Michigan Laws 550.910 – Third party administrator; certificate required; requirements; instances in which TPA subject to act; name
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(1) A person shall not operate as a third party administrator without obtaining and maintaining a certificate of authority pursuant to this act.
(2) A third party administrator shall continue to meet the requirements of this act at all times.
Terms Used In Michigan Laws 550.910
- 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
- Person: means an individual, sole proprietorship, partnership, corporation, association, or any other legal entity. 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
- 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.
- 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
(3) A third party administrator is subject to this act in the following instances:
(a) The TPA is domiciled in this state.
(b) The TPA has its principal administrative office or principal headquarters located in this state.
(c) The TPA solicits a plan or sponsor of a plan or provides administrative services to a plan or sponsor of a plan, which plan or sponsor is either domiciled in this state or has its principal headquarters or principal administrative office in this state. This subdivision shall not apply to a TPA who has been licensed or certified as a TPA in that TPA’s state of domicile pursuant to a statute or regulation similar to this act.
(d) The TPA provides substantial administrative services to a carrier for the carrier’s business in this state.
(4) Each TPA shall transact its business under its own name. A TPA shall not be permitted to do business in this state under a name which is the same as or which closely resembles the name of a TPA which is authorized to do business under the laws of this state.