reglab/housing_qa huggingface dataset:
MI Comp L § 500.3406m (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480)|Section 500.3406m - Access by Insured to Obstetrician-Gynecologist.

500.3406m Access by insured to obstetrician-gynecologist.Sec. 3406m.  (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that requires an insured to designate a participating primary care provider and provides for annual well-woman examinations and routine obstetrical and gynecologic services shall permit a female insured to access an obstetrician-gynecologist for annual well-woman examinations and routine obstetrical and gynecologic services.  (2) An insurer shall not require prior authorization or referral for access under subsection (1) to an obstetrician-gynecologist who is participating with the insurer. An insurer may require prior authorization or referral for access to a nonparticipating obstetrician-gynecologist.  (3) An insurer shall include a description of the coverage required under this section in a communication sent to the insured or group purchaser of coverage. History: Add. 1998, Act 402, Eff. Mar. 23, 1999 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218
MI Comp L § 500.3406n (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480)|Section 500.3406n - Access to Pediatric Care Services.

500.3406n Access to pediatric care services.Sec. 3406n.  (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that requires an insured to designate a participating primary care provider and provides for dependent care coverage shall permit a dependent minor insured to select and access a pediatrician for general pediatric care services.  (2) An insurer shall not require prior authorization or referral for access under subsection (1) to a pediatrician who participates with the insurer. An insurer may require prior authorization or referral for access to a nonparticipating pediatrician. History: Add. 1999, Act 179, Imd. Eff. Nov. 16, 1999 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218
MI Comp L § 500.3406o (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480)|Section 500.3406o - Insurer Providing Prescription Drug Coverage; Formulary Restrictions; Expedited Review of Coverage for Nonformulary Alternative; Determination; Subject to 500.3406w.

500.3406o Insurer providing prescription drug coverage; formulary restrictions; expedited review of coverage for nonformulary alternative; determination; subject to 500.3406w.Sec. 3406o.  (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription drugs and limits those benefits to drugs included in a formulary shall do all of the following:  (a) Provide for participation of participating physicians, dentists, and pharmacists in the development of the formulary.  (b) Disclose to health care providers and upon request to insureds the nature of the formulary restrictions.  (c) Provide for exceptions from the formulary limitation when a nonformulary alternative is a medically necessary and appropriate alternative. This subdivision does not prevent an insurer from establishing prior authorization requirements or another process for consideration of coverage or higher cost-sharing for nonformulary alternatives.  (2) On a request for an expedited review of coverage for a nonformulary alternative based on exigent circumstances, an insurer shall make a determination and notify the enrollee or the enrollee's designee and the prescribing physician, or other prescriber, as appropriate, of the determination within 24 hours after the insurer receives all information necessary to determine whether the exception should be granted. For purposes of this subsection, exigent circumstances exist when an enrollee is suffering from a health condition that may seriously jeopardize the enrollee's life, health, or ability to regain maximum function or when an enrollee is undergoing a current course of treatment using a nonformulary drug.  (3) If subsection (2) does not apply, an insurer shall make a determination on coverage for a nonformulary alternative and notify the enrollee or the enrollee's designee and the prescribing physician, or other prescriber, as appropriate, of the determination within 72 hours after the insurer receives all information necessary to determine whether the exception should be granted.  (4) This section is subject to section 3406w. History: Add. 1999, Act 177, Imd. Eff. Nov. 16, 1999 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 ;-- Am. 2020, Act 322, Imd. Eff. Dec. 29, 2020 Popular Name: Act 218
MI Comp L § 500.3406r (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480)|Section 500.3406r - Coverage for Obstetrical and Gynecological Services by Physician or Nurse Midwife.

