reglab/housing_qa huggingface dataset:
MI Comp L § 500.3509 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3509 - Certificate of Authority; Application; Form; Limitation; Change of Service Area.

500.3509 Certificate of authority; application; form; limitation; change of service area.Sec. 3509.  (1) An application to the director for a certificate of authority must be on a form prescribed and provided by the director.  (2) A certificate of authority issued to a health maintenance organization under this act is limited to the service area described in the application on which the certificate of authority was issued. Approved parts of a health maintenance organization's service area are not required to be contiguous.  (3) A health maintenance organization seeking to change the approved service area shall submit an application to change service area to the director and shall not change the service area until approval is received. The director shall specify the information required to be in the application under this subsection. History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3511 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3511 - Governing Body; Election of Enrollee Board Members; Requirements; Meetings.

500.3511 Governing body; election of enrollee board members; requirements; meetings.Sec. 3511.  (1) A health maintenance organization's governing body must include no less than 1 individual who represents the health maintenance organization's membership.  (2) A health maintenance organization that is under a contract with this state to provide medical services authorized under subchapter XIX or XXI of the social security act, 42 USC 1396 to 1396w-5 and 1397aa to 1397mm, shall comply with either of the following requirements:  (a) A minimum of 1/3 of its governing body must be representatives of its membership consisting of enrollees of the organization who are not compensated officers, employees, or other individuals responsible for the conduct of, or financially interested in, the organization's affairs.   (b) The health maintenance organization must establish a consumer advisory council that reports to the governing body. The consumer advisory council must include at least 1 enrollee, 1 family member or legal guardian of an enrollee, and 1 consumer advocate.  (3) A health maintenance organization's governing body shall meet at least quarterly unless specifically exempted from this requirement by the director. History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3513 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3513 - Health Maintenance Organization Operations; Regulation by Director; Incorporation as Legal Entity.

500.3513 Health maintenance organization operations; regulation by director; incorporation as legal entity.Sec. 3513.  (1) The director shall regulate health delivery aspects of health maintenance organization operations to ensure that health maintenance organizations are capable of providing care and services promptly, appropriately, and in a manner that ensures continuity and acceptable quality of health care. The director shall encourage health maintenance organizations to use a wide variety of health-related disciplines and facilities and to develop services that contribute to the prevention of disease and disability and the restoration of health.  (2) The director shall ensure that health maintenance organizations operate in the interest of enrollees consistent with overall health care cost containment while delivering acceptable quality of care and services that are available and accessible to enrollees with appropriate administrative costs and health care provider incentives. A health maintenance organization shall do all of the following:  (a) Provide, as promptly as appropriate, health services in a manner that ensures continuity and imparts quality health care under conditions the director considers to be in the public interest.  (b) Provide health services within its service area that are available and accessible to enrollees 24 hours a day and 7 days a week for the treatment of emergency episodes of illness or injury.  (c) Provide that reasonable provisions exist for an enrollee to obtain emergency health services both within and outside of its service area.  (3) A health maintenance organization must be incorporated as a distinct legal entity under the business corporation act, 1972 PA 284, MCL 450.1101 to 450.2098, the nonprofit corporation act, 1982 PA 162, MCL 450.2101 to 450.3192, or the Michigan limited liability company act, 1993 PA 23, MCL 450.4101 to 450.5200. History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3515 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3515 - Additional Health Services; Deductibles; Copayments; "Preventive Health Care Services" Defined; Partial Payment From Government or Private Person.

500.3515 Additional health services; deductibles; copayments; "preventive health care services" defined; partial payment from government or private person.Sec. 3515.  (1) A health maintenance organization may provide additional health services or any other related health care service or treatment not required under this act.  (2) A health maintenance organization may have health maintenance contracts with deductibles. A health maintenance organization may have health maintenance contracts that include copayments, stated as dollar amounts for the cost of covered services, and coinsurance, stated as percentages for the cost of covered services. This subsection does not limit the director's authority to regulate and establish fair, sound, and reasonable copayment and coinsurance limits including out of pocket maximums.  (3) A health maintenance organization shall not require that contributions be made to a deductible for preventive health care services. As used in this subsection, "preventive health care services" means services designated to maintain an individual in optimum health and to prevent unnecessary injury, illness, or disability.  (4) A health maintenance organization may accept from governmental agencies and from private persons payments covering any part of the cost of health maintenance contracts. History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 ;-- Am. 2002, Act 304, Imd. Eff. May 10, 2002 ;-- Am. 2002, Act 621, Imd. Eff. Dec. 23, 2002 ;-- Am. 2005, Act 306, Imd. Eff. Dec. 21, 2005 ;-- Am. 2016, Act 97, Eff. Aug. 1, 2016 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3517 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3517 - Healthy Lifestyle Programs; Emergency or Out-of-Area Service; Payment of Expenses or Fees.

