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2,111 sections in this chapter.
Neb. Rev. Stat. § 44-6850 Settlement, negotiation; mediation, when.
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(1) If an insurer or an out-of-network health care provider provides notification that it considers a claim or payment to be not reasonable, the insurer and the health care provider shall have thirty days after the date of such notification to negotiate a settlement. If a settlem…
Neb. Rev. Stat. § 44-6901 Definitions, where found.
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For purposes of sections 44-6901 to 44-6918, the definitions found in sections 44-6902 to 44-6915.01 shall be used.
Neb. Rev. Stat. § 44-6902 Affiliation period, defined.
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Affiliation period means a period which, under the terms of the health insurance coverage offered by a health maintenance organization, must expire before the health insurance coverage becomes effective.
Neb. Rev. Stat. § 44-6903 Church plan, defined.
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Church plan means a plan as defined under 29 U.S.C. 1002.
Neb. Rev. Stat. § 44-6904 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) Part A or Part B of Title XVIII of the Social Security Act; (d) Title XIX of the Social Security Act, 4…
Neb. Rev. Stat. § 44-6905 Director, defined.
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Director means the Director of Insurance.
Neb. Rev. Stat. § 44-6905.01 Enrollment date, defined.
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Enrollment date means the first day of coverage in the health benefit plan or, if earlier, the first day of the waiting period.
Neb. Rev. Stat. § 44-6906 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. § 44-6907 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. § 44-6908 Health benefit plan, defined.
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(1) Health benefit plan means any employer group hospital or medical policy or certificate or employer group health maintenance organization subscriber contract. (2) Health benefit plan does not include one or more, or any combination, of the following: (a) Coverage only for acci…
Neb. Rev. Stat. § 44-6909 Health carrier, defined.
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Health carrier means any entity that provides a health benefit plan including an insurance company, a fraternal benefit society, a health maintenance organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation.
Neb. Rev. Stat. § 44-6909.01 Health maintenance organization, defined.
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Health maintenance organization means a person that undertakes to provide or arrange for the delivery of basic health care services to enrollees on a prepaid basis, except for enrollee responsibility for copayments or deductibles or both.
Neb. Rev. Stat. § 44-6910 Health-status-related factor, defined.
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Health-status-related factor means any of the following factors: (1) Health status; (2) Medical condition, including both physical and mental illnesses; (3) Claims experience; (4) Receipt of health care; (5) Medical history; (6) Genetic information; (7) Evidence of insurability, …
Neb. Rev. Stat. § 44-6911 Late enrollee, defined.
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Late enrollee means an eligible employee or dependent who requests enrollment in a health benefit plan following the initial enrollment period during which the individual is entitled to enroll under the terms of the health benefit plan if the initial enrollment period is a period…
Neb. Rev. Stat. § 44-6912 Medical care, defined.
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Medical care means amounts paid for: (1)(a) The diagnosis, care, mitigation, treatment, or prevention of disease or (b) the purpose of affecting any structure or function of the body; (2) Transportation primarily for and essential to medical care referred to in subdivision (1) of…
Neb. Rev. Stat. § 44-6913 Network plan, defined.
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Network plan means health insurance coverage offered by a health carrier under which the financing and delivery of medical care including items and services paid for as medical care are provided, in whole or in part, through a defined set of providers under contract with the heal…
Neb. Rev. Stat. § 44-6914 Plan sponsor, defined.
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Plan sponsor has the meaning given such term under 29 U.S.C. 1002.
Neb. Rev. Stat. § 44-6915 Preexisting condition, defined.
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Preexisting condition means a condition whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the six-month period ending on the enrollment date. Genetic information shall n…
Neb. Rev. Stat. § 44-6915.01 Waiting period, defined.
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Waiting period means the period that must pass with respect to an individual before the individual is eligible to be covered for benefits under the terms of the health benefit plan. If an individual enrolls as a late enrollee or on a special enrollment date, any period before suc…
Neb. Rev. Stat. § 44-6916 Health carrier; health benefit plan; restrictions; duties; preexisting condition exclusion; late enrollee; when.
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(1) A health carrier shall not: (a) Offer coverage to only certain individuals in an employer group or to only a part of the group except in the case of late enrollees; (b) Require any individual to pay a premium which is greater than such premium for a similarly situated individ…
Neb. Rev. Stat. § 44-6917 Health benefit plan; renewable; exceptions.
