(1) No health maintenance organization may refer to itself in its
name or advertising with any of the words: "insurance",
"casualty", "surety", "mutual", or any other words descriptive of
the insurance, casualty, or surety business, or deceptively
similar to the name or description of any insurance or surety
corporation or health care service contractor or other health
maintenance organization doing business in this state.
(2) No health maintenance organization, nor any health care
facility or provider with which such organization has contracted
to provide health care services, shall discriminate against any
person from whom or on whose behalf, payment to meet the required
charge is available, with regard to enrollment, disenrollment, or
the provision of health care services, on the basis of such
person's race, color, sex, religion, place of residence if there
is reasonable access to the facility of the health maintenance
organization, socioeconomic status, or status as a recipient of
medicare under Title XVIII of the Social Security Act, 42 U.S.C.
section 1396, et seq.
(3) Where a health maintenance organization determines that
an enrolled participant has received health care services to
which such enrolled participant is not entitled under the terms
of his or her health maintenance agreement, neither such
organization, nor any health care facility or provider with which
such organization has contracted to provide health care services,
shall have recourse against such enrolled participant for any
amount above the actual cost of providing such service, if any,
specified in such agreement, unless the enrolled participant or a
member of his or her family has given or withheld information to
the health maintenance organization, the effect of which is to
mislead or misinform the health maintenance organization as to
the enrolled participant's right to receive such services.
[2009 c 549 § 7151; 1983 c 202 § 11; 1975 1st ex.s. c 290 § 12.]