Chapter 44 — INSURANCE
2,728 sections in this chapter.
Neb. Rev. Stat. § 44-4202 Legislative purpose and intent.
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It is the purpose and intent of the Legislature to provide access to health insurance coverage at an affordable premium to all residents of Nebraska, including those individuals denied coverage due to a preexisting medical condition or whose policy includes a restrictive rider li…
Neb. Rev. Stat. § 44-4203 Definitions, where found.
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For the purposes of the Comprehensive Health Insurance Pool Act, the definitions found in sections 44-4204 to 44-4215.02 shall be used.
Neb. Rev. Stat. § 44-4204 Agent or insurance agent, defined.
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Agent or insurance agent means any person licensed as an insurance agent by the department and duly appointed and authorized by an insurer to solicit applications for insurance and to discharge such other duties as may be vested in or required of the agent by the insurer.
Neb. Rev. Stat. § 44-4205 Benefits plan, defined.
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Benefits plan means the coverages to be offered by the pool to eligible individuals meeting the requirements of section 44-4221.
Neb. Rev. Stat. § 44-4206 Board, defined.
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Board means the Board of Directors of the pool.
Neb. Rev. Stat. § 44-4206.01 Church plan, defined.
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Church plan means a plan as defined under 29 U.S.C. 1002.
Neb. Rev. Stat. § 44-4206.02 Creditable coverage, defined.
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(1) Creditable coverage means, with respect to an individual, coverage of the individual under any of the following: (a) A group health plan; (b) Health insurance coverage; (c) Medicare; (d) Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq., other than coverage consist…
Neb. Rev. Stat. § 44-4207 Department, defined.
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Department means the Department of Insurance.
Neb. Rev. Stat. § 44-4208 Director, defined.
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Director means the Director of Insurance.
Neb. Rev. Stat. § 44-4208.01 Governmental plan, defined.
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Governmental plan means a plan as defined under 29 U.S.C. 1002 and any plan maintained for its employees by the United States Government or by any agency or instrumentality of the United States Government.
Neb. Rev. Stat. § 44-4208.02 Group health plan, defined.
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Group health plan means an employee welfare benefit plan as defined by 29 U.S.C. 1002 to the extent that the plan provides any hospital, surgical, or medical expense benefits to employees or their dependents, as defined under the terms of the plan, directly or through insurance, …
Neb. Rev. Stat. § 44-4209 Health insurance, defined.
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Health insurance means any hospital, surgical, or medical expense-incurred policy or health maintenance organization contract. Health insurance does not include (1) accident-only, disability income, hospital confinement indemnity, dental, or credit insurance, (2) coverage issued …
Neb. Rev. Stat. § 44-421 Actuarial opinions; life insurance company; annual submission.
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Every life insurance company doing business in this state shall annually submit the opinion of a qualified actuary as to whether the reserves and related actuarial items held in support of the policies and contracts specified by the director are computed appropriately, are based …
Neb. Rev. Stat. § 44-4210 Insurer, defined.
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Insurer means any insurance company as defined in section 44-103 or health maintenance organization as defined in section 44-32,105 authorized to transact health insurance business in the State of Nebraska.
Neb. Rev. Stat. § 44-4211 Medicare, defined.
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Medicare means coverage under parts A and B of Title XVIII of the Social Security Act, 42 U.S.C. 1395 et seq., as amended.
Neb. Rev. Stat. § 44-4212 Member, defined.
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Member means any insurer participating in the pool.
Neb. Rev. Stat. § 44-4213 Net loss, defined.
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Net loss means the excess of incurred claims plus expenses over the sum of written and renewed premiums and other appropriate revenue.
Neb. Rev. Stat. § 44-4214 Plan of operation, defined.
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Plan of operation means the plan of operation of the pool, including articles, bylaws, and operating rules, submitted by the board pursuant to section 44-4218.
Neb. Rev. Stat. § 44-4215 Pool, defined.
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Pool means the Comprehensive Health Insurance Pool.
Neb. Rev. Stat. § 44-4215.01 Resident, defined.
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Resident means an individual who is legally domiciled in this state.
Neb. Rev. Stat. § 44-4215.02 Qualified trade adjustment assistance eligible individual, defined.
