reglab/housing_qa huggingface dataset:
NE Code § 44-796 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-796 - Coverage for certain hearing screening tests; requirements.

44-796.  Coverage for certain hearing screening tests; requirements.(1) Notwithstanding section 44-3,131:(a) Under a health insurance plan which provides coverage for hearing screening tests for newborns and infants, such coverage shall be subject to copayment, coinsurance, deductible, and dollar-limit provisions to the extent that other medical services covered by the health insurance plan are subject to such provisions; and(b) This section applies to health insurance plans delivered, issued for delivery, or which become effective on or after April 11, 2000, and also applies to all renewals or changes which are effective on or after April 11, 2000.(2) For purposes of this section, health insurance plan means a plan which includes dependent coverage for children which is delivered, issued for delivery, renewed, extended, or modified in this state. A health insurance plan includes any such group or individual sickness and accident insurance policy, health maintenance organization contract, subscriber contract, employee medical, surgical, or hospital care benefit plan, or self-funded employee benefit plan to the extent not preempted by federal law. Health insurance plan includes any policy, contract, or plan offered or administered by the state or its political subdivisions. Health insurance plan does not include policies providing coverage for a specified disease, accident-only coverage, hospital indemnity coverage, disability income coverage, medicare supplement coverage, long-term care coverage, or other limited-benefit coverage.(3) The Department of Insurance shall adopt and promulgate rules and regulations necessary to implement this section.Source Laws 2000, LB 950, § 13.
NE Code § 44-798 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-798 - Coverage for dental care requiring hospitalization and general anesthesia; requirements.

44-798.  Coverage for dental care requiring hospitalization and general anesthesia; requirements.(1) Notwithstanding section 44-3,131, (a) any employer group sickness and accident insurance policy or subscriber contract delivered, issued for delivery, or renewed in this state and any employer group hospital, medical, or surgical expense-incurred policy, except for policies that provide coverage for a specified disease or other limited-benefit coverage, and (b) any self-funded employee benefit plan to the extent not preempted by federal law shall include coverage for the reasonable cost of hospitalization and general anesthesia in order for a covered person to safely receive dental care if he or she is under eight years of age or is developmentally disabled.(2)(a) This section does not prevent application of deductible or copayment provisions contained in the group policy, contract, or benefit plan or require that coverage under a group policy, contract, or benefit plan be extended to any other procedures, including dental care.(b) This section does not prevent application of prior authorization requirements or other requirements of a managed care plan as established by the group policy, contract, or benefit plan, including a requirement that coverage under subsection (1) of this section shall be provided only through a contracted network of providers.(3) For purposes of this section, the reasonable determination that hospitalization and general anesthesia are necessary for safe dental care shall be made by the entity providing coverage under subsection (1) of this section. Medical necessity shall be as defined by the group policy, contract, or benefit plan.(4) For purposes of this section, hospital and hospitalization includes ambulatory surgical center and care at an ambulatory surgical center.Source Laws 2000, LB 1253, § 1.
NE Code § 44-799 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-799 - Coverage for newly adopted children; requirements.

44-799.  Coverage for newly adopted children; requirements.(1)(a) 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, except for policies that provide coverage for a specified disease or other limited-benefit coverage, and (b) any self-funded employee benefit plan to the extent not preempted by federal law shall cover newly adopted children of the insured or enrollee. The coverage for newly adopted children shall be the same as for other dependents. No policy or health benefit plan provision concerning preexisting condition limitations, insurability, eligibility, or health underwriting approval may be applied to newly adopted children when they are enrolled in accordance with this section.(2) The coverage required by this section:(a) Is effective upon the earlier of (i) the date of placement for the purpose of adoption or (ii) the date of the entry of an order granting the adoptive parent custody of the child for purposes of adoption;(b) Continues unless the placement is disrupted prior to legal adoption and the child is removed from placement; and(c) Continues unless required action as described in subsection (3) of this section is not taken.(3) If the payment of a specific premium or subscription fee is required to provide coverage for an adopted child, the policy or health benefit plan may require that notification of the adoption of the child and the payment of the required premium or fee be furnished to the insurer or health benefit plan within thirty-one days after the adoption of the child in order to have the coverage continue beyond the thirty-one-day period.Source Laws 2000, LB 1253, § 43.
NE Code § 44-7,100 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7,100 - Genetic testing; prohibited acts.

