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2,111 sections in this chapter.
Neb. Rev. Stat. § 44-32,137 Investments.
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With the exception of investments made in accordance with subdivision (1) of section 44-32,122, the investable funds of a health maintenance organization shall be invested only as authorized under the Insurers Investment Act for a domestic life insurance company.
Neb. Rev. Stat. § 44-32,138 Net worth requirements.
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(1) Before issuing a certificate of authority, the director shall require that the health maintenance organization have an initial net worth of one million five hundred thousand dollars and maintain the minimum net worth required under this section. (2) Except as provided in subs…
Neb. Rev. Stat. § 44-32,139 Deposit requirements.
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(1) Except as provided in subsection (2) of this section, each health maintenance organization shall deposit with the director, or at the discretion of the director with any organization or trustee acceptable to him or her through which a custodial or controlled account is utiliz…
Neb. Rev. Stat. § 44-32,140 Liabilities; computation.
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Every health maintenance organization shall, when determining liabilities, include an amount estimated in the aggregate to provide (1) for any unearned premium, (2) for the payment of all claims for health care expenditures which have been incurred, whether reported or unreported…
Neb. Rev. Stat. § 44-32,141 Provider contracts; requirements.
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Every contract between a health maintenance organization and a participating provider shall be in writing and shall provide that, if the health maintenance organization fails to pay for health care services as set forth in the contract, the subscriber or enrollee will not be liab…
Neb. Rev. Stat. § 44-32,142 Provider agreement; notice of termination.
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An agreement to provide health care services between a provider and a health maintenance organization shall require that, if the provider terminates the agreement, the provider will give the health maintenance organization at least sixty days' notice of termination.
Neb. Rev. Stat. § 44-32,143 Insolvency; plan required.
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The director shall require that each health maintenance organization have a plan for handling insolvency which allows for continuation of benefits for the duration of the contract period for which premiums have been paid and continuation of benefits to members who are confined on…
Neb. Rev. Stat. § 44-32,144 Uncovered expenditures insolvency deposit.
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(1) If uncovered expenditures exceed ten percent of the total health care expenditures of a health maintenance organization for the previous calendar quarter, the health maintenance organization shall place an uncovered expenditures insolvency deposit of cash or securities that a…
Neb. Rev. Stat. § 44-32,145 Uncovered expenditures insolvency deposit; use.
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The deposit required under section 44-32,144 shall be in trust and may be used only by the director for administrative costs associated with administering the deposit and payment of claims of enrollees of this state for uncovered expenditures. Claims for uncovered expenditures sh…
Neb. Rev. Stat. § 44-32,146 Uncovered expenditures; reports.
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The director may require a health maintenance organization to file annual or quarterly, or more frequent, reports of uncovered expenditures and liability for uncovered expenditures. The director may require that the reports include an audit opinion.
Neb. Rev. Stat. § 44-32,147 Insolvency; replacement coverage; duty to provide; director; duties.
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(1) If a health maintenance organization is determined to be insolvent and ordered liquidated by a court of competent jurisdiction, upon such order, all other carriers which participated in the enrollment process with the insolvent health maintenance organization at a group's las…
Neb. Rev. Stat. § 44-32,148 Replacement coverage; requirements.
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(1) Any carrier providing replacement coverage with respect to group hospital, medical, or surgical expense or service benefits within a period of sixty days from the date of discontinuance of a prior health maintenance organization contract or policy providing such hospital, med…
Neb. Rev. Stat. § 44-32,149 Premium rates.
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(1) No premium rate may be used until either a schedule of premium rates or methodology for determining premium rates has been filed with and approved by the director. A specific schedule of premium rates or a methodology for determining premium rates shall be established in acco…
Neb. Rev. Stat. § 44-32,150 Insurance Producers Licensing Act; applicability.
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The Insurance Producers Licensing Act shall apply to health maintenance organization producers except to the extent that the director determines that the nature of health maintenance organizations renders application of the act clearly inappropriate.
Neb. Rev. Stat. § 44-32,151 Powers of insurers.
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(1) An insurer licensed in this state may, either directly or through a subsidiary or affiliate, organize and operate a health maintenance organization under the Health Maintenance Organization Act. Any two or more such insurers or subsidiaries or affiliates thereof may jointly o…
Neb. Rev. Stat. § 44-32,152 Examinations; expenses.
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(1) The Director of Insurance may make an examination of the affairs of any health maintenance organization in accordance with the Insurers Examination Act and any provider with whom such health maintenance organization has contracts, agreements, or other arrangements as often as…
Neb. Rev. Stat. § 44-32,153 Certificate of authority; suspension, revocation, or denial; grounds.
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If the Director of Insurance finds that any of the conditions listed in this section exist, any certificate of authority issued under the Health Maintenance Organization Act may be suspended or revoked or any application for a certificate of authority may be denied: (1) The healt…
Neb. Rev. Stat. § 44-32,154 Deficiency in net worth; impaired condition; director; powers.