500.3517 Healthy lifestyle programs; emergency or out-of-area service; payment of expenses or fees.Sec. 3517.  (1) A health maintenance contract shall not provide for payment of cash or other material benefit to an enrollee other than as permitted under the law of this state or as approved by the director under section 2236.  (2) Subsection (1) does not prohibit a health maintenance organization from promoting optimum health by offering to all currently enrolled subscribers or to all currently covered enrollees 1 or more healthy lifestyle programs. As used in this subsection, "healthy lifestyle program" means a program recognized by a health maintenance organization that enhances health, educates enrollees on health-related matters, or reduces risk of disease, including, but not limited to, promoting nutrition and physical exercise and compliance with disease management programs and preventive service guidelines that are supported by evidence-based medical practice. A healthy lifestyle program may include other requirements in addition to those that enhance health, educate enrollees on health-related matters, or reduce risk of disease if the healthy lifestyle program, taken as a whole, meets the intent of this subsection. Subsection (1) does not prohibit a health maintenance organization from offering a currently enrolled subscriber or currently covered enrollee goods, vouchers, or equipment that supports achieving optimal health goals. An offering of goods, vouchers, or equipment under this subsection is not a violation of subsection (1) and is not valuable consideration, a material benefit, a gift, a rebate, or an inducement under this act.  (3) For an emergency episode of illness or injury that requires immediate treatment before it can be secured through the health maintenance organization, or for an out-of-area service specifically authorized by the health maintenance organization, an enrollee may use a provider in or outside of this state not normally engaged by the health maintenance organization to render service to its enrollees. The health maintenance organization shall pay reasonable expenses or fees to the provider or enrollee as appropriate in an individual case. These transactions are not acts of insurance and, except as provided in this chapter and section 3406k, are not otherwise subject to this act. History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 ;-- Am. 2005, Act 306, Imd. Eff. Dec. 21, 2005 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3519 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3519 - Contract and Contract Rates; Fairness; Rate Differential; Basic Health Services to Large Employers Required.

500.3519 Contract and contract rates; fairness; rate differential; basic health services to large employers required.Sec. 3519.  (1) A health maintenance organization contract and the contract's rates, including any deductibles, copayments, and coinsurances, between the organization and its subscribers must be fair, sound, and reasonable in relation to the services provided, and the procedures for offering and terminating contracts must not be unfairly discriminatory.  (2) A health maintenance organization contract and the contract's rates must not discriminate on the basis of race, color, creed, national origin, residence within the approved service area of the health maintenance organization, lawful occupation, sex, handicap, or marital status, except that marital status may be used to classify individuals or risks for the purpose of insuring family units. The director may approve a rate differential based on sex, age, residence, disability, marital status, or lawful occupation, if the differential is supported by sound actuarial principles, a reasonable classification system, and is related to the actual and credible loss statistics or reasonably anticipated experience for new coverages. A healthy lifestyle program as defined in section 3517(2) is not subject to the director's approval under this subsection and is not required to be supported by sound actuarial principles, a reasonable classification system, or be related to actual and credible loss statistics or reasonably anticipated experience for new coverages.  (3) A health maintenance organization contract shall offer basic health services to large employers in at least 1 health maintenance contract. History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 ;-- Am. 2002, Act 304, Imd. Eff. May 10, 2002 ;-- Am. 2002, Act 621, Imd. Eff. Dec. 23, 2002 ;-- Am. 2005, Act 306, Imd. Eff. Dec. 21, 2005 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3521 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3521 - Prepayment Rates; Filing and Approval of Methodology; Schedule.

500.3521 Prepayment rates; filing and approval of methodology; schedule. Sec. 3521.  (1) The methodology used to determine prepayment rates by category rates charged by the health maintenance organization and any changes to either the methodology or the rates shall be filed with and approved by the commissioner before becoming effective.  (2) A health maintenance organization shall submit supporting data used in the development of a prepayment rate or rating methodology and all other data sufficient to establish the financial soundness of the prepayment plan or rating methodology.  (3) The commissioner may annually require a schedule of rates for all subscriber contracts and riders. All submissions shall note changes of rates previously filed or approved. History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3523 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3523 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

500.3523 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016. Compiler's Notes: The repealed section pertained to provisions included in health maintenance contract.Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3527 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3527 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

500.3527 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016. Compiler's Notes: The repealed section pertained to performance of obligations under health maintenance contract.Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3528 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3528 - Health Maintenance Organization; Credentialing Verification; Accreditation by Nationally Recognized Accredited Body.

