Chapter 44 — INSURANCE
2,728 sections in this chapter.
Neb. Rev. Stat. § 44-7105 Network adequacy.
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(1) A health carrier providing a managed care plan shall maintain a network that is sufficient in numbers and types of providers to assure that all health care services to covered persons will be accessible without unreasonable delay. In the case of emergency services, covered pe…
Neb. Rev. Stat. § 44-7106 Requirements for health carriers and participating providers.
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(1) A health carrier offering a managed care plan shall satisfy all the requirements contained in this section. (2)(a) A health carrier shall establish a mechanism by which the participating provider will be notified on an ongoing basis of the specific covered health services for…
Neb. Rev. Stat. § 44-7107 Intermediaries.
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(1) A contract between a health carrier and an intermediary shall satisfy all the requirements contained in this section. (2)(a) Intermediaries and participating providers with whom they contract shall comply with all the applicable requirements of section 44-7106. (b) A health c…
Neb. Rev. Stat. § 44-7108 Filing requirements.
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(1) A health carrier that offers closed plans or combination plans having a closed component shall file with the director sample contract forms proposed for use with its participating providers and intermediaries. (2) A health carrier that offers closed plans or combination plans…
Neb. Rev. Stat. § 44-7109 Health carrier violation; notice; hearing.
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If the director finds that any health carrier doing business in this state is engaging in any violation of the Managed Care Network Adequacy Act and that a proceeding in respect thereto would be in the public interest, the director shall issue and serve upon such health carrier a…
Neb. Rev. Stat. § 44-711 Sickness and accident insurance; hearing on policy form; disapproval; appeal.
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After the expiration of such thirty days from the filing of any such form, as provided in section 44-710, or at any time after having given written approval thereof, the director may, after a hearing of which at least ten days' written notice has been given to the insurer issuing…
Neb. Rev. Stat. § 44-7110 Violation; penalty.
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If, after the hearing, the director finds a health carrier has violated the Managed Care Network Adequacy Act, the director shall reduce his or her findings to writing and shall issue and cause to be served upon the health carrier charged with the violation a copy of the findings…
Neb. Rev. Stat. § 44-7111 Violation of cease and desist order; penalty.
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Any health carrier who violates a cease and desist order of the director under section 44-7110 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 violation, not to exceed an aggregate…
Neb. Rev. Stat. § 44-7112 Rules and regulations.
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The director may adopt and promulgate rules and regulations to carry out the Managed Care Plan Network Adequacy Act.
Neb. Rev. Stat. § 44-712 Sickness and accident insurance; good faith estimate; requirements; effect.
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(1) Any individual or group sickness and accident insurance policy or subscriber contract, any hospital, medical, or surgical expense-incurred policy, and any prepaid dental service plan that is issued for delivery, delivered, or renewed in this state, except policies that provid…
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Neb. Rev. Stat. § 44-713 Insured in temporary custody; health insurance policy; insurer; duties; powers; incarceration; notice; refusal to credential health care provider; notice; applicability of section.
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(1) For purposes of this section: (a) Notwithstanding section 44-3,131, health insurance policy means (i) 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 s…
Neb. Rev. Stat. § 44-714 Health benefit plan; plan sponsor; electronic delivery of communications; consent on behalf of covered person; conditions.
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(1) For purposes of this section: (a) Health benefit plan means a policy, a contract, a certificate, or an agreement entered into, offered by, or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a vis…
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Neb. Rev. Stat. § 44-7201 Act, how cited.
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Sections 44-7201 to 44-7215 shall be known and may be cited as the Quality Assessment and Improvement Act.
Neb. Rev. Stat. § 44-7202 Purpose and intent.
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The Quality Assessment and Improvement Act establishes criteria for the quality assessment activities of all health carriers that offer managed care plans and for the quality improvement activities of health carriers issuing closed plans or combination plans having a closed compo…
Neb. Rev. Stat. § 44-7203 Terms, defined.
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For purposes of the Quality Assessment and Improvement Act: (1) Closed plan means a managed care plan that requires a covered person to use participating providers under the terms of the managed care plan; (2) Consumer means someone in the general public who may or may not be a c…
Neb. Rev. Stat. § 44-7204 Applicability of act.
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The Quality Assessment and Improvement Act applies to all health carriers that offer closed plans or combination plans having a closed component on and after July 15, 1998. The act, except sections 44-7207 to 44-7209, applies to all health carriers that offer open plans on and af…
Neb. Rev. Stat. § 44-7205 Use of nationally recognized private accrediting entities; authorized.
