218-1956-35 Chapter 35 Health Maintenance Organizations (500.3501...500.3580)

218-1956-35 Chapter 35 Health Maintenance Organizations (500.3501...500.3580)

Section 500.3501 Definitions.
Section 500.3503 Applicability of Provisions to Health Maintenance Organization.
Section 500.3505 Health Maintenance Contract; Use of Descriptive Words; Restrictions.
Section 500.3507 Authorizing and Regulating Health Maintenance Organization; Establishment of System by Director.
Section 500.3508 Quality Assessment Program; Quality Improvement Program.
Section 500.3509 Certificate of Authority; Application; Form; Limitation; Change of Service Area.
Section 500.3511 Governing Body; Election of Enrollee Board Members; Requirements; Meetings.
Section 500.3513 Health Maintenance Organization Operations; Regulation by Director; Incorporation as Legal Entity.
Section 500.3515 Additional Health Services; Deductibles; Copayments; "Preventive Health Care Services" Defined; Partial Payment From Government or Private Person.
Section 500.3517 Healthy Lifestyle Programs; Emergency or Out-of-Area Service; Payment of Expenses or Fees.
Section 500.3519 Contract and Contract Rates; Fairness; Rate Differential; Basic Health Services to Large Employers Required.
Section 500.3521 Prepayment Rates; Filing and Approval of Methodology; Schedule.
Section 500.3523 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3525 Proposal to Revise Contract or Rate; Approval of Commissioner; Approval With Modifications; Hearing; Disposition; Exception; Notice.
Section 500.3527 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3528 Health Maintenance Organization; Credentialing Verification; Accreditation by Nationally Recognized Accredited Body.
Section 500.3529 Affiliated Provider Contracts; Collection of Payments From Enrollees; Contract Provisions; Waiver of Requirement Under Subsection (2); Contract Format; Evidence of Sufficient Number of Providers.
Section 500.3530 Availability of Covered Services; Assurance; Establishment and Maintenance of Proximity.
Section 500.3531 Contracts With Health Care Providers to Become Affiliated Providers; Requirements; Standards; Filing; Duplicative Standards; Notice Procedures; Provider Application Period; Approval or Rejection as Affiliated Provider; Termination of Contract; Providing Information to Insurer.
Section 500.3533 Prudent Purchaser Contracts; Reimbursement for Unauthorized Services or Services by Nonaffiliated Providers.
Section 500.3535 Solicitation or Advertising.
Section 500.3537 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3539 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3541 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3542 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3543 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3544 Noninsured Benefit Plan; Processing and Payment of Claims.
Section 500.3545 Acquisition of Obligations From Another Managed Care Entity.
Section 500.3547 Health Care Service Operations; Visitation or Examination by Director; Consultation With Enrollees; Authority; Access to Information Relating to Delivery of Services; Submission of Information Regarding Proposed Contract.
Section 500.3548 Maintenance of Books, Records, Files, and Financial Records; Funds and Assets.
Section 500.3549 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3551 Health Maintenance Organization; Net Worth.
Section 500.3553 Certificate of Authority; Deposit Requirements.
Section 500.3555 Financial Plan.
Section 500.3557 Notice of Changes in Operations.
Section 500.3559 Reinsurance Contract or Plan of Self-Insurance; Purpose; Filing; Approval; Coverage.
Section 500.3561 Insolvency; Continuation of Benefits.
Section 500.3563 Insolvency; Offer of Enrollment by Health Insurers Participating in Enrollment Process; Allocation of Group Coverage to Health Maintenance Organizations or Insurers Within Service Area; Nongroup Coverage; Reassignment of Enrollees of Insolvent Organization Contracting With State Funded Health Care Program; Substitute Coverage Under American Health Benefit Exchange.
Section 500.3565 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3567 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.
Section 500.3569 Assumption of Financial Risk.
Section 500.3571 State or Federal Health Programs.
Section 500.3573 Operation of Health Care Delivery System Not Meeting Requirements of Act; Permitted Conduct; Limitations.
Section 500.3580 Repealed. 2016, Act 276, Imd. Eff. July 1, 2016.

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