act 84, Imd. Eff. June 2, 1992 ;-- Am. 2018, Act 429, Eff. Mar. 20, 2019 Popular Name: Act 218
MI Comp L § 500.3851 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)|Section 500.3851 - Aggregate Benefits; Rates, Rating Schedules, and Rate Revisions.

500.3851 Aggregate benefits; rates, rating schedules, and rate revisions. Sec. 3851.  (1) A medicare supplement policy form or certificate form shall not be delivered or issued for delivery unless the policy form or certificate form can be expected, as estimated for the entire period for which rates are computed to provide coverage, to return to policyholders and certificate holders in the form of aggregate benefits, not including anticipated refunds or credits, the following:  (a) For group policies at least 75% of the aggregate amount of premiums earned calculated on the basis of incurred claims experience and earned premiums for the entire period for which rates are computed and in accordance with accepted actuarial principles and practices.  (b) For individual policies at least 65% of the aggregate amount of premium earned calculated on the basis of incurred claims experience and earned premiums for the entire period for which rates are computed and in accordance with accepted actuarial principles and practices.  (2) All filings of rates and rating schedules shall demonstrate that expected claims in relation to premiums comply with the requirements of this section when combined with actual experience to date. Filings of rate revisions shall also demonstrate that the anticipated loss ratio over the entire future period for which the revised rates are computed to provide coverage can be expected to meet the appropriate loss ratio standards. History: Add. 1992, Act 84, Imd. Eff. June 2, 1992 Popular Name: Act 218
MI Comp L § 500.3852 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)|Section 500.3852 - Benchmark Ratio.

500.3852 Benchmark ratio. Sec. 3852.  An insurer shall file by May 31 of each year a reporting form for the calculation of benchmark ratio since inception in a format prescribed by the commissioner for each type in a standard medicare supplement benefit plan. History: Add. 1992, Act 84, Imd. Eff. June 2, 1992 Popular Name: Act 218
MI Comp L § 500.3853 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)|Section 500.3853 - Refund or Credit Calculation; Form; Interest; Due Date.

500.3853 Refund or credit calculation; form; interest; due date. Sec. 3853.  If on the basis of the experience as reported by an insurer under section 3852 the benchmark ratio since inception (ratio 1) exceeds the adjusted experienced ratio since inception (ratio 3), then a refund or credit calculation is required. The refund calculation shall be done on a statewide basis on a refund calculation form in a format prescribed by the commissioner for each type in a standard medicare supplement benefit plan. For purposes of the refund or credit calculation, only experience on policies issued within the reporting year shall be excluded. A refund or credit shall be made only where the benchmark loss ratio exceeds the adjusted experienced loss ratio and the amount to be refunded or credited exceeds the minimum level. The refund shall include interest from the end of the calendar year to the date of the refund or credit at a rate specified by the secretary of health and human services, but not less than the average rate of interest for 13-week treasury notes. A refund or credit against premiums due shall be made by September 30 following the experience year upon which the refund or credit is based. History: Add. 1992, Act 84, Imd. Eff. June 2, 1992 Popular Name: Act 218
MI Comp L § 500.3855 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)|Section 500.3855 - Annual Filing of Rates, Rating Schedule, and Supporting Documentation; Premium Adjustments; Public Hearing for Rate Increase; Failure to Make Premium Adjustments.

