Mich. Comp. Laws » Michigan Compiled Laws / Chapter 500 / Act 218 of 1956
Michigan Compiled Laws

Mich. Comp. Laws § 500.3406k (2026)

Emergency health services; medically necessary coverage; "stabilization" defined.

✓ current as of July 2026
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THE INSURANCE CODE OF 1956


Act 218 of 1956


500.3406k Emergency health services; medically necessary coverage; "stabilization" defined.

Sec. 3406k.

    (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for emergency health services shall provide coverage for medically necessary services provided to an insured for the sudden onset of a medical condition that manifests itself by signs and symptoms of sufficient severity, including severe pain, such that a prudent layperson who possesses an average knowledge of health and medicine could reasonably expect the absence of immediate medical attention to result in serious jeopardy to the individual's health or to a pregnancy in the case of a pregnant woman, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part. An insurer shall not require a physician to transfer a patient before the physician determines that the patient has reached the point of stabilization. An insurer shall not deny payment for emergency health services up to the point of stabilization provided to an insured under this subsection because of either of the following:

    (a) The final diagnosis.

    (b) Prior authorization not being given by the insurer before emergency health services were provided.

    (2) As used in this section, "stabilization" means the point at which no material deterioration of a condition is likely, within reasonable medical probability, to result from or occur during transfer of the patient.

History: Add. 1998, Act 125, Imd. Eff. June 10, 1998 ;-- Am. 2004, Act 7, Imd. Eff. Feb. 20, 2004 ;-- Am. 2016, Act 276, Imd. Eff. July 1, 2016

PopularName Notes:

Act 218
Notes of Decisions
Cited in 5 cases (1 in the last 5 years), 2005–2021 · leading case: Ross v. Blue Care Network of Michigan, 747 N.W.2d 828 (Mich. 2008).
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Ross v. Blue Care Network of Michigan, 747 N.W.2d 828 (Mich. 2008). · cites it 28× “RO three requests *832 for clarification whether the June 30, 2002, outpatient consultation, the July 8, 2002, to July 23, 2002, inpatient admission, the August 1, 2002, to August 2, 2002, inpatient admission, and the September 9, 2002, to November 17, 2002, follow-up testing…”
Tinman v. Blue Cross & Blue Shield, 692 N.W.2d 58 (Mich. Ct. App. 2005). “3 Plaintiff further alleged in count one that defendant’s conduct violates MCL 500.3406k. The trial court granted defendant’s subsequent motion for summary disposition regarding that assertion.”
Ross v. Blue Care Network of Mich., 722 N.W.2d 223 (Mich. Ct. App. 2006). · cites it 2× “[MCL 500.3406k(l).] MCL 500.3406k(l) goes on to define “stabilization” as “the point at which no material deterioration of a *379 condition is likely, within reasonable medical probability, to result from or occur during transfer of the patient.”
Emergency Dep't Physicians P.C. v. UnitedHealthcare, Inc. (E.D. Mich. 2020). · cites it 2× “But Plaintiffs' counsel omitted that § 500.3406k prevents an insurer from denying payment only "because of .”
Emergency Dep't Physicians P.C. v. UnitedHealthcare, Inc. (E.D. Mich. 2021). · cites it 2× “And we specifically point the Court to Section 500.3406k of the [I]nsurance [C]ode.”
— Mich. Comp. Laws § 500.3406k(1) — 2 cases
Ross v. Blue Care Network of Michigan, 747 N.W.2d 828 (Mich. 2008). “RO three requests *832 for clarification whether the June 30, 2002, outpatient consultation, the July 8, 2002, to July 23, 2002, inpatient admission, the August 1, 2002, to August 2, 2002, inpatient admission, and the September 9, 2002, to November 17, 2002, follow-up testing…”
Emergency Dep't Physicians P.C. v. UnitedHealthcare, Inc. (E.D. Mich. 2020). “But Plaintiffs' counsel omitted that § 500.3406k prevents an insurer from denying payment only "because of .”
— Mich. Comp. Laws § 500.3406k(2) — 1 case
Ross v. Blue Care Network of Michigan, 747 N.W.2d 828 (Mich. 2008). “RO three requests *832 for clarification whether the June 30, 2002, outpatient consultation, the July 8, 2002, to July 23, 2002, inpatient admission, the August 1, 2002, to August 2, 2002, inpatient admission, and the September 9, 2002, to November 17, 2002, follow-up testing…”
— Mich. Comp. Laws § 500.3406k(l) — 2 cases
Ross v. Blue Care Network of Michigan, 747 N.W.2d 828 (Mich. 2008). “RO three requests *832 for clarification whether the June 30, 2002, outpatient consultation, the July 8, 2002, to July 23, 2002, inpatient admission, the August 1, 2002, to August 2, 2002, inpatient admission, and the September 9, 2002, to November 17, 2002, follow-up testing…”
Ross v. Blue Care Network of Mich., 722 N.W.2d 223 (Mich. Ct. App. 2006). “[MCL 500.3406k(l).] MCL 500.3406k(l) goes on to define “stabilization” as “the point at which no material deterioration of a *379 condition is likely, within reasonable medical probability, to result from or occur during transfer of the patient.”
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