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2,111 sections in this chapter.
Neb. Rev. Stat. § 44-319.01 Domestic companies; securities; terms, defined.
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For purposes of sections 44-319.01 to 44-319.13, unless the context otherwise requires: (1) Director shall mean the Director of Insurance or his or her authorized representative; (2) Policyholders shall mean all persons having a legal or equitable right against a depositing insur…
Neb. Rev. Stat. § 44-319.02 Domestic companies; securities; amount required.
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Every domestic insurer hereafter organized to transact the business of insurance in this state shall deposit and continually maintain with the Department of Insurance eligible securities for the benefit of all of its policyholders or policyholders and creditors in the United Stat…
Neb. Rev. Stat. § 44-319.03 Domestic companies; securities; deposit; minimum required.
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Every domestic assessment association hereafter organized to transact the business of insurance in this state, except (1) health and accident assessment associations and (2) assessment associations organized primarily to write insurance coverage on farm properties against the per…
Neb. Rev. Stat. § 44-319.04 Domestic companies; securities; transacting business in foreign state; deposit permitted.
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Domestic insurers and assessment associations transacting or desiring to transact business in any other state, province, or country may deposit additional securities with the Department of Insurance in the kind and to the amount required by such other state, province, or country …
Neb. Rev. Stat. § 44-319.05 Domestic companies; securities; deposit; aggregate required.
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Every domestic insurer and assessment association required by Chapter 44 to deposit securities with the Department of Insurance shall continue to deposit all of its eligible securities until they aggregate the sum of one hundred thousand dollars.
Neb. Rev. Stat. § 44-319.06 Foreign companies; securities; amount required.
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No foreign insurer or assessment association now or hereafter authorized to do business in this state shall henceforth transact such business unless it shall deposit and continually maintain with the Department of Insurance or with the proper official of some one state of the Uni…
Neb. Rev. Stat. § 44-319.07 Securities; exchange; withdrawal; approval of director; forfeiture for failure to comply.
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(1) The depositing insurer or assessment association may, from time to time, exchange for the deposited securities, or any of them, other securities eligible for deposit if the aggregate value of such deposit will not thereby be reduced below the amount required by sections 44-31…
Neb. Rev. Stat. § 44-319.08 Securities; not subject to execution.
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No creditor or other claimant may levy upon such a deposit or any part thereof. Upon an order of liquidation, rehabilitation, or conservation of any depositing insurer or assessment association by a court of competent jurisdiction, the funds deposited and the income therefrom sha…
Neb. Rev. Stat. § 44-319.09 Securities deposited under former law; treatment.
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All securities now held on deposit by the director, which were made pursuant to any prior insurance law, shall be deemed to be held in compliance with the provisions of sections 44-319.01 to 44-319.13, for the purpose for which such deposits were originally made.
Neb. Rev. Stat. § 44-319.10 Interest; collectible by depositing insurer; Securities Deposit Trust Fund; created; disbursement.
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(1) Unless prohibited by the order of a court, all income on securities deposited with the Department of Insurance or with an authorized depository of the department shall be collectible by the depositing insurer or assessment association. In the event such income is paid to the …
Neb. Rev. Stat. § 44-319.11 Securities; designation of depository; director; duties.
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The director may designate any bank or trust company domiciled in this state as the depository for the Department of Insurance to receive and hold for safekeeping purposes any securities deposited pursuant to sections 44-319.01 to 44-319.13 or any prior insurance law. The holding…
Neb. Rev. Stat. § 44-319.12 Securities; liquidation; effect.
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All securities heretofore or hereafter deposited with the Department of Insurance by any incorporated or unincorporated insurer or assessment association shall become the property of the State of Nebraska in the event such securities remain unclaimed for a period of not less than…
Neb. Rev. Stat. § 44-319.13 Sections; cumulative.
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Nothing in sections 44-319.01 to 44-319.13 shall be construed to amend, repeal, or otherwise affect the provisions of sections 44-305 and 44-821 to 44-825.
Neb. Rev. Stat. § 44-32,100 Evidence of coverage, defined.
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Evidence of coverage shall mean a statement of the essential features and services of the health maintenance organization coverage which is given to the subscriber by the health maintenance organization or by the group contract holder.
Neb. Rev. Stat. § 44-32,101 Extension of benefits, defined.
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Extension of benefits shall mean the continuation of coverage under a particular benefit provided under a contract following termination with respect to an enrollee who is totally disabled on the date of termination.
Neb. Rev. Stat. § 44-32,102 Grievance, defined.