500.3406r Coverage for obstetrical and gynecological services by physician or nurse midwife.Sec. 3406r.  (1) As used in this section, "nurse midwife" means an individual licensed as a registered professional nurse under article 15 of the public health code, 1978 PA 368, MCL 333.16101 to 333.18838, who has been issued a specialty certification in the practice of nurse midwifery by the Michigan board of nursing under section 17210 of the public health code, 1978 PA 368, MCL 333.17210.  (2) An insurer that delivers, issues for delivery, or renews in this state a policy of health insurance that provides coverage for obstetrical and gynecological services shall include coverage for obstetrical and gynecological services whether performed by a physician or a nurse midwife acting within the scope of his or her license or specialty certification or shall do 1 or both of the following:  (a) Offer to provide coverage for obstetrical and gynecological services whether performed by a physician or a nurse midwife acting within the scope of his or her license or specialty certification.  (b) Offer to provide coverage for maternity services and gynecological services rendered during pre- and post-natal care whether performed by a physician or a nurse midwife acting within the scope of his or her license or specialty certification. History: Add. 2004, Act 375, Imd. Eff. Oct. 11, 2004 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218
MI Comp L § 500.3406u (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480)|Section 500.3406u - Coverage for Prescription Eyedrops; Requirements; "Prescriber" Defined.

500.3406u Coverage for prescription eyedrops; requirements; "prescriber" defined.Sec. 3406u.  (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription eyedrops shall not deny coverage for a refill of the prescription if all of the following apply:  (a) For a 30-day supply, the amount of time has passed within which the insured should have used 75% of the dosage units of the drug according to the prescriber's instructions, or 23 days have passed after either of the following:  (i) The original date the prescription was distributed to the insured.  (ii) The date the most recent refill was distributed to the insured.  (b) The prescriber indicates on the original prescription that additional quantities are needed.  (c) The prescription eye drops prescribed by the prescriber are covered under the health insurance policy.  (2) As used in this section, "prescriber" means that term as defined in section 17708 of the public health code, 1978 PA 368, MCL 333.17708. History: Add. 2019, Act 139, Imd. Eff. Dec. 5, 2019 Compiler's Notes: Enacting section 1 of Act 139 of 2019 provides:"Enacting section 1. This amendatory act applies to health insurance policies delivered, executed, issued, amended, adjusted, or renewed in this state, or outside of this state if covering residents of this state, beginning 90 days after the date this amendatory act is enacted into law."Ninety days after the enactment date of Act 139 of 2019 is March 4, 2020.Popular Name: Act 218
MI Comp L § 500.3406v (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480)|Section 500.3406v - Coverage for Emergency Supply of Insulin.

500.3406v Coverage for emergency supply of insulin.Sec. 3406v.  Beginning on the effective date of the amendatory act that added this section, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription drugs shall provide coverage for any emergency supply of insulin that is covered under an insured's health insurance policy and that is dispensed to the insured by a pharmacist as provided in section 17744f of the public health code, 1978 PA 368, MCL 333.17744f. History: Add. 2021, Act 37, Imd. Eff. July 1, 2021 Popular Name: Act 218
MI Comp L § 500.3406w (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480)|Section 500.3406w - Temporary Emergency and Early Refills for Prescription Drugs; Inapplicable After March 31, 2021.

500.3406w Temporary emergency and early refills for prescription drugs; inapplicable after March 31, 2021.Sec. 3406w.  (1) Beginning on the effective date of the amendatory act that added this section, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription drugs shall do both of the following:  (a) Provide coverage for an emergency refill of up to a 60-day supply of any covered maintenance prescription drug.  (b) Provide coverage for an early refill of any 30-day or 60-day covered maintenance prescription drug to allow for up to a 90-day supply, without regard to whether the pharmacy is mail order or in person.  (2) This section does not apply after March 31, 2021.  (3) As used in this section:  (a) "Emergency refill" means a refill where, in the pharmacist's professional judgment, failure to refill the prescription may interrupt the patient's ongoing care and have a significant adverse effect on the patient's well-being as provided in section 17713 of the public health code, 1978 PA 368, MCL 333.17713.  (b) "Maintenance prescription drug" means a prescription drug that meets the requirements under section 3406t(1)(b)(i) to (iii). History: Add. 2020, Act 322, Imd. Eff. Dec. 29, 2020 Popular Name: Act 218
MI Comp L § 500.3407 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480)|Section 500.3407 - Entire Contract; Changes.

