Michigan Laws 500.3533 – Prudent purchaser contracts; reimbursement for unauthorized services or services by nonaffiliated providers
Current as of: 2023 | Check for updates
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Terms Used In Michigan Laws 500.3533
- Contract: A legal written agreement that becomes binding when signed.
- 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 500.3501person: may extend and be applied to bodies politic and corporate, as well as to individuals. See Michigan Laws 8.3l
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.