§ 550.901 Short title
§ 550.902 Definitions
§ 550.910 Third party administrator; certificate required; requirements; instances in which TPA subject to act; name
§ 550.912 Application for certificate of authority; form, verification, and contents; filing notice of modification
§ 550.914 Certificate of authority; issuance; notice of disapproval; continued compliance with subsection (1)
§ 550.918 Fees; payment; collection; and designation
§ 550.919 TPA advisory board; creation; appointment, qualifications, and terms of members; expenses; duty of board; report
§ 550.920 Authority of commissioner
§ 550.922 Hearings
§ 550.924 Destruction or disposal of records, books, papers, and other data
§ 550.926 340B Program entities; reimbursement, co-pay, and discrimination prohibitions; definitions
§ 550.927 Disclosure of current selling prices; prohibited contract provisions
§ 550.930 Provision of administrative services pursuant to written service contract; maintenance of books and records; TPA and manager as fiduciary
§ 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
§ 550.934 Confidentiality
§ 550.936 Annual statement; report
§ 550.940 Prohibited conduct generally
§ 550.942 Additional prohibited conduct
§ 550.944 Additional prohibited conduct
§ 550.950 Violation; probable cause; notice; conference; disposition of matter upon agreement of parties; action for damages; hearing; findings and decision; cease and desist order; additional order
§ 550.952 Civil fine; suspension or revocation of certificate or license; refusal to issue; grounds for denial, suspension, revocation, or cease and desist order; definition
§ 550.954 Alteration, modification, or setting aside of order
§ 550.956 Judicial review; petition for review; transcript of record and copy of order or decision; hearing cause as civil case in equity; evidence; duty of court; incomplete record; stay of order or decis
§ 550.958 Self-incrimination; false oath or affirmation
§ 550.960 Rules
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Terms Used In Michigan Laws > Chapter 550 > Act 218 of 1984 - Third Party Administrator Act

  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Board: means the TPA advisory board created under section 19. See Michigan Laws 550.902
  • Carrier: means an insurer, including a health maintenance organization, regulated under the insurance code of 1956, 1956 PA 218, MCL 500. See Michigan Laws 550.902
  • Claim: means a request for payment for administering, filling, or refilling a drug or for providing a pharmacy service or a medical supply or device to an enrollee as that term is defined in section 116 of the insurance code of 1956, 1956 PA 218, MCL 500. See Michigan Laws 550.902
  • Commissioner: means the director. See Michigan Laws 550.902
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Department: means the department of insurance and financial services. See Michigan Laws 550.902
  • Director: means the director of the department. See Michigan Laws 550.902
  • ERISA: means the employee retirement income security act of 1974, Public Law 93-406. See Michigan Laws 550.902
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Fiduciary: A trustee, executor, or administrator.
  • Freedom of Information Act: A federal law that mandates that all the records created and kept by federal agencies in the executive branch of government must be open for public inspection and copying. The only exceptions are those records that fall into one of nine exempted categories listed in the statute. Source: OCC
  • Health plan: means a qualified health plan as that term is defined in section 1261 of the insurance code of 1956, 1956 PA 218, MCL 500. See Michigan Laws 550.902
  • in writing: shall be construed to include printing, engraving, and lithographing; except that if the written signature of a person is required by law, the signature shall be the proper handwriting of the person or, if the person is unable to write, the person's proper mark, which may be, unless otherwise expressly prohibited by law, a clear and classifiable fingerprint of the person made with ink or another substance. See Michigan Laws 8.3q
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
  • manager: means an individual responsible for conducting the daily operations of a third party administrator. See Michigan Laws 550.902
  • Manufacturer: means that term as defined in section 17706 of the public health code, 1978 PA 368, MCL 333. See Michigan Laws 550.902
  • Nolo contendere: No contest-has the same effect as a plea of guilty, as far as the criminal sentence is concerned, but may not be considered as an admission of guilt for any other purpose.
  • oath: shall be construed to include the word "affirmation" in all cases where by law an affirmation may be substituted for an oath; and in like cases the word "sworn" shall be construed to include the word "affirmed". See Michigan Laws 8.3k
  • Oath: A promise to tell the truth.
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • Person: means an individual, sole proprietorship, partnership, corporation, association, or any other legal entity. See Michigan Laws 550.902
  • Personal data: means any record or information pertaining to the diagnosis, treatment, or health of an individual covered by a plan. See Michigan Laws 550.902
  • Pharmacy: means that term as defined in section 17707 of the public health code, 1978 PA 368, MCL 333. See Michigan Laws 550.902
  • pharmacy benefit manager: means an entity that contracts with a pharmacy or a pharmacy services administration organization on behalf of a health plan or carrier to provide pharmacy health services to individuals covered by the health plan or carrier or administration that includes, but is not limited to, any of the following:
    (i) Contracting directly or indirectly with pharmacies to provide drugs to enrollees or other covered persons. See Michigan Laws 550.902
  • Pharmacy services administration organization: means an entity that provides contracting and other administrative services relating to prescription drug benefits to pharmacies. See Michigan Laws 550.902
  • plan: means a medical, surgical, dental, vision, or health care benefit plan and may include coverage under a policy or certificate issued by a carrier. See Michigan Laws 550.902
  • Plea: In a criminal case, the defendant's statement pleading "guilty" or "not guilty" in answer to the charges, a declaration made in open court.
  • Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. Source: OCC
  • Probable cause: A reasonable ground for belief that the offender violated a specific law.
  • Processes claims: means the administrative services performed in connection with a claim for benefits under a plan. See Michigan Laws 550.902
  • Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
  • rebate: means a formulary discount or remuneration attributable to the use of prescription drugs that is paid by a manufacturer or third party, directly or indirectly, to a pharmacy benefit manager after a claim has been adjudicated at a pharmacy. See Michigan Laws 550.902
  • Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
  • Service contract: means the written agreement for the provision of administrative services between the TPA and a plan, a sponsor of a plan, or a carrier. See Michigan Laws 550.902
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • shall not apply: means that the pertinent provision is not operative as to certain persons or things or in conjunction with a particular date or dates. See Michigan Laws 8.4c
  • 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
  • Statute: A law passed by a legislature.
  • Testify: Answer questions in court.
  • Testimony: Evidence presented orally by witnesses during trials or before grand juries.
  • TPA: means a person that directly or indirectly processes claims under a service contract and that may also provide 1 or more other administrative services under a service contract, other than under a worker's compensation self-insurance program pursuant to section 611 of the worker's disability compensation act of 1969, 1969 PA 317, MCL 418. See Michigan Laws 550.902
  • Transcript: A written, word-for-word record of what was said, either in a proceeding such as a trial or during some other conversation, as in a transcript of a hearing or oral deposition.
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.