reglab/housing_qa huggingface dataset:
NE Code § 44-1314 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1314 - Liability for damages.

44-1314.  Liability for damages.No independent review organization, clinical reviewer working on behalf of an independent review organization, or employee, agent, or contractor of an independent review organization shall be liable in damages to any person for any opinions rendered or acts or omissions performed within the scope of the organization's or person's duties under the law during or upon completion of an external review conducted pursuant to the Health Carrier External Review Act, unless the opinion was rendered or act or omission performed in bad faith or involved gross negligence.Source Laws 2013, LB147, § 14.
NE Code § 44-1315 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1315 - Records; report; contents.

44-1315.  Records; report; contents.(1)(a) An independent review organization assigned pursuant to section 44-1308, 44-1309, or 44-1310 to conduct an external review shall maintain written records in the aggregate by state and by health carrier on all requests for external review for which it conducted an external review during a calendar year and, upon request, submit a report to the director as required under subdivision (1)(b) of this section.(b) Each independent review organization required to maintain written records on all requests for external review pursuant to subdivision (1)(a) of this section for which it was assigned to conduct an external review shall submit to the director, upon request, a report in the format specified by the director.(c) The report shall include in the aggregate by state, and for each health carrier:(i) The total number of requests for external review;(ii) The number of requests for external review resolved and, of those resolved, the number resolved upholding the adverse determination or final adverse determination and the number resolved reversing the adverse determination or final adverse determination;(iii) The average length of time for resolution;(iv) A summary of the types of coverages or cases for which an external review was sought, as provided in the format required by the director;(v) The number of external reviews pursuant to section 44-1308 that were terminated as the result of a reconsideration by the health carrier of its adverse determination or final adverse determination after the receipt of additional information from the covered person or the covered person's authorized representative; and(vi) Any other information the director may request or require.(d) The independent review organization shall retain the written records required pursuant to this subsection for at least three years.(2)(a) Each health carrier shall maintain written records in the aggregate, by state and for each type of health benefit plan offered by the health carrier, on all requests for external review that the health carrier receives notice of from the director pursuant to the Health Carrier External Review Act.(b) Each health carrier required to maintain written records on all requests for external review pursuant to subdivision (2)(a) of this section shall submit to the director, upon request, a report in the format specified by the director.(c) The report shall include in the aggregate, by state, and by type of health benefit plan:(i) The total number of requests for external review;(ii) From the total number of requests for external review reported under subdivision (2)(c)(i) of this section, the number of requests determined eligible for a full external review; and(iii) Any other information the director may request or require.(d) The health carrier shall retain the written records required pursuant to this section for at least three years.Source Laws 2013, LB147, § 15.
NE Code § 44-1316 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1316 - Health carrier; cost.

44-1316.  Health carrier; cost.The health carrier against which a request for a standard external review or an expedited external review is filed shall pay the cost of the independent review organization for conducting the external review.Source Laws 2013, LB147, § 16.
NE Code § 44-1317 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1317 - Health carrier; disclosure; format; contents.

44-1317.  Health carrier; disclosure; format; contents.(1)(a) Each health carrier shall include a description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage it provides to covered persons.(b) The disclosure required by subdivision (1)(a) of this section shall be in a format prescribed by the director.(2) The description required under subsection (1) of this section shall include a statement that informs the covered person of the right of the covered person to file a request for an external review of an adverse determination or final adverse determination with the director. The statement may explain that external review is available when the adverse determination or final adverse determination involves an issue of medical necessity, appropriateness, health care setting, level of care, or effectiveness. The statement shall include the telephone number and address of the director.(3) In addition to the contents required by subsection (2) of this section, the statement shall inform the covered person that, when filing a request for an external review, the covered person will be required to authorize the release of any medical records of the covered person that may be required to be reviewed for the purpose of reaching a decision on the external review.Source Laws 2013, LB147, § 17.
NE Code § 44-1318 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1318 - Applicability of act.

44-1318.  Applicability of act.The Health Carrier External Review Act applies to any claim submitted on and after January 1, 2014.Source Laws 2013, LB147, § 18.
NE Code § 44-1401 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1401 - Act, how cited.

44-1401.  Act, how cited.Sections 44-1401 to 44-1414 shall be known and may be cited as the Nebraska Right to Shop Act.Source Laws 2018, LB1119, § 11.
NE Code § 44-1402 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1402 - Terms, defined.

