reglab/statecodes huggingface dataset:
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 173 of 1958 - Credit Insurance Act (550.601 - 550.624) › Section 550.615 - Papers Filed With Commissioner of Issuing State; Withdrawal of Approval.

550.615 Papers filed with commissioner of issuing state; withdrawal of approval.
Sec. 15.
The commissioner, at any time after a hearing, of not less than 20 days written notice to the insurer, may withdraw his approval of any such form on any of such grounds.
History:
1958, Act 173, Eff. Sept. 13, 1958
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 173 of 1958 - Credit Insurance Act (550.601 - 550.624) › Section 550.616 - Papers Filed With Commissioner of Issuing State; Use After Withdrawal of Approval.

550.616 Papers filed with commissioner of issuing state; use after withdrawal of approval.
Sec. 16.
It is not lawful for the insurer to issue such forms or use them after the effective date of such withdrawal of approval.
History:
1958, Act 173, Eff. Sept. 13, 1958
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 173 of 1958 - Credit Insurance Act (550.601 - 550.624) › Section 550.617 - Papers Filed With Commissioner of Issuing State; Judicial Review.

550.617 Papers filed with commissioner of issuing state; judicial review.
Sec. 17.
Any order or final determination of the commissioner under the provisions of this section shall be subject to judicial review.
History:
1958, Act 173, Eff. Sept. 13, 1958
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 173 of 1958 - Credit Insurance Act (550.601 - 550.624) › Section 550.618 - Schedule of Premium Rates; Refunds; Nonissuance Credit.

550.618 Schedule of premium rates; refunds; nonissuance credit.
Sec. 18.
Each insurer issuing credit life insurance or credit accident and health insurance shall file with the commissioner its schedules of premium rates for use in connection with such insurance. Any insurer may revise such schedules from time to time, and shall file such revised schedules with the commissioner. No insurer shall issue any credit life insurance policy or credit accident and health insurance policy for which the premium rate exceeds that determined by the schedules of such insurer as then on file with the commissioner. The commissioner may require the filing of the schedule of premium rates for use in connection with and as a part of the specific policy filings as provided by sections 12 to 17. Each individual policy, group certificate or notice of proposed insurance of credit life insurance and credit accident and health insurance shall provide that in the event of termination of the insurance prior to the scheduled maturity date of the indebtedness, any refund of premium due shall be paid or credited promptly to the person entitled thereto: Provided, however, That the commissioner shall prescribe a minimum refund and no refund which would be less than such minimum need be made. The formula to be used in computing such refund shall be filed with the commissioner. If a creditor requires a debtor to make a payment in connection with credit life insurance and credit accident and health insurance and an individual policy or group certificate of insurance is not issued, the creditor shall immediately give written notice to such debtor and shall promptly make an appropriate credit to the account.
History:
1958, Act 173, Eff. Sept. 13, 1958
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 173 of 1958 - Credit Insurance Act (550.601 - 550.624) › Section 550.619 - Policies Issuable Only by Authorized Insurers.

550.619 Policies issuable only by authorized insurers.
Sec. 19.
All policies of credit life insurance and credit accident and health insurance shall be delivered or issued for delivery in this state only by an insurer authorized to do an insurance business therein, and shall be issued only through holders of licenses or authorizations issued by the commissioner.
History:
1958, Act 173, Eff. Sept. 13, 1958
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 173 of 1958 - Credit Insurance Act (550.601 - 550.624) › Section 550.620 - Payment of Claims; Claim Files; Group Insurance Claims.

550.620 Payment of claims; claim files; group insurance claims.
Sec. 20.
All claims shall be promptly reported to the insurer or its designated claim representative, and the insurer shall maintain adequate claim files. All claims shall be settled as soon as possible and in accordance with the terms of the insurance contract. All claims shall be paid either by draft drawn upon the insurer or by check of the insurer to the order of the claimant to whom payment of the claim is due pursuant to the policy provisions, or upon direction of such claimant to one specified. No plan or arrangement shall be used whereby any person, firm or corporation other than the insurer or its designated claim representative shall be authorized to settle or adjust claims. The creditor shall not be designated as claim representative for the insurer in adjusting claims; but a group policyholder, by arrangement with the group insurer, may draw drafts or checks in payment of claims due to the group policyholder subject to audit and review by the insurer.
History:
1958, Act 173, Eff. Sept. 13, 1958
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 173 of 1958 - Credit Insurance Act (550.601 - 550.624) › Section 550.621 - Procurement of Insurance by Debtor.