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Grievance shall mean a written complaint submitted in accordance with the health maintenance organization's formal grievance procedure by or on behalf of the enrollee regarding any aspect of the health maintenance organization relative to the enrollee.
Neb. Rev. Stat. § 44-32,103 Group contract, defined.
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Group contract shall mean a contract for health care services which by its terms limits eligibility to members of a specified group. The group contract may include coverage for dependents.
Neb. Rev. Stat. § 44-32,104 Group contract holder, defined.
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Group contract holder shall mean the person to which a group contract has been issued.
Neb. Rev. Stat. § 44-32,105 Health maintenance organization, defined.
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Health maintenance organization shall mean any person who 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.
Neb. Rev. Stat. § 44-32,106 Health maintenance organization producer, defined.
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Health maintenance organization producer shall mean a person licensed under subdivision (1)(b) of section 44-4054 who solicits, negotiates, effects, procures, delivers, renews, or continues a policy or contract for health maintenance organization membership, or who takes or trans…
Neb. Rev. Stat. § 44-32,107 Individual contract, defined.
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Individual contract shall mean a contract for health care services issued to and covering an individual. The individual contract may include coverage for dependents of the subscriber.
Neb. Rev. Stat. § 44-32,108 Insolvent or insolvency, defined.
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Insolvent or insolvency shall mean that the health maintenance organization has been declared insolvent and placed under an order of liquidation by a court of competent jurisdiction.
Neb. Rev. Stat. § 44-32,109 Net worth, defined.
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Net worth shall mean the excess of total admitted assets over total liabilities. Liabilities shall not include fully subordinated debt.
Neb. Rev. Stat. § 44-32,110 Participating provider, defined.
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Participating provider shall mean a provider who, under an express or implied contract with the health maintenance organization or with its contractor or subcontractor, has agreed to provide health care services to enrollees with an expectation of receiving payment, other than co…
Neb. Rev. Stat. § 44-32,111 Provider, defined.
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Provider shall mean any physician, hospital, or other person licensed or otherwise authorized to furnish health care services.
Neb. Rev. Stat. § 44-32,112 Replacement coverage, defined.
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Replacement coverage shall mean the benefits provided by a succeeding carrier.
Neb. Rev. Stat. § 44-32,113 Subscriber, defined.
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Subscriber shall mean an individual whose employment or other status, except family dependency, is the basis for eligibility for enrollment in the health maintenance organization or, in the case of an individual contract, the individual in whose name the contract is issued.
Neb. Rev. Stat. § 44-32,114 Uncovered expenditures, defined.
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Uncovered expenditures shall mean the costs to the health maintenance organization for health care services that are the obligation of the health maintenance organization for which an enrollee may also be liable in the event of the health maintenance organization's insolvency and…
Neb. Rev. Stat. § 44-32,115 Establishment of health maintenance organization; certificate of authority required.
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Any person may apply to the director for a certificate of authority to establish and operate a health maintenance organization in compliance with the Health Maintenance Organization Act. No person shall establish or operate a health maintenance organization in this state without …
Neb. Rev. Stat. § 44-32,116 Existing health maintenance organization; application.
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Any health maintenance organization which has not received a certificate of authority to operate as a health maintenance organization under prior law as of July 10, 1990, shall submit an application for a certificate of authority within ninety days of such date. Each such applica…
Neb. Rev. Stat. § 44-32,117 Certificate of authority; application; contents.
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Each application for a certificate of authority shall be verified by an officer or authorized representative of the applicant, shall be in a form prescribed by the director, and shall set forth or be accompanied by the following: (1) A copy of the organizational documents of the …
Neb. Rev. Stat. § 44-32,118 Modification or amendment of application; required; when.
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(1) Any modification or amendment to the items described in section 44-32,117 shall be submitted to the director for his or her approval prior to the effectuation of the modification or amendment. (2) Any modification or amendment shall be deemed approved unless disapproved withi…
Neb. Rev. Stat. § 44-32,119 Application; transmittal to Department of Health and Human Services; duties; applicability.
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(1) Upon receipt of an application for issuance of a certificate of authority, the Director of Insurance shall forthwith transmit copies of such application and accompanying documents to the Department of Health and Human Services. (2) The Department of Health and Human Services …
Neb. Rev. Stat. § 44-32,120 Certificate of authority; issuance; conditions.
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The Director of Insurance shall, within forty-five days of receipt of certification or notice of deficiencies pursuant to section 44-32,119, issue a certificate of authority to any person filing a completed application upon receiving the prescribed fees and being satisfied that: …
Neb. Rev. Stat. § 44-32,121 Certificate of authority; expiration; renewal.