44-1402.  Terms, defined.For purposes of the Nebraska Right to Shop Act:(1) Allowed amount means the contractually agreed-upon amount paid by an insurance carrier to a health care entity participating in the insurance carrier’s network or the amount the health plan is required to pay under the health plan policy or certificate of insurance for out-of-network covered benefits provided to the patient;(2) Department means the Department of Insurance;(3) Director means the Director of Insurance;(4) Enrollee means an individual receiving health insurance coverage from an insurance carrier;(5) Health care entity means:(a) A facility licensed under the Health Care Facility Licensure Act;(b) A health care professional licensed under the Uniform Credentialing Act; and(c) An organization or association of health care professionals licensed under the Uniform Credentialing Act;(6) Incentive payment means a payment described in section 44-1407 that is made by an insurance carrier to an enrollee;(7) Insurance carrier means any entity that provides health insurance in this state. Insurance carrier includes (a) an insurance company, (b) a fraternal benefit society, (c) a health maintenance organization, and (d) any other entity providing a plan of health insurance or health benefits subject to state insurance regulation;(8) Shared savings incentive payment program means a program established by an insurance carrier pursuant to section 44-1407 to provide incentive payments to enrollees; and(9) Shoppable health care service means a health care service for which an insurance carrier offers incentive payments under a shared savings incentive payment program established by the insurance carrier. Shoppable health care service includes, at a minimum, health care services in the following categories:(a) Physical and occupational therapy services;(b) Obstetrical and gynecological services;(c) Radiology and imaging services;(d) Laboratory services;(e) Infusion therapy;(f) Inpatient or outpatient surgical procedures; and(g) Outpatient nonsurgical diagnostic tests or procedures.Source Laws 2018, LB1119, § 12. Cross References   Health Care Facility Licensure Act, see section 71-401.  Uniform Credentialing Act, see section 38-101.
NE Code § 44-1403 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1403 - Applicability of act; election; notice.

44-1403.  Applicability of act; election; notice.The Nebraska Right to Shop Act shall apply to any insurance carrier that elects to be subject to the act. An insurance carrier making such election shall file a notice of the election with the department.Source Laws 2018, LB1119, § 13.
NE Code § 44-1404 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1404 - Health care entity; disclose allowed amount or charge; updated estimate; other cost estimate.

44-1404.  Health care entity; disclose allowed amount or charge; updated estimate; other cost estimate.(1) Prior to a nonemergency admission, procedure, or service and upon request by a patient or prospective patient, a health care entity within the patient’s or prospective patient’s insurer network shall, within three working days, disclose the allowed amount of the nonemergency admission, procedure, or service, including the amount for any facility fees required, to the patient or prospective patient.(2) Prior to a nonemergency admission, procedure, or service and upon request by a patient or prospective patient, a health care entity outside the patient’s or prospective patient’s insurer network shall, within three working days, disclose the amount that will be charged for the nonemergency admission, procedure, or service, including the amount for any facility fees required, to the patient or prospective patient.(3) If a health care entity is unable to quote a specific amount under subsection (1) or (2) of this section in advance due to the health care entity’s inability to predict the specific treatment or diagnostic code, the health care entity shall disclose what is known for the estimated amount for a proposed nonemergency admission, procedure, or service, including the amount for any facility fees required. A health care entity shall disclose the incomplete nature of the estimate and shall inform the patient or prospective patient of his or her ability to obtain an updated estimate once additional information is determined.(4) If a patient or prospective patient is covered by insurance, a health care entity that participates in an insurance carrier’s network shall, upon request of a patient or prospective patient, provide, based on the information available to the health care entity at the time of the request, sufficient information regarding the proposed nonemergency admission, procedure, or service for the patient or prospective patient to receive a cost estimate from his or her insurance carrier to identify out-of-pocket costs, which could be through an insurance carrier's toll-free telephone number or website. A health care entity may assist a patient or prospective patient in using an insurance carrier’s toll-free telephone number or website.Source Laws 2018, LB1119, § 14.
NE Code § 44-1405 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1405 - Insurance carrier; interactive mechanism on website; duties.

44-1405.  Insurance carrier; interactive mechanism on website; duties.An insurance carrier shall establish an interactive mechanism on its publicly accessible website that enables an enrollee to request and obtain from the insurance carrier information on the payments made by the insurance carrier to network providers for health care services. The interactive mechanism must allow an enrollee seeking information about the cost of a particular health care service to compare costs among network providers.Source Laws 2018, LB1119, § 15.
NE Code § 44-1406 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1406 - Estimate of out-of-pocket amount.