550.621 Procurement of insurance by debtor.
Sec. 21.
When credit life insurance or credit accident and health insurance is required as additional security for any indebtedness, the debtor, upon request to the creditor, shall have the option of furnishing the required amount of insurance through existing policies of insurance owned or controlled by him or of procuring and furnishing the required coverage through any insurer authorized to transact an insurance business within this state.
History:
1958, Act 173, Eff. Sept. 13, 1958
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 173 of 1958 - Credit Insurance Act (550.601 - 550.624) › Section 550.622 - Rules; Violation, Notice of Hearing, Finding, Order.

550.622 Rules; violation, notice of hearing, finding, order.
Sec. 22.
The commissioner, after notice and hearing, may issue such rules and regulations in accordance with Act No. 88 of the Public Acts of 1943, as amended, being sections 24.71 to 24.82 of the Compiled Laws of 1948, and subject to Act No. 197 of the Public Acts of 1952, as amended, being sections 24.101 to 24.110 of the Compiled Laws of 1948, as he deems appropriate for the supervision of this act. Whenever the commissioner finds that there has been a violation of this act or any rules or regulations issued pursuant thereto, and after written notice thereof and hearing given to the insurer or other person authorized or licensed by the commissioner, he shall set forth the details of his findings together with an order for compliance by a specified date. The order shall be binding on the insurer and other person authorized or licensed by the commissioner on the date specified unless sooner withdrawn by the commissioner or a stay thereof has been ordered by a court of competent jurisdiction.
History:
1958, Act 173, Eff. Sept. 13, 1958
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.
Admin Rule:
R 500.2031 et seq. of the Michigan Administrative Code.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 173 of 1958 - Credit Insurance Act (550.601 - 550.624) › Section 550.623 - Violation; Penalty; License or Authority, Suspension or Revocation.

550.623 Violation; penalty; license or authority, suspension or revocation.
Sec. 23.
In addition to any other penalty provided by law, any person who violates an order of the commissioner after it has become final, and while such order is in effect, shall, upon proof thereof to the satisfaction of the court, forfeit and pay to the state a sum not to exceed the $250.00 which may be recovered in a civil action, except that if such violation is found to be willful, the amount of such penalty shall be a sum not to exceed the $1,000.00. The commissioner, in his discretion, may revoke or suspend the license or certificate of authority of the person guilty of such violation.
History:
1958, Act 173, Eff. Sept. 13, 1958
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 173 of 1958 - Credit Insurance Act (550.601 - 550.624) › Section 550.624 - Effect of Act; Scope of Act.

550.624 Effect of act; scope of act.
Sec. 24.
This act shall not alter or amend any provision of Act No. 21 of the Public Acts of 1939, as amended, being sections 493.1 to 493.26 of the Compiled Laws of 1948, or permit any premium, contribution or other charge to be collected for credit life or health and accident insurance in connection with loans made by licensees under said act: Provided, however, That if section 13 of said Act No. 21 of the Public Acts of 1939, as amended, is amended to permit licensees to collect premiums from borrowers for credit life insurance or credit health and accident insurance in addition to the maximum rate of charge authorized by said section 13, this act shall apply to licensees as provided by such amendment to section 13.
History:
1958, Act 173, Eff. Sept. 13, 1958
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 388 of 1913 - State Insurance (550.701 - 550.711) › Section 550.702, 550.703 - Repealed. 1965, Act 365, Imd. Eff. July 23, 1965.

550.702, 550.703 Repealed. 1965, Act 365, Imd. Eff. July 23, 1965.
Compiler's Notes:
The repealed sections provided for state insurance fund and for investment of moneys therein.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 388 of 1913 - State Insurance (550.701 - 550.711) › Section 550.704 - Loss in Case of Damage; Fixing Amount.

