{"data":{"id":"us-mi/mich.-comp.-laws-500.3501","jurisdiction":"us-mi","citation":"Mich. Comp. Laws § 500.3501","heading":"Definitions.","body":"Sec. 3501.\n\nAs used in this chapter:\n\n(a) \"Affiliated provider\" means a health professional, licensed hospital, licensed pharmacy, or any other institution, organization, or person that has entered into a participating provider contract, directly or indirectly, with a health maintenance organization to render 1 or more health services to an enrollee. Affiliated provider includes a person described in this subdivision that has entered into a written arrangement with another person, including, but not limited to, a physician hospital organization or physician organization, that contracts directly with a health maintenance organization.\n\n(b) \"Basic health services\" means medically necessary health services that health maintenance organizations must offer to large employers in at least 1 health maintenance contract. Basic health services include all of the following:\n\n( i ) Physician services including primary care and specialty care.\n\n( ii ) Ambulatory services.\n\n( iii ) Inpatient hospital services.\n\n( iv ) Emergency health services.\n\n( v ) Mental health and substance use disorder services.\n\n( vi ) Diagnostic laboratory and diagnostic and therapeutic radiological services.\n\n( vii ) Home health services.\n\n( viii ) Preventive health services.\n\n(c) \"Credentialing verification\" means the process of obtaining and verifying information about a health professional and evaluating the health professional when the health professional applies to become a participating provider with a health maintenance organization.\n\n(d) \"Health maintenance contract\" means a contract between a health maintenance organization and a subscriber or group of subscribers to provide or arrange for the provision of health services within the health maintenance organization's service area. Health maintenance contract includes a prudent purchaser agreement under section 3405.\n\n(e) \"Health maintenance organization\" means a person that, among other things, does the following:\n\n( 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.\n\n( ii ) Is responsible for the availability, accessibility, and quality of the health services provided.\n\n(f) \"Health professional\" means an individual licensed, certified, or authorized in accordance with state law to practice a health profession in his or her respective state.\n\n(g) \"Health services\" means services provided to enrollees of a health maintenance organization under their health maintenance contract.\n\n(h) \"Service area\" means a defined geographical area in which covered health services are generally available and readily accessible to enrollees and where health maintenance organizations may market their contracts.","path":["MI Code","Chapter 500","Act Act-218-of-1956"],"source_url":"https://www.legislature.mi.gov/Laws/MCL?objectName=mcl-500-3501","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:31Z","sha256":"68017247215e0971bb69582cb83abba186002aa480a8e46b9c75f78980845d53","source_id":"us-mi","stale":false,"prev":"us-mi/mich.-comp.-laws-500.3477","next":"us-mi/mich.-comp.-laws-500.3503"},"notice":"GroundRules: Original legal text. Not legal advice."}