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(1) A health benefit plan shall be renewable with respect to all eligible employees or dependents, at the option of the plan sponsor, except in any of the following cases: (a) The plan sponsor has failed to pay premiums or contributions in accordance with the terms of the health …
Neb. Rev. Stat. § 44-6917.01 Certification of creditable coverage.
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(1) Health carriers shall provide written certification of creditable coverage to individuals in accordance with subsection (2) of this section. (2) The certification of creditable coverage shall be provided: (a) At the time an individual ceases to be covered under the health ben…
Neb. Rev. Stat. § 44-6918 Rules and regulations.
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The director may adopt and promulgate rules and regulations to carry out sections 44-6901 to 44-6918.
Neb. Rev. Stat. § 44-7,100 Genetic testing; prohibited acts.
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(1)(a) Any hospital, medical, or surgical expense-incurred policy or certificate delivered, issued for delivery, or renewed in this state and (b) any self-funded employee benefit plan to the extent not preempted by federal law shall not require a covered person or his or her depe…
Neb. Rev. Stat. § 44-7,101 Prescription drug information card or other technology; requirements; use.
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(1) All insurers delivering, issuing for delivery, or renewing in this state a health benefit plan which provides coverage for prescription drugs and devices and that issues, uses, or requires a card or other technology for prescription claims submission, or the insurer's agents …
Neb. Rev. Stat. § 44-7,102 Coverage for screening for colorectal cancer.
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(1) Notwithstanding section 44-3,131, (a) any individual or group sickness and accident insurance policy, certificate, or subscriber contract delivered, issued for delivery, or renewed in this state and any hospital, medical, or surgical expense-incurred policy, except for short-…
Neb. Rev. Stat. § 44-7,103 Continuing coverage for children to age thirty; requirements.
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(1) For purposes of this section, health benefit plan means any expense-incurred individual or group sickness and accident insurance policy, health maintenance organization contract, subscriber contract, or self-funded employee benefit plan to the extent not preempted by federal …
Neb. Rev. Stat. § 44-7,104 Coverage for orally administered anticancer medication; requirements; applicability.
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(1) Notwithstanding section 44-3,131, (a) any individual or group sickness and accident insurance policy, certificate, or subscriber contract delivered, issued for delivery, or renewed in this state and any hospital, medical, or surgical expense-incurred policy, except for polici…
Neb. Rev. Stat. § 44-7,105 Fees charged for dental services; prohibited acts.
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Notwithstanding section 44-3,131, (1) an individual or group sickness or accident policy, certificate, or subscriber contract delivered, issued for delivery, or renewed in this state and a hospital, medical, or surgical expense-incurred policy, (2) a self-funded employee benefit …
Neb. Rev. Stat. § 44-7,106 Coverage for screening, diagnosis, and treatment of autism spectrum disorder; requirements.
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(1) For purposes of this section: (a) Applied behavior analysis means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct o…
Neb. Rev. Stat. § 44-7,107 Telehealth; asynchronous review by dermatologist; coverage.
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(1) For purposes of this section: (a) Asynchronous review means the acquisition and storage of medical information at one site that is then forwarded to or retrieved by a health care provider at another site for medical evaluation; (b) Dermatologist means a board-certified physic…
Neb. Rev. Stat. § 44-7,108 Synchronizing patient's medications; coverage.
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(1) Notwithstanding section 44-3,131, (a) any individual or group sickness and accident insurance policy, certificate, or subscriber contract delivered, issued for delivery, or renewed in this state and any hospital, medical, or surgical expense-incurred policy, except for polici…
Neb. Rev. Stat. § 44-7,109 Network provider; legislative findings; facility; prohibited acts; contract voidable.
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(1) The Legislature finds and declares that: (a) Nebraskans who have a plan of health insurance, health benefits, or health care services provided through a health insurer and who receive health care services from a network provider receive such health care services at rates nego…
Neb. Rev. Stat. § 44-7,110 Dental services; provider network contracts; restrictions on method of payment, prohibited; third-party access; conditions; applicability of provisions.
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(1) For the purposes of this section: (a) Contracting entity means a person or entity that enters into direct contracts with providers for the delivery of dental services in the ordinary course of business, including a dental carrier or third-party administrator; (b) Dental carri…
Neb. Rev. Stat. § 44-7,111 Step-Therapy Reform Act, how cited.
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Sections 44-7,111 to 44-7,117 shall be known and may be cited as the Step-Therapy Reform Act.
Neb. Rev. Stat. § 44-7,112 Terms, defined.