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(1) Whenever the director finds that the net worth maintained by any health maintenance organization is less than the minimum net worth required to be maintained by section 44-32,138, he or she shall give written notice to the health maintenance organization of the amount of the …
Neb. Rev. Stat. § 44-32,155 Certificate of authority; suspension, revocation, or denial; administrative penalty; procedure.
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A certificate of authority shall be suspended or revoked, an application for a certificate of authority denied, or an administrative penalty imposed pursuant to section 44-32,164 only after compliance with the requirements of sections 44-32,156 to 44-32,158.
Neb. Rev. Stat. § 44-32,156 Suspension, revocation, denial, or administrative penalty; order; hearing.
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Suspension or revocation of a certificate of authority, the denial of an application for a certificate, or the imposition of an administrative penalty shall be by written order and shall be sent by the Director of Insurance to the health maintenance organization or applicant by c…
Neb. Rev. Stat. § 44-32,157 Hearing; notice; decision; appeal.
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(1) If the health maintenance organization or applicant requests a hearing pursuant to section 44-32,156, the Director of Insurance shall issue a written notice of hearing and send it to the health maintenance organization or applicant by certified or registered mail and to the D…
Neb. Rev. Stat. § 44-32,158 Certificate of authority; suspension or revocation; effect.
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(1) When the certificate of authority of a health maintenance organization is suspended, the health maintenance organization shall not, during the period of such suspension, enroll any additional enrollees other than newborn children or other newly acquired dependents of existing…
Neb. Rev. Stat. § 44-32,159 Hazardous operation; violations; director; powers.
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Whenever the director determines that the financial condition of any health maintenance organization is such that its continued operation might be hazardous to its enrollees or creditors or the general public or that it has violated the Health Maintenance Organization Act, he or …
Neb. Rev. Stat. § 44-32,160 Hazardous operation; violations; uniform standards and criteria; remedies not exclusive.
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The director may set uniform standards and criteria for early warning that the continued operation of any health maintenance organization might be hazardous to its enrollees or creditors or the general public and standards for evaluating the financial condition of any health main…
Neb. Rev. Stat. § 44-32,161 Supervision, rehabilitation, liquidation, or conservation; grounds and procedure applicable.
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(1) Any supervision, rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the supervision, rehabilitation, liquidation, or conservation of an insurance company and shall be conducted pursuant to the Nebraska Insurers Supervision,…
Neb. Rev. Stat. § 44-32,162 Rules and regulations.
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The director shall adopt and promulgate rules and regulations to carry out the Health Maintenance Organization Act.
Neb. Rev. Stat. § 44-32,163 Fees; distribution.
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Every health maintenance organization subject to the Health Maintenance Organization Act shall pay to the director the following fees: (1) For filing an application for a certificate of authority or amendment thereto, three hundred dollars; (2) For filing an amendment to the orga…
Neb. Rev. Stat. § 44-32,164 Administrative penalty.
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The director may, in lieu of suspension or revocation of a certificate of authority, levy an administrative penalty in an amount not less than five hundred dollars nor more than ten thousand dollars if reasonable notice in writing is given of the intent to levy the penalty and th…
Neb. Rev. Stat. § 44-32,165 Violations; conference; requirements.
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If the Director of Insurance or the Department of Health and Human Services has for any reason cause to believe that any violation of the Health Maintenance Organization Act has occurred or is threatened, the Director of Insurance or the Department of Health and Human Services ma…
Neb. Rev. Stat. § 44-32,166 Cease and desist order; hearing; appeal; injunction.
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The director may issue an order directing a health maintenance organization or a representative of a health maintenance organization to cease and desist from engaging in any action or practice in violation of the Health Maintenance Organization Act. Within ten days after service …
Neb. Rev. Stat. § 44-32,167 Net worth violation; director; powers.
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If a health maintenance organization fails to comply with the net worth requirement of section 44-32,138, the director may take appropriate action to assure that the continued operation of the health maintenance organization will not be hazardous to its enrollees.
Neb. Rev. Stat. § 44-32,168 Insurance laws; when applicable.
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Except as otherwise provided in Chapter 44 or the Health Maintenance Organization Act, the insurance laws shall not be applicable to any health maintenance organization granted a certificate of authority under the act. This section shall not apply to an insurer licensed and regul…
Neb. Rev. Stat. § 44-32,169 Solicitation of enrollees; other law; how construed.
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Solicitation of enrollees by a health maintenance organization granted a certificate of authority or its representatives shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals.
Neb. Rev. Stat. § 44-32,170 Practice of medicine; laws not applicable.
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Any health maintenance organization authorized under the Health Maintenance Organization Act shall not be deemed to be practicing medicine and shall be exempt from the Medicine and Surgery Practice Act relating to the practice of medicine.