500.3528 Health maintenance organization; credentialing verification; accreditation by nationally recognized accredited body.Sec. 3528.  (1) A health maintenance organization shall establish written policies and procedures for credentialing verification of all health professionals with whom the health maintenance organization contracts. A health maintenance organization shall apply these standards consistently. This act does not require a health maintenance organization to select a provider as an affiliated provider solely because the provider meets the health maintenance organization's credentialing verification standards. This act does not prevent a health maintenance organization from using separate or additional criteria in selecting the health professionals with whom it contracts.  (2) A health maintenance organization is considered to meet the requirements of this section if the health maintenance organization is accredited by a nationally recognized accredited body approved by the director. As used in this subsection, "nationally recognized accredited body" includes the National Committee for Quality Assurance. History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 ;-- Am. 2002, Act 621, Imd. Eff. Dec. 23, 2002 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3530 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3530 - Availability of Covered Services; Assurance; Establishment and Maintenance of Proximity.

500.3530 Availability of covered services; assurance; establishment and maintenance of proximity. Sec. 3530.  (1) A health maintenance organization shall maintain contracts with those numbers and those types of affiliated providers that are sufficient to assure that covered services are available to its enrollees without unreasonable delay. The commissioner shall determine what is sufficient as provided in this section and as may be established by reference to reasonable criteria used by the health maintenance organization, including, but not limited to, provider-covered person ratios by specialty, primary care provider-covered person ratios, geographic accessibility, waiting times for appointments with participating providers, hours of operation, and the volume of technological and specialty services available to serve the needs of enrollees requiring technologically advanced or specialty care.  (2) If a health maintenance organization has an insufficient number or type of participating providers to provide a covered benefit, the health maintenance organization shall ensure that the enrollee obtains the covered benefit at no greater cost to the enrollee than if the benefit were obtained from participating providers, or shall make other arrangements acceptable to the commissioner.  (3) A health maintenance organization shall establish and maintain adequate arrangements to ensure reasonable proximity of participating providers to the business or personal residence of enrollees. In determining whether a health maintenance organization has complied with this provision, the commissioner shall give due consideration to the relative availability of health care providers in the service area. History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3533 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3533 - Prudent Purchaser Contracts; Reimbursement for Unauthorized Services or Services by Nonaffiliated Providers.

500.3533 Prudent purchaser contracts; reimbursement for unauthorized services or services by nonaffiliated providers.Sec. 3533.  Subject to section 3405, a health maintenance organization may offer prudent purchaser contracts to groups or individuals and in conjunction with those contracts a health maintenance organization may pay or may reimburse enrollees, or may contract with another person to pay or reimburse enrollees, for unauthorized services or for services by nonaffiliated providers in accordance with the terms of the contract and subject to copayments, coinsurances, deductibles, or other financial penalties designed to encourage enrollees to obtain services from affiliated providers. History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 ;-- Am. 2005, Act 306, Imd. Eff. Dec. 21, 2005 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3535 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3535 - Solicitation or Advertising.

500.3535 Solicitation or advertising.Sec. 3535.  Solicitation of enrollees or advertising of the services, charges, or other nonprofessional aspects of the health maintenance organization's operation under this section is not in violation of laws relating to solicitation or advertising by health professionals. A health maintenance organization shall not, in its solicitation or advertising allowed under this section, include advertising that makes a qualitative judgment as to a health professional who provides services for the health maintenance organization. A health maintenance organization shall not, in its solicitation or advertising allowed under this section, offer a material benefit or other thing of value as an inducement to prospective subscribers other than the services of the health maintenance organization. History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3537 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3537 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

500.3537 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016. Compiler's Notes: The repealed section pertained to open enrollment period for health maintenance organizations.Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3539 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3539 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

500.3539 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016. Compiler's Notes: The repealed section pertained to exclusions and limitations contained in nongroup contract and renewal requirements.Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3541 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3541 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

500.3541 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016. Compiler's Notes: The repealed section pertained to health professional advocating on behalf of enrollee.Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3542 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3542 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

500.3542 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016. Compiler's Notes: The repealed section pertained to prohibition against use of financial inducement or payment to health professional.Popular Name: Act 218Popular Name: HMO
MI Comp L § 500.3543 (2021)
2021 Michigan Compiled Laws|Chapter 500 - Insurance Code of 1956|Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)|218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)|Section 500.3543 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

500.3543 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016. Compiler's Notes: The repealed section pertained to owning or investing in third party administrator.Popular Name: Act 218Popular Name: HMO