Chapter 44, INSURANCE
2,111 sections in this chapter.
Neb. Rev. Stat. § 44-1311 External review decision; how treated; limitation on subsequent request.
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(1) An external review decision is binding on the health carrier except to the extent the health carrier has other remedies available under applicable state law. (2) An external review decision is binding on the covered person except to the extent the covered person has other rem…
Neb. Rev. Stat. § 44-1312 Independent review organizations; approval; qualifications; application; contents; fee; termination of approval; director; powers and duties.
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(1) The director shall approve independent review organizations eligible to be assigned to conduct external reviews under the Health Carrier External Review Act. (2) In order to be eligible for approval by the director under this section to conduct external reviews under the act,…
Neb. Rev. Stat. § 44-1313 Independent review organization; minimum qualifications; clinical reviewers; qualifications; limitation on ownership or control; conflict of interests; presumption of compliance; director; powers; duties.
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(1) To be approved under section 44-1312 to conduct external reviews, an independent review organization shall have and maintain written policies and procedures that govern all aspects of both the standard external review process and the expedited external review process set fort…
Neb. Rev. Stat. § 44-1314 Liability for damages.
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No independent review organization, clinical reviewer working on behalf of an independent review organization, or employee, agent, or contractor of an independent review organization shall be liable in damages to any person for any opinions rendered or acts or omissions performed…
Neb. Rev. Stat. § 44-1315 Records; report; contents.
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(1)(a) An independent review organization assigned pursuant to section 44-1308, 44-1309, or 44-1310 to conduct an external review shall maintain written records in the aggregate by state and by health carrier on all requests for external review for which it conducted an external …
Neb. Rev. Stat. § 44-1316 Health carrier; cost.
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The health carrier against which a request for a standard external review or an expedited external review is filed shall pay the cost of the independent review organization for conducting the external review.
Neb. Rev. Stat. § 44-1317 Health carrier; disclosure; format; contents.
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(1)(a) Each health carrier shall include a description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage it provides to covered persons. (b) The disclosure required by subdivision (1…
Neb. Rev. Stat. § 44-1318 Applicability of act.
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The Health Carrier External Review Act applies to any claim submitted on and after January 1, 2014.
Neb. Rev. Stat. § 44-133 Domestic company; certificate of authority; suspension or revocation; appeal.
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Whenever any of the grounds mentioned in section 44-4809, 44-4812, or 44-4817 are shown to exist as to a domestic company after a hearing upon notice to the company, the Department of Insurance may suspend or revoke the certificate of authority of such company to do business, ins…
Neb. Rev. Stat. § 44-134 Foreign or alien company; certificate of authority; suspension or revocation; appeal.
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Whenever the authority of a foreign or alien company to do business is suspended or revoked by its state of domicile or state of entry into the United States or whenever any of the grounds mentioned in section 44-4809, 44-4812, or 44-4817 exist as to a foreign or alien company, t…
Neb. Rev. Stat. § 44-135 Foreign company; certificate of authority; required; personal jurisdiction.
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Any foreign or alien insurance company or association, before it shall do any business in this state, shall procure a certificate of authority to do business in this state as provided by the laws of the State of Nebraska. Procuring such a certificate shall constitute sufficient c…
Neb. Rev. Stat. § 44-136 Foreign company; dissolution; effect on actions.
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The dissolution of any foreign insurance company or association shall not take away or impair the right of any person to commence an action in this state against such companies or associations, or their statutory successors as agents thereof, and procure service upon such compani…
Neb. Rev. Stat. § 44-1401 Act, how cited.
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Sections 44-1401 to 44-1414 shall be known and may be cited as the Nebraska Right to Shop Act.
Neb. Rev. Stat. § 44-1402 Terms, defined.
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For purposes of the Nebraska Right to Shop Act: (1) Allowed amount means the contractually agreed-upon amount paid by an insurance carrier to a health care entity participating in the insurance carrier’s network or the amount the health plan is required to pay under the health pl…
Neb. Rev. Stat. § 44-1403 Applicability of act; election; notice.
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The Nebraska Right to Shop Act shall apply to any insurance carrier that elects to be subject to the act. An insurance carrier making such election shall file a notice of the election with the department.
Neb. Rev. Stat. § 44-1404 Health care entity; disclose allowed amount or charge; updated estimate; other cost estimate.
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(1) Prior to a nonemergency admission, procedure, or service and upon request by a patient or prospective patient, a health care entity within the patient’s or prospective patient’s insurer network shall, within three working days, disclose the allowed amount of the nonemergency …
Neb. Rev. Stat. § 44-1405 Insurance carrier; interactive mechanism on website; duties.
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An insurance carrier shall establish an interactive mechanism on its publicly accessible website that enables an enrollee to request and obtain from the insurance carrier information on the payments made by the insurance carrier to network providers for health care services. The …
Neb. Rev. Stat. § 44-1406 Estimate of out-of-pocket amount.
