reglab/housing_qa huggingface dataset:
MI Comp L § 500.3405a (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 500.3405a - Use of Most Favored Nation Clause.

500.3405a Use of most favored nation clause.Sec. 3405a.  (1) Notwithstanding any provision of this act to the contrary, this section applies to the use of a most favored nation clause in a provider contract on and after February 1, 2013.  (2) Subject to subsection (3), beginning February 1, 2013, an insurer or a health maintenance organization shall not use a most favored nation clause in any provider contract, including a provider contract in effect on February 1, 2013, unless the most favored nation clause has been filed with and approved by the director. Subject to subsection (3), beginning February 1, 2013, an insurer or a health maintenance organization shall not enforce a most favored nation clause in any provider contract without the prior approval of the director.  (3) Beginning January 1, 2014, an insurer or a health maintenance organization shall not use a most favored nation clause in any provider contract, including a provider contract in effect on January 1, 2014.  (4) As used in this section, "most favored nation clause" means a clause that does any of the following:  (a) Prohibits, or grants a contracting insurer or health maintenance organization an option to prohibit, a provider from contracting with another party to provide health care services at a lower rate than the payment or reimbursement rate specified in the contract with the insurer or health maintenance organization.  (b) Requires, or grants a contracting insurer or health maintenance organization an option to require, a provider to accept a lower payment or reimbursement rate if the provider agrees to provide health care services to any other party at a lower rate than the payment or reimbursement rate specified in the contract with the insurer or health maintenance organization.  (c) Requires, or grants a contracting insurer or health maintenance organization an option to require, termination or renegotiation of an existing provider contract if a provider agrees to provide health care services to any other party at a lower rate than the payment or reimbursement rate specified in the contract with the insurer or health maintenance organization.  (d) Requires a provider to disclose, to the insurer or health maintenance organization or the insurer's or health maintenance organization's designee, the provider's contractual payment or reimbursement rates with other parties.  (5) As used in this section, after December 31, 2016, "insurer" includes a nonprofit dental care corporation operating under 1963 PA 125, MCL 550.351 to 550.373. History: Add. 2013, Act 5, Imd. Eff. Mar. 18, 2013 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218
MI Comp L § 500.3406 (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 500.3406 - Disability Insurance Policy; Provisions Required, Captions, Omissions, Substitutions.

500.3406 Disability insurance policy; provisions required, captions, omissions, substitutions. Sec. 3406.  (1) Except as provided in subsection (2) of this section, each such policy delivered or issued for delivery to any person in this state shall contain the provisions specified in sections 3407 through 3424 in the words in which the same appear in such sections: Provided, however, That the insurer may, at its option, substitute for 1 or more of such provisions corresponding provisions of different wording approved by the commissioner which are in each instance not less favorable in any respect to the insured or the beneficiary. Such provisions shall be preceded individually by the caption appearing in the pertinent section or, at the option of the insurer, by such appropriate individual or group captions or subcaptions as the commissioner may approve.  (2) If any such provision is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy the insurer, with the approval of the commissioner, shall omit from such policy any inapplicable provision or part of a provision, and shall modify any inconsistent provision or part of the provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy. History: 1956, Act 218, Eff. Jan. 1, 1957 Popular Name: Act 218
MI Comp L § 500.3406a (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 500.3406a - Reconstructive Surgery Following Mastectomy; Prosthetic Device.

500.3406a Reconstructive surgery following mastectomy; prosthetic device.Sec. 3406a.  An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall offer benefits for prosthetic devices to maintain or replace the body parts of an individual who has undergone a mastectomy. This coverage must 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 are 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 required under this section. History: Add. 1982, Act 527, Eff. Mar. 30, 1983 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218
MI Comp L § 500.3406b (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 500.3406b - Coverage for Mental Health Services by Mental Health Care Provider.

500.3406b Coverage for mental health services by mental health care provider. Sec. 3406b.  A policy or certificate which provides coverage for mental health services shall provide coverage for mental health services provided to an individual by a mental health care provider operated by or under contract with the department of mental health or a county community mental health board in those instances when appropriate mental health services cannot be delivered otherwise, or if the provider of the mental health services is designated by an order of a court; provided that the mental health provider meets the standards set by the insurer for all other providers of the type. History: Add. 1984, Act 280, Imd. Eff. Dec. 20, 1984 Popular Name: Act 218
MI Comp L § 500.3406c (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 500.3406c - Hospice Care; Definition; Description of Coverage.

