Chapter 44 — INSURANCE
2,728 sections in this chapter.
Neb. Rev. Stat. § 44-5241.02 Group health plan, defined.
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Group health plan shall mean 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 insura…
Neb. Rev. Stat. § 44-5242 Health benefit plan, defined.
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(1) Health benefit plan shall mean any hospital or medical policy or certificate, major medical expense insurance, or health maintenance organization subscriber contract. (2) Health benefit plan shall not include one or more, or any combination, of the following: (a) Coverage onl…
Neb. Rev. Stat. § 44-5242.01 Health carrier or carrier, defined.
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Health carrier or carrier shall mean any entity that provides health insurance in this state. Health carrier or carrier shall include an insurance company, a fraternal benefit society, a health maintenance organization, and any other entity providing a plan of health insurance or…
Neb. Rev. Stat. § 44-5242.02 Health-status-related factor, defined.
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Health-status-related factor shall mean 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 insurabil…
Neb. Rev. Stat. § 44-5242.03 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. § 44-5243 Index rate, defined.
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Index rate shall mean, for each class of business as to a rating period for small employers with similar case characteristics, the arithmetic average of the applicable base premium rate and the corresponding highest premium rate.
Neb. Rev. Stat. § 44-5244 Late enrollee, defined.
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Late enrollee shall mean an eligible employee or dependent who requests enrollment in a health benefit plan of a small employer following the initial enrollment period during which the individual is entitled to enroll under the terms of the health benefit plan if the initial enro…
Neb. Rev. Stat. § 44-5244.01 Medical care, defined.
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Medical care shall mean 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 (…
Neb. Rev. Stat. § 44-5244.02 Network plan, defined.
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Network plan shall mean 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…
Neb. Rev. Stat. § 44-5245 New business premium rate, defined.
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New business premium rate shall mean, for each class of business as to a rating period, the lowest premium rate charged or offered or which could have been charged or offered by the small employer carrier to small employers with similar case characteristics for newly issued healt…
Repealed. Laws 2017, LB644, § 21.
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[Repealed or reserved.]
Neb. Rev. Stat. § 44-5246.01 Plan sponsor, defined.
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Plan sponsor shall have the meaning given such term under 29 U.S.C. 1002.
Neb. Rev. Stat. § 44-5246.02 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. § 44-5247 Premium, defined.
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Premium shall mean all money paid by a small employer and eligible employees as a condition of receiving coverage from a small employer carrier, including any fees or other contributions associated with the health benefit plan.
Repealed. Laws 2017, LB644, § 21.
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[Repealed or reserved.]
Repealed. Laws 1997, LB 862, § 50.
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[Repealed or reserved.]
Neb. Rev. Stat. § 44-525 Health claim form; purposes of act.
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The purposes of the Standardized Health Claim Form Act are to standardize the forms used in the billing and reimbursement of health care, reduce the number of forms utilized and increase efficiency in the reimbursement of health care through standardization, and encourage the use…
Neb. Rev. Stat. § 44-5250 Rating period, defined.
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Rating period shall mean the calendar period for which premium rates established by a small employer carrier are assumed to be in effect.
Repealed. Laws 2017, LB644, § 21.
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[Repealed or reserved.]
Neb. Rev. Stat. § 44-5252 Restricted network provision, defined.
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Restricted network provision shall mean any provision of a health benefit plan that conditions the payment of benefits, in whole or in part, on the use of health care providers that have entered into contractual arrangement with the carrier to provide health care services to cove…
Neb. Rev. Stat. § 44-5253 Small employer, defined.
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Small employer shall mean any person, political subdivision, firm, corporation, limited liability company, partnership, or association that is actively engaged in business that, on at least fifty percent of its working days during the preceding calendar quarter, employed at least…
Neb. Rev. Stat. § 44-5254 Small employer carrier, defined.
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Small employer carrier shall mean a carrier that offers health benefit plans covering eligible employees of one or more small employers in this state.
Neb. Rev. Stat. § 44-5255 Standard health benefit plan, defined.
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Standard health benefit plan shall mean a health benefit plan regulated by the Department of Insurance.
Neb. Rev. Stat. § 44-5255.01 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. § 44-5256 Act; applicability; conditions; waiver.
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(1) The Small Employer Health Insurance Availability Act shall apply to any health benefit plan that provides coverage to the employees of a small employer in this state if any of the following conditions are met: (a) Any portion of the premium or benefits is paid by or on behalf…
Neb. Rev. Stat. § 44-5257 Separate class of business; established; when; limit.
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(1) A small employer carrier may establish a separate class of business only to reflect substantial differences in expected claims experience or administrative costs related to the following reasons: (a) The small employer carrier uses more than one type of system for the marketi…
Neb. Rev. Stat. § 44-5258 Premium rates; requirements; limitation on transfers; director; powers; disclosures required; small employer carrier; duties.