44-1406.  Estimate of out-of-pocket amount.(1) Within two working days of an enrollee’s request, an insurance carrier shall provide a good faith estimate of the amount the enrollee will be responsible to pay out-of-pocket for a proposed nonemergency procedure or service that is a medically necessary covered benefit from an insurance carrier’s network provider, including any copayment, deductible, coinsurance, or other out-of-pocket amount for any covered benefit, based on the information available to the insurance carrier at the time the request is made.(2) Nothing in this section shall prohibit an insurance carrier from imposing cost-sharing requirements disclosed in the enrollee’s certificate of coverage for unforeseen health care services that arise out of the nonemergency procedure or service or for a procedure or service provided to an enrollee that was not included in the original estimate.(3) An insurance carrier shall notify the enrollee that the amounts provided under subsection (1) of this section are estimated costs and that the actual amount the enrollee will be responsible to pay may vary due to unforeseen services that arise out of the proposed nonemergency procedure or service.Source Laws 2018, LB1119, § 16.
NE Code § 44-1407 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1407 - Shared savings incentive payment program; incentive payments; calculation.

44-1407.  Shared savings incentive payment program; incentive payments; calculation.(1) An insurance carrier shall develop and implement a shared savings incentive payment program that provides incentive payments for enrollees in a health plan who elect to receive shoppable health care services that are covered by the plan from providers that charge less than the average price paid by that insurance carrier for that shoppable health care service.(2) Incentive payments may be calculated as a percentage of the difference in price, as a flat dollar amount, or by some other reasonable methodology approved by the director. The insurance carrier must provide the incentive payment as a cash payment to the enrollee.(3) The shared savings incentive payment program must provide enrollees with at least fifty percent of the insurance carrier’s saved costs for each shoppable health care service or category of shoppable health care service resulting from shopping by enrollees. An insurance carrier is not required to provide an incentive payment or credit to an enrollee when the insurance carrier’s saved cost is fifty dollars or less.(4) An insurance carrier shall base the average price on the average amount paid to an in-network provider for the procedure or service under the enrollee’s health plan within a reasonable timeframe not to exceed one year. An insurance carrier may determine an alternate methodology for calculating the average price if approved by the director.Source Laws 2018, LB1119, § 17.
NE Code § 44-1408 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1408 - Availability of shared savings incentive payment program.

44-1408.  Availability of shared savings incentive payment program.An insurance carrier shall make the shared savings incentive payment program available as a component of all health plans offered by the insurance carrier in this state. Annually at enrollment or renewal, an insurance carrier shall provide notice about the availability of the program to any enrollee who is enrolled in a health plan eligible for the program.Source Laws 2018, LB1119, § 18.
NE Code § 44-1409 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1409 - Filing with department; review; confidentiality.

44-1409.  Filing with department; review; confidentiality.Prior to offering the shared savings incentive payment program to any enrollee, an insurance carrier shall file a description of the program with the department in the manner determined by the director. The department may review the filing made by the insurance carrier to determine if the insurance carrier’s program complies with the requirements of the Nebraska Right to Shop Act. Filings and any supporting documentation submitted pursuant to this section are confidential until the filing has been reviewed by the department.Source Laws 2018, LB1119, § 19.
NE Code § 44-1410 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1410 - Service from out-of-network provider; how treated.

44-1410.  Service from out-of-network provider; how treated.If an enrollee elects to receive a shoppable health care service from an out-of-network provider that results in an incentive payment, the insurance carrier shall apply the amount paid for the shoppable health care service toward the enrollee’s member cost sharing as specified in the enrollee’s health plan as if the health care services were provided by an in-network provider.Source Laws 2018, LB1119, § 20.
NE Code § 44-1411 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1411 - Incentive payment; how treated.

44-1411.  Incentive payment; how treated.An incentive payment made by an insurance carrier in accordance with the Nebraska Right to Shop Act is not an administrative expense of the insurance carrier for rate development or rate filing purposes.Source Laws 2018, LB1119, § 21.
NE Code § 44-1412 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1412 - Insurance carrier; annual filing; contents; report.

44-1412.  Insurance carrier; annual filing; contents; report.(1) On or before March 31 each year, each insurance carrier shall file with the department the following information for the most recent calendar year:(a) The total number of incentive payments made pursuant to the insurance carrier’s shared savings incentive payment program;(b) The use of shoppable health care services by category of service for which incentive payments are made;(c) The total amount of incentive payments made to enrollees;(d) The average amount of incentive payments made by category of shoppable health care service;(e) The total savings achieved below the average prices by category of shoppable health care service; and(f) The total number and percentage of an insurance carrier's enrollees that participated in the shared savings incentive payment program.(2) On or before July 1, 2019, and on or before July 1 of each year thereafter, the department shall electronically submit an aggregate report for all insurance carriers filing the information required by subsection (1) of this section to the Legislature.Source Laws 2018, LB1119, § 22.
NE Code § 44-1413 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1413 - Personnel division of Department of Administrative Services; program for state employees; report; contents.

