reglab/housing_qa huggingface dataset:
MI Comp L § 550.930 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962)|Section 550.930 - Provision of Administrative Services Pursuant to Written Service Contract; Maintenance of Books and Records; Tpa and Manager as Fiduciary.

550.930 Provision of administrative services pursuant to written service contract; maintenance of books and records; TPA and manager as fiduciary. Sec. 30.  (1) A TPA may only provide administrative services pursuant to a written service contract. For the duration of the service contract, a TPA shall maintain at its principal administrative office the TPA's books and records of all transactions under the service contract in accordance with generally accepted accounting principles or as required by ERISA.  (2) A TPA and a manager are a fiduciary when collecting, expending, and maintaining money for the payment of claims pursuant to the service contract. History: 1984, Act 218, Eff. Jan. 1, 1985
MI Comp L § 550.934 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962)|Section 550.934 - Confidentiality.

550.934 Confidentiality. Sec. 34.  (1) A TPA shall provide for the confidentiality of personal data identifying an individual covered by a plan. A TPA shall not disclose records containing personal information that may be associated with an identifiable individual covered by a plan to a person other than the individual to whom the information pertains. Except as is necessary to comply with a court order, an administrator shall not disclose personal data concerning a covered individual without the prior consent of the covered individual. If the individual covered by a plan has authorized the release of information to a third person, the third person shall not release that information unless the individual executes in writing another consent authorizing the additional release.  (2) Subsection (1) shall not be construed to apply to information disclosed for any of the following reasons:  (a) For claims adjudication.  (b) For claims verification.  (c) For other proper plan administration.  (d) For an audit conducted pursuant to ERISA.  (e) To an insurer for the purchase of excess loss insurance and for claims under the excess loss insurance. However, an insurer obtaining information under this subdivision shall be subject to the requirements of subsection (1).  (f) To the plan or a fiduciary of the plan.  (g) To the commissioner. However, information obtained by the commissioner under this subdivision shall be exempt from disclosure under the freedom of information act, Act No. 442 of the Public Acts of 1976, being sections 15.231 to 15.246 of the Michigan Compiled Laws.  (h) As required by law. History: 1984, Act 218, Eff. Jan. 1, 1985
MI Comp L § 550.936 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962)|Section 550.936 - Annual Statement; Report.

550.936 Annual statement; report. Sec. 36.  (1) Each TPA acting within this state shall annually, on or before March 1, prepare under oath and deposit with the commissioner a statement concerning its affairs upon a form provided by the commissioner. The annual statement shall be filed on or before March 1 of the year following that covered by the statement. Upon request and for good cause shown, the commissioner may grant to any TPA a reasonable extension of time not to exceed 30 days within which the statement shall be filed. The TPA shall pay the filing fee prescribed in section 18.  (2) The commissioner shall submit to the legislature on or before April 1, 1985, a report detailing the impact of this act on plans, individuals covered by plans, carriers, and TPAs. The report shall also, in consultation with the revenue commissioner, estimate the total financial impact on the state of Michigan during the preceding legislative biennium. History: 1984, Act 218, Eff. Jan. 1, 1985
MI Comp L § 550.940 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962)|Section 550.940 - Prohibited Conduct Generally.

550.940 Prohibited conduct generally. Sec. 40.  A TPA or manager, in processing claims, shall not do any of the following:  (a) Misrepresent pertinent facts relating to coverage.  (b) Fail to make a good faith effort to acknowledge promptly or to act reasonably and promptly upon communications with respect to a claim for benefits.  (c) Fail to adopt and implement reasonable standards for the prompt investigation of a claim for benefits.  (d) Refuse to process claims without conducting a reasonable investigation based upon the available information.  (e) Fail to communicate affirmation or denial of coverage of a claim for benefits within a reasonable time after a claim has been received.  (f) Fail to make a good faith effort to promptly, fairly, and equitably process a claim for benefits.  (g) Fail to promptly provide a reasonable explanation of the basis for denial or partial denial of a claim for benefits.  (h) Refuse to process claims because of race, color, creed, marital status, sex, national origin, residence, age, disability, or lawful occupation.  (i) Knowingly compel individuals covered by the plan to institute litigation to recover amounts due under a benefit plan by offering substantially less than the amounts due unless the amounts due are reasonably in dispute.  (j) For the purpose of coercing an individual covered by the plan to accept a settlement or compromise of a claim, inform the individual of a policy of the TPA of appealing judicial, arbitration, or administrative hearing decisions which are in favor of individuals covered by the plan.  (k) Delay the investigation or processing of a claim by requiring an individual covered by the plan, or the provider of services to the individual covered by the plan, to submit a preliminary claim and then requiring subsequent submission of a formal claim, seeking solely the duplication of a verification. This subdivision does not apply to the predetermination or precertification of benefits. History: 1984, Act 218, Eff. Jan. 1, 1985 ;-- Am. 1998, Act 79, Imd. Eff. May 4, 1998
MI Comp L § 550.942 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962)|Section 550.942 - Additional Prohibited Conduct.

