§ 500.3501 Definitions
§ 500.3503 Applicability of provisions to health maintenance organization
§ 500.3505 Health maintenance contract; use of descriptive words; restrictions
§ 500.3507 Authorizing and regulating health maintenance organization; establishment of system by director
§ 500.3508 Quality assessment program; quality improvement program
§ 500.3509 Certificate of authority; application; form; limitation; change of service area
§ 500.3511 Governing body; election of enrollee board members; requirements; meetings
§ 500.3513 Health maintenance organization operations; regulation by director; incorporation as legal entity
§ 500.3515 Additional health services; deductibles; copayments; “preventive health care services” defined; partial payment from government or private person
§ 500.3517 Healthy lifestyle programs; emergency or out-of-area service; payment of expenses or fees
§ 500.3519 Contract and contract rates; fairness; rate differential; basic health services to large employers required
§ 500.3521 Prepayment rates; filing and approval of methodology; schedule
§ 500.3525 Proposal to revise contract or rate; approval of commissioner; approval with modifications; hearing; disposition; exception; notice
§ 500.3528 Health maintenance organization; credentialing verification; accreditation by nationally recognized accredited body
§ 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
§ 500.3530 Availability of covered services; assurance; establishment and maintenance of proximity
§ 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 af
§ 500.3533 Prudent purchaser contracts; reimbursement for unauthorized services or services by nonaffiliated providers
§ 500.3535 Solicitation or advertising
§ 500.3544 Noninsured benefit plan; processing and payment of claims
§ 500.3545 Acquisition of obligations from another managed care entity
§ 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 regardi
§ 500.3548 Maintenance of books, records, files, and financial records; funds and assets
§ 500.3551 Health maintenance organization; net worth
§ 500.3553 Certificate of authority; deposit requirements
§ 500.3555 Financial plan
§ 500.3557 Notice of changes in operations
§ 500.3559 Reinsurance contract or plan of self-insurance; purpose; filing; approval; coverage
§ 500.3561 Insolvency; continuation of benefits
§ 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 cover
§ 500.3569 Assumption of financial risk
§ 500.3571 State or federal health programs
§ 500.3573 Operation of health care delivery system not meeting requirements of act; permitted conduct; limitations

Terms Used In Michigan Laws > Chapter 500 > Act 218 of 1956 > Chapter 35 - Health Maintenance Organizations

  • Advice and consent: Under the Constitution, presidential nominations for executive and judicial posts take effect only when confirmed by the Senate, and international treaties become effective only when the Senate approves them by a two-thirds vote.
  • Affiliated provider: means a health professional, licensed hospital, licensed pharmacy, or any other institution, organization, or person that has entered into a participating provider contract, directly or indirectly, with a health maintenance organization to render 1 or more health services to an enrollee. See Michigan Laws 500.3501
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Basic health services: means medically necessary health services that health maintenance organizations must offer to large employers in at least 1 health maintenance contract. See Michigan Laws 500.3501
  • Bequest: Property gifted by will.
  • board: means the board of control of Lake Superior state university. See Michigan Laws 390.391
  • Commissioner: means the director. See Michigan Laws 500.102
  • Concurrent resolution: A legislative measure, designated "S. Con. Res." and numbered consecutively upon introduction, generally employed to address the sentiments of both chambers, to deal with issues or matters affecting both houses, such as a concurrent budget resolution, or to create a temporary joint committee. Concurrent resolutions are not submitted to the President/Governor and thus do not have the force of law.
  • Continuance: Putting off of a hearing ot trial until a later time.
  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Credentialing verification: means the process of obtaining and verifying information about a health professional and evaluating the health professional when the health professional applies to become a participating provider with a health maintenance organization. See Michigan Laws 500.3501
  • Deed: The legal instrument used to transfer title in real property from one person to another.
  • Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
  • Devise: To gift property by will.
  • Director: means , unless the context clearly implies a different meaning, the director of the department. See Michigan Laws 500.102
  • Donor: The person who makes a gift.
  • Enrollee: means an individual who is entitled to receive health services under a health insurance contract, unless the context requires otherwise. See Michigan Laws 500.116
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Ex officio: Literally, by virtue of one's office.
  • Gift: A voluntary transfer or conveyance of property without consideration, or for less than full and adequate consideration based on fair market value.
  • Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
  • Health insurance policy: means an expense-incurred hospital, medical, or surgical policy, certificate, or contract. See Michigan Laws 500.608
  • Health maintenance contract: means a contract between a health maintenance organization and a subscriber or group of subscribers to provide or arrange for the provision of health services within the health maintenance organization's service area. See Michigan Laws 500.3501
  • Health maintenance organization: means a person that, among other things, does the following:
  (i) Delivers health services that are medically necessary to enrollees under the terms of its health maintenance contract, directly or through contracts with affiliated providers, in exchange for a fixed prepaid sum or per capita prepayment, without regard to the frequency, extent, or kind of health services. See Michigan Laws 500.3501
  • Health professional: means an individual licensed, certified, or authorized in accordance with state law to practice a health profession in his or her respective state. See Michigan Laws 500.3501
  • Health services: means services provided to enrollees of a health maintenance organization under their health maintenance contract. See Michigan Laws 500.3501
  • in writing: shall be construed to include printing, engraving, and lithographing; except that if the written signature of a person is required by law, the signature shall be the proper handwriting of the person or, if the person is unable to write, the person's proper mark, which may be, unless otherwise expressly prohibited by law, a clear and classifiable fingerprint of the person made with ink or another substance. See Michigan Laws 8.3q
  • Insurer: means an individual, corporation, association, partnership, reciprocal exchange, inter-insurer, Lloyds organization, fraternal benefit society, or other legal entity, engaged or attempting to engage in the business of making insurance or surety contracts. See Michigan Laws 500.106
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Participating provider: means a provider that, under contract with an insurer that issues policies of health insurance or with such an insurer's contractor or subcontractor, has agreed to provide health care services to covered individuals and to accept payment by the insurer, contractor, or subcontractor for covered services as payment in full, other than coinsurance, copayments, or deductibles. See Michigan Laws 500.116
  • person: may extend and be applied to bodies politic and corporate, as well as to individuals. See Michigan Laws 8.3l
  • Plaintiff: The person who files the complaint in a civil lawsuit.
  • Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
  • Quorum: The number of legislators that must be present to do business.
  • Rate: means the cost of insurance per payroll before adjustment for an individual insured's size, exposure, or loss experience. See Michigan Laws 500.2402
  • reciprocal agreement: means a contractual arrangement permitting resident students of a designated state to be admitted to a public institution of higher education in another state at an agreed tuition rate less than normally charged nonresident students of that state. See Michigan Laws 390.501
  • Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
  • seal: shall be construed to include any of the following:
    •   (a) The impression of the seal on the paper alone. See Michigan Laws 8.3n
  • Service area: means a defined geographical area in which covered health services are generally available and readily accessible to enrollees and where health maintenance organizations may market their contracts. See Michigan Laws 500.3501
  • Service of process: The service of writs or summonses to the appropriate party.
  • shall not apply: means that the pertinent provision is not operative as to certain persons or things or in conjunction with a particular date or dates. See Michigan Laws 8.4c
  • state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories belonging to the United States; and the words "United States" shall be construed to include the district and territories. See Michigan Laws 8.3o
  • Statute: A law passed by a legislature.
  • subscriber: means an individual who enters into an insurance contract for health insurance, or on whose behalf an insurance contract for health insurance is entered into, with an insurer. See Michigan Laws 500.116
  • Trustee: A person or institution holding and administering property in trust.