Section 550.1952 – Entities Contracting With State or Local Government for Costs of Health Care Services Under Self-Funded Plan; Duties.
550.1952 Entities contracting with state or local government for costs of health care services under self-funded plan; duties. Sec. 2. (1) An entity that contracts with a state or local unit of government to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services provided under a self-funded plan […]
Section 550.1953 – Exceptions.
550.1953 Exceptions. Sec. 3. This act does not apply to a self-funded plan that provides coverage only for dental, vision care, or any other limited supplemental benefit. History: 2006, Act 495, Imd. Eff. Dec. 29, 2006
Section 550.2001 – Short Title; Intent; Establishment.
550.2001 Short title; intent; establishment. Sec. 1. (1) This act shall be known and may be cited as the “elder prescription insurance coverage act”. (2) It is the intent of the legislature that the EPIC program defray the cost of obtaining medically necessary prescription drugs by elderly Michigan residents under the conditions specified in this […]
Section 550.2002 – Definitions.
550.2002 Definitions. Sec. 2. As used in this act: (a) “Department” means the department of community health. (b) “EPIC program” means the elder prescription insurance coverage program created in section 3 or any other state program, federal program, or combination of state programs and federal programs, providing services to the population specified in section 3. […]
Section 550.2003 – Epic Program; Provisions; Eligibility Requirements; Enrollment; Assessment for Medicaid; “Institution” Explained; Business With Not More Than 1 Employee and Less Than $200,000.00 in Assets.
550.2003 EPIC program; provisions; eligibility requirements; enrollment; assessment for medicaid; “institution” explained; business with not more than 1 employee and less than $200,000.00 in assets. Sec. 3. (1) The EPIC program shall provide prescription drug coverage, including related supplies as determined by the department in consultation with the advisory committee established in section 7, to […]
Section 550.1923 – Maintenance of Records; Report to Director.
550.1923 Maintenance of records; report to director. Sec. 23. (1) An independent review organization assigned to conduct an external review under section 11 or 13 shall maintain for 3 years written records in the aggregate and by health carrier on all requests for external review for which it conducted an external review during a calendar […]
Section 550.1903 – Definitions.
550.1903 Definitions. Sec. 3. As used in this act: (a) “Adverse determination” means a determination by a health carrier or its designee utilization review organization that an admission, availability of care, continued stay, or other health care service that is a covered benefit has been reviewed and, based on the information provided, does not meet […]
Section 550.1905 – Scope.
550.1905 Scope. Sec. 5. (1) Except as otherwise provided in subsection (2), this act applies to all health carriers. (2) This act does not apply to a policy or certificate that provides coverage only for specified accident or accident-only coverage, credit, disability income, hospital indemnity, long-term care insurance, as that term is defined in section […]
Section 550.1907 – Right to Request External Review for Adverse Determination; Written Notice.
550.1907 Right to request external review for adverse determination; written notice. Sec. 7. (1) A health carrier shall provide written notice to a covered person of the internal grievance and external review processes at the time the health carrier sends written notice of an adverse determination. (2) Except as provided in subsection (3)(a), a request […]
Section 550.1909 – Written Request to Director; Manner; Electronic Communication.
550.1909 Written request to director; manner; electronic communication. Sec. 9. (1) Except for a request for an expedited external review under section 13, all requests for external review must be made in writing to the director. (2) A written notice required to be provided under this act must be provided in a culturally and linguistically […]