550.704 Loss in case of damage; fixing amount.
Sec. 4.
In case any buildings or property of the state other than those insured under the provisions of section 1 shall be damaged by fire, lightning, windstorm, explosion, riot, riot attending a strike, civil commotion, falling aircraft, hail (except growing crops) and smoke, caused from faulty operation of a heating plant using oil or gas fuel the controller, within 30 days or as soon as possible thereafter, shall ascertain and fix the amount of such damage. The ascertained amount of such damage shall in no case be less than the amount necessary to rebuild, repair or replace the property so damaged.
History:
1913, Act 388, Eff. Aug. 14, 1913 ;-- CL 1915, 9271 ;-- CL 1929, 12683 ;-- Am. 1945, Act 314, Imd. Eff. May 25, 1945 ;-- CL 1948, 550.704 ;-- Am. 1965, Act 365, Imd. Eff. July 23, 1965
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 388 of 1913 - State Insurance (550.701 - 550.711) › Section 550.705 - Loss in Case of Damage; Payment, Release of Additional Amounts Necessary to Rebuild or Restore.

550.705 Loss in case of damage; payment, release of additional amounts necessary to rebuild or restore.
Sec. 5.
When the amount of loss has been fixed and determined to be $50,000.00 or less by the controller, the amount so determined is appropriated in the applicable fund to be used by the state administrative board, for the rebuilding or restoring of the property damaged, and to be disbursed in such manner as other state funds are paid out. If during the rebuilding or restoring of such property damaged it shall be necessary in the opinion of the state administrative board to expend any additional amounts over and above the amounts certified by the controller, an additional amount equal to 10% of such previously determined amount is appropriated, but in no case to exceed $50,000.00 to be paid out in the same manner as provided for the payments made from the original appropriation. When the amount of loss has been fixed and determined to be more than $50,000.00, not to exceed a total of $5,000.00 is appropriated to be used under the supervision of the state administrative board for preliminary expenses connected with the loss, to be disbursed in such manner as other state funds are paid out. No payment in excess of $5,000.00 for any such loss shall be made until authorized and provided for by either the legislature or the special commission on appropriations created under the provisions of Act No. 120 of the Public Acts of 1937, as amended, being sections 5.1 to 5.5 of the Compiled Laws of 1948.
History:
1913, Act 388, Eff. Aug. 14, 1913 ;-- CL 1915, 9272 ;-- CL 1929, 12684 ;-- Am. 1945, Act 314, Imd. Eff. May 25, 1945 ;-- CL 1948, 550.705 ;-- Am. 1955, Act 203, Imd. Eff. June 17, 1955 ;-- Am. 1965, Act 365, Imd. Eff. July 23, 1965
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 388 of 1913 - State Insurance (550.701 - 550.711) › Section 550.706 - Repealed. 1993, Act 199, Eff. Dec. 28, 1994.

550.706 Repealed. 1993, Act 199, Eff. Dec. 28, 1994.
Compiler's Notes:
The repealed section pertained to determination of assessments by state accident fund.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 388 of 1913 - State Insurance (550.701 - 550.711) › Section 550.707, 550.708 - Repealed. 1965, Act 365, Imd. Eff. July 23, 1965.

550.707, 550.708 Repealed. 1965, Act 365, Imd. Eff. July 23, 1965.
Compiler's Notes:
The repealed sections pertained to duties of commissioner of insurance in administering state insurance act.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 388 of 1913 - State Insurance (550.701 - 550.711) › Section 550.709 - Self-Liquidation Projects Exempted; Applicability of Act.

550.709 Self-liquidation projects exempted; applicability of act.
Sec. 9.
The provisions of this act shall not have application to any structure, building, or the contents thereof, acquired, purchased or erected as self-liquidating projects pursuant to the terms of Act No. 15 of the Public Acts of 1937, as amended, being sections 390.451 to 390.456, inclusive, of the Compiled Laws of 1948, or Act No. 9 of the Public Acts of the Extra Session of 1938, as amended, being sections 390.371 to 390.375, inclusive, of the Compiled Laws of 1948, where the state board of education or the board of control of Michigan college of mining and technology has arranged for insuring such property against the perils designated in section 1 hereof in companies authorized to operate in the state of Michigan, in such amounts as such board shall deem adequate.
History:
Add. 1949, Act 100, Eff. Sept. 23, 1949
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 388 of 1913 - State Insurance (550.701 - 550.711) › Section 550.710 - Election of Coverage.

550.710 Election of coverage.
Sec. 10.
An institution, agency, authority or instrumentality of the state which, under the constitution or laws of the state, has control and direction of the expenditures of its funds may elect to be covered under the provisions of this act.
History:
Add. 1965, Act 365, Imd. Eff. July 23, 1965
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 388 of 1913 - State Insurance (550.701 - 550.711) › Section 550.711 - State Insurance Fund Abolished; Reversion of Funds.

