Michigan Compiled Laws
218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)
Section 500.3533 - Prudent Purchaser Contracts; Reimbursement for Unauthorized Services or Services by Nonaffiliated Providers.

Sec. 3533.
Subject to section 3405, a health maintenance organization may offer prudent purchaser contracts to groups or individuals and in conjunction with those contracts a health maintenance organization may pay or may reimburse enrollees, or may contract with another person to pay or reimburse enrollees, for unauthorized services or for services by nonaffiliated providers in accordance with the terms of the contract and subject to copayments, coinsurances, deductibles, or other financial penalties designed to encourage enrollees to obtain services from affiliated providers.
History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 ;-- Am. 2005, Act 306, Imd. Eff. Dec. 21, 2005 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218Popular Name: HMO

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Structure Michigan Compiled Laws

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 500.3507 - Authorizing and Regulating Health Maintenance Organization; Establishment of System by Director.

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 500.3513 - Health Maintenance Organization Operations; Regulation by Director; Incorporation as Legal Entity.

Section 500.3515 - Additional Health Services; Deductibles; Copayments; "Preventive Health Care Services" Defined; Partial Payment From Government or Private Person.

Section 500.3517 - Healthy Lifestyle Programs; Emergency or Out-of-Area Service; Payment of Expenses or Fees.

Section 500.3519 - Contract and Contract Rates; Fairness; Rate Differential; Basic Health Services to Large Employers Required.

Section 500.3521 - Prepayment Rates; Filing and Approval of Methodology; Schedule.

Section 500.3523 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

Section 500.3525 - Proposal to Revise Contract or Rate; Approval of Commissioner; Approval With Modifications; Hearing; Disposition; Exception; Notice.

Section 500.3527 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

Section 500.3528 - Health Maintenance Organization; Credentialing Verification; Accreditation by Nationally Recognized Accredited Body.

Section 500.3529 - Affiliated Provider Contracts; Collection of Payments From Enrollees; Contract Provisions; Waiver of Requirement Under Subsection (2); Contract Format; Evidence of Sufficient Number of Providers.

Section 500.3530 - Availability of Covered Services; Assurance; Establishment and Maintenance of Proximity.

Section 500.3531 - Contracts With Health Care Providers to Become Affiliated Providers; Requirements; Standards; Filing; Duplicative Standards; Notice Procedures; Provider Application Period; Approval or Rejection as Affiliated Provider; Termination...

Section 500.3533 - Prudent Purchaser Contracts; Reimbursement for Unauthorized Services or Services by Nonaffiliated Providers.

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 500.3547 - Health Care Service Operations; Visitation or Examination by Director; Consultation With Enrollees; Authority; Access to Information Relating to Delivery of Services; Submission of Information Regarding Proposed Contract.

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 500.3559 - Reinsurance Contract or Plan of Self-Insurance; Purpose; Filing; Approval; Coverage.

Section 500.3561 - Insolvency; Continuation of Benefits.

Section 500.3563 - Insolvency; Offer of Enrollment by Health Insurers Participating in Enrollment Process; Allocation of Group Coverage to Health Maintenance Organizations or Insurers Within Service Area; Nongroup Coverage; Reassignment of Enrollees...

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 500.3573 - Operation of Health Care Delivery System Not Meeting Requirements of Act; Permitted Conduct; Limitations.

Section 500.3580 - Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.