reglab/statecodes huggingface dataset:
2023 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 550.1401b - Certificate Providing Benefits for Mental Health Services; Requirements.

550.1401b Certificate providing benefits for mental health services; requirements.
Sec. 401b.
A certificate issued by a corporation which provides benefits for mental health services shall provide benefits 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 corporation for all other providers of the type.
History:
Add. 1984, Act 230, Eff. Dec. 20, 1984
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1401f - Health Care Corporation; Access to Obstetrician-Gynecologist.

550.1401f Health care corporation; access to obstetrician-gynecologist.
Sec. 401f.
(1) A health care corporation certificate that requires a member to designate a participating primary care provider and provides for annual well-woman examinations and routine obstetrical and gynecologic services shall permit a female member to access an obstetrician-gynecologist for annual well-woman examinations and routine obstetrical and gynecologic services.
(2) A health care corporation shall not require prior authorization or referral for access under subsection (1) to an obstetrician-gynecologist who participates with the health care corporation. A health care corporation may require prior authorization or referral for access to a nonparticipating obstetrician-gynecologist.
(3) A description of the benefit provided by this section shall be included by the health care corporation in a communication sent to the individual or group purchaser of coverage.
History:
Add. 1998, Act 412, Eff. Mar. 23, 1999
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1401g - Health Care Corporation; Access to Pediatric Care Services.

550.1401g Health care corporation; access to pediatric care services.
Sec. 401g.
(1) A health care corporation certificate that requires a member to designate a participating primary care provider and provides for dependent care coverage shall permit a dependent minor member to select and access a pediatrician for general pediatric care services.
(2) A health care corporation shall not require prior authorization or referral for access under subsection (1) to a pediatrician who participates with the health care corporation. A health care corporation may require prior authorization or referral for access to a nonparticipating pediatrician.
History:
Add. 1999, Act 178, Imd. Eff. Nov. 16, 1999
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1401h - Health Care Corporation Providing Prescription Drug Coverage; Formulary Restrictions.

550.1401h Health care corporation providing prescription drug coverage; formulary restrictions.
Sec. 401h.
A health care corporation that provides coverage for prescription drugs and limits those benefits to drugs included in a formulary shall do all of the following:
(a) Provide for participation of participating physicians, dentists, and pharmacists in the development of the formulary.
(b) Disclose to health care providers and upon request to members the nature of the formulary restrictions.
(c) Provide for exceptions from the formulary limitation when a nonformulary alternative is a medically necessary and appropriate alternative. This subdivision does not prevent a health care corporation from establishing prior authorization requirements or another process for consideration of coverage or higher cost-sharing for nonformulary alternatives. Notice as to whether or not an exception under this subdivision has been granted shall be given by the health care corporation within 24 hours after receiving all information necessary to determine whether the exception should be granted.
History:
Add. 1999, Act 175, Imd. Eff. Nov. 16, 1999
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1401j - Prescription Drug Coverage; Rate Differentials; Filing.

550.1401j Prescription drug coverage; rate differentials; filing.
Sec. 401j.
The rates charged to nongroup and group conversion subscribers for a certificate that includes prescription drug coverage pursuant to section 401i may include rate differentials based on age, with not more than 8 separate age bands. The health care corporation shall file its rates for the prescription drug coverage in this section in the same manner and under the same requirements as provided in section 607.
History:
Add. 2003, Act 59, Eff. July 23, 2003
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1401k - Telemedicine Services; Provisions; Definition; Applicability.

550.1401k Telemedicine services; provisions; definition; applicability.
Sec. 401k.
(1) A group or nongroup health care corporation certificate must not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the health care corporation. Telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the patient is located. Telemedicine services are subject to all terms and conditions of the certificate agreed upon between the certificate holder and the health care corporation, including, but not limited to, required copayments, coinsurances, deductibles, and approved amounts.
(2) As used in this section, "telemedicine" means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a health insurance portability and accountability act of 1996, Public Law 104-91 compliant, secure interactive audio or video, or both, telecommunications system, or through the use of store and forward online messaging.
(3) This section applies to a certificate issued or renewed after December 31, 2012.
History:
Add. 2012, Act 214, Imd. Eff. June 28, 2012 ;-- Am. 2020, Act 98, Imd. Eff. June 24, 2020
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1401m - Offer of Health Care Benefits to All Residents Regardless of Health Status.