550.942 Additional prohibited conduct. Sec. 42.  A manager or TPA, in order to induce a person to contract or to continue to contract with the TPA; to induce a person to lapse, forfeit, or surrender a service contract entered into with a TPA; or to induce a person to secure or terminate coverage with a carrier or other person, shall not directly or indirectly:  (a) Offer to make or make an agreement relating to a service contract or issue or deliver to the person money or any other valuable consideration other than as plainly expressed in the service contract.  (b) Give or pay or offer to give or pay, directly or indirectly, a rebate or adjustment of the fee payable under the service contract, or an advantage in the services thereunder, except as reflected in the fee and expressly provided in the service contract.  (c) Make, issue, or circulate, or cause to be made, issued, or circulated, any estimate, illustration, circular, or statement misrepresenting the terms of a service contract, the advantages provided thereunder, or the true nature thereof.  (d) Make a misrepresentation in a comparison, whether oral or written, between service contracts of the TPA and another TPA or between service contracts of the TPA and a carrier. History: 1984, Act 218, Eff. Jan. 1, 1985
MI Comp L § 550.944 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962)|Section 550.944 - Additional Prohibited Conduct.

550.944 Additional prohibited conduct. Sec. 44.  (1) A TPA shall not refuse to enter into a service contract or provide administrative services other than processing claims because of race, color, creed, marital status, sex, national origin, residence, age, disability, or lawful occupation.  (2) A TPA or manager shall not misrepresent the financial condition of a TPA or of any person engaged in the business of insurance, or misrepresent the financial aspects of the services offered by the TPA or make a statement which is maliciously false, maliciously critical of, or maliciously derogatory to the financial condition of another TPA or of a person engaged in the business of insurance.  (3) A TPA or manager shall not misrepresent the nature of the services provided by the TPA, including but not limited to, the existence or identity of any carrier or other TPA involved with the plan; the extent of risk assumed by any particular named carrier, if any; or the regulatory status of the carrier or TPA.  (4) A TPA or manager shall not make, or participate in the making of, any fraudulent statement on a claims form for the purpose of obtaining money or other benefits.  (5) A TPA shall process claims for benefits on a timely basis. History: 1984, Act 218, Eff. Jan. 1, 1985 ;-- Am. 1998, Act 79, Imd. Eff. May 4, 1998
MI Comp L § 550.950 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962)|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.

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. Sec. 50.  (1) When the commissioner has probable cause to believe that a TPA or manager is violating, or has violated section 40, indicating a persistent tendency to engage in conduct prohibited by that section, or has probable cause to believe that a TPA or manager is violating, or has violated other provisions of this act, he or she shall give written notice to the TPA or manager, pursuant to the administrative procedures act, Act No. 306 of the Public Acts of 1969, being sections 24.201 to 24.315 of the Michigan Compiled Laws, setting forth the general nature of the complaint against the TPA or manager and the proceedings contemplated under this section. Before the issuance of a notice of hearing, the staff of the bureau of insurance responsible for the matters which would be at issue in the hearing shall give the TPA or manager an opportunity to confer and discuss the possible complaint and proceedings in person with the commissioner or a representative of the commissioner, and the matter may be disposed of summarily upon agreement of the parties. This subsection shall not be construed to create or diminish any right of a person to bring an action for damages under this section.  (2) A hearing held pursuant to subsection (1) shall be held pursuant to the administrative procedures act, Act No. 306 of the Public Acts of 1969. If, after the hearing, the commissioner determines that the TPA or manager is violating, or has violated section 40, indicating a persistent tendency to engage in conduct prohibited by that section, or has violated or is violating other provisions of this act, the commissioner shall reduce his or her findings and decision to writing, and shall issue and cause to be served upon the TPA or manager a copy of the findings and an order requiring the TPA or manager to cease and desist from engaging in the prohibited activity, and the commissioner may order any of the following:  (a) Payment of a monetary penalty of not more than $500.00 for each violation but not to exceed an aggregate penalty of $5,000.00, unless the TPA or manager knew or reasonably should have known it was in violation of this act, in which case the penalty shall not be more than $2,500.00 for each violation and shall not exceed an aggregate penalty of $25,000.00 for all violations committed in a 6-month period.  (b) Suspension or revocation of the TPA's certificate of authority or the manager's license if the TPA or manager knowingly and persistently violated this act.  (c) Restitution or refund to an aggrieved person. History: 1984, Act 218, Eff. Jan. 1, 1985
MI Comp L § 550.952 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962)|Section 550.952 - Civil Fine; Suspension or Revocation of Certificate or License.

