reglab/housing_qa huggingface dataset:
MI Comp L § 550.1403 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|Section 550.1403 - Payment of Benefits; Interest; Claim Form; Exception.

550.1403 Payment of benefits; interest; claim form; exception. Sec. 403.  (1) A health care corporation, on a timely basis, shall pay to a member benefits as are entitled and provided under the applicable certificate. When not paid on a timely basis, benefits payable to a member shall bear simple interest from a date 60 days after a satisfactory claim form was received by the health care corporation, at a rate of 12% interest per annum. The interest shall be paid in addition to, and at the time of payment of, the claim. Section 2006(7) to (14) of the insurance code of 1956, 1956 PA 218, MCL 500.2006, applies to a health care corporation.  (2) A health care corporation shall specify in writing the materials that constitute a satisfactory claim form not later than 30 days after receipt of a claim, unless the claim is settled within 30 days. If a claim form is not supplied as to the entire claim, the amount supported by the claim form shall be considered to be paid on a timely basis if paid within 60 days after receipt of the claim form by the corporation. This subsection does not apply to a health care corporation when paying a claim under section 2006(7) to (14) of the insurance code of 1956, 1956 PA 218, MCL 500.2006. History: 1980, Act 350, Eff. Apr. 3, 1981 ;-- Am. 2002, Act 317, Eff. Oct. 1, 2002 Compiler's Notes: Enacting section 1 of Act 317 of 2002 provides:“Enacting section 1. This amendatory act takes effect on October 1, 2002 and applies to all health care claims with dates of service on and after October 1, 2002.”Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1403a (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|Section 550.1403a - Benefits Paid by Check or Written Instrument; Escheat.

550.1403a Benefits paid by check or written instrument; escheat. Sec. 403a.  Benefits paid by a health care corporation to a subscriber or provider by way of a check or other similar written instrument for the transmission or payment of money, that is not cashed within the period prescribed in the uniform unclaimed property act, shall escheat to the state pursuant to the uniform unclaimed property act. History: Add. 1990, Act 172, Imd. Eff. July 2, 1990 ;-- Am. 1995, Act 49, Eff. Jan. 1, 1996 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1403b (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|Section 550.1403b - Advertising Material Prohibited.

550.1403b Advertising material prohibited. Sec. 403b.  A health care corporation shall not include in any bill for services or products any advertising material for any other service or product sold by a subsidiary of the corporation. History: Add. 2003, Act 59, Eff. July 23, 2003 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1405 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|Section 550.1405 - Single Billing Form; Development; Explanation of Total Bill for Services.

550.1405 Single billing form; development; explanation of total bill for services. Sec. 405.  (1) A health care corporation, in consultation with the department of social services, shall develop a single billing form to be used for the billing of each of the following: hospital services, physician services, and pharmaceutical services. If such forms are subsequently developed by the federal government, they may be used in the place of forms developed pursuant to this subsection.  (2) A health care corporation shall provide each member with a detailed and accurate explanation of his or her total bill for services rendered by a health care provider and provided under a certificate with a health care corporation, including charges for specific types of services rendered, the date of services rendered, the amounts reimbursed by the corporation, and the reasons for denial of any payments for expenses incurred. History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1407 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|Section 550.1407 - Complaint System; Procedures; Response to Complaint; Access to Complaints and Responses; Record of Complaints; Annual Report; Other Legal Remedies.

550.1407 Complaint system; procedures; response to complaint; access to complaints and responses; record of complaints; annual report; other legal remedies. Sec. 407.  (1) A health care corporation shall establish and maintain a complaint system which affords adequate and reasonable procedures for the expeditious resolution of written complaints initiated by members concerning any matter relating to the provisions of a certificate. At a minimum, procedures shall be developed by a corporation for the resolution of claims for reimbursement; denial, cancellations, or nonrenewals of certificates; and complaints regarding the quality of the services delivered by health care providers and health care facilities which receive reimbursement from the corporation.  (2) A health care corporation, within 30 days after receipt of written complaint, shall give a reasonable written response to each written complaint which it receives. The commissioner shall have free access, as defined in section 603(2), to complaints and responses, which shall be made available to the commissioner for inspection. If the matter complained of is reasonably believed by the complainant to be a violation of section 402 or 403, the complainant shall be entitled to a private informal managerial-level conference with the health care corporation, as provided for in section 404.  (3) The health care corporation shall maintain a complete record of all of the written complaints of its members which the corporation has received since the date of the last examination. This record shall indicate the total number of complaints; and by line of business, the nature of each complaint, the disposition of each complaint, and the time taken to process each complaint.  (4) A health care corporation shall submit to the commissioner an annual report which describes the complaint system of the corporation, and includes a compilation and analysis of the written complaints filed with the corporation, their disposition and underlying causes, and measures being implemented to alleviate those causes. The report shall be compiled in a manner which protects an individual's right to privacy with respect to medical information and shall not disclose the identity of a member by name or other personal identifier without the member's consent pursuant to section 406(1). The annual report shall be a public record.  (5) This section shall not prevent a member from seeking other remedies available by law. History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1408 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|Section 550.1408 - False, Dishonest, or Fraudulent Claim for Payment as Misdemeanor; Penalty; Civil Action; Prosecution.

