550.901 Short title. Sec. 1. This act shall be known and may be cited as the “third party administrator act”. History: 1984, Act 218, Eff. Jan. 1, 1985 Compiler’s Notes: For transfer of the Department of Insurance and Office of the Commissioner on Insurance from the Department of Licensing and Regulation to the Department of […]
550.902 Definitions. Sec. 2. As used in this act: (a) “Administrative services manager” or “manager” means an individual responsible for conducting the daily operations of a third party administrator. (b) “Benefit plan” or “plan” means a medical, surgical, dental, vision, or health care benefit plan and may include coverage under a policy or certificate issued […]
550.910 Third party administrator; certificate required; requirements; instances in which TPA subject to act; name. Sec. 10. (1) A person shall not operate as a third party administrator without obtaining and maintaining a certificate of authority pursuant to this act. (2) A third party administrator shall continue to meet the requirements of this act at […]
550.912 Application for certificate of authority; form, verification, and contents; filing notice of modification. Sec. 12. (1) An application for a certificate of authority to operate as a TPA shall be in a form prescribed by the commissioner, shall be verified by an officer or authorized representative of the TPA, and shall include all of […]
550.914 Certificate of authority; issuance; notice of disapproval; continued compliance with subsection (1). Sec. 14. (1) The commissioner shall issue a certificate of authority to operate as a TPA if the commissioner is satisfied that the TPA has adequate facilities, personnel, and managers to act as a third party administrator. (2) If the commissioner disapproves […]
550.916 Repealed. 2002, Act 74, Imd. Eff. Mar. 15, 2002. Compiler’s Notes: The repealed section pertained to license as administrative services manager.
550.918 Fees; payment; collection; and designation. Sec. 18. (1) The commissioner shall collect, and the persons affected shall pay to the commissioner, the following fees: (a) Filing fee to accompany application for third party administrator’s certificate of authority……….. $ 200.00. (b) Certificate of authority for a third party administrator…………………………………….. $ 25.00. (c) Filing fee for […]
550.919 TPA advisory board; creation; appointment, qualifications, and terms of members; expenses; duty of board; report. Sec. 19. (1) A TPA advisory board is created. The board shall consist of 7 members appointed by the commissioner, at least 4 of whom shall be individuals employed by TPAs who are not in the employ of a […]
550.920 Authority of commissioner. Sec. 20. The commissioner shall have the same authority with respect to a TPA or manager as he or she does with respect to an insurance agency or agent under the insurance code of 1956, Act No. 218 of the Public Acts of 1956, being sections 500.100 to 500.8302 of the […]
550.922 Hearings. Sec. 22. The commissioner may designate 1 or more persons to conduct hearings provided for under this act, hearings required by the administrative procedures act of 1969, Act No. 306 of the Public Acts of 1969, being sections 24.201 to 24.315 of the Michigan Compiled Laws, and hearings which the commissioner considers necessary […]
550.924 Destruction or disposal of records, books, papers, and other data. Sec. 24. The commissioner is authorized to destroy or otherwise dispose of all records, books, papers, and other data on file with the department which in his or her opinion and on the advice of the attorney general, are of no further material value […]
550.926 340B Program entities; reimbursement, co-pay, and discrimination prohibitions; definitions. Sec. 26. (1) A carrier or third party administrator that is a pharmacy benefit manager shall not prohibit a 340B Program entity or a pharmacy that has a license in good standing in this state under contract with a 340B Program entity from participating in […]
550.927 Disclosure of current selling prices; prohibited contract provisions. Sec. 27. A contract between a carrier or third party administrator that is a pharmacy benefit manager and a pharmacy must not prohibit the pharmacy from disclosing the current selling price of a drug in accordance with section 17757 of the public health code, 1978 PA […]
550.930 Provision of administrative services pursuant to written service contract; maintenance of books and records; TPA and manager as fiduciary. Sec. 30. (1) A TPA may only provide administrative services pursuant to a written service contract. For the duration of the service contract, a TPA shall maintain at its principal administrative office the TPA’s books […]
550.932 Benefit plan; notice; plan covering less than 500 individuals; service contract between TPA and governmental entity not subject to ERISA; construction of act. Sec. 32. (1) A TPA, in connection with a benefit plan, shall provide in its service contract a provision that the person contracting for the services shall provide written notice to […]
550.934 Confidentiality. Sec. 34. (1) A TPA shall provide for the confidentiality of personal data identifying an individual covered by a plan. A TPA shall not disclose records containing personal information that may be associated with an identifiable individual covered by a plan to a person other than the individual to whom the information pertains. […]
550.936 Annual statement; report. Sec. 36. By July 1, 2022 and each July 1 after that date, a third party administrator shall prepare under oath and file with the director a statement concerning the third party administrator’s affairs on a form provided by the director. A third party administrator shall file the annual statement required […]
550.940 Prohibited conduct generally. Sec. 40. A TPA or manager, in processing claims, shall not do any of the following: (a) Misrepresent pertinent facts relating to coverage. (b) Fail to make a good faith effort to acknowledge promptly or to act reasonably and promptly upon communications with respect to a claim for benefits. (c) Fail […]
550.942 Additional prohibited conduct. Sec. 42. 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 […]
550.944 Additional prohibited conduct. Sec. 44. (1) A TPA shall not refuse to enter into a service contract or provide administrative services other than processing claims because of race, color, creed, marital status, sex, national origin, residence, age, disability, or lawful occupation. (2) A TPA or manager shall not misrepresent the financial condition of a […]