44-7,100.  Genetic testing; prohibited acts.(1)(a) Any hospital, medical, or surgical expense-incurred policy or certificate delivered, issued for delivery, or renewed in this state and (b) any self-funded employee benefit plan to the extent not preempted by federal law shall not require a covered person or his or her dependent or an asymptomatic applicant for coverage or his or her asymptomatic dependent to undergo any genetic test before issuing, renewing, or continuing the policy or certificate in this state.(2) This section does not prohibit requiring an applicant for coverage to answer questions concerning family history.(3) For purposes of this section:(a) Clinical purposes includes:(i) Predicting the risk of diseases;(ii) Identifying carriers for single-gene disorders;(iii) Establishing prenatal and clinical diagnosis or prognosis;(iv) Prenatal, newborn, and other carrier screening, as well as testing in high-risk families;(v) Testing for metabolites if undertaken with high probability that an excess or deficiency of the metabolite indicates or suggests the presence of heritable mutations in single genes; and(vi) Other testing if the intended purpose is diagnosis of a presymptomatic genetic condition; and(b) Genetic test means the analysis of human DNA, RNA, and chromosomes and those proteins and metabolites used to detect heritable or somatic disease-related genotypes or karyotypes for clinical purposes. A genetic test must be generally accepted in the scientific and medical communities as being specifically determinative for the presence, absence, or mutation of a gene or chromosome in order to qualify under this definition. Genetic test does not include a routine physical examination or a routine analysis, including a chemical analysis, of body fluids unless conducted specifically to determine the presence, absence, or mutation of a gene or chromosome.Source Laws 2001, LB 432, § 2.
NE Code § 44-7,102 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7,102 - Coverage for screening for colorectal cancer.

44-7,102.  Coverage for screening for colorectal cancer.(1) Notwithstanding section 44-3,131, (a) any individual or group sickness and accident insurance policy, certificate, or subscriber contract delivered, issued for delivery, or renewed in this state and any hospital, medical, or surgical expense-incurred policy, except for short-term major medical policies of six months or less duration and policies that provide coverage for a specified disease or other limited-benefit coverage, and (b) any self-funded employee benefit plan to the extent not preempted by federal law shall include screening coverage for a colorectal cancer examination and laboratory tests for cancer for any nonsymptomatic person fifty years of age and older covered under such policy, certificate, contract, or plan. Such screening coverage shall include a maximum of one screening fecal occult blood test annually and a flexible sigmoidoscopy every five years, a colonoscopy every ten years, or a barium enema every five to ten years, or any combination, or the most reliable, medically recognized screening test available. The screenings selected shall be as deemed appropriate by a health care provider and the patient.(2) This section does not prevent application of deductible or copayment provisions contained in the policy, certificate, contract, or employee benefit plan or require that such coverage be extended to any other procedures.Source Laws 2007, LB247, § 86.
NE Code § 44-7,103 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7,103 - Continuing coverage for children to age thirty; requirements.

44-7,103.  Continuing coverage for children to age thirty; requirements.(1) For purposes of this section, health benefit plan means any expense-incurred individual or group sickness and accident insurance policy, health maintenance organization contract, subscriber contract, or self-funded employee benefit plan to the extent not preempted by federal law, except for any policy or contract that provides coverage only for excepted benefits as defined in the federal Health Insurance Portability and Accountability Act of 1996, 29 U.S.C. 1191b, and regulations adopted pursuant to the act, as such act and regulations existed on January 1, 2009, or any policy or contract that provides coverage for a specified disease or other limited-benefit coverage.(2) Notwithstanding section 44-3,131, any health benefit plan that provides coverage for children shall provide for continuing coverage for such children as follows:(a) If coverage under the health benefit plan would otherwise terminate because a covered child ceases to be a dependent, ceases to be a full-time student, or attains an age which exceeds the specified age at which coverage ceases pursuant to the plan, the health benefit plan shall provide the option to the insured to continue coverage for such child through the end of the month in which the child (i) marries, (ii) ceases to be a resident of the state, unless the child is under nineteen years of age or is enrolled on a full-time basis in any college, university, or trade school, (iii) receives coverage under another health benefit plan or a self-funded employee benefit plan that is not included in the definition of a health benefit plan under subsection (1) of this section but provides similar coverage, or (iv) attains thirty years of age; and(b) The health benefit plan may require:(i) A written election from the insured; and(ii) An additional premium for the child. Such premium shall not vary based upon the health status of the child and shall not exceed the amount the health benefit plan would receive for an identical individual for a single adult insured. No employer shall be required to contribute to any additional premium under this subdivision.Source Laws 2009, LB551, § 3.
NE Code § 44-7,104 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7,104 - Coverage for orally administered anticancer medication; requirements; applicability.