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(1) Premium rates for health benefit plans subject to the Small Employer Health Insurance Availability Act shall be subject to the following provisions: (a) The index rate for a rating period for any class of business shall not exceed the index rate for any other class of busines…
Neb. Rev. Stat. § 44-5259 Health benefit plan; renewable; exceptions; small employer carrier; requirements.
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(1) A health benefit plan subject to the Small Employer Health Insurance Availability Act shall be renewable with respect to all eligible employees or dependents, at the option of the small employer, except in any of the following cases: (a) The small employer has failed to pay p…
Neb. Rev. Stat. § 44-526 Health claim form; terms, defined.
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For purposes of the Standardized Health Claim Form Act: (1) Ambulatory surgical facility shall mean a facility, not a part of a hospital, which provides surgical treatment to patients not requiring hospitalization and which is licensed as a health clinic as defined by section 71-…
Neb. Rev. Stat. § 44-5260 Small employer, defined; group health plan; health benefit plans; requirements; filing; exceptions; preexisting condition exclusion; network plans.
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(1) For purposes of this section, small employer shall mean, in connection with a group health plan with respect to a calendar year and a plan year, any person, firm, corporation, partnership, association, or political subdivision that is actively engaged in business that employe…
Neb. Rev. Stat. § 44-5260.01 Certification of creditable coverage.
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(1) Small employer 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 he…
Repealed. Laws 2017, LB644, § 21.
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[Repealed or reserved.]
Repealed. Laws 2009, LB 154, § 27.
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[Repealed or reserved.]
Repealed. Laws 2017, LB644, § 21.
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[Repealed or reserved.]
Neb. Rev. Stat. § 44-5264 Basic health benefit plan; required coverage; applicability.
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Except for specified childhood immunizations of children from birth to six years of age, a statute requiring coverage of a health care service or benefit or requiring the reimbursement, utilization, or inclusion of a specific category of licensed health care practitioner shall no…
Neb. Rev. Stat. § 44-5265 Rules and regulations.
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The director shall adopt and promulgate rules and regulations to carry out the Small Employer Health Insurance Availability Act.
Neb. Rev. Stat. § 44-5266 Small employer carrier; market health benefit plan coverage; carrier, agent, or broker; prohibited activities; compensation to agent or broker; denial of application; rules and regulations; unfair trade practice; when; third-party administrator.
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(1) Each small employer carrier shall actively market health benefit plan coverage, including the basic health benefit plans and standard health benefit plans, to eligible small employers in the state. If a small employer carrier denies coverage to a small employer on the basis o…
Neb. Rev. Stat. § 44-5267 Reissuance of health benefit plan; when; director; powers.
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The director may adopt and promulgate rules and regulations to require small employer carriers, as a condition of transacting business with small employers in this state after January 1, 1995, to reissue a health benefit plan to any small employer whose health benefit plan has be…
Neb. Rev. Stat. § 44-527 Health claim form; director; duties.
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The Director of Insurance shall develop uniform claim forms and uniform electronic transfer procedures for issuers, institutional care providers, and health care practitioners. The director shall consult with interested individuals and associations who have expertise in the devel…
Neb. Rev. Stat. § 44-528 Health claim form; acceptance and utilization required.
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No issuer, institutional care provider, or health care practitioner shall contract with any person or employer, union, or other organization under which health care services or benefits are provided unless such person or organization accepts and utilizes or agrees to accept and u…
Neb. Rev. Stat. § 44-529 Health claim form; hospital and ambulatory surgical facility; billing invoice; duty.
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Each hospital and ambulatory surgical facility shall issue and complete a billing invoice on the uniform claim form for outpatient and inpatient services provided by the hospital or ambulatory surgical facility as a condition of reimbursement by medicaid, medicare, and issuers.
Neb. Rev. Stat. § 44-530 Health claim form; violation; penalty; license revocation.
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Any person who knowingly violates or knowingly aids or abets in the violation of the Standardized Health Claim Form Act or who fails to perform any duty under such act shall be guilty of a Class III misdemeanor. Any issuer who violates the act shall be subject to license revocati…
Repealed. Laws 2025, LB326, § 16.
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[Repealed or reserved.]
Repealed. Laws 2025, LB326, § 16.
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[Repealed or reserved.]
Repealed. Laws 2025, LB326, § 16.
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[Repealed or reserved.]
Repealed. Laws 2025, LB326, § 16.
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[Repealed or reserved.]
Repealed. Laws 2025, LB326, § 16.
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[Repealed or reserved.]
Repealed. Laws 2025, LB326, § 16.
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[Repealed or reserved.]
Repealed. Laws 2025, LB326, § 16.
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[Repealed or reserved.]
Repealed. Laws 2025, LB326, § 16.
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[Repealed or reserved.]