550.1408 False, dishonest, or fraudulent claim for payment as misdemeanor; penalty; civil action; prosecution. Sec. 408.  Any provider, member, or other person who knowingly makes, presents, or causes to be presented to a health care corporation any false, dishonest, or fraudulent claim for payment to or from the health care corporation, is guilty of a misdemeanor, punishable by a fine of not more than $1,000.00 or imprisonment for not more than 3 months, or both. This section shall not preclude a civil action for recovery of money due the corporation, nor shall it preclude the prosecution of any such provider, member, or other person under the applicable provisions of Act No. 328 of the Public Acts of 1931, as amended, being sections 750.1 to 750.568 of the Michigan Compiled Laws. History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1409 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|Section 550.1409 - Civil Action for Negligence.

550.1409 Civil action for negligence. Sec. 409.  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 corporation. History: 1980, Act 350, Eff. Apr. 3, 1981 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1409a (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|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.

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.Sec. 409a.  (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 students shall continue coverage for that dependent student if the dependent student is covered under that certificate and takes a leave of absence from school due to illness or injury. Coverage under this section shall continue for 12 months from the last day of attendance in school or until the dependent reaches the age at which coverage would otherwise terminate, whichever period is shorter.  (2) To qualify for coverage under this section, the dependent student's attending physician shall certify in writing to the health care corporation that it is medically necessary for the dependent student to take a leave of absence from school.  (3) Coverage under this section shall be provided at the same rate as that charged for dependent student status.  (4) A dependent child must continue to meet all other eligibility requirements for dependent coverage in the health care corporation's certificate or rider if the dependent child takes a leave of absence from school due to illness or injury. History: Add. 2006, Act 538, Eff. Jan. 1, 2007 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1410 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|Section 550.1410 - Certificate Providing Coverage of Dependent Terminating at Specified Age; Exceptions.

550.1410 Certificate providing coverage of dependent terminating at specified age; exceptions.Sec. 410.  Any certificate issued by a health care corporation that provides that coverage of a dependent of the subscriber terminates at a specified age shall not terminate with respect to an unmarried child who is incapable of self-sustaining employment by reason of developmental disability or physical disability, if the following conditions are met:  (a) The child became incapable before 19 years of age and is chiefly dependent upon the subscriber for support and maintenance.  (b) Before the child turns 19 years of age, or within 31 days after that, the subscriber has submitted proof of the dependent's incapacity to the corporation. History: 1980, Act 350, Eff. Apr. 3, 1981 ;-- Am. 1998, Act 24, Imd. Eff. Mar. 12, 1998 ;-- Am. 2014, Act 75, Imd. Eff. Mar. 28, 2014 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1410b (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|Section 550.1410b - Premium for Group Conversion Certificate After January 1, 2014; Determination; Rating Factors.

550.1410b Premium for group conversion certificate after January 1, 2014; determination; rating factors.Sec. 410b.  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 a group conversion certificate under section 410a shall be determined only by using the rating factors set forth in section 3474a of the insurance code of 1956, 1956 PA 218, MCL 500.3474a. History: Add. 2013, Act 4, Imd. Eff. Mar. 18, 2013 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1411-550.1413a (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|Section 550.1411-550.1413a - Repealed. 1994, Act 40, Imd. Eff. Mar. 14, 1994.

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 medicare program, and condition to issuance of certificate.Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1414 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|Section 550.1414 - Expired. 1980, Act 430, Eff. Jan. 1, 1982.

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
MI Comp L § 550.1414b (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|Section 550.1414b - Offer of Wellness Coverage by Health Care Corporation.

550.1414b Offer of wellness coverage by health care corporation.Sec. 414b.  (1) A health care corporation may offer group wellness coverage. Wellness coverage may provide for an appropriate rebate or reduction in premiums or for reduced copayments, coinsurance, or deductibles, or a combination of these incentives, for participation in any health behavior wellness, maintenance, or improvement program offered by the employer. The employer shall provide evidence of demonstrative maintenance or improvement of the members' health behaviors as determined by assessments of agreed-upon health status indicators between the employer and the health care corporation. Any rebate or premium provided by the health care corporation is presumed to be appropriate unless credible data demonstrate otherwise, but shall not exceed 30% of paid premiums, unless otherwise approved by the commissioner. A health care corporation shall make available to employers all wellness coverage plans that it markets to employers in this state.  (2) A health care corporation may offer nongroup wellness coverage. Wellness coverage may provide for an appropriate rebate or reduction in premiums or for reduced copayments, coinsurance, or deductibles, or a combination of these incentives, for participation in any health behavior wellness, maintenance, or improvement program approved by the health care corporation. The member shall provide evidence of demonstrative maintenance or improvement of the individual's or family's health behaviors as determined by assessments of agreed-upon health status indicators between the member and the health care corporation. Any rebate of premium provided by the health care corporation is presumed to be appropriate unless credible data demonstrate otherwise, but shall not exceed 30% of paid premiums, unless otherwise approved by the commissioner. A health care corporation shall make available to individuals all wellness coverage plans that it markets to individuals in this state.  (3) A health care corporation is not required to continue any health behavior wellness, maintenance, or improvement program or to continue any incentive associated with a health behavior wellness, maintenance, or improvement program. History: Add. 2006, Act 413, Eff. Mar. 30, 2007 ;-- Am. 2013, Act 4, Imd. Eff. Mar. 18, 2013 Compiler's Notes: Enacting section 2 of Act 413 of 2006 provides:"Enacting section 2. It is only the intent of this amendatory act to promote the availability of health behavior wellness, maintenance, and improvement programs."Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1415 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|Section 550.1415 - Benefits for Prosthetic Devices.