44-7,104.  Coverage for orally administered anticancer medication; requirements; applicability.(1) Notwithstanding section 44-3,131, (a) any individual or group sickness and accident insurance policy, certificate, or subscriber contract delivered, issued for delivery, or renewed in this state and any hospital, medical, or surgical expense-incurred policy, except for policies that provide coverage for a specified disease or other limited-benefit coverage, and (b) any self-funded employee benefit plan to the extent not preempted by federal law that provides coverage for cancer treatment shall provide coverage for a prescribed, orally administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected anticancer medications that are covered as medical benefits by the policy, certificate, contract, or plan.(2) This section does not prohibit such policy, certificate, contract, or plan from requiring prior authorization for a prescribed, orally administered anticancer medication. If such medication is authorized, the cost to the covered individual shall not exceed the coinsurance or copayment that would be applied to any other cancer treatment involving intravenously administered or injected anticancer medications.(3) A policy, certificate, contract, or plan provider shall not reclassify any anticancer medication or increase a coinsurance, copayment, deductible, or other out-of-pocket expense imposed on any anticancer medication to achieve compliance with this section. Any change that otherwise increases an out-of-pocket expense applied to any anticancer medication shall also be applied to the majority of comparable medical or pharmaceutical benefits under the policy, certificate, contract, or plan.(4) This section does not prohibit a policy, certificate, contract, or plan provider from increasing cost-sharing for all benefits, including cancer treatments.(5) This section shall apply to any policy, certificate, contract, or plan that is delivered, issued for delivery, or renewed in this state on or after October 1, 2012.Source  Laws 2012, LB882, § 1;  Laws 2014, LB254, § 1.
NE Code § 44-7,105 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7,105 - Fees charged for dental services; prohibited acts.

44-7,105.  Fees charged for dental services; prohibited acts.Notwithstanding section 44-3,131, (1) an individual or group sickness or accident policy, certificate, or subscriber contract delivered, issued for delivery, or renewed in this state and a hospital, medical, or surgical expense-incurred policy, (2) a self-funded employee benefit plan to the extent not preempted by federal law, and (3) a certificate, agreement, or contract to provide limited health services issued by a prepaid limited health service organization as defined in section 44-4702 shall not include a provision, stipulation, or agreement establishing or limiting any fees charged for dental services that are not covered by the policy, certificate, contract, agreement, or plan.Source Laws 2012, LB810, § 1.
NE Code § 44-7,107 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7,107 - Telehealth; asynchronous review by dermatologist; coverage.

44-7,107.  Telehealth; asynchronous review by dermatologist; coverage.(1) For purposes of this section:(a) Asynchronous review means the acquisition and storage of medical information at one site that is then forwarded to or retrieved by a health care provider at another site for medical evaluation;(b) Dermatologist means a board-certified physician who is trained to evaluate and treat individuals with benign and malignant disorders of the skin, hair, nails, and adjacent mucous membranes with a specialization in the diagnosis and treatment of skin cancers, melanomas, moles, and other tumors of the skin along with surgical techniques used in dermatology and interpretation of skin biopsies; and(c) Telehealth has the same meaning as in section 44-312.(2) Any insurer offering (a) any individual or group sickness and accident insurance policy, certificate, or subscriber contract delivered, issued for delivery, or renewed in this state, (b) any hospital, medical, or surgical expense-incurred policy, or (c) any self-funded employee benefit plan to the extent not preempted by federal law, shall not exclude, in any policy, certificate, contract, or plan offered or renewed on or after August 24, 2017, a service from coverage solely because the service is delivered through telehealth, including services originating from any location where the patient is located, and is not provided through in-person consultation or contact between a licensed health care provider and a patient.(3)(a) Any insurer offering any policy, certificate, contract, or plan described in subsection (2) of this section for which coverage of benefits begins on or after January 1, 2021, shall not exclude from coverage telehealth services provided by a dermatologist solely because the service is delivered asynchronously.(b) An insurer shall reimburse a health care provider for asynchronous review by a dermatologist delivered through telehealth at a rate negotiated between the provider and the insurer.(c) It is not a violation of this subsection for an insurer to include a deductible, copayment, or coinsurance requirement for a health care service provided through telehealth if such costs do not exceed those included for the same services provided through in-person contact.(4) Nothing in this section shall be construed to require an insurer to provide coverage for services that are not medically necessary.(5) This section does not apply to any policy, certificate, contract, or plan that provides coverage for a specified disease or other limited-benefit coverage.Source  Laws 2017, LB92, § 1;  Laws 2020, LB760, § 1;  Laws 2021, LB400, § 2.   Effective Date: August 28, 2021
NE Code § 44-7,108 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7,108 - Synchronizing patient's medications; coverage.

