reglab/statecodes huggingface dataset:
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.919 - Tpa Advisory Board; Creation; Appointment, Qualifications, and Terms of Members; Expenses; Duty of Board; Report.

550.919 TPA advisory board; creation; appointment, qualifications, and terms of members; expenses; duty of board; report.
Sec. 19.
(1) A TPA advisory board is created. The board shall consist of 7 members appointed by the commissioner, at least 4 of whom shall be individuals employed by TPAs who are not in the employ of a carrier and who do not have a significant ownership interest in a carrier. The members of the board shall serve 3-year terms and shall serve without compensation but shall be reimbursed for their actual and necessary expenses incurred in the performance of their duties. The board shall advise the commissioner as to the operations of this act, including:
(a) The procedure for granting licenses and certificates.
(b) The subject areas for the written examination for managers.
(c) The implementation of this act.
(d) Making recommendations to the commissioner for guidelines for the implementation of sections 40 to 44.
(e) Making recommendations to the commissioner regarding the regulatory standards for excess loss insurance required by section 32(4).
(2) The board shall issue a report to the commissioner on the operations of this act not later than 3 years after the effective date of this act.
History:
1984, Act 218, Eff. Jan. 1, 1985
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.920 - Authority of Commissioner.

550.920 Authority of commissioner.
Sec. 20.
The commissioner shall have the same authority with respect to a TPA or manager as he or she does with respect to an insurance agency or agent under the insurance code of 1956, Act No. 218 of the Public Acts of 1956, being sections 500.100 to 500.8302 of the Michigan Compiled Laws, including but not limited to the rights of examination, suspension, revocation, and limitation of authority, and liquidations and receiverships.
History:
1984, Act 218, Eff. Jan. 1, 1985
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.922 - Hearings.

550.922 Hearings.
Sec. 22.
The commissioner may designate 1 or more persons to conduct hearings provided for under this act, hearings required by the administrative procedures act of 1969, Act No. 306 of the Public Acts of 1969, being sections 24.201 to 24.315 of the Michigan Compiled Laws, and hearings which the commissioner considers necessary and appropriate for fact-finding or information gathering before making decisions, policies, and determinations allowable or required by law in the course of carrying out the duties of the commissioner. Hearings under this act shall be conducted in the same manner as hearings conducted under the insurance code of 1956, Act No. 218 of the Public Acts of 1956, being sections 500.100 to 500.8302 of the Michigan Compiled Laws.
History:
1984, Act 218, Eff. Jan. 1, 1985
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.924 - Destruction or Disposal of Records, Books, Papers, and Other Data.

550.924 Destruction or disposal of records, books, papers, and other data.
Sec. 24.
The commissioner is authorized to destroy or otherwise dispose of all records, books, papers, and other data on file with the department which in his or her opinion and on the advice of the attorney general, are of no further material value to the state of Michigan; but the destruction or other disposal thereof shall not be ordered or made by him or her of any records, books, papers, or other data required by law to be filed or kept on file with the insurance bureau until the expiration of a period of 10 years, nor of any such records, books, papers, or other data filed during his or her administration or administrations. Such authorization shall be effected through official rules of the commissioner. However, this authorization shall not extend to articles of incorporation, and amendments thereto, copies of bylaws and amendments thereto, copies of certificates or other written evidence of authorization to transact business or of approval of articles of incorporation and bylaws.
History:
1984, Act 218, Eff. Jan. 1, 1985
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.926 - 340b Program Entities; Reimbursement, Co-Pay, and Discrimination Prohibitions; Definitions.

