reglab/housing_qa huggingface dataset:
NE Code § 44-32,134 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,134 - Filings; required.

44-32,134.  Filings; required.(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 shall be on forms prescribed by the Director of Insurance and shall be prepared in accordance with annual statement instructions and accounting practices and procedures manuals as prescribed by the director which conform substantially to the annual statement instructions and the Accounting Practices and Procedures Manuals of the National Association of Insurance Commissioners.(2) Every health maintenance organization shall file annually, on or before March 1, with the Director of Insurance, with a copy to the department:(a) A list of the providers who have executed a contract that complies with section 44-32,141; and(b) A description of the grievance procedures, the total number of grievances handled through such procedures, a compilation of the causes underlying those grievances, and a summary of the final disposition of those grievances.(3) Every health maintenance organization shall file annually, on or before June 1, audited financial statements with the Director of Insurance, with a copy to the department.(4) The Director of Insurance may require such additional reports as are deemed necessary and appropriate to carry out his or her duties under the Health Maintenance Organization Act.Source   Laws 1990, LB 1136, § 43;   Laws 1996, LB 1044, § 249;  Laws 2000, LB 930, § 9;  Laws 2007, LB296, § 188.
NE Code § 44-32,135 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,135 - Information to subscribers and enrollees.

44-32,135.  Information to subscribers and enrollees.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 to its subscribers if the change affects the subscribers directly. An enrollee shall be notified in writing by the health maintenance organization of the termination of the primary care provider who provided health care services to that enrollee. The health maintenance organization shall provide assistance to the enrollee in transferring to another participating provider. Each health maintenance organization shall provide to subscribers information on how services may be obtained and where additional information on access to services can be obtained and a toll-free telephone number for calls within the service area.Source  Laws 1990, LB 1136, § 44.
NE Code § 44-32,136 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,136 - Grievance procedure.

44-32,136.  Grievance procedure.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 Services. The Director of Insurance or the department may examine the grievance procedure. The health maintenance organization shall maintain records regarding grievances received since the date of the last examination.Source   Laws 1990, LB 1136, § 45;   Laws 1996, LB 1044, § 250;  Laws 2007, LB296, § 189.
NE Code § 44-32,137 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,137 - Investments.

44-32,137.  Investments.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.Source   Laws 1990, LB 1136, § 46;   Laws 1991, LB 237, § 69.  Cross References  Insurers Investment Act, see section 44-5101.
NE Code § 44-32,138 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,138 - Net worth requirements.

44-32,138.  Net worth requirements.(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 subsection (3) of this section, a health maintenance organization shall maintain a minimum net worth equal to the greater of:(a) One million dollars; or(b) Two percent of annual premium revenue as reported on the most recent annual financial statement filed with the director on the first one hundred fifty million dollars of premium revenue and one percent of annual premium revenue on the premium revenue in excess of one hundred fifty million dollars.(3) A health maintenance organization licensed under prior law before July 10, 1990, shall maintain a minimum net worth of:(a) Twenty-five percent of the amount required by subsection (2) of this section by December 31, 1990;(b) Fifty percent of the amount required by subsection (2) of this section by December 31, 1991;(c) Seventy-five percent of the amount required by subsection (2) of this section by December 31, 1992; and(d) One hundred percent of the amount required by subsection (2) of this section by December 31, 1993.(4) In determining net worth, no debt shall be considered fully subordinated unless the subordination clause is in a form acceptable to the director. Any interest obligation relating to the repayment of any subordinated debt shall be similarly subordinated. The interest expenses relating to the repayment of any fully subordinated debt shall be considered covered expenses. Any debt incurred by a note meeting the requirements of this subsection and otherwise acceptable to the director shall not be considered a liability and shall be recorded as equity.Source  Laws 1990, LB 1136, § 47.
NE Code § 44-32,139 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,139 - Deposit requirements.

44-32,139.  Deposit requirements.(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 utilized, cash, securities, or any combination of cash or securities or other measures that are acceptable to the director which at all times have a value of not less than three hundred thousand dollars.(2) A health maintenance organization that is in operation under prior law on July 10, 1990, shall make a deposit equal to one hundred fifty thousand dollars for the first year and three hundred thousand dollars for the second year.(3) The deposit made pursuant to this section shall be an admitted asset of the health maintenance organization in the determination of net worth. All income from a deposit shall be an asset of the health maintenance organization. A health maintenance organization that has made a securities deposit may withdraw that deposit or any part thereof after making a substitute deposit of cash, securities, or any combination of cash or securities or other measures of equal amount and value. Any securities or other measures shall be approved by the director before being deposited or substituted.(4) The deposit made pursuant to this section shall be used to protect the interests of the health maintenance organization's enrollees and to assure continuation of health care services to enrollees of a health maintenance organization which is in rehabilitation or conservation. The director may use the deposit for administrative costs directly attributable to a receivership or liquidation. If the health maintenance organization is placed in receivership or liquidation, the deposit shall be an asset subject to the Nebraska Insurers Supervision, Rehabilitation, and Liquidation Act.(5) The director may reduce or eliminate the deposit requirement if the health maintenance organization deposits with the state treasurer, insurance commissioner, insurance director, insurance superintendent, or equivalent official of the state or jurisdiction of domicile for the protection of all subscribers and enrollees of such health maintenance organization, wherever located, cash, acceptable securities, or surety and delivers to the director a certificate to such effect duly authenticated by the appropriate official holding the deposit.Source  Laws 1990, LB 1136, § 48. Cross References  Nebraska Insurers Supervision, Rehabilitation, and Liquidation Act, see section 44-4862.
NE Code § 44-32,140 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,140 - Liabilities; computation.