Neb. Rev. Stat. § 44-32,171 Applications, filings, and reports; public documents; exception.
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All applications, filings, and reports required under the Health Maintenance Organization Act shall be treated as public documents except those which are trade secrets or privileged or confidential quality assurance, commercial, or financial information other than any annual fina…
Neb. Rev. Stat. § 44-32,172 Confidential information; disclosure prohibited; exception.
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Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except (1) to the exte…
Neb. Rev. Stat. § 44-32,173 Health care review committee; health maintenance organization; exemption from liability.
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A person who, in good faith and without malice, takes any action or makes any decision or recommendation as a member, agent, or employee of a health care review committee or who furnishes any records, information, or assistance to such a committee shall not be subject to liabilit…
Neb. Rev. Stat. § 44-32,174 Health care review committee; information and records; confidentiality.
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(1) The information considered by a health care review committee and the records of their actions and proceedings shall be confidential and not subject to subpoena or order to produce except in proceedings before the appropriate state licensing or certifying agency or in an appea…
Neb. Rev. Stat. § 44-32,175 Quality assurance; access to records and information.
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To fulfill its quality assurance obligations, a health maintenance organization shall have access to treatment records and other information pertaining to the diagnosis, treatment, or health status of any enrollee.
Neb. Rev. Stat. § 44-32,176 Department of Health and Human Services; contracts authorized.
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The Department of Health and Human Services, in carrying out obligations under the Health Maintenance Organization Act, may contract with qualified persons to make recommendations concerning the determinations required to be made. Such recommendations may be accepted in full or i…
Neb. Rev. Stat. § 44-32,177 Health maintenance organization; acquisition, merger, and consolidation; procedure.
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No person shall (1) make a tender for or a request or invitation for tenders of, (2) enter into an agreement to exchange securities for, or (3) acquire in the open market or otherwise any voting security of a health maintenance organization or enter into any other agreement if, a…
Neb. Rev. Stat. § 44-32,178 Coordination of benefits.
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A health maintenance organization may, but shall not be required to, adopt coordination-of-benefits provisions to avoid overinsurance and to provide for the orderly payment of claims when a person is covered by two or more group health insurance or health care plans. If a health …
Neb. Rev. Stat. § 44-32,179 Unfair trade and claims settlement practices laws; applicability.
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The Unfair Insurance Trade Practices Act and the Unfair Insurance Claims Settlement Practices Act shall apply to health maintenance organizations except to the extent that the director determines the nature of health maintenance organizations renders application of either act cle…
Neb. Rev. Stat. § 44-32,180 Taxation.
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(1) Any health maintenance organization subject to the Health Maintenance Organization Act shall also be subject to (a) the premium taxation provisions of Chapter 77, article 9, to the extent that the direct writing premiums are not otherwise subject to taxation under such articl…
Neb. Rev. Stat. § 44-320 Domestic company; officers and directors; borrowing and sales to company prohibited; exception.
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(1) Except as provided in subsections (2) through (6) of this section, no director or officer of any domestic insurance company shall directly or indirectly receive any money or valuable consideration for negotiating any loan for the company or for selling or aiding in the sale o…
Neb. Rev. Stat. § 44-320.01 Domestic company; capital stock; retirement not to constitute sale, when; reinsurance or consolidation; effect.
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Retirement of the capital stock of a domestic stock insurance company and the payment to the holders of such stock of its value under a plan for the mutualization of such company shall not constitute a sale of such stock within the prohibition of section 44-320; nor shall a contr…
Neb. Rev. Stat. § 44-321 Health insurance policy; mental health service delivered in a school; insurer; prohibited acts.
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(1) For purposes of this section: (a) 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 surgical expense-incurred policy, e…
Neb. Rev. Stat. § 44-322 Insurance companies; annual financial statement; contents; time of filing; failure to file; administrative penalty; participation in information system.
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(1)(a)(i) Every insurance company holding a certificate of authority to transact the business of insurance in this state shall file with the director or, if required by the director, with the National Association of Insurance Commissioners, on or before March 1 of each year, an a…
Neb. Rev. Stat. § 44-322.01 Financial analysis ratios; examination synopses; confidentiality; immunity.
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(1) All financial analysis ratios and examination synopses concerning insurance companies that are submitted to the director by the National Association of Insurance Commissioners which are determined by such association to be confidential may not be disclosed or released for pub…
Neb. Rev. Stat. § 44-323 Life insurance policy, disability insurance policy, or long-term care insurance policy; living organ donor; treatment.
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(1) For purposes of this section: (a) Insurance coverage means coverage under a disability insurance, life insurance, or long-term care insurance policy; and (b) Living organ donor means an individual who: (i) Has donated all or part of an organ; and (ii) Is not deceased. (2) It …