reglab/housing_qa huggingface dataset:
NE Code § 44-32,109 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,109 - Net worth, defined.

44-32,109.  Net worth, defined.Net worth shall mean the excess of total admitted assets over total liabilities. Liabilities shall not include fully subordinated debt.Source  Laws 1990, LB 1136, § 18.
NE Code § 44-32,110 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,110 - Participating provider, defined.

44-32,110.  Participating provider, defined.Participating provider shall mean a provider who, under an express or implied contract with the health maintenance organization or with its contractor or subcontractor, has agreed to provide health care services to enrollees with an expectation of receiving payment, other than copayment or deductible, directly or indirectly from the health maintenance organization.Source  Laws 1990, LB 1136, § 19.
NE Code § 44-32,111 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,111 - Provider, defined.

44-32,111.  Provider, defined.Provider shall mean any physician, hospital, or other person licensed or otherwise authorized to furnish health care services.Source  Laws 1990, LB 1136, § 20.
NE Code § 44-32,112 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,112 - Replacement coverage, defined.

44-32,112.  Replacement coverage, defined.Replacement coverage shall mean the benefits provided by a succeeding carrier.Source  Laws 1990, LB 1136, § 21.
NE Code § 44-32,113 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,113 - Subscriber, defined.

44-32,113.  Subscriber, defined.Subscriber shall mean an individual whose employment or other status, except family dependency, is the basis for eligibility for enrollment in the health maintenance organization or, in the case of an individual contract, the individual in whose name the contract is issued.Source  Laws 1990, LB 1136, § 22.
NE Code § 44-32,114 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,114 - Uncovered expenditures, defined.

44-32,114.  Uncovered expenditures, defined.Uncovered expenditures shall mean the costs to the health maintenance organization for health care services that are the obligation of the health maintenance organization for which an enrollee may also be liable in the event of the health maintenance organization's insolvency and for which no alternative arrangements have been made that are acceptable to the director.Source  Laws 1990, LB 1136, § 23.
NE Code § 44-32,115 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,115 - Establishment of health maintenance organization; certificate of authority required.

44-32,115.  Establishment of health maintenance organization; certificate of authority required.Any person may apply to the director for a certificate of authority to establish and operate a health maintenance organization in compliance with the Health Maintenance Organization Act. No person shall establish or operate a health maintenance organization in this state without obtaining a certificate of authority under the act. Operating a health maintenance organization without a certificate of authority shall be a violation of the Unauthorized Insurers Act. A foreign corporation may qualify under the Health Maintenance Organization Act if it registers to do business in this state as a foreign corporation under the Nebraska Model Business Corporation Act and complies with the Health Maintenance Organization Act and other applicable state laws.Source   Laws 1990, LB 1136, § 24;   Laws 1993, LB 583, § 88;   Laws 1995, LB 109, § 224;  Laws 2014, LB749, § 290. Cross References   Nebraska Model Business Corporation Act, see section 21-201.  Unauthorized Insurers Act, see section 44-2008.
NE Code § 44-32,116 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,116 - Existing health maintenance organization; application.

44-32,116.  Existing health maintenance organization; application.Any health maintenance organization which has not received a certificate of authority to operate as a health maintenance organization under prior law as of July 10, 1990, shall submit an application for a certificate of authority within ninety days of such date. Each such applicant may continue to operate until the director acts upon the application. If the application is denied, the applicant shall be treated as a health maintenance organization whose certificate of authority has been revoked.Source  Laws 1990, LB 1136, § 25.
NE Code § 44-32,118 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,118 - Modification or amendment of application; required; when.

44-32,118.  Modification or amendment of application; required; when.(1) Any modification or amendment to the items described in section 44-32,117 shall be submitted to the director for his or her approval prior to the effectuation of the modification or amendment.(2) Any modification or amendment shall be deemed approved unless disapproved within thirty days, except that the director may postpone the action for such further time, not exceeding an additional thirty days, as necessary for proper consideration.Source   Laws 1990, LB 1136, § 27;   Laws 1993, LB 583, § 89.
NE Code § 44-32,119 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,119 - Application; transmittal to Department of Health and Human Services; duties; applicability.

