Michigan Laws 500.3515 – Additional health services; deductibles; copayments; “preventive health care services” defined; partial payment from government or private person
Current as of: 2023 | Check for updates
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Terms Used In Michigan Laws 500.3515
- Director: means , unless the context clearly implies a different meaning, the director of the department. See Michigan Laws 500.102
- 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 500.3501Health services: means services provided to enrollees of a health maintenance organization under their health maintenance contract. See Michigan Laws 500.3501
(1) A health maintenance organization may provide additional health services or any other related health care service or treatment not required under this act.
(2) A health maintenance organization may have health maintenance contracts with deductibles. A health maintenance organization may have health maintenance contracts that include copayments, stated as dollar amounts for the cost of covered services, and coinsurance, stated as percentages for the cost of covered services. This subsection does not limit the director‘s authority to regulate and establish fair, sound, and reasonable copayment and coinsurance limits including out of pocket maximums.
(3) A health maintenance organization shall not require that contributions be made to a deductible for preventive health care services. As used in this subsection, “preventive health care services” means services designated to maintain an individual in optimum health and to prevent unnecessary injury, illness, or disability.
(4) A health maintenance organization may accept from governmental agencies and from private persons payments covering any part of the cost of health maintenance contracts.