44-1413.  Personnel division of Department of Administrative Services; program for state employees; report; contents.(1) The personnel division of the Department of Administrative Services, in its discretion, may develop and implement a program for state employees receiving health insurance coverage under sections 84-1601 to 84-1615 that is similar to the shared savings incentive payment program described in section 44-1407. If the division develops and implements such a program, the division may use the State Employees Insurance Fund to make incentive payments to state employees pursuant to such program.(2) If a program for state employees is developed and implemented pursuant to this section, then on or before July 1 of each year after implementation of such program, the personnel division of the Department of Administrative Services shall electronically report to the Legislature the following information for the most recent calendar year:(a) The total number of incentive payments made pursuant to the program;(b) The use of shoppable health care services by category of service for which incentive payments are made;(c) The total amount of incentive payments made to state employees;(d) The average amount of incentive payments made by category of shoppable health care service;(e) The total savings achieved below the average prices by category of shoppable health care service; and(f) The total number and percentage of state employees that participated in the program.Source Laws 2018, LB1119, § 23.
NE Code § 44-1414 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1414 - Rules and regulations.

44-1414.  Rules and regulations.The department may adopt and promulgate rules and regulations as necessary to carry out the Nebraska Right to Shop Act.Source Laws 2018, LB1119, § 24.
NE Code § 44-1521 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1521 - Act, how cited.

44-1521.  Act, how cited.Sections 44-1521 to 44-1535 shall be known and may be cited as the Unfair Insurance Trade Practices Act.Source   Laws 1991, LB 234, § 3;  Laws 2008, LB855, § 6.
NE Code § 44-1522 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1522 - Purpose of act.

44-1522.  Purpose of act.The purpose of the Unfair Insurance Trade Practices Act is to regulate unfair trade practices in the business of insurance, in accordance with the intent of the Congress of the United States as expressed in Public Law 79-15, by defining, or providing for the determination of, all acts and practices in this state which constitute unfair trade practices and by prohibiting the acts and practices so defined or determined.Source   Laws 1973, LB 349, § 1;   Laws 1991, LB 234, § 4.  Annotations Sections of Nebraska Unfair Competition Act and Trade Practices Act governing insurance business do not contemplate private suits but only suits by State Director of Insurance. Allied Financial Services, Inc. v. Foremost Ins. Co., 418 F.Supp. 157 (D. Neb. 1976).
NE Code § 44-1523 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1523 - Terms, defined.

44-1523.  Terms, defined.For purposes of the Unfair Insurance Trade Practices Act:(1) Department shall mean the Department of Insurance;(2) Director shall mean the Director of Insurance;(3) Insured shall mean the party named on a policy or certificate as the individual with legal rights to the benefits provided by such policy or certificate;(4) Insurer shall mean any person, reciprocal exchange, interinsurer, Lloyds-type insurer or other similar group which includes incorporated and individual unincorporated underwriters, fraternal benefit society, and other legal entity engaged in the business of insurance, including agents, brokers, insurance consultants, adjusters, and third-party administrators. Insurer shall also mean health maintenance organizations, prepaid limited health service organizations, and dental, optometric, and other similar health service plans. For purposes of the act, all such insurers shall be deemed to be engaged in the business of insurance;(5) Person shall mean any natural or artificial entity, including, but not limited to, an individual, partnership, limited liability company, association, trust, or corporation; and(6) Policy or certificate shall include any contract of insurance, indemnity, suretyship, or annuity issued, proposed for issuance, or intended for issuance by any insurer.Source   Laws 1973, LB 349, § 2;   Laws 1989, LB 92, § 173;   Laws 1991, LB 234, § 5;   Laws 1993, LB 121, § 230;   Laws 1994, LB 978, § 21.
NE Code § 44-1524 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-1524 - Unfair trade practice; prohibited acts.

44-1524.  Unfair trade practice; prohibited acts.It shall be an unfair trade practice in the business of insurance for any insurer to commit any act or practice defined in section 44-1525 if the act or practice (1) is committed flagrantly and in conscious disregard of the Unfair Insurance Trade Practices Act or any rule or regulation adopted pursuant to the act or (2) has been committed with such frequency as to indicate a general business practice to engage in that type of conduct.Source   Laws 1973, LB 349, § 3;   Laws 1991, LB 234, § 6.