Sec. 3519.
(1) A health maintenance organization contract and the contract's rates, including any deductibles, copayments, and coinsurances, between the organization and its subscribers must be fair, sound, and reasonable in relation to the services provided, and the procedures for offering and terminating contracts must not be unfairly discriminatory.
(2) A health maintenance organization contract and the contract's rates must not discriminate on the basis of race, color, creed, national origin, residence within the approved service area of the health maintenance organization, lawful occupation, sex, handicap, or marital status, except that marital status may be used to classify individuals or risks for the purpose of insuring family units. The director may approve a rate differential based on sex, age, residence, disability, marital status, or lawful occupation, if the differential is supported by sound actuarial principles, a reasonable classification system, and is related to the actual and credible loss statistics or reasonably anticipated experience for new coverages. A healthy lifestyle program as defined in section 3517(2) is not subject to the director's approval under this subsection and is not required to be supported by sound actuarial principles, a reasonable classification system, or be related to actual and credible loss statistics or reasonably anticipated experience for new coverages.
(3) A health maintenance organization contract shall offer basic health services to large employers in at least 1 health maintenance contract.
History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 ;-- Am. 2002, Act 304, Imd. Eff. May 10, 2002 ;-- Am. 2002, Act 621, Imd. Eff. Dec. 23, 2002 ;-- Am. 2005, Act 306, Imd. Eff. Dec. 21, 2005 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218Popular Name: HMO
Structure Michigan Compiled Laws
Chapter 500 - Insurance Code of 1956
Act 218 of 1956 - The Insurance Code of 1956 (500.100 - 500.8302)
218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)
Section 500.3501 - Definitions.
Section 500.3503 - Applicability of Provisions to Health Maintenance Organization.
Section 500.3505 - Health Maintenance Contract; Use of Descriptive Words; Restrictions.
Section 500.3508 - Quality Assessment Program; Quality Improvement Program.
Section 500.3509 - Certificate of Authority; Application; Form; Limitation; Change of Service Area.
Section 500.3511 - Governing Body; Election of Enrollee Board Members; Requirements; Meetings.
Section 500.3521 - Prepayment Rates; Filing and Approval of Methodology; Schedule.
Section 500.3523 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3527 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3535 - Solicitation or Advertising.
Section 500.3537 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3539 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3541 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3542 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3543 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3544 - Noninsured Benefit Plan; Processing and Payment of Claims.
Section 500.3545 - Acquisition of Obligations From Another Managed Care Entity.
Section 500.3548 - Maintenance of Books, Records, Files, and Financial Records; Funds and Assets.
Section 500.3549 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3551 - Health Maintenance Organization; Net Worth.
Section 500.3553 - Certificate of Authority; Deposit Requirements.
Section 500.3555 - Financial Plan.
Section 500.3557 - Notice of Changes in Operations.
Section 500.3561 - Insolvency; Continuation of Benefits.
Section 500.3565 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3567 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3569 - Assumption of Financial Risk.
Section 500.3571 - State or Federal Health Programs.
Section 500.3580 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.