550.711 State insurance fund abolished; reversion of funds.
Sec. 11.
The state insurance fund is abolished on June 30, 1965, and any unencumbered balance in the fund at that time shall revert to the several state funds in the same proportion as the last previous premium assessments against such funds.
History:
Add. 1965, Act 365, Imd. Eff. July 23, 1965
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 › Repealed - Act 176 of 1895 - Repair of Destroyed State Property (550.801 - 550.805)

REPAIR OF DESTROYED STATE PROPERTY
Act 176 of 1895
550.801-550.805 Repealed. 1965, Act 318, Imd. Eff. July 22, 1965.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 11 of 2022 - Pharmacy Benefit Manager Licensure and Regulation Act (550.811 - 550.845) › Section 550.811 - Short Title.

550.811 Short title.
Sec. 1.
This act may be cited as the "pharmacy benefit manager licensure and regulation act".
History:
2022, Act 11, Eff. Jan. 1, 2024
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 11 of 2022 - Pharmacy Benefit Manager Licensure and Regulation Act (550.811 - 550.845) › Section 550.819 - Definitions; R to W.

550.819 Definitions; R to W.
Sec. 9.
As used in this act:
(a) "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.
(b) "Retail pharmacy" means a pharmacy that dispenses prescription drugs to the public at retail primarily to individuals that reside in close proximity to the pharmacy, typically by face-to-face interaction with the individual or the individual's caregiver.
(c) "Rule" means a rule promulgated under the administrative procedures act of 1969, 1969 PA 306, MCL 24.201 to 24.328.
(d) "Specialty drug" means a drug that provides treatment for serious, chronic, or life-threatening diseases that is covered under a patient's health plan or by a patient's carrier to which any of the following apply:
(i) The cost of the drug exceeds the drug cost threshold established by the Centers for Medicare and Medicaid Services under the Medicare Part D program.
(ii) The drug requires special administration, including, but not limited to, injection, infusion, or inhalation.
(iii) The drug requires unique storage, handling, or distribution.
(iv) The drug requires special oversight, intensive monitoring, complex education and support, or care coordination with a person licensed under article 15 of the public health code, 1978 PA 368, MCL 333.16101 to 333.18838.
(e) "Specialty pharmacy" means a pharmacy that dispenses specialty drugs to patients and that is nationally accredited by an independent third party.
(f) "Spread pricing" means the model of prescription drug pricing in which a pharmacy benefit manager charges a health plan a contracted price for prescription drugs, and the contracted price for the prescription drugs differs from the amount the pharmacy benefit manager directly or indirectly pays the pharmacist or pharmacy for pharmacist services.
(g) Except as otherwise provided in subdivision (h), "third party" means a person that is not an enrollee or insured in a health plan.
(h) "Third party" does not include a pharmacy benefit manager.
(i) "Wholesale distributor" means that term as defined in section 17709 of the public health code, 1978 PA 368, MCL 333.17709.
History:
2022, Act 11, Eff. Jan. 1, 2024
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 11 of 2022 - Pharmacy Benefit Manager Licensure and Regulation Act (550.811 - 550.845) › Section 550.823 - Promulgation of Rules.

550.823 Promulgation of rules.
Sec. 13.
(1) The director shall promulgate rules that are necessary or required to implement this act.
(2) The rules promulgated by the director under subsection (1) must include fines, suspension of licensure, restriction of licensure, and revocation of licensure in accordance with this act.
History:
2022, Act 11, Eff. Jan. 1, 2024
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 11 of 2022 - Pharmacy Benefit Manager Licensure and Regulation Act (550.811 - 550.845) › Section 550.825 - Contractual Responsibilities; Conflict of Interest; Exception for Certain Audits.