550.952 Civil fine; suspension or revocation of certificate or license. Sec. 52.  If a TPA or manager violates a cease and desist order under this act and has been given notice and an opportunity for a hearing held pursuant to the administrative procedures act of 1969, Act No. 306 of the Public Acts of 1969, being sections 24.201 to 24.315 of the Michigan Compiled Laws, the commissioner may order a civil fine of not more than $10,000.00 for each violation, or a suspension or revocation of the TPA's certificate of authority or manager's license, or both the fine and suspension or revocation. History: 1984, Act 218, Eff. Jan. 1, 1985
MI Comp L § 550.954 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962)|Section 550.954 - Alteration, Modification, or Setting Aside of Order.

550.954 Alteration, modification, or setting aside of order. Sec. 54.  The commissioner may at any time, by order, after notice and opportunity for hearing, reopen and alter, modify, or set aside, in whole or in part, an order issued by him or her under this act, when in his or her opinion conditions of fact or of law have so changed as to require that action or if the public interest shall so require. History: 1984, Act 218, Eff. Jan. 1, 1985
MI Comp L § 550.956 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962)|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.

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. Sec. 56.  (1) Any final order or decision made, issued, or executed by the commissioner under this act shall be subject to review, after hearing had before the commissioner or a deputy commissioner without leave by the circuit court of Ingham county or the circuit court of the county in which the principal office in this state of the TPA aggrieved by such order or decision is located, or where the person resides against whom such order is directed.  (2) A petition as of right for the review of such order or decision shall be filed within 30 days from the date of service of a copy of said order or decision upon the TPA or other person against whom said order or decision shall run. Copy of such petition for review as filed with and certified by the clerk of the court shall be served upon the commissioner, or in his or her absence upon someone in active charge of the insurance bureau, within 5 days after the filing thereof. If a petition for review is not filed within the 30 days, the party aggrieved shall be deemed to have waived the right to have the merits of the order or decision reviewed, and there shall be no trial of the merits thereof by any court to which application may be made by petition or otherwise. Within 10 days after the service of copy of the petition for review, unless the time be extended by order of court, the commissioner shall prepare and file with the clerk of the court in which the petition for review was filed, a complete transcript of the record of the hearing had before him or her, and a true and certified copy of his or her order or decision.  (3) The cause shall be heard before the court as a civil case in equity upon such transcript of the record and such additional evidence as may be offered by any of the parties at the hearing of the cause before the court. It shall be the duty of the court to hear and determine such petition with all convenient speed. If on the hearing before the court it appears that the record filed by the commissioner is incomplete, the court by appropriate order may direct the commissioner to certify any or all parts of the records so omitted. The commencement of proceedings under this section shall not operate as a stay of the enforcement of the commissioner's order or decision unless so ordered by the court or commissioner, and under such conditions as the court or commissioner may impose. The court shall have the jurisdiction to affirm, modify, or to set aside the order or decision of the commissioner and to restrain the enforcement thereof. History: 1984, Act 218, Eff. Jan. 1, 1985
MI Comp L § 550.958 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962)|Section 550.958 - Self-Incrimination; False Oath or Affirmation.