44-32,140.  Liabilities; computation.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, which are unpaid, and for which such organization is or may be liable, and (3) for the expense of adjustment or settlement of such claims. Such liabilities shall be computed in accordance with rules and regulations adopted and promulgated by the director upon reasonable consideration of the ascertained experience and character of the health maintenance organization.Source  Laws 1990, LB 1136, § 49.
NE Code § 44-32,141 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,141 - Provider contracts; requirements.

44-32,141.  Provider contracts; requirements.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 liable to the provider for any sum owed by the health maintenance organization. If the contract has not been reduced to writing or fails to contain the provision required by this section, the participating provider shall not collect or attempt to collect from the subscriber or enrollee sums owed by the health maintenance organization. No participating provider, or agent, trustee, or assignee of a participating provider, may maintain any action at law against a subscriber or enrollee to collect sums owed by the health maintenance organization.Source  Laws 1990, LB 1136, § 50.
NE Code § 44-32,142 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,142 - Provider agreement; notice of termination.

44-32,142.  Provider agreement; notice of termination.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.Source  Laws 1990, LB 1136, § 51.
NE Code § 44-32,143 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,143 - Insolvency; plan required.

44-32,143.  Insolvency; plan required.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 the date of insolvency in an inpatient facility until their discharge or expiration of benefits. The director may require:(1) Insurance to cover the expenses to be paid for continued benefits after an insolvency;(2) Provisions in provider contracts that obligate the provider to provide services for the duration of the period after the health maintenance organization's insolvency for which premium payment has been made and until the enrollees' discharge from inpatient facilities;(3) Insolvency reserves;(4) Acceptable letters of credit; and(5) Any other arrangements to assure that benefits are continued as specified in this section.Source  Laws 1990, LB 1136, § 52.
NE Code § 44-32,144 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,144 - Uncovered expenditures insolvency deposit.

44-32,144.  Uncovered expenditures insolvency deposit.(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 are acceptable to the director with the director or with any organization or trustee acceptable to the director through which a custodial or controlled account is maintained. Such deposit shall at all times have a fair market value in an amount of one hundred twenty percent of the health maintenance organization's outstanding liability for uncovered expenditures for enrollees in this state, including incurred but not reported claims. The fair market value of the deposit shall be calculated as of the first day of the month and maintained for the remainder of the month. If a health maintenance organization is not otherwise required to file a quarterly report, it shall file a report within forty-five days of the end of the calendar quarter with information sufficient to demonstrate compliance with this section.(2) The deposit required under this section shall be in addition to the deposit required under section 44-32,139 and shall be an admitted asset of the health maintenance organization in the determination of net worth. All income from such deposits or trust accounts shall be assets of the health maintenance organization and may be withdrawn quarterly with the approval of the director.(3) A health maintenance organization that has made a deposit may withdraw that deposit or any part of the deposit if (a) a substitute deposit of cash or securities of equal amount and value is made, (b) the fair market value of the deposit exceeds the amount of the required deposit, or (c) the required deposit is reduced or eliminated. Deposits, substitutions, or withdrawals may be made only with the prior written approval of the director.Source  Laws 1990, LB 1136, § 53.
NE Code § 44-32,145 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,145 - Uncovered expenditures insolvency deposit; use.

44-32,145.  Uncovered expenditures insolvency deposit; use.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 shall be paid on a pro rata basis based on assets available to pay such ultimate liability for incurred uncovered expenses. Partial distribution may be made pending final distribution. Any amount of the deposit remaining shall be paid into the liquidation or receivership of the health maintenance organization. The director may prescribe the time, manner, and form for filing claims under this section.Source  Laws 1990, LB 1136, § 54.
NE Code § 44-32,146 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,146 - Uncovered expenditures; reports.

44-32,146.  Uncovered expenditures; reports.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.Source  Laws 1990, LB 1136, § 55.
NE Code § 44-32,147 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,147 - Insolvency; replacement coverage; duty to provide; director; duties.