550.825 Contractual responsibilities; conflict of interest; exception for certain audits.
Sec. 15.
(1) A pharmacy benefit manager shall exercise good faith and fair dealing in the performance of its contractual duties to a health plan or network pharmacy. A provision in a contract that attempts to waive or limit the obligation under this subsection is void.
(2) A pharmacy benefit manager shall notify a health plan in writing of any activity, policy, or practice of the pharmacy benefit manager that directly or indirectly presents a conflict of interest with the duties imposed in this section.
(3) A pharmacy benefit manager shall not directly or indirectly, including indirectly through a pharmacy services administrative organization, charge or hold a pharmacist or pharmacy responsible for a fee related to a claim or reduce the amount of the claim at the time of the claim's adjudication or after the claim is adjudicated.
(4) This section does not apply to an audit under section 28 of a pharmacy's records if either of the following applies:
(a) The review of claims data or statements indicates fraud, abuse, other intentional misconduct, or waste.
(b) An investigative method, other than a review described in subdivision (a), indicates that the pharmacy is or has committed fraud or other intentional misrepresentation.
(5) Except for the recoupment of money under an audit conducted under section 28, a pharmacy benefit manager shall not recoup money from a pharmacist or pharmacy in connection with a claim for which the pharmacist or pharmacy has been paid unless the recoupment is required by law.
History:
2022, Act 11, Eff. Jan. 1, 2024
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 11 of 2022 - Pharmacy Benefit Manager Licensure and Regulation Act (550.811 - 550.845) › Section 550.827 - Pharmacy Benefit Manager Network; Report; Waiver; Prohibition on Spread Pricing and Fees for Electronic Processing.

550.827 Pharmacy benefit manager network; report; waiver; prohibition on spread pricing and fees for electronic processing.
Sec. 17.
(1) A pharmacy benefit manager shall provide a reasonably adequate and accessible retail pharmacy benefit manager network for the provision of drugs for a health plan that must provide for convenient enrollee access to pharmacies within a reasonable distance from an enrollee's residence, as determined by the director. For purposes of this subsection, retail pharmacy benefit manager network does not include a mail-order pharmacy or specialty pharmacy.
(2) A pharmacy benefit manager shall submit to the director a retail pharmacy benefit manager network adequacy report that describes the retail pharmacy benefit manager network and the retail pharmacy benefit manager network's accessibility in this state. The report must categorize the network by urban, suburban, and rural geography and must include the applicable zip codes.
(3) A pharmacy benefit manager may apply for a waiver from the director if the pharmacy benefit manager is unable to meet the network adequacy requirements under subsection (1).
(4) To apply for a waiver under subsection (3), a pharmacy benefit manager must submit to the director an application in a form and manner prescribed by the director that does both of the following:
(a) Demonstrates with specific data why the pharmacy benefit manager is not able to meet the network adequacy requirements under subsection (1).
(b) Includes information as to the steps that the pharmacy benefit manager has taken and will take to address network adequacy.
(5) If the director grants a waiver under subsection (3), the waiver expires after 2 years. If a pharmacy benefit manager seeks a renewal of the waiver, the director must consider the steps that the pharmacy benefit manager has taken over the 2-year period covered by the waiver to address network adequacy.
(6) A pharmacy benefit manager shall not conduct spread pricing in this state. However, if a contract between a plan sponsor and a health plan is in effect on the effective date of this act and the contract conflicts with this subsection, for that contract, this subsection applies to the pharmacy benefit manager beginning on the date the contract is amended, extended, or renewed, or before January 1, 2028, whichever is earlier.
(7) A pharmacy benefit manager shall not charge a pharmacy or pharmacist a fee to process a claim electronically.
History:
2022, Act 11, Eff. Jan. 1, 2024
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 11 of 2022 - Pharmacy Benefit Manager Licensure and Regulation Act (550.811 - 550.845) › Section 550.829 - Prohibited Conduct.

