Section 500.3539 - Nongroup contract; exclusion or limitation; preexisting condition; renewal or continuation of nongroup contract or group contract; guaranteed renewal; healthy lifestyle program; "gr
THE INSURANCE CODE OF 1956 (EXCERPT)
Act 218 of 1956
500.3539 Nongroup contract; exclusion or limitation; preexisting condition; renewal or continuation of nongroup contract or group contract; guaranteed renewal; healthy lifestyle program; "group" defined.
Sec. 3539.
(1) For an individual covered under a nongroup contract or under a contract not covered under subsection (2), a health maintenance organization may exclude or limit coverage for a condition only if the exclusion or limitation relates to a condition for which medical advice, diagnosis, care, or treatment was recommended or received within 6 months before enrollment and the exclusion or limitation does not extend for more than 6 months after the effective date of the health maintenance contract.
(2) A health maintenance organization shall not exclude or limit coverage for a preexisting condition for an individual covered under a group contract.
(3) Except as provided in subsection (5), a health maintenance organization that has issued a nongroup contract shall renew or continue in force the contract at the option of the individual.
(4) Except as provided in subsection (5), a health maintenance organization that has issued a group contract shall renew or continue in force the contract at the option of the sponsor of the plan.
(5) Guaranteed renewal is not required in cases of fraud, intentional misrepresentation of material fact, lack of payment, if the health maintenance organization no longer offers that particular type of coverage in the market, or if the individual or group moves outside the service area.
(6) A health maintenance organization is not required to continue a healthy lifestyle program or to continue any incentive associated with a healthy lifestyle program, including, but not limited to, goods, vouchers, or equipment.
(7) As used in this section, "group" means a group of 2 or more subscribers.
History: Add. 2000, Act 252, Imd. Eff. June 29, 2000 ;-- Am. 2005, Act 306, Imd. Eff. Dec. 21, 2005
Popular Name: Act 218
Popular Name: HMO