Michigan Compiled Laws
218-1956-35 - Chapter 35 Health Maintenance Organizations (500.3501...500.3580)
Section 500.3573 - Operation of Health Care Delivery System Not Meeting Requirements of Act; Permitted Conduct; Limitations.

Sec. 3573.
(1) A person that proposes to operate a system of health care delivery and financing to be offered to individuals, whether or not as members of groups, in exchange for a fixed payment and to be organized so that providers and the organization are in some part at risk for the cost of services in a manner similar to a health maintenance organization, but that fails to meet the requirements of this act for a health maintenance organization, may operate the system of health care delivery and financing if the director finds that the proposed operation will benefit persons who will be served by it. The director shall authorize and regulate the operation of the system in the same manner as a health maintenance organization under this act, including the filing of periodic reports, except to the extent that the director finds that the regulation is inappropriate to the system of health care delivery and financing.
(2) A person operating a system of health care delivery and financing under this section shall not advertise or solicit or in any way identify itself in a manner implying to the public that it is a health maintenance organization authorized under this act.
History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016 Popular Name: Act 218Popular Name: HMO

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.