550.926 340B Program entities; reimbursement, co-pay, and discrimination prohibitions; definitions.
Sec. 26.
(1) A carrier or third party administrator that is a pharmacy benefit manager shall not prohibit a 340B Program entity or a pharmacy that has a license in good standing in this state under contract with a 340B Program entity from participating in the carrier's or third party administrator that is a pharmacy benefit manager's provider network solely because it is a 340B Program entity or a pharmacy under contract with a 340B Program entity. A carrier or third party administrator that is a pharmacy benefit manager shall not reimburse a 340B Program entity or a pharmacy under contract with a 340B Program entity differently than other similarly situated pharmacies. As used in this subsection, "340B Program entity" means an entity authorized to participate in the federal 340B Program under section 340B of the public health service act, 42 USC 256b.
(2) A carrier or other third party, or a third party administrator that is a pharmacy benefit manager, shall not, except as required by law to prevent a duplicate rebate, require a claim for a drug to include a modifier or otherwise to indicate that the drug is a 340B drug unless the claim is for payment, directly or indirectly, by the Medicaid program. As used in this subsection:
(a) "Medicaid program" means the program for medical assistance established under title XIX of the social security act, 42 USC 1396 to 1396w-6.
(b) "Rebate" means a formulary discount or remuneration attributable to the use of prescription drugs that is paid by a manufacturer or third party, directly or indirectly, to a pharmacy benefit manager after a claim has been adjudicated at a pharmacy. Rebate does not include a fee, including, but not limited to, a bona fide service fee or administrative fee, that is not a formulary discount or remuneration described in this subdivision.
(c) "Third party" does not include a pharmacy benefit manager or carrier.
(d) "340B drug" means a covered drug as that term is defined in 42 USC 256b.
(3) A third party administrator that is a pharmacy benefit manager shall not exclude or discriminate against a pharmacy solely based on the carrier not having a vested financial interest in the pharmacy. As used in this subsection, "having a vested financial interest" means having ownership, having co-ownership, being a shareholder, or having another connection from which financial gain or loss could be realized.
History:
Add. 2022, Act 12, Imd. Eff. Feb. 23, 2022
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.927 - Disclosure of Current Selling Prices; Prohibited Contract Provisions.

550.927 Disclosure of current selling prices; prohibited contract provisions.
Sec. 27.
A contract between a carrier or third party administrator that is a pharmacy benefit manager and a pharmacy must not prohibit the pharmacy from disclosing the current selling price of a drug in accordance with section 17757 of the public health code, 1978 PA 368, MCL 333.17757. This section applies to a contract described in this section executed, extended, or renewed on or after the effective date of the amendatory act that added this section.
History:
Add. 2022, Act 12, Imd. Eff. Feb. 23, 2022
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.930 - Provision of Administrative Services Pursuant to Written Service Contract; Maintenance of Books and Records; Tpa and Manager as Fiduciary.

550.930 Provision of administrative services pursuant to written service contract; maintenance of books and records; TPA and manager as fiduciary.
Sec. 30.
(1) A TPA may only provide administrative services pursuant to a written service contract. For the duration of the service contract, a TPA shall maintain at its principal administrative office the TPA's books and records of all transactions under the service contract in accordance with generally accepted accounting principles or as required by ERISA.
(2) A TPA and a manager are a fiduciary when collecting, expending, and maintaining money for the payment of claims pursuant to the service contract.
History:
1984, Act 218, Eff. Jan. 1, 1985
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.934 - Confidentiality.

550.934 Confidentiality.
Sec. 34.
(1) A TPA shall provide for the confidentiality of personal data identifying an individual covered by a plan. A TPA shall not disclose records containing personal information that may be associated with an identifiable individual covered by a plan to a person other than the individual to whom the information pertains. Except as is necessary to comply with a court order, an administrator shall not disclose personal data concerning a covered individual without the prior consent of the covered individual. If the individual covered by a plan has authorized the release of information to a third person, the third person shall not release that information unless the individual executes in writing another consent authorizing the additional release.
(2) Subsection (1) shall not be construed to apply to information disclosed for any of the following reasons:
(a) For claims adjudication.
(b) For claims verification.
(c) For other proper plan administration.
(d) For an audit conducted pursuant to ERISA.
(e) To an insurer for the purchase of excess loss insurance and for claims under the excess loss insurance. However, an insurer obtaining information under this subdivision shall be subject to the requirements of subsection (1).
(f) To the plan or a fiduciary of the plan.
(g) To the commissioner. However, information obtained by the commissioner under this subdivision shall be exempt from disclosure under the freedom of information act, Act No. 442 of the Public Acts of 1976, being sections 15.231 to 15.246 of the Michigan Compiled Laws.
(h) As required by law.
History:
1984, Act 218, Eff. Jan. 1, 1985
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.936 - Annual Statement; Report.

550.936 Annual statement; report.
Sec. 36.
By July 1, 2022 and each July 1 after that date, a third party administrator shall prepare under oath and file with the director a statement concerning the third party administrator's affairs on a form provided by the director. A third party administrator shall file the annual statement required under this section by July 1 of the year following the year covered by the statement. On request and for good cause shown, the director may grant to a third party administrator a reasonable extension of time not to exceed 30 days within which the statement must be filed. A third party administrator shall pay the annual statement filing fee prescribed in section 18.
History:
1984, Act 218, Eff. Jan. 1, 1985 ;-- Am. 2022, Act 12, Imd. Eff. Feb. 23, 2022
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.940 - Prohibited Conduct Generally.