550.829 Prohibited conduct.
Sec. 19.
(1) A pharmacy benefit manager shall not discriminate against a nonaffiliated pharmacy that is a retail pharmacy.
(2) A pharmacy benefit manager shall not impose limits, including quantity limits or refill frequency limits, on an enrollee's access to retail prescription drugs that differ based solely on whether the pharmacy benefit manager has an ownership interest in a pharmacy or the pharmacy has an ownership interest in the pharmacy benefit manager.
(3) A pharmacy benefit manager or carrier 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 pharmacy benefit manager's or carrier's provider network solely because it is a 340B Program entity or a pharmacy under contract with a 340B Program entity. A pharmacy benefit manager or carrier 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.
(4) Unless required by applicable law or as required under Medicaid by the department of health and human services, a carrier, health plan, or pharmacy benefit manager shall not require an enrollee or covered person to use only an affiliated pharmacy that is a retail pharmacy.
(5) A carrier, health plan, pharmacy, or pharmacy benefit manager shall not financially induce an enrollee or covered person or prescriber to transfer an enrollee or covered person prescription to a retail affiliated pharmacy. As used in this subsection, "prescriber" means that term as defined in section 17708 of the public health code, 1978 PA 368, MCL 333.17708.
(6) A carrier, health plan, or pharmacy benefit manager shall not require a retail nonaffiliated pharmacy to transfer an enrollee's or covered person's retail prescription to a retail affiliated pharmacy without the prior consent of the enrollee or patient.
(7) A pharmacy benefit manager shall not unreasonably restrict an enrollee or covered person from using a particular network retail pharmacy for the purposes of receiving pharmacist services covered by the enrollee's or covered person's health plan.
(8) Before a prescription is dispensed, an affiliated pharmacy shall disclose to an enrollee or covered person that the affiliated pharmacy is an affiliated pharmacy and that the enrollee or covered person is not obligated to use the affiliated pharmacy.
(9) This section does not prohibit a health plan or carrier from doing any of the following:
(a) Offering customized pharmacy network options to its clients.
(b) Offering mail order of specialty treatments.
(c) Establishing a tiered network.
History:
2022, Act 11, Eff. Jan. 1, 2024
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 11 of 2022 - Pharmacy Benefit Manager Licensure and Regulation Act (550.811 - 550.845) › Section 550.831 - Contractual Restrictions and Limitations With Pharmacists or Pharmacies; Disclosure of Costs; Payment at Point of Sale.

550.831 Contractual restrictions and limitations with pharmacists or pharmacies; disclosure of costs; payment at point of sale.
Sec. 21.
(1) A contract between a pharmacy benefit manager and a pharmacist or a pharmacy that provides drug coverage for health plans must not prohibit or restrict a pharmacy or pharmacist from, or penalize a pharmacy or pharmacist for, disclosing to a covered person or enrollee health care information that the pharmacy or pharmacist considers appropriate regarding any of the following:
(a) The nature of the treatment or the risks or the alternatives to the treatment.
(b) The availability of alternate therapies, consultations, or tests.
(2) A pharmacy benefit manager shall not prohibit a pharmacy or pharmacist from discussing information regarding the total cost for pharmacist services for a drug or from selling a more affordable alternative to the covered person or enrollee if a more affordable alternative is available.
(3) A carrier, health plan, or pharmacy benefit manager shall not require a covered person or enrollee to make a payment for a prescription drug at the point of sale in an amount greater than the lesser of the following:
(a) The applicable copayment, coinsurance, and deductible.
(b) The final reimbursement amount to the network pharmacy.
History:
2022, Act 11, Eff. Jan. 1, 2024
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 11 of 2022 - Pharmacy Benefit Manager Licensure and Regulation Act (550.811 - 550.845) › Section 550.837 - Maximum Allowable Costs; Pharmacy Benefit Manager Duties.

550.837 Maximum allowable costs; pharmacy benefit manager duties.
Sec. 27.
(1) For each drug that a pharmacy benefit manager establishes a maximum allowable cost, the pharmacy benefit manager shall do all of the following:
(a) Provide each pharmacy subject to a maximum allowable cost list with access to the maximum allowable cost list and the source used to determine the maximum allowable cost for each drug.
(b) Update its maximum allowable cost list at least once every 7 calendar days.
(c) Provide a process for each pharmacy subject to the maximum allowable cost list to receive prompt notification of an update to the maximum allowable cost list.
(d) Establish and maintain a reasonable administrative appeals process to allow a pharmacy subject to the maximum allowable cost list or an agent of a pharmacy subject to the maximum allowable cost list to challenge the adjudication of a pharmacy's claim.
(e) Investigate and resolve an appeal under this subsection within 14 calendar days after the pharmacy benefit manager receives the appeal. An appeal under this subsection must be submitted to the pharmacy benefit manager not later than 45 calendar days after the date the pharmacy's claim for reimbursement has been adjudicated.
(f) Respond in writing to any appealing pharmacy or an appealing pharmacy's agent not later than 30 calendar days after receipt of an appeal if the pharmacy filed the appeal more than 10 calendar days after the date the pharmacy's claim for reimbursement is adjudicated.
(g) If an appeal is denied, provide the appealing pharmacy or the appealing pharmacy's agent the national drug code number available for purchase in this state at or below the appealed maximum allowable cost.
(h) If an appeal is granted, permit the pharmacy to reverse and rebill the claim and all claims for the drug.
(2) Before a pharmacy benefit manager places or continues a drug on a maximum allowable cost list, all of the following conditions must be met:
(a) The drug is available for purchase by pharmacies in this state from wholesale distributors operating in this state.
(b) The drug is not obsolete.
(c) The drug is a multiple source drug.
(3) All benefits payable by a carrier, health plan, or pharmacy benefit manager to a pharmacy must be paid within 14 days after adjudication of a claim if claims are submitted electronically.
History:
2022, Act 11, Eff. Jan. 1, 2024
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 11 of 2022 - Pharmacy Benefit Manager Licensure and Regulation Act (550.811 - 550.845) › Section 550.840 - Enforcement of Act; Examination and Audit.