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(1) Within two working days of an enrollee’s request, an insurance carrier shall provide a good faith estimate of the amount the enrollee will be responsible to pay out-of-pocket for a proposed nonemergency procedure or service that is a medically necessary covered benefit from a…
Neb. Rev. Stat. § 44-1407 Shared savings incentive payment program; incentive payments; calculation.
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(1) An insurance carrier shall develop and implement a shared savings incentive payment program that provides incentive payments for enrollees in a health plan who elect to receive shoppable health care services that are covered by the plan from providers that charge less than th…
Neb. Rev. Stat. § 44-1408 Availability of shared savings incentive payment program.
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An insurance carrier shall make the shared savings incentive payment program available as a component of all health plans offered by the insurance carrier in this state. Annually at enrollment or renewal, an insurance carrier shall provide notice about the availability of the pro…
Neb. Rev. Stat. § 44-1409 Filing with department; review; confidentiality.
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Prior to offering the shared savings incentive payment program to any enrollee, an insurance carrier shall file a description of the program with the department in the manner determined by the director. The department may review the filing made by the insurance carrier to determi…
Neb. Rev. Stat. § 44-1410 Service from out-of-network provider; how treated.
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If an enrollee elects to receive a shoppable health care service from an out-of-network provider that results in an incentive payment, the insurance carrier shall apply the amount paid for the shoppable health care service toward the enrollee’s member cost sharing as specified in…
Neb. Rev. Stat. § 44-1411 Incentive payment; how treated.
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An incentive payment made by an insurance carrier in accordance with the Nebraska Right to Shop Act is not an administrative expense of the insurance carrier for rate development or rate filing purposes.
Neb. Rev. Stat. § 44-1412 Insurance carrier; annual filing; contents; report.
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(1) On or before March 31 each year, each insurance carrier shall file with the department the following information for the most recent calendar year: (a) The total number of incentive payments made pursuant to the insurance carrier's shared savings incentive payment program; (b…
Neb. Rev. Stat. § 44-1413 Personnel division of Department of Administrative Services; program for state employees; report; contents.
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(1) The personnel division of the Department of Administrative Services, in its discretion, may develop and implement a program for state employees receiving health insurance coverage under sections 84-1601 to 84-1615 that is similar to the shared savings incentive payment progra…
Neb. Rev. Stat. § 44-1414 Rules and regulations.
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The department may adopt and promulgate rules and regulations as necessary to carry out the Nebraska Right to Shop Act.
Neb. Rev. Stat. § 44-149 Domestic companies; right to do business in other states; reciprocity.
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If any domestic insurance company or association, or domestic fraternal benefit society, having a certificate of authority from the Department of Insurance, shall make application for admission to any other state or country, and shall comply with all the statutory regulations of …
Neb. Rev. Stat. § 44-150 Reciprocal licenses; retaliation; penalties; taxes; domicile of alien insurer.
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(1) When by or pursuant to the laws of any other state or foreign country any taxes, licenses and other fees, in the aggregate, or any fines, penalties, deposit requirements, or other material obligations, prohibitions, or restrictions, are or would be imposed upon Nebraska insur…
Neb. Rev. Stat. § 44-151 Loan, surrender or nonforfeiture values; reciprocal interest provisions.
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Whenever the laws of any other state, or the rules and regulations of the insurance department of any such state, shall require of insurance companies organized under the laws of this state the payment of loan, surrender or nonforfeiture values to policyholders of such companies …
Neb. Rev. Stat. § 44-152 Domestic company; refusal of another state or country to license; retaliatory action.
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Whenever it appears to the Director of Insurance that permission to transact business within any state of the United States or within any foreign country is refused to a company organized under the laws of this state after a certificate of compliance has been issued to the compan…
Neb. Rev. Stat. § 44-1521 Act, how cited.
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Sections 44-1521 to 44-1535 shall be known and may be cited as the Unfair Insurance Trade Practices Act.
Neb. Rev. Stat. § 44-1522 Purpose of act.
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The purpose of the Unfair Insurance Trade Practices Act is to regulate unfair trade practices in the business of insurance, in accordance with the intent of the Congress of the United States as expressed in Public Law 79-15, by defining, or providing for the determination of, all…
Neb. Rev. Stat. § 44-1523 Terms, defined.
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For purposes of the Unfair Insurance Trade Practices Act: (1) Customer means an individual who purchases, applies to purchase, or is solicited to purchase an insurance product primarily for personal, family, or household purposes; (2) Department means the Department of Insurance;…
Neb. Rev. Stat. § 44-1524 Unfair trade practice; prohibited acts.