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The director may recognize accreditation by one or more nationally recognized private accrediting entities, with established and maintained standards, as evidence of meeting some or all of the requirements of the Quality Assessment and Improvement Act. A recognized accrediting en…
Neb. Rev. Stat. § 44-7206 Quality assessment; infrastructure and disclosure systems.
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A health carrier that provides managed care plans shall develop and maintain the infrastructure and disclosure systems necessary to measure the quality of health care services provided to covered persons on a regular basis and appropriate to the types of managed care plans offere…
Neb. Rev. Stat. § 44-7207 Quality improvement; internal structures and activities.
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A health carrier that issues a closed plan or a combination plan having a closed component shall, in addition to complying with the requirements of section 44-7206, develop and maintain the internal structures and activities necessary to improve quality as required by this sectio…
Neb. Rev. Stat. § 44-7208 Quality assessment and quality improvement activities; oversight.
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The chief medical officer or clinical director of the health carrier shall have primary responsibility for the quality assessment and quality improvement activities carried out by, or on behalf of, the health carrier and for ensuring that all requirements of the Quality Assessmen…
Neb. Rev. Stat. § 44-7209 Reporting and disclosure requirements.
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(1) A health carrier shall document and communicate information, as provided in this section, about its quality assessment program and its quality improvement program, if it has one, and shall include a description of its quality assessment and quality improvement programs and a …
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Neb. Rev. Stat. § 44-7210 Confidentiality; immunity.
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(1) Data or information pertaining to the diagnosis, treatment, or health of a covered person obtained from the person or from a provider by a health carrier is confidential and shall not be disclosed to any person except to the extent that it may be necessary to carry out the pu…
Neb. Rev. Stat. § 44-7211 Contracts; duties.
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Whenever a health carrier contracts to have another entity perform the quality assessment or quality improvement functions required by the Quality Assessment and Improvement Act or applicable rules and regulations, the director shall hold the health carrier responsible for monito…
Neb. Rev. Stat. § 44-7212 Health carrier violation; notice; hearing.
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If the director finds that any health carrier doing business in this state is engaging in any violation of the Quality Assessment and Improvement Act and that a proceeding in respect thereto would be in the public interest, the director shall issue and serve upon such health carr…
Neb. Rev. Stat. § 44-7213 Violation; penalty.
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If, after the hearing, the director finds a health carrier has violated the Quality Assessment and Improvement Act, the director shall reduce his or her findings to writing and shall issue and cause to be served upon the health carrier charged with the violation a copy of the fin…
Neb. Rev. Stat. § 44-7214 Violation of cease and desist order; penalty.
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Any health carrier who violates a cease and desist order of the director under section 44-7213 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 violation, not to exceed an aggregate…
Neb. Rev. Stat. § 44-7215 Rules and regulations.
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The director may adopt and promulgate rules and regulations to carry out the Quality Assessment and Improvement Act.
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Repealed. Laws 1957, c. 188, § 22.
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[Repealed or reserved.]
Neb. Rev. Stat. § 44-7301 Act, how cited.
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Sections 44-7301 to 44-7315 shall be known and may be cited as the Health Carrier Grievance Procedure Act.
Neb. Rev. Stat. § 44-7302 Purpose of act.
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The purpose of the Health Carrier Grievance Procedure Act is to provide standards for the establishment and maintenance of procedures by health carriers to assure that covered persons have the opportunity for the appropriate resolution of their grievances as defined in the act.
Neb. Rev. Stat. § 44-7303 Terms, defined.
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For purposes of the Health Carrier Grievance Procedure Act: (1) Adverse determination means a determination by a health carrier or its designee utilization review agent that an admission, availability of care, continued stay, or other health care service has been reviewed and, ba…
Neb. Rev. Stat. § 44-7304 Applicability of act.
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Except as otherwise specified, the Health Carrier Grievance Procedure Act applies to all health carriers that offer managed care plans.
Neb. Rev. Stat. § 44-7305 Use of nationally recognized private accrediting entities; authorized.
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The director may recognize accreditation by one or more nationally recognized private accrediting entities, with established and maintained standards, as evidence of meeting some or all of the requirements of the Health Carrier Grievance Procedure Act. A recognized accrediting en…