550.840 Enforcement of act; examination and audit.
Sec. 30.
(1) The director shall enforce this act.
(2) The director may examine or audit the relevant books and records of a pharmacy benefit manager providing claims processing services or other drug or device services for a health plan to determine if the pharmacy benefit manager is in compliance with this act.
(3) All of the following apply to information or data acquired during an examination under subsection (2), or otherwise acquired under this act:
(a) The information or data is considered proprietary and confidential.
(b) The information or data is not subject to the freedom of information act, 1976 PA 442, MCL 15.231 to 15.246.
(c) The information or data is only to be used for purposes of ensuring a pharmacy benefit manager's compliance with this act.
History:
2022, Act 11, Eff. Jan. 1, 2024
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 11 of 2022 - Pharmacy Benefit Manager Licensure and Regulation Act (550.811 - 550.845) › Section 550.841 - Contract Compliance; License Requirement.

550.841 Contract compliance; license requirement.
Sec. 31.
A contract between a pharmacy benefit manager and an insurer that exists on the date of licensure of the pharmacy benefit manager must comply with the requirements of this act as a condition of licensure for the pharmacy benefit manager.
History:
2022, Act 11, Eff. Jan. 1, 2024
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 11 of 2022 - Pharmacy Benefit Manager Licensure and Regulation Act (550.811 - 550.845) › Section 550.843 - Retention Schedule; Records, Books, Papers, and Other Data; Destruction or Disposal of Certain Documents Prohibited.

550.843 Retention schedule; records, books, papers, and other data; destruction or disposal of certain documents prohibited.
Sec. 33.
(1) The director shall establish a retention schedule for all records, books, papers, and other data on file with the department related to the enforcement of this act.
(2) The director shall not order the destruction or other disposal of a record, book, paper, or other data that is any of the following:
(a) Required by law to be filed or kept on file with the department until 10 years have passed.
(b) Filed during the director's administration or administrations.
History:
2022, Act 11, Eff. Jan. 1, 2024
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 11 of 2022 - Pharmacy Benefit Manager Licensure and Regulation Act (550.811 - 550.845) › Section 550.845 - Scope of Act.

550.845 Scope of act.
Sec. 35.
This act does not apply with respect to a claim that is entirely preempted by federal law, including Medicare Part D or the employee retirement income security act of 1974, Public Law 93-406.
History:
2022, Act 11, Eff. Jan. 1, 2024
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.901 - Short Title.

550.901 Short title.
Sec. 1.
This act shall be known and may be cited as the "third party administrator act".
History:
1984, Act 218, Eff. Jan. 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.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.910 - Third Party Administrator; Certificate Required; Requirements; Instances in Which Tpa Subject to Act; Name.

550.910 Third party administrator; certificate required; requirements; instances in which TPA subject to act; name.
Sec. 10.
(1) A person shall not operate as a third party administrator without obtaining and maintaining a certificate of authority pursuant to this act.
(2) A third party administrator shall continue to meet the requirements of this act at all times.
(3) A third party administrator is subject to this act in the following instances:
(a) The TPA is domiciled in this state.
(b) The TPA has its principal administrative office or principal headquarters located in this state.
(c) The TPA solicits a plan or sponsor of a plan or provides administrative services to a plan or sponsor of a plan, which plan or sponsor is either domiciled in this state or has its principal headquarters or principal administrative office in this state. This subdivision shall not apply to a TPA who has been licensed or certified as a TPA in that TPA's state of domicile pursuant to a statute or regulation similar to this act.
(d) The TPA provides substantial administrative services to a carrier for the carrier's business in this state.
(4) Each TPA shall transact its business under its own name. A TPA shall not be permitted to do business in this state under a name which is the same as or which closely resembles the name of a TPA which is authorized to do business under the laws of this state.
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 550.912 - Application for Certificate of Authority; Form, Verification, and Contents; Filing Notice of Modification.