550.940 Prohibited conduct generally.
Sec. 40.
A TPA or manager, in processing claims, shall not do any of the following:
(a) Misrepresent pertinent facts relating to coverage.
(b) Fail to make a good faith effort to acknowledge promptly or to act reasonably and promptly upon communications with respect to a claim for benefits.
(c) Fail to adopt and implement reasonable standards for the prompt investigation of a claim for benefits.
(d) Refuse to process claims without conducting a reasonable investigation based upon the available information.
(e) Fail to communicate affirmation or denial of coverage of a claim for benefits within a reasonable time after a claim has been received.
(f) Fail to make a good faith effort to promptly, fairly, and equitably process a claim for benefits.
(g) Fail to promptly provide a reasonable explanation of the basis for denial or partial denial of a claim for benefits.
(h) Refuse to process claims because of race, color, creed, marital status, sex, national origin, residence, age, disability, or lawful occupation.
(i) Knowingly compel individuals covered by the plan to institute litigation to recover amounts due under a benefit plan by offering substantially less than the amounts due unless the amounts due are reasonably in dispute.
(j) For the purpose of coercing an individual covered by the plan to accept a settlement or compromise of a claim, inform the individual of a policy of the TPA of appealing judicial, arbitration, or administrative hearing decisions which are in favor of individuals covered by the plan.
(k) Delay the investigation or processing of a claim by requiring an individual covered by the plan, or the provider of services to the individual covered by the plan, to submit a preliminary claim and then requiring subsequent submission of a formal claim, seeking solely the duplication of a verification. This subdivision does not apply to the predetermination or precertification of benefits.
History:
1984, Act 218, Eff. Jan. 1, 1985 ;-- Am. 1998, Act 79, Imd. Eff. May 4, 1998
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.942 - Additional Prohibited Conduct.

550.942 Additional prohibited conduct.
Sec. 42.
A manager or TPA, in order to induce a person to contract or to continue to contract with the TPA; to induce a person to lapse, forfeit, or surrender a service contract entered into with a TPA; or to induce a person to secure or terminate coverage with a carrier or other person, shall not directly or indirectly:
(a) Offer to make or make an agreement relating to a service contract or issue or deliver to the person money or any other valuable consideration other than as plainly expressed in the service contract.
(b) Give or pay or offer to give or pay, directly or indirectly, a rebate or adjustment of the fee payable under the service contract, or an advantage in the services thereunder, except as reflected in the fee and expressly provided in the service contract.
(c) Make, issue, or circulate, or cause to be made, issued, or circulated, any estimate, illustration, circular, or statement misrepresenting the terms of a service contract, the advantages provided thereunder, or the true nature thereof.
(d) Make a misrepresentation in a comparison, whether oral or written, between service contracts of the TPA and another TPA or between service contracts of the TPA and a carrier.
History:
1984, Act 218, Eff. Jan. 1, 1985
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.944 - Additional Prohibited Conduct.

550.944 Additional prohibited conduct.
Sec. 44.
(1) A TPA shall not refuse to enter into a service contract or provide administrative services other than processing claims because of race, color, creed, marital status, sex, national origin, residence, age, disability, or lawful occupation.
(2) A TPA or manager shall not misrepresent the financial condition of a TPA or of any person engaged in the business of insurance, or misrepresent the financial aspects of the services offered by the TPA or make a statement which is maliciously false, maliciously critical of, or maliciously derogatory to the financial condition of another TPA or of a person engaged in the business of insurance.
(3) A TPA or manager shall not misrepresent the nature of the services provided by the TPA, including but not limited to, the existence or identity of any carrier or other TPA involved with the plan; the extent of risk assumed by any particular named carrier, if any; or the regulatory status of the carrier or TPA.
(4) A TPA or manager shall not make, or participate in the making of, any fraudulent statement on a claims form for the purpose of obtaining money or other benefits.
(5) A TPA shall process claims for benefits on a timely basis.
History:
1984, Act 218, Eff. Jan. 1, 1985 ;-- Am. 1998, Act 79, Imd. Eff. May 4, 1998
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.950 - Violation; Probable Cause; Notice; Conference; Disposition of Matter Upon Agreement of Parties; Action for Damages; Hearing; Findings and Decision; Cease and Desist Order; Additional Order.