550.1401m Offer of health care benefits to all residents regardless of health status.
Sec. 401m.
Until January 1, 2014, a health care corporation established, maintained, or operating in this state shall offer health care benefits to all residents of this state regardless of health status.
History:
Add. 2013, Act 4, Imd. Eff. Mar. 18, 2013
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1402b - Preexisting Condition Limitation or Exclusion; Prohibition; Exception; “Group” Defined.

550.1402b Preexisting condition limitation or exclusion; prohibition; exception; “group” defined.
Sec. 402b.
(1) For an individual covered under a nongroup certificate or under a certificate not covered under subsection (2), a health care corporation may exclude or limit coverage for a condition only if the exclusion or limitation relates to a condition for which medical advice, diagnosis, care, or treatment was recommended or received within 6 months before enrollment and the exclusion or limitation does not extend for more than 6 months after the effective date of the certificate.
(2) A health care corporation shall not exclude or limit coverage for a preexisting condition for an individual covered under a group certificate.
(3) Notwithstanding subsection (1), a health care corporation shall not issue a certificate to a person eligible for nongroup coverage or eligible for a certificate not covered under subsection (2) that excludes or limits coverage for a preexisting condition or provides a waiting period if all of the following apply:
(a) The person's most recent health coverage prior to applying for coverage with the health care corporation was under a group health plan.
(b) The person was continuously covered prior to the application for coverage with the health care corporation under 1 or more health plans for an aggregate of at least 18 months with no break in coverage that exceeded 62 days.
(c) The person is no longer eligible for group coverage and is not eligible for medicare or medicaid.
(d) The person did not lose eligibility for coverage for failure to pay any required contribution or for an act to defraud a health care corporation, a health insurer, or a health maintenance organization.
(e) If the person was eligible for continuation of health coverage from that group health plan pursuant to the consolidated omnibus budget reconciliation act of 1985, Public Law 99-272, 100 Stat. 82, he or she has elected and exhausted that coverage.
(4) As used in this section, "group" means a group of 2 or more subscribers.
History:
Add. 1996, Act 516, Eff. Oct. 1, 1997 ;-- Am. 1999, Act 7, Imd. Eff. Mar. 9. 1999
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1402d - Applicability of MCL 500.2212c to Health Care Corporation.

550.1402d Applicability of MCL 500.2212c to health care corporation.
Sec. 402d.
Section 2212c of the insurance code of 1956, 1956 PA 218, MCL 500.2212c, applies to a health care corporation.
History:
Add. 2013, Act 31, Eff. Mar. 14, 2014
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 Shield
Popular Name:
Act 350
2023 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 550.1416a - Coverage for Drug Used in Antineoplastic Therapy and Cost of Its Administration; Conditions.

550.1416a Coverage for drug used in antineoplastic therapy and cost of its administration; conditions.
Sec. 416a.
A health care corporation shall provide coverage in each group and nongroup certificate for a federal food and drug administration approved drug used in antineoplastic therapy and the reasonable cost of its administration. Coverage shall be provided 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 federal 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 federal 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 which includes federal food and drug administration approved drugs for off-label indications.
History:
Add. 1989, Act 57, Imd. Eff. June 16, 1989
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1416d - Coverage for Obstetrical and Gynecological Services by Physician or Nurse Midwife.

550.1416d Coverage for obstetrical and gynecological services by physician or nurse midwife.
Sec. 416d.
(1) As used in this section, "nurse midwife" means an individual licensed as a registered professional nurse under article 15 of the public health code, 1978 PA 368, MCL 333.16101 to 333.18838, who has been issued a specialty certification in the practice of nurse midwifery by the Michigan board of nursing under section 17210 of the public health code, 1978 PA 368, MCL 333.17210.
(2) Effective March 1, 2005, a group or nongroup certificate that provides coverage for obstetrical and gynecological services shall include coverage for obstetrical and gynecological services whether performed by a physician or a nurse midwife acting within the scope of his or her license or specialty certification or shall do 1 or both of the following:
(a) Offer to provide coverage for obstetrical and gynecological services whether performed by a physician or a nurse midwife acting within the scope of his or her license or specialty certification.
(b) Offer to provide coverage for maternity services and gynecological services rendered during pre- and post-natal care whether performed by a physician or a nurse midwife acting within the scope of his or her license or specialty certification.
History:
Add. 2004, Act 374, Imd. Eff. Oct. 11, 2004
2023 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 550.1417 - Hospice Care; Contracts With Health Care Corporation; Description of Benefit.