500.3855 Annual filing of rates, rating schedule, and supporting documentation; premium adjustments; public hearing for rate increase; failure to make premium adjustments. Sec. 3855.  (1) Each insurer that issues medicare supplement policies for delivery in this state shall file annually with the commissioner, on a form and in the manner prescribed by the commissioner, its rates, rating schedule, and supporting documentation including all claims experience of the insurer for medicare supplement coverage. The filings and schedules shall demonstrate that the actual and expected losses in relation to premiums are in compliance with the applicable loss ratio standards of this state. The supporting documentation shall also be in accordance with actuarial standards of practice using reasonable assumptions that the appropriate loss ratio standards can be expected to be met over the entire period for which rates are computed excluding active life reserves. An expected third-year loss ratio that is greater than or equal to the applicable percentage under section 3851 shall be demonstrated for policies or certificates in force less than 3 years.  (2) An insurer shall make such premium adjustments as are necessary to produce an expected loss ratio under the medicare supplement policy as will conform with minimum loss ratio standards for medicare supplement policies and certificates and that are expected to result in a loss ratio at least as great as that originally anticipated in the rates used to produce current premiums by the insurer for such medicare supplement insurance policies. A premium adjustment that would modify the loss ratio experience under the policy shall not be made with respect to a policy at any time other than upon its renewal date or anniversary date.  (3) The commissioner may conduct a public hearing to gather information concerning a request by a medicare supplement insurer for an increase in a rate for a medicare supplement policy form or certificate form issued before or after the effective date of this chapter if the experience of the form for the previous reporting period is not in compliance with the applicable loss ratio standard. The determination of compliance shall be made without consideration of any refund or credit for the reporting period. Public notice of the hearing shall be furnished in a manner considered appropriate by the commissioner.  (4) If a medicare supplement insurer fails to make premium adjustments acceptable to the commissioner, the commissioner may order premium adjustments, refunds, or premium credits considered necessary to achieve the loss ratio required by this section. History: Add. 1992, Act 84, Imd. Eff. June 2, 1992 Popular Name: Act 218
MI Comp L § 500.3857 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)|Section 500.3857 - Duties of Insurer; Certification of Compliance With Subsection (1)(a).

500.3857 Duties of insurer; certification of compliance with subsection (1)(a). Sec. 3857.  (1) An insurer shall do all of the following:  (a) Accept a notice from a medicare carrier on dually assigned claims submitted by participating physicians and suppliers as a claim for benefits in place of any other claim form otherwise required and make a payment determination on the basis of the information contained in that notice.  (b) Notify the participating physician or supplier and the beneficiary of the payment determination.  (c) Pay the participating physician or supplier directly.  (d) Furnish, at the time of enrollment, each enrollee with a card listing the policy name, number, and a central mailing address to which notices from a medicare carrier may be sent.  (e) Pay user fees for claim notices that are transmitted electronically or otherwise.  (f) Provide to the secretary of health and human services, at least annually, a central mailing address to which all claims may be sent by medicare carriers.  (2) Compliance with the requirements set forth in subsection (1)(a) shall be certified on the medicare supplement insurance experience reporting form. History: Add. 1992, Act 84, Imd. Eff. June 2, 1992 Popular Name: Act 218
MI Comp L § 500.3859 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-38 - Chapter 38 Medicare Supplement Policies and Certificates (500.3801...500.3861)|Section 500.3859 - Prohibited Conduct; Violation as Misdemeanor; Penalty.

500.3859 Prohibited conduct; violation as misdemeanor; penalty. Sec. 3859.  (1) A person shall not knowingly sell a health insurance policy or certificate to an individual entitled to benefits under part A or enrolled under part B of medicare with knowledge that the policy or certificate substantially duplicates health benefits to which the individual is otherwise entitled, other than benefits to which the individual is entitled under a requirement of state or federal law other than medicare. A person who violates this subsection is guilty of a misdemeanor punishable by imprisonment for not more than 2 years, or a fine of not more than $10,000.00, or both. The court may order a person convicted under this subsection to pay restitution to individuals for expenses incurred as a result of violation of this subsection. For purposes of this subsection, benefits that are payable to or on behalf of an individual without regard to other health benefit coverage of the individual shall not be considered as duplicative. The selling of a group certificate or contract of the trustees of a fund established by 1 or more employers, labor organizations, or both, for employees, former employees, or both, or for members or former members, or both, of labor organizations, shall not be considered to be a violation of this subsection.  (2) A person shall not falsely assume or pretend to be acting or misrepresent in any way that he or she is acting under the authority of or in association with medicare or any state or federal agency, for the purpose of selling or attempting to sell insurance or, in such a pretended character, demand or obtain money, paper, documents, or any thing of value. A person who violates this subsection is guilty of a misdemeanor punishable by imprisonment for not more than 2 years, or a fine of not more than $10,000.00, or both.  (3) A person shall not solicit, offer for sale, or deliver a medicare supplement policy in this state, unless the policy has been approved by the commissioner. A person who violates this subsection is guilty of a misdemeanor punishable by imprisonment for not more than 1 year, or a fine of not more than $5,000.00, or both. History: Add. 1992, Act 84, Imd. Eff. June 2, 1992 Popular Name: Act 218