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For purposes of the Step-Therapy Reform Act: (1) Clinical practice guidelines means a systematically developed statement to assist decisionmaking by health care providers and decisions by covered persons about appropriate health care for specific clinical circumstances and condit…
Neb. Rev. Stat. § 44-7,113 Health carrier or utilization review organization; step-therapy protocol; clinical review criteria.
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A health carrier or utilization review organization shall consider available recognized evidence-based and peer-reviewed clinical practice guidelines when establishing a step-therapy protocol. Upon written request of a covered person, a health carrier or utilization review organi…
Neb. Rev. Stat. § 44-7,114 Step-therapy override exception; process.
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When coverage of a prescription drug for the treatment of any medical condition is restricted for use by a health carrier or utilization review organization through the use of a step-therapy protocol, the prescribing health care provider and the covered person shall have access t…
Neb. Rev. Stat. § 44-7,115 Step-therapy override exception; approval; procedure; effect.
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(1) A step-therapy override exception shall be approved by a health carrier or utilization review organization if any of the following circumstances apply: (a) The prescription drug required under the step-therapy protocol is contraindicated pursuant to the drug manufacturer's pr…
Neb. Rev. Stat. § 44-7,116 Rules and regulations.
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The Director of Insurance may adopt and promulgate rules and regulations necessary to enforce the Step-Therapy Reform Act.
Neb. Rev. Stat. § 44-7,117 Act; applicability.
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(1) The Step-Therapy Reform Act applies to all individual and group health insurance policies, contracts, and certificates issued by health carriers, self-funded nonfederal governmental plans, and state employee health plans offered by the State of Nebraska. (2) The Step-Therapy …
Neb. Rev. Stat. § 44-7,118 Coverage for services performed by rural emergency hospital; requirements.
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Any individual or group sickness and accident insurance policy or subscriber contract, nonprofit hospital or medical service policy or plan contract, or health maintenance organization contract and any self-funded employee benefit plan to the extent not preempted by federal law o…
Neb. Rev. Stat. § 44-7,119 Self-funded health benefit plan; not considered insurance; when; certification; required; reinsurance; authorized.
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(1) A health benefit plan is not insurance and except as provided in this section is not subject to any law regarding insurance if: (a) The health benefit plan provides health benefits under a self-funded arrangement administered by an entity licensed as a third-party administrat…
Neb. Rev. Stat. § 44-7,120 Lung cancer screening; deductible, coinsurance, cost-sharing requirements; prohibited, when.
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Notwithstanding section 44-3,131, beginning January 1, 2025, no policy, certificate, or contract, delivered, issued for delivery, or renewed in this state, or any self-funded employee benefit plan, to the extent not preempted by federal law, shall impose a deductible, coinsurance…
Neb. Rev. Stat. § 44-7,121 Coverage for epinephrine injectors; requirements.
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(1)(a) Except as provided in subdivision (b) of this subsection, beginning January 1, 2026, and notwithstanding section 44-3,131, (i) any individual or group sickness and accident insurance policy or subscriber contract delivered, issued for delivery, or renewed in this state and…
Neb. Rev. Stat. § 44-7,122 Biomarker testing; terms, defined.
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For purposes of sections 44-7,122 to 44-7,124: (1) Biomarker means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a specific therapeutic intervention, including known …
Neb. Rev. Stat. § 44-7,123 Biomarker testing; coverage required.
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(1) On and after January 1, 2028, and notwithstanding section 44-3,131, (a) any individual or group sickness and accident insurance policy or subscriber contract delivered, issued for delivery, or renewed in this state and any hospital, medical, or surgical expense-incurred polic…
Neb. Rev. Stat. § 44-7,124 Biomarker testing; covered by medical assistance program; when.
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(1) The medical assistance program shall cover biomarker testing no later than January 1, 2028. (2) Biomarker testing shall be covered when: (a) The test is used for: (i) The diagnosis, treatment, appropriate management, or ongoing monitoring of cancer, an autoimmune or autoinfla…
Neb. Rev. Stat. § 44-7,125 Coverage for pediatric autoimmune neuropsychiatric disorder and pediatric acute-onset neuropsychiatric syndrome; requirements.
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(1) Notwithstanding section 44-3,131, on or after January 1, 2027, (a) any individual or group sickness and accident insurance policy or subscriber contract delivered, issued for delivery, or renewed in this state and any hospital, medical, or surgical expense-incurred policy, ex…
Neb. Rev. Stat. § 44-7001 Act, how cited.
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Sections 44-7001 to 44-7013 shall be known and may be cited as the Health Care Professional Credentialing Verification Act.