44-32,119.  Application; transmittal to Department of Health and Human Services; duties; applicability.(1) Upon receipt of an application for issuance of a certificate of authority, the Director of Insurance shall forthwith transmit copies of such application and accompanying documents to the Department of Health and Human Services.(2) The Department of Health and Human Services shall determine whether the applicant has complied with sections 44-32,126 to 44-32,128 with respect to health care services to be furnished.(3) Within forty-five days of receipt of the application for issuance of a certificate of authority, the Department of Health and Human Services shall certify to the Director of Insurance that the proposed health maintenance organization meets the requirements of such sections or notify the Director of Insurance that the health maintenance organization does not meet such requirements and specify in what respects it is deficient.(4) This section shall not apply to an application from an applicant that only provides health care benefits pursuant to Title 42, Chapter 7, Subchapter XVIII, Part C or D, of the United States Code, commonly known as Medicare Parts C and D. If a certificate of authority was originally issued to a health maintenance organization only authorizing the provision of health care benefits through Medicare Part C or D and such health maintenance organization expands its operations after receiving such certificate of authority, the expansion shall be treated as a new application to the Department of Insurance and transmitted to the Department of Health and Human Services for review pursuant to this section.Source   Laws 1990, LB 1136, § 28;   Laws 1996, LB 1044, § 245;  Laws 2007, LB296, § 184;  Laws 2021, LB21, § 3.   Effective Date: August 28, 2021
NE Code § 44-32,120 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,120 - Certificate of authority; issuance; conditions.

44-32,120.  Certificate of authority; issuance; conditions.The Director of Insurance shall, within forty-five days of receipt of certification or notice of deficiencies pursuant to section 44-32,119, issue a certificate of authority to any person filing a completed application upon receiving the prescribed fees and being satisfied that:(1) The persons responsible for the conduct of the affairs of the applicant are competent, trustworthy, and possess good reputations;(2) Any deficiencies identified by the Department of Health and Human Services have been corrected and the department has certified to the Director of Insurance that the health maintenance organization's proposed plan of operation meets the requirements of sections 44-32,126 to 44-32,128;(3) The health maintenance organization will effectively provide or arrange for the provision of basic health care services on a prepaid basis, through insurance or otherwise, except to the extent of reasonable requirements for copayments or deductibles; and(4) The health maintenance organization is in compliance with sections 44-32,138 to 44-32,148.A certificate of authority shall be denied only after the Director of Insurance complies with the requirements of section 44-32,153.Source   Laws 1990, LB 1136, § 29;   Laws 1996, LB 1044, § 246;  Laws 2007, LB296, § 185.
NE Code § 44-32,121 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,121 - Certificate of authority; expiration; renewal.

44-32,121.  Certificate of authority; expiration; renewal.A certificate of authority issued pursuant to sections 44-32,119 and 44-32,120 shall expire on April 30 in each year and shall be renewed annually if the health maintenance organization has continued to comply with the laws of this state and the rules and regulations.Source  Laws 1990, LB 1136, § 30.
NE Code § 44-32,122 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,122 - Health maintenance organization; powers.

44-32,122.  Health maintenance organization; powers.The powers of a health maintenance organization shall include, but not be limited to, the following:(1) The purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical facilities, and ancillary equipment and such property as may reasonably be required for its principal office or for such purposes as may be necessary in the transaction of the business of the health maintenance organization;(2) Transactions between affiliated entities, including loans and the transfer of responsibility under all contracts, including provider and subscriber contracts, between affiliates or between the health maintenance organization and its parent;(3) Furnishing of basic health care services through providers, provider associations, or agents for providers which are under contract with or employed by the health maintenance organization;(4) Contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment, and administration;(5) Contracting with an insurance company licensed in this state for the provision of insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization;(6) Offering of other health care services in addition to basic health care services. Nonbasic health care services may be offered by a health maintenance organization on a prepaid basis without offering basic health care services to any group or individual; and(7) The joint marketing of products with an insurance company licensed in this state as long as the company that is offering each product is clearly identified.Source  Laws 1990, LB 1136, § 31.
NE Code § 44-32,123 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,123 - Health maintenance organization; exercise of powers; approval requirements.

