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Licensure of Managed Health Care Plans FAQ

What are Michigan's licensure requirements for utilization review firms?
What are Michigan's licensure requirements for preferred provider organizations (PPOs)?
What are Michigan's licensure requirements for multiple employer welfare arrangements (MEWAs)?
 
 
Question What are Michigan's licensure requirements for utilization review firms?
Answer

Michigan has no licensure requirements for utilization review firms.

   
Question What are Michigan's licensure requirements for preferred provider organizations (PPOs)?
Answer

Michigan does not require licensure of PPOs that bear no insurance risk, that is PPOs that accept fee-for-service reimbursement with no risk pooling or transfer. Licensed risk bearers and licensed claim processors (insurers and third party administrators) that condition the delivery of benefits upon the use of a particular panel of healthcare providers are subject to Michigan's Prudent Purchaser Act (PPA).

   
Question What are Michigan's licensure requirements for multiple employer welfare arrangements (MEWAs)?
Answer

Michigan requires licensure of MEWAs that do business with Michigan employers and are not fully insured. To obtain licensure, a MEWA must be controlled by its members, have adequate cash reserves, and purchase excess loss insurance. A complete description of MEWA licensure requirements can be found in Chapter 70 or the Michigan Insurance Code.

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