550.958 Self-incrimination; false oath or affirmation. Sec. 58.  (1) A person shall not be excused from attending and testifying, or producing any books, papers, or other documents before any court or magistrate, arbitrator or board of arbitrators, upon any investigation, proceeding, or trial, for a violation of any of the provisions of this act, upon the ground or for the reason that the testimony or evidence documentary or otherwise, required of him or her may tend to incriminate him or her; but a person shall not be prosecuted or subjected to any penalty or forfeiture for or on account of any transaction, matter, or thing concerning which he or she may so testify or produce evidence, documentary or otherwise, and testimony so given or produced shall not be used against him or her upon any criminal investigation or proceeding.  (2) A person required by this act to take an oath or affirmation who makes a false oath or affirmation is guilty of perjury. History: 1984, Act 218, Eff. Jan. 1, 1985
MI Comp L § 550.960 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962)|Section 550.960 - Rules.

550.960 Rules. Sec. 60.  (1) The commissioner, after notice and hearing, may promulgate rules pursuant to the administrative procedures act of 1969, Act No. 306 of the Public Acts of 1969, being sections 24.201 to 24.315 of the Michigan Compiled Laws, as necessary to effectuate the purposes of this act.  (2) A copy of the rules promulgated under this act and any amendments thereto shall be mailed to each TPA authorized to do business in this state 30 days prior to the effective date thereof. History: 1984, Act 218, Eff. Jan. 1, 1985
MI Comp L § 550.962 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962)|Section 550.962 - Repealed. 2002, Act 74, Imd. Eff. Mar. 15, 2002.

550.962 Repealed. 2002, Act 74, Imd. Eff. Mar. 15, 2002. Compiler's Notes: The repealed section pertained to effective date of act.
MI Comp L § 550.1001 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020)|Section 550.1001 - Short Title.

550.1001 Short title. Sec. 1.  This act shall be known and may be cited as "the health benefit agent act". History: 1986, Act 252, Eff. Mar. 31, 1987 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.
MI Comp L § 550.1002 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020)|Section 550.1002 - Definitions.

550.1002 Definitions. Sec. 2.  As used in this act:  (a) "Affiliate" means that term as defined in section 1301 of the insurance code of 1956, Act No. 218 of the Public Acts of 1956, being section 500.1301 of the Michigan Compiled Laws.  (b) "Commissioner" means the commissioner of insurance.  (c) "Control" means that term as defined in section 1301 of the insurance code of 1956, Act No. 218 of the Public Acts of 1956, being section 500.1301 of the Michigan Compiled Laws.  (d) "Health benefit" means any benefit or service lawfully provided by a health benefit corporation.  (e) "Health benefit agent" means a person who meets all of the following criteria:  (i) Is a licensed accident and health insurance agent under chapter 12 of the insurance code of 1956, Act No. 218 of the Public Acts of 1956, being sections 500.1201 to 500.1244 of the Michigan Compiled Laws.  (ii) Is authorized in writing by a health benefit corporation to act as an agent for the health benefit corporation and a copy of the authorization is filed with the commissioner.  (f) "Health benefit corporation" means:  (i) A health care corporation organized under Act No. 350 of the Public Acts of 1980, being sections 550.1101 to 550.1704 of the Michigan Compiled Laws.  (ii) A nonprofit dental care corporation organized under Act No. 125 of the Public Acts of 1963, being sections 550.351 to 550.373 of the Michigan Compiled Laws.  (iii) A health maintenance organization licensed under part 210 of Act No. 368 of the Public Acts of 1978, being sections 333.21001 to 333.21098 of the Michigan Compiled Laws.  (g) "Influence" means to manage, direct, mandate, or give a reward or benefit to a person. Influence does not mean to respond to a request for information.  (h) "Package" means to sell health benefits simultaneously or in conjunction with the sale of insurance.  (i) "Subscriber" means a person who enters into a contract, or on whose behalf a contract is entered into, with a health benefit corporation for the provision of health benefits. History: 1986, Act 252, Eff. Mar. 31, 1987 Compiler's Notes: 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.
MI Comp L § 550.1004 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020)|Section 550.1004 - Influencing Agent Prohibited.

550.1004 Influencing agent prohibited. Sec. 4.  A health benefit corporation shall not attempt in any way to influence an agent in the packaging of health benefits. History: 1986, Act 252, Eff. Mar. 31, 1987 Compiler's Notes: 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.