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It shall be an unfair trade practice in the business of insurance for any insurer, health insurance lead generator, or person engaged in the business of insurance to commit any act or practice defined in section 44-1525 if the act or practice (1) is committed flagrantly and in co…
Neb. Rev. Stat. § 44-1525 Unfair trade practices; enumerated.
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Any of the following acts or practices, if committed in violation of section 44-1524, shall be an unfair trade practice in the business of insurance: (1) Making, issuing, circulating, or causing to be made, issued, or circulated an estimate, illustration, circular, statement, sal…
Neb. Rev. Stat. § 44-1526 Lender or creditor; prohibited acts; director; powers.
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(1) No person who lends money or extends credit shall: (a) Require, as a condition precedent to the lending of money or extension of credit or any renewal thereof, that the borrower, mortgagor, or purchaser to whom such money or credit is extended or whose obligation the creditor…
Neb. Rev. Stat. § 44-1527 Director; investigatory powers; costs.
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The director may examine and investigate the affairs of every insurer or health insurance lead generator doing business in this state in order to determine whether such insurer or health insurance lead generator has been, or is, engaged in an unfair trade practice as defined in s…
Neb. Rev. Stat. § 44-1528 Practices; hearings; witnesses; appearances; production of books; service of process.
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(1) Whenever the director has reason to believe that an insurer, health insurance lead generator, or person has engaged, or is engaging, in this state in any unfair trade practice whether or not defined in the Unfair Insurance Trade Practices Act and that a proceeding in respect …
Neb. Rev. Stat. § 44-1529 Cease and desist order; monetary penalty; suspension or revocation of license or certificate.
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If, after the hearing, the director finds that the insurer, health insurance lead generator, or person charged has engaged in an unfair trade practice, the director shall reduce the findings to writing and shall issue and cause to be served upon the insurer, health insurance lead…
Neb. Rev. Stat. § 44-1530 Appeals.
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(1) Any insurer, health insurance lead generator, or person subject to an order of the director under section 44-1529 or 44-1532 may appeal the order. The appeal shall be in accordance with the Administrative Procedure Act. (2) An order issued by the director under section 44-152…
Neb. Rev. Stat. § 44-1531 Intervenor; appeal.
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If, after any hearing as provided by section 44-1528 or 44-1532, the report of the director does not charge a violation of the Unfair Insurance Trade Practices Act, then any intervenor as provided by section 44-1528 may, within ten days after the service of such report, appeal th…
Neb. Rev. Stat. § 44-1532 Cease and desist orders; violations.
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Any insurer, health insurance lead generator, or person violating a cease and desist order of the director under section 44-1529 may after notice and hearing and upon order of the director be subject to: (1) A monetary penalty of not more than thirty thousand dollars for each vio…
Neb. Rev. Stat. § 44-1533 Rules and regulations.
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The director may adopt and promulgate rules and regulations to carry out the Unfair Insurance Trade Practices Act.
Neb. Rev. Stat. § 44-1534 Director; additional powers.
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The powers vested in the director by the Unfair Insurance Trade Practices Act shall be additional to any other powers to enforce any penalties, fines, or forfeitures authorized by law with respect to the acts and practices defined and determined by such act to be unfair.
Neb. Rev. Stat. § 44-1534.01 Director; power to protect members of the United States Armed Forces; rules and regulations.
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The Director of Insurance may adopt and promulgate rules and regulations to protect members of the United States Armed Forces from dishonest and predatory insurance sales practices by declaring certain identified practices to be false, misleading, deceptive, or unfair as required…
Neb. Rev. Stat. § 44-1535 Immunity from prosecution; when.
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If any person asks to be excused from attending and testifying or from producing any books, papers, records, correspondence, or other documents at any hearing on the ground that the testimony or evidence required may tend to incriminate the person or subject the person to a penal…
Neb. Rev. Stat. § 44-1536 Act, how cited.
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Sections 44-1536 to 44-1544 shall be known and may be cited as the Unfair Insurance Claims Settlement Practices Act.
Neb. Rev. Stat. § 44-1537 Purpose of act.
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The purpose of the Unfair Insurance Claims Settlement Practices Act is to set forth standards for the investigation and disposition of claims arising under policies issued to residents of this state.
Neb. Rev. Stat. § 44-1538 Terms, defined.
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(1) For purposes of the Unfair Insurance Claims Settlement Practices Act: (a) Director shall mean the Director of Insurance; (b) Insured shall mean the party named on a policy or certificate as the individual with legal rights to the benefits provided by such policy or certificat…
Neb. Rev. Stat. § 44-1539 Unfair claims settlement practice; conduct prohibited.
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It shall be an unfair claims settlement practice for any domestic, foreign, or alien insurer transacting business in this state to commit an act or practice defined in section 44-1540 if the act or practice (1) is committed flagrantly and in conscious disregard of the Unfair Insu…