550.950 Violation; probable cause; notice; conference; disposition of matter upon agreement of parties; action for damages; hearing; findings and decision; cease and desist order; additional order.
Sec. 50.
(1) When the commissioner has probable cause to believe that a TPA or manager is violating, or has violated section 40, indicating a persistent tendency to engage in conduct prohibited by that section, or has probable cause to believe that a TPA or manager is violating, or has violated other provisions of this act, he or she shall give written notice to the TPA or manager, pursuant to the administrative procedures act, Act No. 306 of the Public Acts of 1969, being sections 24.201 to 24.315 of the Michigan Compiled Laws, setting forth the general nature of the complaint against the TPA or manager and the proceedings contemplated under this section. Before the issuance of a notice of hearing, the staff of the bureau of insurance responsible for the matters which would be at issue in the hearing shall give the TPA or manager an opportunity to confer and discuss the possible complaint and proceedings in person with the commissioner or a representative of the commissioner, and the matter may be disposed of summarily upon agreement of the parties. This subsection shall not be construed to create or diminish any right of a person to bring an action for damages under this section.
(2) A hearing held pursuant to subsection (1) shall be held pursuant to the administrative procedures act, Act No. 306 of the Public Acts of 1969. If, after the hearing, the commissioner determines that the TPA or manager is violating, or has violated section 40, indicating a persistent tendency to engage in conduct prohibited by that section, or has violated or is violating other provisions of this act, the commissioner shall reduce his or her findings and decision to writing, and shall issue and cause to be served upon the TPA or manager a copy of the findings and an order requiring the TPA or manager to cease and desist from engaging in the prohibited activity, and the commissioner may order any of the following:
(a) Payment of a monetary penalty of not more than $500.00 for each violation but not to exceed an aggregate penalty of $5,000.00, unless the TPA or manager knew or reasonably should have known it was in violation of this act, in which case the penalty shall not be more than $2,500.00 for each violation and shall not exceed an aggregate penalty of $25,000.00 for all violations committed in a 6-month period.
(b) Suspension or revocation of the TPA's certificate of authority or the manager's license if the TPA or manager knowingly and persistently violated this act.
(c) Restitution or refund to an aggrieved person.
History:
1984, Act 218, Eff. Jan. 1, 1985
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.954 - Alteration, Modification, or Setting Aside of Order.

550.954 Alteration, modification, or setting aside of order.
Sec. 54.
The commissioner may at any time, by order, after notice and opportunity for hearing, reopen and alter, modify, or set aside, in whole or in part, an order issued by him or her under this act, when in his or her opinion conditions of fact or of law have so changed as to require that action or if the public interest shall so require.
History:
1984, Act 218, Eff. Jan. 1, 1985
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.956 - Judicial Review; Petition for Review; Transcript of Record and Copy of Order or Decision; Hearing Cause as Civil Case in Equity; Evidence; Duty of Court; Incomplete Record; Stay of Order or Decision; Jurisdiction.

550.956 Judicial review; petition for review; transcript of record and copy of order or decision; hearing cause as civil case in equity; evidence; duty of court; incomplete record; stay of order or decision; jurisdiction.
Sec. 56.
(1) Any final order or decision made, issued, or executed by the commissioner under this act shall be subject to review, after hearing had before the commissioner or a deputy commissioner without leave by the circuit court of Ingham county or the circuit court of the county in which the principal office in this state of the TPA aggrieved by such order or decision is located, or where the person resides against whom such order is directed.
(2) A petition as of right for the review of such order or decision shall be filed within 30 days from the date of service of a copy of said order or decision upon the TPA or other person against whom said order or decision shall run. Copy of such petition for review as filed with and certified by the clerk of the court shall be served upon the commissioner, or in his or her absence upon someone in active charge of the insurance bureau, within 5 days after the filing thereof. If a petition for review is not filed within the 30 days, the party aggrieved shall be deemed to have waived the right to have the merits of the order or decision reviewed, and there shall be no trial of the merits thereof by any court to which application may be made by petition or otherwise. Within 10 days after the service of copy of the petition for review, unless the time be extended by order of court, the commissioner shall prepare and file with the clerk of the court in which the petition for review was filed, a complete transcript of the record of the hearing had before him or her, and a true and certified copy of his or her order or decision.
(3) The cause shall be heard before the court as a civil case in equity upon such transcript of the record and such additional evidence as may be offered by any of the parties at the hearing of the cause before the court. It shall be the duty of the court to hear and determine such petition with all convenient speed. If on the hearing before the court it appears that the record filed by the commissioner is incomplete, the court by appropriate order may direct the commissioner to certify any or all parts of the records so omitted. The commencement of proceedings under this section shall not operate as a stay of the enforcement of the commissioner's order or decision unless so ordered by the court or commissioner, and under such conditions as the court or commissioner may impose. The court shall have the jurisdiction to affirm, modify, or to set aside the order or decision of the commissioner and to restrain the enforcement thereof.
History:
1984, Act 218, Eff. Jan. 1, 1985
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.958 - Self-Incrimination; False Oath or Affirmation.