44-7,108.  Synchronizing patient's medications; coverage.(1) Notwithstanding section 44-3,131, (a) any individual or group sickness and accident insurance policy, certificate, or subscriber contract delivered, issued for delivery, or renewed in this state and any hospital, medical, or surgical expense-incurred policy, except for policies that provide coverage for a specified disease or other limited-benefit coverage, and (b) any self-funded employee benefit plan to the extent not preempted by federal law that provides coverage for prescription medications shall apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for a partial supply if the prescribing practitioner or pharmacist determines the fill or refill to be in the best interest of the patient and the patient requests or agrees to a partial supply for the purpose of synchronizing the patient's medications.(2) A policy, certificate, contract, or plan provider shall not deny coverage for the dispensing of a medication that is dispensed by a network pharmacy on the basis that the dispensing is for a partial supply if the prescribing practitioner or pharmacist determines the fill or refill to be in the best interest of the patient and the patient requests or agrees to a partial supply for the purpose of synchronizing the patient's medications. The policy, certificate, contract, or plan shall allow a pharmacy to override any denial codes indicating that a prescription is being refilled too soon for purposes of medication synchronization.(3) To be eligible for coverage under this section, the medication:(a) Must be covered by the enrollee's health benefit plan or have been approved by a formulary exception process;(b) Must meet the prior authorization or utilization management criteria specifically applicable to the medication under the health benefit plan on the date the request for synchronization is made;(c) Must be used for treatment and management of a chronic illness;(d) Must be a formulation that can be safely split into short-fill periods to achieve medication synchronization; and(e) Must not be a controlled substance listed in Schedule II of section 28-405.(4) A policy, certificate, contract, or plan provider shall not use payment structures incorporating prorated dispensing fees. Dispensing fees for partially filled or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of any prorated daily cost-sharing for the beneficiary or fee paid for alignment services.(5) For purposes of this section, synchronizing the patient's medications means the coordination of medications for a patient who has been prescribed two or more medications for one or more chronic conditions so that the patient's medications are refilled on the same schedule for a given time period.(6) This section shall apply to any policy, certificate, contract, or plan that is delivered, issued for delivery, or renewed in this state on or after September 7, 2019.Source Laws 2019, LB442, § 1.
NE Code § 44-7,111 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7,111 - Step-Therapy Reform Act, how cited.

44-7,111.  Step-Therapy Reform Act, how cited.Sections 44-7,111 to 44-7,117 shall be known and may be cited as the Step-Therapy Reform Act.Source  Laws 2021, LB337, § 1.   Effective Date: August 28, 2021
NE Code § 44-7,112 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-7,112 - Terms, defined.

44-7,112.  Terms, defined.For purposes of the Step-Therapy Reform Act:(1) Clinical practice guidelines means a systematically developed statement to assist decisionmaking by health care providers and decisions by covered persons about appropriate health care for specific clinical circumstances and conditions;(2) Clinical review criteria means the written screening procedures, decision abstracts, clinical protocols, and clinical practice guidelines used by a health carrier or utilization review organization to determine the medical necessity and appropriateness of health care services;(3) Health carrier means an entity subject to the insurance laws and regulations of this state, or subject to the jurisdiction of the Director of Insurance, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits, or health care services. Health carrier does not include a managed care organization;(4) Pharmaceutical sample means a unit of a prescription drug that is not intended to be sold and is intended to promote the sale of the drug;(5) Step-therapy override exception means that a step-therapy protocol should be overridden in favor of coverage of the prescription drug selected by a health care provider within the applicable timeframes, based on a review of the request of the health care provider or covered person for an override, along with supporting rationale and documentation;(6) Step-therapy protocol means a protocol, policy, or program that establishes the specific sequence in which prescription drugs for a specified medical condition and medically appropriate for a particular covered person are covered under a pharmacy or medical benefit by a health carrier or a utilization review organization, including self-administered drugs and drugs administered by a health care provider; and(7) Utilization review organization means an entity that conducts a utilization review other than a health carrier performing a review for its own health benefit plans.Source  Laws 2021, LB337, § 2.   Effective Date: August 28, 2021