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Qualified trade adjustment assistance eligible individual shall mean an individual who is eligible for the credit for health insurance costs under section 35 of the Internal Revenue Code.
Neb. Rev. Stat. § 44-4216 Comprehensive Health Insurance Pool; created; membership; board of directors.
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(1) There is hereby created a nonprofit entity to be known as the Comprehensive Health Insurance Pool. All insurers authorized to issue or provide health insurance in this state shall be members of the pool. (2)(a) Prior to January 1, 2001, the pool shall be managed by a board of…
Neb. Rev. Stat. § 44-4217 Board; pool administrator; selection.
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The director shall select the board. The board shall select a pool administrator pursuant to section 44-4223.
Neb. Rev. Stat. § 44-4218 Administration of pool; submit plan of operation; procedure.
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The board shall submit to the department a plan of operation for the pool and any amendments thereto necessary or suitable to assure the fair, reasonable, and equitable administration of the pool. The director shall, after notice and hearing, approve the plan of operation if the …
Neb. Rev. Stat. § 44-4219 Plan of operation; contents.
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In its plan of operation, the board shall: (1) Establish procedures for the handling and accounting of assets and funds of the pool; (2) Select a pool administrator in accordance with section 44-4223; (3) Establish procedures for the selection, replacement, term of office, and qu…
Neb. Rev. Stat. § 44-422 Actuarial opinions; life insurance company; additional requirements.
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Every life insurance company, except as exempted by the director by rule or regulation, shall also annually include in the opinion required by section 44-421 an opinion of the same qualified actuary as to whether the reserves and related actuarial items held in support of the pol…
Neb. Rev. Stat. § 44-4220 Board; powers; enumerated.
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The board shall have the general powers and authority granted under the laws of this state to insurance companies licensed to transact the business of health insurance and, in addition thereto, the power to carry out the provisions and purposes of the Comprehensive Health Insuran…
Neb. Rev. Stat. § 44-4220.01 Review of operation; report.
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Following the close of each calendar year, the board shall conduct a review of the operation of the pool and report to the director the board's recommendations for cost savings in the operation of the pool.
Neb. Rev. Stat. § 44-4220.02 Review of health care provider reimbursement rates; report; health care provider; reimbursement; other payments.
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(1)(a) In addition to the requirements of section 44-4220.01, following the close of each calendar year, the board shall conduct a review of health care provider reimbursement rates for benefits payable under pool coverage for covered services. The board shall report to the direc…
Neb. Rev. Stat. § 44-4221 Purchase pool coverage; eligibility.
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(1) To be eligible to purchase pool coverage, an individual shall: (a) Be a resident of the state for a period of at least six months and shall be an individual: (i) Who is not eligible for coverage under a group health plan comparable to pool coverage, medicare by reason of age,…
Neb. Rev. Stat. § 44-4222 Purchase of pool coverage; ineligibility.
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(1) An individual shall not be eligible for initial or continued pool coverage if: (a) He or she is eligible for medicare benefits by reason of age or medical assistance established pursuant to the Medical Assistance Act; (b) He or she is a resident or inmate of a correctional fa…
Neb. Rev. Stat. § 44-4222.01 Insurer, agent, broker, or third-party administrator; prohibited acts; violation; unfair trade practice.
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(1) No insurer, agent, broker, or third-party administrator shall refer an individual employee to the pool or arrange for an individual employee to apply for pool coverage for the purpose of separating that individual employee from group health insurance coverage in connection wi…
Neb. Rev. Stat. § 44-4223 Selection of pool administrator; procedure.
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(1) The board shall select a pool administrator through a competitive bidding process to administer the pool. The pool administrator may be an insurer or a third-party administrator authorized to transact business in this state. The board shall evaluate bids submitted on the basi…
Neb. Rev. Stat. § 44-4224 Pool administrator; duties.
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The pool administrator shall: (1) Perform all eligibility verification functions relating to the pool; (2) Establish a premium billing procedure for collection of premiums from covered individuals on a periodic basis as determined by the board; (3) Perform all necessary functions…
Neb. Rev. Stat. § 44-4225 Board; report; Comprehensive Health Insurance Pool Distributive Fund; created; use; investment; director; funding powers.