550.958 Self-incrimination; false oath or affirmation.
Sec. 58.
(1) A person shall not be excused from attending and testifying, or producing any books, papers, or other documents before any court or magistrate, arbitrator or board of arbitrators, upon any investigation, proceeding, or trial, for a violation of any of the provisions of this act, upon the ground or for the reason that the testimony or evidence documentary or otherwise, required of him or her may tend to incriminate him or her; but a person shall not be prosecuted or subjected to any penalty or forfeiture for or on account of any transaction, matter, or thing concerning which he or she may so testify or produce evidence, documentary or otherwise, and testimony so given or produced shall not be used against him or her upon any criminal investigation or proceeding.
(2) A person required by this act to take an oath or affirmation who makes a false oath or affirmation is guilty of perjury.
History:
1984, Act 218, Eff. Jan. 1, 1985
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.960 - Rules.

550.960 Rules.
Sec. 60.
(1) The commissioner, after notice and hearing, may promulgate rules pursuant to the administrative procedures act of 1969, Act No. 306 of the Public Acts of 1969, being sections 24.201 to 24.315 of the Michigan Compiled Laws, as necessary to effectuate the purposes of this act.
(2) A copy of the rules promulgated under this act and any amendments thereto shall be mailed to each TPA authorized to do business in this state 30 days prior to the effective date thereof.
History:
1984, Act 218, Eff. Jan. 1, 1985
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.962 - Repealed. 2002, Act 74, Imd. Eff. Mar. 15, 2002.

550.962 Repealed. 2002, Act 74, Imd. Eff. Mar. 15, 2002.
Compiler's Notes:
The repealed section pertained to effective date of act.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Repealed - Act 289 of 1994 - Medical Care Savings Account Act (550.981 - 550.988)

MEDICAL CARE SAVINGS ACCOUNT ACT
Act 289 of 1994
550.981-550.988 Repealed. 1994, Act 289, Eff. Jan. 1, 1999.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020) › Section 550.1001 - Short Title.

550.1001 Short title.
Sec. 1.
This act shall be known and may be cited as "the health benefit agent act".
History:
1986, Act 252, Eff. Mar. 31, 1987
Compiler's Notes:
For transfer of the Department of Insurance and Office of the Commissioner on Insurance from the Department of Licensing and Regulation to the Department of Commerce, see E.R.O. No. 1991-9, compiled at MCL 338.3501 of the Michigan Compiled Laws.For transfer of authority, powers, duties, functions, and responsibilities of the insurance bureau and the commissioner of insurance to the commissioner of the office of financial and insurance services and the office of financial and insurance services, see E.R.O. No. 2000-2, compiled at MCL 445.2003 of the Michigan compiled laws.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020) › Section 550.1002 - Definitions.

550.1002 Definitions.
Sec. 2.
As used in this act:
(a) "Affiliate" means that term as defined in section 1301 of the insurance code of 1956, Act No. 218 of the Public Acts of 1956, being section 500.1301 of the Michigan Compiled Laws.
(b) "Commissioner" means the commissioner of insurance.
(c) "Control" means that term as defined in section 1301 of the insurance code of 1956, Act No. 218 of the Public Acts of 1956, being section 500.1301 of the Michigan Compiled Laws.
(d) "Health benefit" means any benefit or service lawfully provided by a health benefit corporation.
(e) "Health benefit agent" means a person who meets all of the following criteria:
(i) Is a licensed accident and health insurance agent under chapter 12 of the insurance code of 1956, Act No. 218 of the Public Acts of 1956, being sections 500.1201 to 500.1244 of the Michigan Compiled Laws.
(ii) Is authorized in writing by a health benefit corporation to act as an agent for the health benefit corporation and a copy of the authorization is filed with the commissioner.
(f) "Health benefit corporation" means:
(i) A health care corporation organized under Act No. 350 of the Public Acts of 1980, being sections 550.1101 to 550.1704 of the Michigan Compiled Laws.
(ii) A nonprofit dental care corporation organized under Act No. 125 of the Public Acts of 1963, being sections 550.351 to 550.373 of the Michigan Compiled Laws.
(iii) A health maintenance organization licensed under part 210 of Act No. 368 of the Public Acts of 1978, being sections 333.21001 to 333.21098 of the Michigan Compiled Laws.
(g) "Influence" means to manage, direct, mandate, or give a reward or benefit to a person. Influence does not mean to respond to a request for information.
(h) "Package" means to sell health benefits simultaneously or in conjunction with the sale of insurance.
(i) "Subscriber" means a person who enters into a contract, or on whose behalf a contract is entered into, with a health benefit corporation for the provision of health benefits.
History:
1986, Act 252, Eff. Mar. 31, 1987
Compiler's Notes:
For transfer of authority, powers, duties, functions, and responsibilities of the insurance bureau and the commissioner of insurance to the commissioner of the office of financial and insurance services and the office of financial and insurance services, see E.R.O. No. 2000-2, compiled at MCL 445.2003 of the Michigan compiled laws.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020) › Section 550.1004 - Influencing Agent Prohibited.