550.1415 Benefits for prosthetic devices. Sec. 415.  (1) Not later than 12 months after the effective date of this act, a health care corporation shall offer or include coverage, in all group and nongroup certificates, to provide benefits for prosthetic devices to maintain or replace the body part of an individual whose covered illness or injury has required the removal of that body part. However, certificates resulting from collective bargaining agreements shall be exempted from this subsection. This coverage shall provide that reasonable charges for medical care and attendance for an individual fitted with a prosthetic device shall be covered benefits after the individual's attending physician has certified the medical necessity or desirability for a proposed course of rehabilitative treatment.  (2) Not later than 12 months after the effective date of this act, a health care corporation shall include coverage, in all group and nongroup certificates, to provide benefits for prosthetic devices to maintain or replace the body part of an individual who has undergone a mastectomy. This coverage shall provide that reasonable charges for medical care and attendance for an individual who receives reconstructive surgery following a mastectomy or who is fitted with a prosthetic device shall be covered benefits after the individual's attending physician has certified the medical necessity or desirability of a proposed course of rehabilitative treatment. The cost and fitting of a prosthetic device following a mastectomy is included within the type of coverage intended by this subsection. History: 1980, Act 350, Eff. Apr. 3, 1981 Constitutionality: This act is unconstitutional in the following three particulars:(1) The act's provision for an actuary panel to resolve risk factor disputes is an unconstitutional delegation of legislative authority in that it lacks adequate standards (MCL 550.1205(6)).(2) The statutory restrictions on administrative services only (ASO) contracts violate equal protection of the laws insofar as they result in arbitrary and discriminatory treatment of health care corporations vis-a-vis commercial insurers (MCL 550.1104(3), 550.1211, 550.1414a, 550.1415, and 550.1607(1)).(3) The commissioner's authority to issue a cease and desist order based on probable cause against a health care corporation for noncompliance with the act establishes an improper burden of proof (MCL 550.1402(7)).The Supreme Court ruling on these three areas of this act does not affect the constitutionality of the remainder of the act. Where, as here, the unconstitutional provisions are easily severable, the remainder of the act need not be affected. Blue Cross and Blue Shield of Michigan v Governor, 422 Mich 1; 367 NW2d 1 (1985).Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350
MI Comp L § 550.1416 (2021)
2021 Michigan Compiled Laws|Chapter 550 - General Insurance Laws|Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704)|350-1980-4 - Part 4 (550.1400...550.1439)|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.

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. Sec. 416.  (1) Subject to dollar limits, deductibles, and coinsurance provisions that are not less favorable than those for physical illness generally, a health care corporation shall offer or include, in each group and nongroup certificate, coverage for breast cancer diagnostic services, breast cancer outpatient treatment services, and breast cancer rehabilitative services.  (2) Subject to dollar limits, deductibles, and coinsurance provisions that are not less favorable than those for physical illness generally, a health care corporation shall offer or include, in each group and nongroup certificate, the following coverage for breast cancer screening mammography:  (a) If performed on a woman 35 years of age or older and under 40 years of age, coverage for 1 screening mammography examination during that 5-year period.  (b) If performed on a woman 40 years of age or older, coverage for 1 screening mammography examination every calendar year.  (3) As used in this section:  (a) "Breast cancer diagnostic services" means a procedure intended to aid in the diagnosis of breast cancer, delivered on an inpatient or outpatient basis, including but not limited to mammography, surgical breast biopsy, and pathologic examination and interpretation.  (b) "Breast cancer rehabilitative services" means a procedure intended to improve the result of, or ameliorate the debilitating consequences of, treatment of breast cancer, delivered on an inpatient or outpatient basis, including but not limited to, reconstructive plastic surgery, physical therapy, and psychological and social support services.  (c) "Breast cancer screening mammography" means a standard 2-view per breast, low-dose radiographic examination of the breasts, using equipment designed and dedicated specifically for mammography, in order to detect unsuspected breast cancer.  (d) "Breast cancer outpatient treatment services" means a procedure intended to treat cancer of the human breast, delivered on an outpatient basis, including but not limited to surgery, radiation therapy, chemotherapy, hormonal therapy, and related medical follow-up services.  (4) This section shall take effect November 1, 1989. History: Add. 1989, Act 57, Eff. Nov. 1, 1989 Popular Name: Blue Cross-Blue ShieldPopular Name: Act 350