550.1417 Hospice care; contracts with health care corporation; description of benefit.
Sec. 417.
(1) A health care corporation shall offer to include benefits for hospice care in each certificate that provides benefits for inpatient hospital care.
(2) A health care corporation may enter into contracts with health care providers for the rendering of hospice care. A contracting health care provider shall be a licensed hospice under article 17 of the public health code, Act No. 368 of the Public Acts of 1978, being sections 333.20101 to 333.22260 of the Michigan Compiled Laws, and shall meet the standards set by the corporation for contracting health care providers.
(3) If benefits for hospice care are provided, a description of the hospice benefit shall be included in communications sent to the individual or group purchaser of coverage.
History:
Add. 1984, Act 369, Eff. Jan. 1, 1986 ;-- Am. 1994, Act 235, Imd. Eff. June 30, 1994
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1418 - Emergency Health Services; Medical Coverage Required; “Stabilization” Defined.

550.1418 Emergency health services; medical coverage required; “stabilization” defined.
Sec. 418.
(1) A health care corporation certificate that provides coverage for emergency health services shall provide coverage for medically necessary services provided to a member for the sudden onset of a medical condition that manifests itself by signs and symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected 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. A health care corporation shall not require a physician to transfer a patient before the physician determines that the patient has reached the point of stabilization. A health care corporation shall not deny payment for emergency health services up to the point of stabilization provided to a member under this subsection because of either of the following:
(a) The final diagnosis.
(b) Prior authorization was not given by the health care corporation 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 124, Imd. Eff. June 10, 1998 ;-- Am. 2004, Act 8, Imd. Eff. Feb. 20, 2004
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1419 - Certificate Offering Dependent Coverage to Child; Denial of Enrollment on Certain Grounds Prohibited.

550.1419 Certificate offering dependent coverage to child; denial of enrollment on certain grounds prohibited.
Sec. 419.
A health care corporation certificate that offers dependent coverage shall not deny enrollment to a subscriber's child on any of the following grounds:
(a) The child was born out of wedlock.
(b) The child is not claimed as a dependent on the subscriber's federal income tax return.
(c) The child does not reside with the subscriber or in the health care corporation's service area.
History:
Add. 1995, Act 238, Eff. Mar. 28, 1996
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1419a - Eligibility of Parent for Dependent Coverage; Health Coverage of Child Through Noncustodial Parent; Court or Administrative Order and Notice Required.

550.1419a Eligibility of parent for dependent coverage; health coverage of child through noncustodial parent; court or administrative order and notice required.
Sec. 419a.
(1) If a parent is eligible for dependent coverage through a health care corporation, the health care corporation 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 certificate or the health care corporation 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 health care corporation, insurer, 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 a health care corporation of a noncustodial parent, that health care corporation 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) If applicable, reimburse or make payment on claims submitted by the custodial parent or medical provider for services obtained or provided under subdivision (b).
(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 health care corporation is notified of that court or administrative order.
History:
Add. 1995, Act 238, Eff. Mar. 28, 1996
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1419b - Individual Eligible Under Title XIX of Social Security Act; Assignment of Rights of Subscriber to Department of Social Services.

550.1419b Individual eligible under title XIX of social security act; assignment of rights of subscriber to department of social services.
Sec. 419b.
(1) A health care corporation 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 subscribers.
(2) If a health care corporation 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 health care corporation 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 a subscriber who is eligible for medical assistance under section 105 of Act No. 280 of the Public Acts of 1939 and is covered by a health care corporation, the health care corporation 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 subscriber.
History:
Add. 1995, Act 238, Eff. Mar. 28, 1996
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350
2023 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 550.1420-550.1430 - Repealed. 2006, Act 441, Imd. Eff. Oct. 19, 2006.

550.1420-550.1430 Repealed. 2006, Act 441, Imd. Eff. Oct. 19, 2006.
Compiler's Notes:
The repealed sections pertained to individual and group long-term care coverage.
Popular Name:
Act 218
2023 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 550.1435 - “Program” Defined.

550.1435 “Program” defined.
Sec. 435.
As used in sections 436 to 439, "program" means the Michigan caring program created in section 436.
History:
Add. 1991, Act 60, Imd. Eff. June 27, 1991
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350