550.1004 Influencing agent prohibited.
Sec. 4.
A health benefit corporation shall not attempt in any way to influence an agent in the packaging of health benefits.
History:
1986, Act 252, Eff. Mar. 31, 1987
Compiler's Notes:
For transfer of authority, powers, duties, functions, and responsibilities of the insurance bureau and the commissioner of insurance to the commissioner of the office of financial and insurance services and the office of financial and insurance services, see E.R.O. No. 2000-2, compiled at MCL 445.2003 of the Michigan compiled laws.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020) › Section 550.1004a - Applicability of Certain Statutory Provisions.

550.1004a Applicability of certain statutory provisions.
Sec. 4a.
(1) The provisions of sections 1, 2, 3, 4(1), (2), (3), (4), (6), 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, and 18 of Act No. 274 of the Public Acts of 1984, as amended, being sections 445.771 to 445.788 of the Michigan Compiled Laws, shall apply to all activities authorized by this act.
(2) The provisions of this act shall apply to an activity of a health benefit corporation notwithstanding the provisions of section 4(5) of Act No. 274 of the Public Acts of 1984, as amended, being section 445.774 of the Michigan Compiled Laws, except where the activity is specifically required by this act or any regulation or orders promulgated by the commissioner pursuant to this act.
History:
1986, Act 252, Eff. Mar. 31, 1987
Compiler's Notes:
For transfer of authority, powers, duties, functions, and responsibilities of the insurance bureau and the commissioner of insurance to the commissioner of the office of financial and insurance services and the office of financial and insurance services, see E.R.O. No. 2000-2, compiled at MCL 445.2003 of the Michigan compiled laws.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020) › Section 550.1005 - Compensation of Health Benefit Agents.

550.1005 Compensation of health benefit agents.
Sec. 5.
Health benefit corporations shall compensate health benefit agents primarily on a reasonable commission basis. Health benefit corporations may provide reasonable bonuses or other reasonable compensation to health benefits agents for the sale of health benefits.
History:
1986, Act 252, Eff. Mar. 31, 1987
Compiler's Notes:
For transfer of authority, powers, duties, functions, and responsibilities of the insurance bureau and the commissioner of insurance to the commissioner of the office of financial and insurance services and the office of financial and insurance services, see E.R.O. No. 2000-2, compiled at MCL 445.2003 of the Michigan compiled laws.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020) › Section 550.1006 - Authorized Agents; Requirements, Duties, and Restrictions; Powers of Commissioner.

550.1006 Authorized agents; requirements, duties, and restrictions; powers of commissioner.
Sec. 6.
(1) Agents licensed under chapter 12 of the insurance code of 1956, Act No. 218 of the Public Acts of 1956, to sell accident and health insurance are deemed to be health benefits agents under this act upon being authorized by a health benefit corporation and filing that authorization with the commissioner.
(2) The requirements, duties, and restrictions of insurance agents and the powers of the commissioner with respect thereto under chapter 20 of the insurance code of 1956, Act No. 218 of the Public Acts of 1956, being sections 500.2001 to 500.2093 of the Michigan Compiled Laws, shall also apply to agents licensed under this act when marketing and selling health benefits to the same extent as if marketing and selling disability insurance.
History:
1986, Act 252, Eff. Mar. 31, 1987
Compiler's Notes:
For transfer of authority, powers, duties, functions, and responsibilities of the insurance bureau and the commissioner of insurance to the commissioner of the office of financial and insurance services and the office of financial and insurance services, see E.R.O. No. 2000-2, compiled at MCL 445.2003 of the Michigan compiled laws.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020) › Section 550.1008 - Contracts or Other Arrangements for Packaging of Health Benefits With Insurance; Policy Supplementing Health Benefits of Health Maintenance Organization.