550.912 Application for certificate of authority; form, verification, and contents; filing notice of modification.
Sec. 12.
(1) An application for a certificate of authority to operate as a TPA shall be in a form prescribed by the commissioner, shall be verified by an officer or authorized representative of the TPA, and shall include all of the following:
(a) All basic organizational documents of the TPA, such as the articles of incorporation, bylaws, articles of association, trade name certificate, and other similar documents and all amendments to those documents.
(b) The names, addresses, official positions, and professional qualifications of the individuals who are responsible for the conduct of the affairs of the TPA, including all administrative services managers, members of the board of directors, board of trustees, executive committee, or other governing board or committee; the officers and shareholders owning stock representing 10% or more of the voting shares of the TPA in the case of a corporation; and the partners or members in the case of a partnership or association.
(c) A description of the TPA, its services, facilities, and personnel.
(d) A power of attorney duly executed by the TPA if not domiciled in this state, appointing the commissioner, the commissioner's successors in office, and the commissioner's duly authorized deputies as the attorney of the TPA in and for this state, upon whom process in any legal action or proceeding against the TPA on a cause of action arising in this state may be served. The fee for such service shall be $5.00, payable at the time of service.
(e) Recent financial statements showing the third party administrator's assets, liabilities, and sources of financial support sufficient in the opinion of the commissioner, upon the advice of the board, to show financial viability of the third party administrator. If the third party administrator's financial affairs are prepared by independent public accountants, a copy of the most recent regular financial statement shall satisfy this requirement unless the commissioner determines that additional or more recent financial information is required for the proper administration of this act.
(f) Such other information as the commissioner may reasonably require. The commissioner may not demand trade secret information from a TPA.
(2) Within 30 days following any significant modification of information submitted with the application for a certificate of authority, a third party administrator shall file a notice of the modification with the commissioner.
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 550.914 - Certificate of Authority; Issuance; Notice of Disapproval; Continued Compliance With Subsection (1).

550.914 Certificate of authority; issuance; notice of disapproval; continued compliance with subsection (1).
Sec. 14.
(1) The commissioner shall issue a certificate of authority to operate as a TPA if the commissioner is satisfied that the TPA has adequate facilities, personnel, and managers to act as a third party administrator.
(2) If the commissioner disapproves an application for a certificate of authority, he or she shall notify the applicant in writing of the reasons for the disapproval.
(3) A TPA shall continue to meet the conditions required under subsection (1) after the certificate of authority is issued.
History:
1984, Act 218, Eff. Jan. 1, 1985 ;-- Am. 2002, Act 74, Imd. Eff. Mar. 15, 2002
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.916 - Repealed. 2002, Act 74, Imd. Eff. Mar. 15, 2002.

550.916 Repealed. 2002, Act 74, Imd. Eff. Mar. 15, 2002.
Compiler's Notes:
The repealed section pertained to license as administrative services manager.
2023 Michigan Compiled Laws › Chapter 550 - General Insurance Laws › Act 218 of 1984 - Third Party Administrator Act (550.901 - 550.962) › Section 550.918 - Fees; Payment; Collection; and Designation.

550.918 Fees; payment; collection; and designation.
Sec. 18.
(1) The commissioner shall collect, and the persons affected shall pay to the commissioner, the following fees:
(a) Filing fee to accompany application for third party administrator's certificate of authority...........
$
200.00.
(b) Certificate of authority for a third party administrator............................................
$
25.00.
(c) Filing fee for annual statement of a third party administrator, each year.................................
$
25.00.
(2) Fees paid under this section shall be designated for the insurance bureau to cover the additional costs incurred as a result of this act.
History:
1984, Act 218, Eff. Jan. 1, 1985 ;-- Am. 2002, Act 74, Imd. Eff. Mar. 15, 2002