Michigan Laws 550.942 – Additional prohibited conduct
Current as of: 2024 | Check for updates
|
Other versions
A manager or TPA, in order to induce a person to contract or to continue to contract with the TPA; to induce a person to lapse, forfeit, or surrender a service contract entered into with a TPA; or to induce a person to secure or terminate coverage with a carrier or other person, shall not directly or indirectly:
(a) Offer to make or make an agreement relating to a service contract or issue or deliver to the person money or any other valuable consideration other than as plainly expressed in the service contract.
Terms Used In Michigan Laws 550.942
- Carrier: means an insurer, including a health maintenance organization, regulated under the insurance code of 1956, 1956 PA 218, MCL 500. See Michigan Laws 550.902
- Contract: A legal written agreement that becomes binding when signed.
- manager: means an individual responsible for conducting the daily operations of a third party administrator. See Michigan Laws 550.902
- Person: means an individual, sole proprietorship, partnership, corporation, association, or any other legal entity. See Michigan Laws 550.902
- 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. See Michigan Laws 550.902
- Service contract: means the written agreement for the provision of administrative services between the TPA and a plan, a sponsor of a plan, or a carrier. See Michigan Laws 550.902
- TPA: means a person that directly or indirectly processes claims under a service contract and that may also provide 1 or more other administrative services under a service contract, other than under a worker's compensation self-insurance program pursuant to section 611 of the worker's disability compensation act of 1969, 1969 PA 317, MCL 418. See Michigan Laws 550.902
(b) Give or pay or offer to give or pay, directly or indirectly, a rebate or adjustment of the fee payable under the service contract, or an advantage in the services thereunder, except as reflected in the fee and expressly provided in the service contract.
(c) Make, issue, or circulate, or cause to be made, issued, or circulated, any estimate, illustration, circular, or statement misrepresenting the terms of a service contract, the advantages provided thereunder, or the true nature thereof.
(d) Make a misrepresentation in a comparison, whether oral or written, between service contracts of the TPA and another TPA or between service contracts of the TPA and a carrier.