550.1008 Contracts or other arrangements for packaging of health benefits with insurance; policy supplementing health benefits of health maintenance organization.
Sec. 8.
(1) Except as otherwise provided in this act, a health care corporation organized under Act No. 350 of the Public Acts of 1980, being sections 550.1101 to 550.1704 of the Michigan Compiled Laws, shall not, either itself or through any affiliate or agent, enter into a contract or other arrangement with any insurer or other person which provides for the packaging of health benefits with insurance.
(2) A health benefit corporation may arrange for excess loss insurance in conjunction with the sale of administrative services benefits.
(3) A health maintenance organization licensed under part 210 of the public health code, Act No. 368 of the Public Acts of 1978, being sections 333.21001 to 333.21098 of the Michigan Compiled Laws, may arrange with an insurer for the insurer to sell a policy to supplement the health benefits of the health maintenance organization.
History:
1986, Act 252, Eff. Mar. 31, 1987
Compiler's Notes:
For transfer of authority, powers, duties, functions, and responsibilities of the insurance bureau and the commissioner of insurance to the commissioner of the office of financial and insurance services and the office of financial and insurance services, see E.R.O. No. 2000-2, compiled at MCL 445.2003 of the Michigan compiled laws.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020) › Section 550.1009 - Licensing Affiliate of Health Benefit Corporation as Insurance Agent Prohibited.

550.1009 Licensing affiliate of health benefit corporation as insurance agent prohibited.
Sec. 9.
An affiliate of a health benefit corporation must not be licensed as an insurance agent under chapter 12 of the insurance code of 1956, 1956 PA 218, MCL 500.1201 to 500.1247.
History:
1986, Act 252, Eff. Mar. 31, 1987 ;-- Am. 2018, Act 430, Imd. Eff. Dec. 20, 2018
Compiler's Notes:
For transfer of authority, powers, duties, functions, and responsibilities of the insurance bureau and the commissioner of insurance to the commissioner of the office of financial and insurance services and the office of financial and insurance services, see E.R.O. No. 2000-2, compiled at MCL 445.2003 of the Michigan compiled laws.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020) › Section 550.1010 - Health Benefit Agent as Fiduciary; Evidence of Violation of Fiduciary Responsibility; Use of Reasonable Accounting Methods; Records Required; Examination of Records; Prohibited Conduct.

550.1010 Health benefit agent as fiduciary; evidence of violation of fiduciary responsibility; use of reasonable accounting methods; records required; examination of records; prohibited conduct.
Sec. 10.
(1) A health benefit agent shall be a fiduciary for all money received or held by him or her in his or her capacity as an agent. Failure by an agent in a timely manner to turn over the money which he or she holds in a fiduciary capacity to the persons to whom they are owed is prima facie evidence of violation of the agent's fiduciary responsibility.
(2) An agent shall use reasonable accounting methods to record funds received in his or her fiduciary capacity including the receipt and distribution of all premiums due each of his or her health benefit corporations. An agent shall record return premiums received by or credited to him or her which are due a subscriber on certificates reduced or canceled or which are due a prospective purchaser of health benefits as a result of a rejected or declined application. Records required by this section shall be open to examination by the commissioner.
(3) An agent shall not reward or remunerate any person for procuring or inducing business in this state, furnishing leads or prospects, or acting in any other manner as an agent.
(4) A person may not sell or attempt to sell health benefits by means of intimidation or threats, whether express or implied. Except as otherwise provided by law, a person may not induce the purchase of health benefits through a particular agent or from a particular health benefit corporation by means of a promise to sell goods, to lend money, to provide services, or by a threat to refuse to sell goods, to refuse to lend money, or to refuse to provide services.
History:
1986, Act 252, Eff. Mar. 31, 1987
Compiler's Notes:
For transfer of authority, powers, duties, functions, and responsibilities of the insurance bureau and the commissioner of insurance to the commissioner of the office of financial and insurance services and the office of financial and insurance services, see E.R.O. No. 2000-2, compiled at MCL 445.2003 of the Michigan compiled laws.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020) › Section 550.1014 - Suspension, Revocation, Refusal to Grant, or Refusal to Renew Accident and Health Insurance License; Grounds; Notice; Hearing; Summary Suspension; Subpoenas.