500.3406c Hospice care; definition; description of coverage.Sec. 3406c.  (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for inpatient hospital care shall offer to include coverage for hospice care. As used in this section, "hospice" means a health care program that provides a coordinated set of services rendered at home or in outpatient or institutional settings for individuals suffering from a disease or condition with a terminal prognosis.  (2) If hospice care coverage is provided, an insurer shall include a description of the hospice coverage in communications sent to the insured. History: Add. 1984, Act 368, Eff. Jan. 1, 1986 ;-- Am. 1994, Act 233, Imd. Eff. June. 30, 1994 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218
MI Comp L § 500.3406d (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 500.3406d - Coverage for Breast Cancer Diagnostic Services, Breast Cancer Outpatient Treatment Services, and Breast Cancer Rehabilitative Services; Coverage for Breast Cancer Screening Mammography; Definitions.

500.3406d Coverage for breast cancer diagnostic services, breast cancer outpatient treatment services, and breast cancer rehabilitative services; coverage for breast cancer screening mammography; definitions.Sec. 3406d.  (1) Subject to dollar limits, deductibles, and coinsurance provisions that are not less favorable than those for physical illness generally, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall offer or include 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, an insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall offer or include 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. History: Add. 1989, Act 59, Eff. Nov. 1, 1989 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218
MI Comp L § 500.3406e (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 500.3406e - Coverage for Drug Used in Antineoplastic Therapy and Cost of Its Administration; Conditions.

500.3406e Coverage for drug used in antineoplastic therapy and cost of its administration; conditions.Sec. 3406e.  An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall provide coverage in each policy for a drug used in antineoplastic therapy and the reasonable cost of its administration. Coverage must be provided for any United States Food and Drug Administration approved drug regardless of whether the specific neoplasm for which the drug is being used as treatment is the specific neoplasm for which the drug has received approval by the United States Food and Drug Administration if all of the following conditions are met:  (a) The drug is ordered by a physician for the treatment of a specific type of neoplasm.  (b) The drug is approved by the United States Food and Drug Administration for use in antineoplastic therapy.  (c) The drug is used as part of an antineoplastic drug regimen.  (d) Current medical literature substantiates its efficacy and recognized oncology organizations generally accept the treatment.  (e) The physician has obtained informed consent from the patient for the treatment regimen that includes United States Food and Drug Administration approved drugs for off-label indications. History: Add. 1989, Act 59, Imd. Eff. June 16, 1989 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218
MI Comp L § 500.3406f (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 500.3406f - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

500.3406f Repealed. 2016, Act 276, Imd. Eff. July 1, 2016. Compiler's Notes: The repealed section pertained to excluded or limited coverage and examination of issue of crediting prior continuous health care coverage.Popular Name: Act 218
MI Comp L § 500.3406g (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 500.3406g - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

500.3406g Repealed. 2016, Act 276, Imd. Eff. July 1, 2016. Compiler's Notes: The repealed section pertained to prohibition against denying coverage to dependent child under certain conditions.Popular Name: Act 218
MI Comp L § 500.3406h (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 500.3406h - Eligibility of Parent for Dependent Coverage; Health Coverage of Child Through Noncustodial Parent; Duties of Insurer; Court or Administrative Order and Notice Required.

500.3406h Eligibility of parent for dependent coverage; health coverage of child through noncustodial parent; duties of insurer; court or administrative order and notice required. Sec. 3406h.  (1) If a parent is eligible for dependent coverage through an insurer, the insurer shall:  (a) Permit the parent to enroll, under the dependent coverage, a child who is otherwise eligible for coverage without regard to any enrollment season restrictions.  (b) If the parent is enrolled but fails to make application to obtain coverage for the child, enroll the child under dependent coverage upon application by the friend of the court or by the child's other parent through the friend of the court.   (c) Not eliminate the child's coverage unless premiums have not been paid as required by the policy or certificate or the insurer is provided with satisfactory written evidence of either of the following:  (i) The court or administrative order is no longer in effect.  (ii) The child is or will be enrolled in comparable health coverage through another insurer, health care corporation, health maintenance organization, or self-funded health coverage plan that will take effect not later than the effective date of the cancellation of the existing coverage.   (2) If a child has health coverage through an insurer of a noncustodial parent, that insurer shall do all of the following:  (a) Provide the custodial parent with information necessary for the child to obtain benefits through that coverage.  (b) Permit the custodial parent or, with the custodial parent's approval, the provider to submit a claim for covered services without the noncustodial parent's approval.   (c) Make payment on claims submitted under subdivision (b) directly to the custodial parent or medical provider.  (3) This section applies only if a parent is required by a court or administrative order to provide health coverage for a child and the insurer is notified of that court or administrative order. History: Add. 1995, Act 237, Eff. Mar. 28, 1996 Popular Name: Act 218
MI Comp L § 500.3406i (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 500.3406i - Individual Eligible Under Title XIX of Social Security Act; Assignment of Rights of Insured to Department of Social Services.

