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Terms Used In Michigan Laws 333.24502

  • Contract: A legal written agreement that becomes binding when signed.
  • person: may extend and be applied to bodies politic and corporate, as well as to individuals. See Michigan Laws 8.3l
  • state: when applied to the different parts of the United States, shall be construed to extend to and include the District of Columbia and the several territories belonging to the United States; and the words "United States" shall be construed to include the district and territories. See Michigan Laws 8.3o
    (1) “Carrier” means any of the following:
    (a) A person that issues a health benefit plan in this state, including an insurer, health maintenance organization, or any other person providing a plan of health benefits, coverage, or insurance subject to state insurance regulation.
    (b) An entity that contracts with this state or a 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 established or maintained by the state or local unit of government for its employees.
    (2) “Department” means the department of insurance and financial services.
    (3) “Director” means the director of the department or his or her designee.
    (4) “Emergency patient” means an individual with a physical or mental condition that manifests itself by acute symptoms of sufficient severity, including, but not limited to, pain such that a prudent layperson, possessing average knowledge of health and medicine, could reasonably expect to result in 1 or more of the following:
    (a) Placing the health of the individual or, in the case of a pregnant woman, the health of the woman or the unborn child, or both, in serious jeopardy.
    (b) Serious impairment of bodily function.
    (c) Serious dysfunction of a body organ or part.
    (5) “Health benefit plan” means an individual or group expense-incurred hospital, medical, or surgical policy or certificate, an individual or group health maintenance organization contract, or a self-funded plan established or maintained by this state or a local unit of government for its employees. Health benefit plan does not include accident-only, credit, dental, or disability income insurance; long-term care insurance; coverage issued as a supplement to liability insurance; coverage only for a specified disease or illness; worker’s compensation or similar insurance; or automobile medical-payment insurance.
    (6) “Health care service” means a diagnostic procedure, medical or surgical procedure, examination, or other treatment.
    (7) “Health facility” means any of the following:
    (a) A hospital.
    (b) A freestanding surgical outpatient facility as that term is defined in section 20104.
    (c) A skilled nursing facility as that term is defined in section 20109.
    (d) A physician’s office or other outpatient setting, that is not otherwise described in this subsection.
    (e) A laboratory.
    (f) A radiology or imaging center.
    (8) “Health maintenance organization” means that term as defined in section 3501 of the insurance code of 1956, 1956 PA 218, MCL 500.3501.
    (9) “Hospital” means that term as defined in section 20106.
    (10) “Insurer” means that term as defined in section 106 of the insurance code of 1956, 1956 PA 218, MCL 500.106.