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A certificate of authority issued pursuant to sections 44-32,119 and 44-32,120 shall expire on April 30 in each year and shall be renewed annually if the health maintenance organization has continued to comply with the laws of this state and the rules and regulations.
Neb. Rev. Stat. § 44-32,122 Health maintenance organization; powers.
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The powers of a health maintenance organization shall include, but not be limited to, the following: (1) The purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical facilities, and ancillary equipment and such property as may reasonably be requi…
Neb. Rev. Stat. § 44-32,123 Health maintenance organization; exercise of powers; approval requirements.
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A health maintenance organization shall file notice, with adequate supporting information, with the director prior to the exercise of any power granted in subdivision (1), (2), or (4) of section 44-32,122 which may affect the financial soundness of the health maintenance organiza…
Neb. Rev. Stat. § 44-32,124 Health maintenance organization; deemed to transact business of insurance.
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Notwithstanding any differences provided by law between a health maintenance organization and an insurer as described in section 44-103, a health maintenance organization shall be deemed to assume, underwrite, and spread risk and otherwise transact the business of insurance.
Neb. Rev. Stat. § 44-32,125 Fiduciary relationships; bond or insurance required.
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Any director, officer, employee, partner, or limited liability company member of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the health maintenance organization shall be responsible for such funds in a…
Neb. Rev. Stat. § 44-32,126 Quality of care; procedures established.
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Each health maintenance organization shall establish procedures to assure that the health care services provided to enrollees are rendered under reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice. Such proced…
Neb. Rev. Stat. § 44-32,127 Quality assurance program; requirements.
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Each health maintenance organization shall have an ongoing, internal quality assurance program to monitor and evaluate its health care services, including primary and specialist physician services, and ancillary and preventive health care services across all institutional and non…
Neb. Rev. Stat. § 44-32,128 Patient record system; requirements.
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Each health maintenance organization shall ensure the use and maintenance of an adequate patient record system which facilitates documentation and retrieval of clinical information for the purpose of the health maintenance organization evaluating continuity and coordination of pa…
Neb. Rev. Stat. § 44-32,129 Group and individual contracts; required provisions.
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Every group and individual contract holder shall be entitled to a group or individual contract. The contract shall not contain provisions or statements which are unjust, unfair, inequitable, misleading, or deceptive or which encourage misrepresentation as described by section 44-…
Neb. Rev. Stat. § 44-32,130 Group and individual contracts; additional required provisions.
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(1) An individual contract shall provide a ten-day period to examine and return the contract and have the premium refunded. If services were received during the ten-day period and the person returns the contract to receive a refund of the premium paid, he or she shall pay for suc…
Neb. Rev. Stat. § 44-32,131 Subscriber; receive evidence of coverage; contents.
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Every subscriber shall receive an evidence of coverage from the group contract holder or the health maintenance organization. The evidence of coverage shall not contain provisions or statements which are unfair, unjust, inequitable, misleading, or deceptive or which encourage mis…
Neb. Rev. Stat. § 44-32,132 Forms; readability standards; filing requirements.
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The director may establish readability standards for individual contract, group contract, and evidence of coverage forms. No group or individual contract, evidence of coverage, or amendment thereto shall be delivered or issued for delivery in this state unless its form has been f…
Neb. Rev. Stat. § 44-32,133 Forms; filing; when; disapproval or withdrawal of approval; notice; hearing.
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(1) Every form required to be filed with the director shall be filed not less than thirty days prior to delivery or issuance for delivery in this state. At any time during the thirty-day period, the director may extend the period for review for an additional thirty days. Notice o…
Neb. Rev. Stat. § 44-32,134 Filings; required.
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(1) Every health maintenance organization shall file annually, on or before March 1, an annual financial statement with the Director of Insurance, with a copy to the Department of Health and Human Services, covering the preceding calendar year. The annual financial statement shal…
Neb. Rev. Stat. § 44-32,135 Information to subscribers and enrollees.
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Each health maintenance organization shall provide a list of providers to its subscribers upon enrollment and reenrollment. Each health maintenance organization shall provide notice within thirty days of any material change in the operation of the health maintenance organization …
Neb. Rev. Stat. § 44-32,136 Grievance procedure.
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Each health maintenance organization shall establish and maintain a grievance procedure to provide for the resolution of grievances initiated by enrollees. The procedure shall be approved by the Director of Insurance after consultation with the Department of Health and Human Serv…