500.3406i Individual eligible under title XIX of social security act; assignment of rights of insured to department of social services. Sec. 3406i.  (1) An insurer shall not consider whether an individual is eligible for or has available medical assistance under title XIX of the social security act, chapter 531, 49 Stat. 620, 42 U.S.C. 1396 to 1396g and 1396i to 1396v, in this or another state when considering eligibility for coverage or making payments under its plan for eligible insureds.  (2) If an insurer has a legal liability to make payments, and payment for covered expenses for medical goods or services furnished to an individual has been made under the medical assistance program established under section 105 of the social welfare act, Act No. 280 of the Public Acts of 1939, being section 400.105 of the Michigan Compiled Laws, the department of social services has the rights of the individual to payment by the insurer to the extent payment was made by the department of social services's medical assistance program for those medical goods or services.  (3) If the department of social services has been assigned the rights of an insured who is eligible for medical assistance under section 105 of Act No. 280 of the Public Acts of 1939 and is covered by an insurer, the insurer shall not impose requirements on the department of social services that are different from requirements that apply to an agent or assignee of any other covered insured. History: Add. 1995, Act 237, Eff. Mar. 28, 1996 Popular Name: Act 218
MI Comp L § 500.3406j (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 500.3406j - Insured or Applicant as Victim of Domestic Violence; Refusal to Provide Coverage Prohibited; Liability; "Domestic Violence" Defined.

500.3406j Insured or applicant as victim of domestic violence; refusal to provide coverage prohibited; liability; "domestic violence" defined.Sec. 3406j.  (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall not rate, cancel coverage on, refuse to provide coverage for, or refuse to issue or renew a health insurance policy solely because an insured or applicant for insurance is or has been a victim of domestic violence.   (2) An insurer is not civilly liable for any cause of action that may result from compliance with this section.  (3) As used in this section, "domestic violence" means inflicting bodily injury on, causing serious emotional injury or psychological trauma to, or placing in fear of imminent physical harm by threat or force a person who is a spouse or former spouse of, has or has had a dating relationship with, resides or has resided with, or has a child in common with the person committing the violence. History: Add. 1998, Act 136, Imd. Eff. June 24, 1998 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218
MI Comp L § 500.3406k (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 500.3406k - Emergency Health Services; Medically Necessary Coverage; "Stabilization" Defined.

500.3406k Emergency health services; medically necessary coverage; "stabilization" defined.Sec. 3406k.  (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for emergency health services shall provide coverage for medically necessary services provided to an insured for the sudden onset of a medical condition that manifests itself by signs and symptoms of sufficient severity, including severe pain, such that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in serious jeopardy to the individual's health or to a pregnancy in the case of a pregnant woman, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. An insurer shall not require a physician to transfer a patient before the physician determines that the patient has reached the point of stabilization. An insurer shall not deny payment for emergency health services up to the point of stabilization provided to an insured under this subsection because of either of the following:  (a) The final diagnosis.  (b) Prior authorization not being given by the insurer before emergency health services were provided.  (2) As used in this section, "stabilization" means the point at which no material deterioration of a condition is likely, within reasonable medical probability, to result from or occur during transfer of the patient. History: Add. 1998, Act 125, Imd. Eff. June 10, 1998 ;-- Am. 2004, Act 7, Imd. Eff. Feb. 20, 2004 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218
MI Comp L § 500.3406l (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 500.3406l - Medical Transportation Services; Reimbursement; Exception.

500.3406l Medical transportation services; reimbursement; exception.Sec. 3406l.  (1) Except as otherwise provided in subsections (2) and (3), an insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides benefits for emergency services shall provide for direct reimbursement to any provider of covered medical transportation services or shall provide that payment be made jointly to the insured and the provider, if the provider has not received payment for those services from any other source.  (2) Subsection (1) does not apply to a transaction between an insurer and a medical transportation service provider if the parties have entered into a contract providing for direct payment.  (3) An insurer for a policy issued under section 3405 does not have to provide for direct reimbursement to any nonaffiliated or nonparticipating provider for medical transportation services that were not emergency health services as described in section 3406k.  (4) This section does not apply to a health maintenance organization contract. History: Add. 2004, Act 171, Imd. Eff. June 24, 2004 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218