550.1014 Suspension, revocation, refusal to grant, or refusal to renew accident and health insurance license; grounds; notice; hearing; summary suspension; subpoenas.
Sec. 14.
(1) The commissioner, after notice and opportunity for a hearing, may suspend or revoke the accident and health insurance license of an agent who violates any provision of this act.
(2) After notice and opportunity for a hearing, the commissioner may refuse to grant or renew an accident and health insurance license to act as an agent if he or she determines by a preponderance of the evidence, that it is probable that the business or primary occupation of the applicant will give rise to coercion, indirect rebating of commissions, or other practices in the sale of health benefits which are prohibited by law.
(3) Without prior hearing, the commissioner may order summary suspension of an accident and health insurance license if he or she finds that protection of the public requires emergency action and incorporates this finding in his or her order. The suspension shall be effective on the date specified in the order or upon service of a certified copy of the order on the licensee, whichever is later. If requested, the commissioner shall conduct a hearing on the suspension within a reasonable time but not later than 20 days after the effective date of the summary suspension unless the person whose license is suspended requests a later date. At the hearing, the commissioner shall determine if the suspension should be continued or if the suspension should be withdrawn, and, if proper notice is given, may determine if the license should be revoked. The commissioner shall announce his or her decision within 30 days after conclusion of the hearing. The suspension shall continue until the decision is announced.
(4) The commissioner, or his or her designated deputy, may issue subpoenas with the approval of a circuit court judge of the circuit court of Ingham county to require the attendance and testimony of witnesses and the production of documents necessary to the conduct of the hearing and may designate an employee of the insurance bureau to make service thereof. The subpoenas issued by the commissioner, or his or her designated deputy, may be enforced upon application by them to the circuit court of Ingham county by proceedings in contempt thereof, as provided by law.
History:
1986, Act 252, Eff. Mar. 31, 1987
Compiler's Notes:
For transfer of authority, powers, duties, functions, and responsibilities of the insurance bureau and the commissioner of insurance to the commissioner of the office of financial and insurance services and the office of financial and insurance services, see E.R.O. No. 2000-2, compiled at MCL 445.2003 of the Michigan compiled laws.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020) › Section 550.1018 - Construction of Act.

550.1018 Construction of act.
Sec. 18.
This act shall not be construed as authorizing a health benefit corporation or affiliate of a health benefit corporation to market or transact, as defined in sections 402a and 402b of the insurance code of 1956, Act No. 218 of the Public Acts of 1956, being sections 500.402a and 500.402b of the Michigan Compiled Laws, any type of insurance described in chapter 6 of the insurance code of 1956, Act No. 218 of the Public Acts of 1956, being sections 500.600 to 500.644 of the Michigan Compiled Laws.
History:
1986, Act 252, Eff. Mar. 31, 1987
Compiler's Notes:
For transfer of authority, powers, duties, functions, and responsibilities of the insurance bureau and the commissioner of insurance to the commissioner of the office of financial and insurance services and the office of financial and insurance services, see E.R.O. No. 2000-2, compiled at MCL 445.2003 of the Michigan compiled laws.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 252 of 1986 - The Health Benefit Agent Act (550.1001 - 550.1020) › Section 550.1020 - Conditional Effective Date.

550.1020 Conditional effective date.
Sec. 20.
This act shall not take effect unless House Bill No. 5527 of the 83rd Legislature is enacted into law.
History:
1986, Act 252, Eff. Mar. 31, 1987
Compiler's Notes:
House Bill No. 5527, referred to in MCL 550.1020, was filed with the Secretary of State December 5, 1986, and became P.A. 1986, No. 253, Eff. Mar. 31, 1987.For transfer of authority, powers, duties, functions, and responsibilities of the insurance bureau and the commissioner of insurance to the commissioner of the office of financial and insurance services and the office of financial and insurance services, see E.R.O. No. 2000-2, compiled at MCL 445.2003 of the Michigan compiled laws.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 350 of 1980 - The Nonprofit Health Care Corporation Reform Act (550.1101 - 550.1704) › 350-1980-1 - Part 1 (550.1101...550.1108) › Section 550.1101 - Short Title.

550.1101 Short title.
Sec. 101.
This act shall be known and may be cited as "the nonprofit health care corporation reform act".
History:
1980, Act 350, Eff. Apr. 3, 1981
Constitutionality:
Procedural fairness is required by the due process clause before governmental action drastically alters essential terms of the contract between nonprofit group health care plans and hospitals and nursing homes providing health care services; however, the guarantee of procedural due process does not necessarily require an adversary proceeding. Convalescent Center v Blue Cross, 414 Mich 247; 324 NW2d 851 (1982).Administrative hearings under the Administrative Procedures Act, however informal, comport with the procedural fairness required by due process in the absence of an explicit statutory requirement that a contested evidentiary hearing be held. Convalescent Center v Blue Cross, 414 Mich 247; 324 NW2d 851 (1982).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).
Compiler's Notes:
For transfer of the Department of Insurance and Office of the Commissioner on Insurance from the Department of Licensing and Regulation to the Department of Commerce, see E.R.O. No. 1991-9, compiled at MCL 338.3501 of the Michigan Compiled Laws.For transfer of authority, powers, duties, functions, and responsibilities of the insurance bureau and the commissioner of insurance to the commissioner of the office of financial and insurance services and the office of financial and insurance services, see E.R.O. No. 2000-2, compiled at MCL 445.2003 of the Michigan compiled laws.
Popular Name:
Blue Cross-Blue Shield
Popular Name:
Act 350