500.3407 Entire contract; changes.Sec. 3407.  Except as otherwise provided in this act, an insurer shall include the following provision in a disability insurance policy:  ENTIRE CONTRACT; CHANGES: This policy, including the applicable riders and endorsements; the application for coverage if specified by the insurer; the identification card if specified by the insurer; and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy is valid until approved by an executive officer of the insurer and unless the approval is endorsed on this policy or attached to this policy. An insurance producer does not have authority to change this policy or to waive any of its provisions. History: 1956, Act 218, Eff. Jan. 1, 1957 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218
MI Comp L § 500.3407a (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480)|Section 500.3407a - Conduct on Behalf of or Information Provided to Insured by Health Care Provider; Prohibition or Discouragement by Disability Insurer.

500.3407a Conduct on behalf of or information provided to insured by health care provider; prohibition or discouragement by disability insurer. Sec. 3407a.  A disability insurer shall not prohibit or discourage a health care provider from advocating on behalf of an insured for appropriate medical treatment options pursuant to the grievance procedure in section 2213 or from discussing with an insured or provider any of the following:  (a) Health care treatments and services.  (b) Quality assurance plans required by law, if applicable.  (c) The financial relationships between the insurer and the health care provider including all of the following as applicable:  (i) Whether a fee-for-service arrangement exists, under which the provider is paid a specified amount for each covered service rendered to the participant.   (ii) Whether a capitation arrangement exists, under which a fixed amount is paid to the provider for all covered services that are or may be rendered to each covered individual or family.  (iii) Whether payments to providers are made based on standards relating to cost, quality, or patient satisfaction. History: Add. 1997, Act 66, Imd. Eff. July 15, 1997 Popular Name: Act 218
MI Comp L § 500.3407b (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480)|Section 500.3407b - Undergoing Genetic Testing as Condition of Issuing, Renewing, or Continuing Policy; Disclosure of Genetic Testing or Genetic Information; Definitions.

500.3407b Undergoing genetic testing as condition of issuing, renewing, or continuing policy; disclosure of genetic testing or genetic information; definitions.Sec. 3407b.  (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not require an insured or his or her dependent or an asymptomatic applicant for insurance or his or her asymptomatic dependent to do either of the following:  (a) Undergo genetic testing before issuing, renewing, or continuing the policy in this state.  (b) Disclose whether genetic testing has been conducted or the results of genetic testing or genetic information.  (2) As used in this section:  (a) "Clinical purposes" includes all of the following:  (i) Predicting risk of diseases.  (ii) Identifying carriers for single-gene disorders.  (iii) Establishing prenatal and clinical diagnosis or prognosis.  (iv) Prenatal, newborn, and other carrier screening, as well as testing in high-risk families.  (v) Testing for metabolites if undertaken with high probability that an excess or deficiency of the metabolite indicates or suggests the presence of heritable mutations in single genes.  (vi) Other testing if the intended purpose is diagnosis of a presymptomatic genetic condition.  (b) "Genetic information" means information about a gene, gene product, or inherited characteristic derived from a genetic test.  (c) "Genetic test" means the analysis of human DNA, RNA, chromosomes, and those proteins and metabolites used to detect heritable or somatic disease-related genotypes or karyotypes for clinical purposes. A genetic test must be generally accepted in the scientific and medical communities as being specifically determinative for the presence, absence, or mutation of a gene or chromosome to qualify under this definition. Genetic test does not include a routine physical examination or a routine analysis, including, but not limited to, a chemical analysis, of body fluids, unless conducted specifically to determine the presence, absence, or mutation of a gene or chromosome.  (d) After December 31, 2017, "insurer" includes a nonprofit dental care corporation operating under 1963 PA 125, MCL 550.351 to 550.373. History: Add. 2000, Act 27, Imd. Eff. Mar. 15, 2000 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 ;-- Am. 2017, Act 223, Imd. Eff. Dec. 20, 2017 Popular Name: Act 218
MI Comp L § 500.3408 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480)|Section 500.3408 - Time Limit on Certain Defenses; Incontestable Policy.