44-32,147.  Insolvency; replacement coverage; duty to provide; director; duties.(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 last regular enrollment period and which are providing coverage for enrollees on the date of the court order shall offer such group's subscribers of the insolvent health maintenance organization a thirty-day enrollment period commencing on the date of the court order. The subscribers transferring from the insolvent health maintenance organization shall be entitled to coverage on the same terms and at the same rates as they would have obtained had they elected the other carrier at the last regular enrollment period.(2) If no other carrier had been offered to some groups enrolled in the insolvent health maintenance organization or if the director determines that the other health benefit plans lack sufficient health care delivery resources to assure that health care services will be available and accessible to all of the group enrollees of the insolvent health maintenance organization, the director shall allocate equitably the insolvent health maintenance organization's group contracts for such groups among all health maintenance organizations which operate within any portion of the insolvent health maintenance organization's service area, taking into consideration the health care delivery resources of each health maintenance organization. Each health maintenance organization to which a group is allocated shall offer such group the health maintenance organization's existing coverage which is most similar to each group's coverage with the insolvent health maintenance organization at rates determined in accordance with the successor health maintenance organization's existing rating methodology.(3) The director shall also allocate equitably the insolvent health maintenance organization's individual enrollees who are unable to obtain other coverage among all health maintenance organizations which operate within any portion of the insolvent health maintenance organization's service area, taking into consideration the health care delivery resources of each such health maintenance organization. Each health maintenance organization to which individual enrollees are allocated shall offer such individual enrollees the health maintenance organization's existing coverage for individual or conversion coverage as determined by his or her type of coverage in the insolvent health maintenance organization at rates determined in accordance with the successor health maintenance organization's existing rating methodology. Successor health maintenance organizations which do not offer direct individual enrollment may aggregate all of the allocated individual enrollees into one group for rating and coverage purposes.Source  Laws 1990, LB 1136, § 56.
NE Code § 44-32,148 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,148 - Replacement coverage; requirements.

44-32,148.  Replacement coverage; requirements.(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, medical, or surgical expense or service benefits shall immediately cover all enrollees who were validly covered under the previous health maintenance organization contract or policy at the date of discontinuance and who would otherwise be eligible for coverage under the succeeding carrier's contract, regardless of any provisions of the contract relating to active employment, hospital confinement, or pregnancy. Discontinuance shall mean the termination of the contract between the group contract holder and a health maintenance organization due to the insolvency of the health maintenance organization and shall not mean the termination of any agreement between any individual enrollee and the health maintenance organization.(2) Except to the extent benefits for a condition would have been reduced or excluded under the prior carrier's contract or policy, no provision in a succeeding carrier's contract of replacement coverage which would operate to reduce or exclude benefits on the basis that the condition giving rise to benefits preexisted the effective date of the succeeding carrier's contract shall be applied with respect to those enrollees validly covered under the prior carrier's contract or policy on the date of discontinuance.Source  Laws 1990, LB 1136, § 57.
NE Code § 44-32,149 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,149 - Premium rates.

44-32,149.  Premium rates.(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 accordance with actuarial principles for various categories of enrollees. The premium applicable to an enrollee shall not be individually determined based on the status of his or her health. The premium rates shall not be excessive, inadequate, or unfairly discriminatory. A certification by a qualified actuary or other qualified person acceptable to the director as to the appropriateness of the use of the methodology, based on reasonable assumptions, shall accompany the filing along with adequate supporting information.(2) The director shall approve the schedule of premium rates or methodology for determining premium rates if the requirements of this section are met. If the director disapproves such filing, he or she shall notify the health maintenance organization. In the notice, the director shall specify the reasons for his or her disapproval. A hearing shall be conducted within thirty days after a request in writing by the person filing. If the director does not take action on such schedule or methodology within thirty days of the filing of such schedule or methodology, it shall be deemed approved.Source  Laws 1990, LB 1136, § 58.
NE Code § 44-32,150 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,150 - Insurance Producers Licensing Act; applicability.

44-32,150.  Insurance Producers Licensing Act; applicability.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.Source  Laws 1990, LB 1136, § 59. Cross References  Insurance Producers Licensing Act, see section 44-4047.
NE Code § 44-32,151 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,151 - Powers of insurers.

44-32,151.  Powers of insurers.(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 organize and operate a health maintenance organization. The business of insurance shall include the providing of health care by a health maintenance organization owned or operated by an insurer or a subsidiary thereof.(2) An insurer may contract with a health maintenance organization to provide insurance or similar protection against the cost of health care services provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations. The enrollees of a health maintenance organization shall constitute a permissible group under the insurance laws of this state. An insurer may make benefit payments to health maintenance organizations for health care services rendered by providers under such contracts.Source  Laws 1990, LB 1136, § 60.