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(1) Following the close of each calendar year, the board shall report the board's determination of the paid and incurred losses for the year, taking into account investment income and other appropriate gains and losses. The board shall distribute copies of the report to the direc…
Neb. Rev. Stat. § 44-4226 Major medical expense coverage required; considerations.
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(1) The pool shall offer major medical expense coverage to every eligible individual. The pool coverage, its schedule of benefits, and exclusions and other limitations shall be established through rules and regulations adopted and promulgated by the director taking into considera…
Neb. Rev. Stat. § 44-4227 Premium and standard risk rates; how determined.
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(1)(a) For calendar years prior to January 1, 2010, rates and rate schedules may be adjusted for appropriate risk factors such as age, sex, and area variation in claim costs in accordance with established actuarial and underwriting practices. Special rates shall be provided for c…
Neb. Rev. Stat. § 44-4228 Pool coverage; exclusions; application for coverage; requirements.
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(1) Pool coverage shall exclude charges or expenses incurred during the first six months following the effective date of pool coverage as to any condition (a) which had manifested itself during the six-month period immediately preceding the effective date of pool coverage in such…
Neb. Rev. Stat. § 44-4229 Reduction of benefits; when.
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Benefits otherwise payable under pool coverage shall be reduced by all amounts paid or payable through any other health insurance or insurance arrangement and by all hospital and medical expense benefits paid or payable under any workers' compensation coverage, automobile medical…
Neb. Rev. Stat. § 44-423 Actuarial opinions; transition period authorized.
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The director may provide for a transition period for establishing any higher reserves which the qualified actuary may deem necessary in order to render the opinion required by section 44-421.
Neb. Rev. Stat. § 44-4230 Recovery of noncovered expenses; cause of action; subrogation.
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The pool shall have a cause of action against a covered individual for the recovery of the amount of benefits paid which are not for covered expenses. Benefits due from the pool may be reduced or refused as a setoff against any amount recoverable under this section. The pool shal…
Neb. Rev. Stat. § 44-4231 Pool; limitation on liability.
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Participation in the pool as members, the establishment of rates, forms, or procedures, or any other joint or collective action required by the Comprehensive Health Insurance Pool Act shall not be the basis of any cause of action, criminal or civil liability, or penalty against t…
Neb. Rev. Stat. § 44-4232 Pool; exempt from taxation.
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The pool shall be exempt from any and all taxes assessed by the State of Nebraska.
Neb. Rev. Stat. § 44-4233 Member; offset tax liability.
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(1) Any member subject to premium and related retaliatory tax liability imposed by section 44-150 or 77-908 may offset assessments paid to the pool by such member against its tax liability in the year of payment or subsequent years. The member may offset such paid assessments aga…
Repealed. Laws 1992, LB 1006, § 99.
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[Repealed or reserved.]
Neb. Rev. Stat. § 44-4235 Insurer; notice required.
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Every insurer shall include a notice of the existence of the pool in (1) any rejection of an application for health insurance coverage for reasons of the health of the applicant and (2) any restrictive health insurance rider issued on or after January 1, 1999.
Neb. Rev. Stat. § 44-424 Actuarial opinions; requirements.
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Every opinion required by section 44-421 shall be governed by the following provisions: (1) The opinion shall be submitted with the annual statement reflecting the valuation of such reserve liabilities for each year ending on or after December 31, 1994; (2) The opinion shall appl…
Neb. Rev. Stat. § 44-425 Actuarial opinions; supporting memorandum; confidentiality.
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Every opinion required by section 44-421 shall be governed by the following provisions in addition to the provisions of section 44-424: (1) A memorandum, in form and substance acceptable to the director, shall be prepared to support each actuarial opinion and made available to th…
Neb. Rev. Stat. § 44-426 Actuarial opinions; valuation of sickness and accident policies.
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The director may adopt and promulgate rules and regulations containing the minimum standards applicable to the valuation of sickness and accident policies.
Neb. Rev. Stat. § 44-427 Actuarial opinions; rules and regulations.
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The director may adopt and promulgate rules and regulations to carry out the provisions of sections 44-420 to 44-427.