500.3408 Time limit on certain defenses; incontestable policy.Sec. 3408.  (1) An insurer shall include in a disability insurance policy, other than a health insurance policy, a provision that consists of both of the following:   (a) One of the following, as applicable:  (i) TIME LIMIT ON CERTAIN DEFENSES: After 3 years from the date of issue of this policy, the insurer will not use a misstatement, except a fraudulent misstatement, made by the applicant in the application for the policy to void the policy or to deny a claim for loss incurred or disability, as defined in the policy, beginning after the expiration of the 3-year period. This policy provision does not affect a legal requirement for avoidance of a policy or denial of a claim during the initial 3-year period, and does not limit the application of sections 3432, 3434, 3436, 3438, and 3440 if a misstatement with respect to age or occupation or other insurance is made.  (ii) Instead of the provision required under subparagraph (i), for a policy that the insured has the right to continue in force subject to its terms by the timely payment of premium until at least age 50 or, for a policy issued after age 44, for at least 5 years after its date of issue, an insurer may include the following in the policy, under the caption "INCONTESTABLE":  After this policy has been in force for a period of 3 years during the lifetime of the insured (excluding any period during which the insured is disabled), it becomes incontestable as to the statements contained in the application.  (b) A claim for a loss incurred or disability, as defined in the policy, beginning after 3 years from the date of issue of this policy will not be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss existed before the effective date of coverage of this policy.  (2) For the purpose of permitting insurers to use a uniform policy in several states, the insurer may print in the policy form in the provisions required under subsection (1)(a) and (b) the term of "3 years". Notwithstanding any provision of the contract or law to the contrary, the time limits for the defenses described in this section and included in a disability insurance policy, not including a health insurance policy, that is delivered or issued for delivery in this state must not exceed 2 years. History: 1956, Act 218, Eff. Jan. 1, 1957 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218
MI Comp L § 500.3410 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480)|Section 500.3410 - Grace Period; Provision Required.

500.3410 Grace period; provision required.  Sec. 3410.  There shall be a provision as follows:  GRACE PERIOD: A grace period of ................ (insert a number not less than "7" for weekly premium policies, "10" for monthly premium policies and "31" for all other policies) days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force.  (A policy which contains a cancellation provision may add, at the end of the above provision, "subject to the right of the insurer to cancel in accordance with the cancellation provision hereof." A policy in which the insurer reserves the right to refuse any renewal shall have, at the beginning of the above provision, "unless not less than 5 days prior to the premium due date the insurer has delivered to the insured or has mailed to his last address as shown by the records of the insurer written notice of its intention not to renew this policy beyond the period for which the premium has been accepted,"). History: 1956, Act 218, Eff. Jan. 1, 1957 Popular Name: Act 218
MI Comp L § 500.3411 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-34 - Chapter 34 Disability Insurance Policies (500.3400...500.3480)|Section 500.3411 - Reinstatement; Provision Required.

500.3411 Reinstatement; provision required.Sec. 3411.  (1) Subject to subsection (2), an insurer shall include the following provision in a disability insurance policy other than a health insurance policy:  REINSTATEMENT: If any renewal premium is not paid within the time granted the insured for payment, a subsequent acceptance of premium by the insurer or by an agent duly authorized by the insurer to accept the premium, without requiring in connection with the acceptance of the premium an application for reinstatement, is a reinstatement of the policy. However, if the insurer or its agent requires an application for reinstatement and issues a conditional receipt for the premium tendered, the policy is reinstated upon approval of the application by the insurer or, if not approved by the insurer, on the forty-fifth day after the date of the conditional receipt unless the insurer has previously notified the insured in writing of its disapproval of the application. Under the reinstated policy, the insurer will cover only loss resulting from accidental injury that is sustained after the date of reinstatement and loss due to sickness that begins more than 10 days after that date. In all other respects, the insured and insurer have the same rights under the policy as they had under the policy immediately before the due date of the defaulted premium, subject to any provisions endorsed on the policy or attached to the policy in connection with the reinstatement. The insurer will apply any premium accepted in connection with a reinstatement to a period for which premium has not been previously paid, but not to any period more than 60 days before the date of reinstatement.  (2) An insurer may omit the last sentence of the provision required under subsection (1) from a policy that the insured has the right to continue in force subject to its terms by the timely payment of premium until at least age 50 or, for a policy issued after age 44, for at least 5 years after its date of issue. History: 1956, Act 218, Eff. Jan. 1, 1957 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218