44-32,123.  Health maintenance organization; exercise of powers; approval requirements.A health maintenance organization shall file notice, with adequate supporting information, with the director prior to the exercise of any power granted in subdivision (1), (2), or (4) of section 44-32,122 which may affect the financial soundness of the health maintenance organization. The director shall disapprove such exercise of power only if it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. If the director does not disapprove the exercise of the power within thirty days of the filing, it shall be deemed approved. The director may exempt activities having a de minimis effect from the filing requirement.Source  Laws 1990, LB 1136, § 32.
NE Code § 44-32,124 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,124 - Health maintenance organization; deemed to transact business of insurance.

44-32,124.  Health maintenance organization; deemed to transact business of insurance.Notwithstanding any differences provided by law between a health maintenance organization and an insurer as described in section 44-103, a health maintenance organization shall be deemed to assume, underwrite, and spread risk and otherwise transact the business of insurance.Source  Laws 1990, LB 1136, § 33.
NE Code § 44-32,125 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,125 - Fiduciary relationships; bond or insurance required.

44-32,125.  Fiduciary relationships; bond or insurance required.Any director, officer, employee, partner, or limited liability company member of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the health maintenance organization shall be responsible for such funds in a fiduciary relationship to the health maintenance organization. A health maintenance organization shall maintain in force a fidelity bond or fidelity insurance on such individuals in an amount not less than two hundred fifty thousand dollars for each health maintenance organization. The requirements of this section may be met for each of two or more health maintenance organizations owned by a common parent if the parent maintains the bond or insurance on behalf of the health maintenance organizations and any other carrier or carriers owned by the parent in an aggregate amount of not less than the lesser of (1) two hundred fifty thousand dollars times the number of such health maintenance organizations and such other carrier or carriers or (2) five million dollars.Source   Laws 1990, LB 1136, § 34;   Laws 1993, LB 121, § 251;   Laws 1994, LB 884, § 61.
NE Code § 44-32,126 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,126 - Quality of care; procedures established.

44-32,126.  Quality of care; procedures established.Each health maintenance organization shall establish procedures to assure that the health care services provided to enrollees are rendered under reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice. Such procedures shall include mechanisms to assure availability, accessibility, and continuity of care.Source  Laws 1990, LB 1136, § 35.
NE Code § 44-32,127 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,127 - Quality assurance program; requirements.

44-32,127.  Quality assurance program; requirements.Each health maintenance organization shall have an ongoing, internal quality assurance program to monitor and evaluate its health care services, including primary and specialist physician services, and ancillary and preventive health care services across all institutional and noninstitutional settings. The quality assurance program shall include, but not be limited to, the following:(1) A written statement of goals and objectives which emphasizes improved health status in evaluating the quality of care rendered to enrollees;(2) A written quality assurance plan which describes the following:(a) The health maintenance organization's scope and purpose in quality assurance;(b) The organizational structure responsible for quality assurance activities;(c) Contractual arrangements, when appropriate, for delegation of quality assurance activities;(d) Confidentiality policies and procedures;(e) A system of ongoing evaluation activities;(f) A system of focused evaluation activities;(g) A system for credentialing providers and performing peer review activities; and(h) Duties and responsibilities of the designated physician responsible for the quality assurance activities;(3) A written statement describing the system of ongoing quality assurance activities, including, but not limited to, the following:(a) Problem assessment, identification, selection, and study;(b) Corrective action, monitoring, evaluation, and reassessment; and(c) Interpretation and analysis of patterns of care rendered to individual patients by individual providers;(4) A written statement describing the system of focused quality assurance activities based on representative samples of the enrolled population which identifies method of topic selection, study, data collection, analysis, interpretation, and report format; and(5) A written plan for taking appropriate corrective action whenever, as determined by the quality assurance program, inappropriate or substandard services have been provided or services which should have been furnished have not been provided.Each health maintenance organization shall record proceedings of formal quality assurance program activities and maintain documentation in a confidential manner. Quality assurance program minutes shall be available to the Department of Health and Human Services. Each health maintenance organization shall also establish a mechanism for periodic reporting of quality assurance program activities to the governing body of the health maintenance organization, the providers, and appropriate staff.Source   Laws 1990, LB 1136, § 36;   Laws 1996, LB 1044, § 247;  Laws 2007, LB296, § 186.
NE Code § 44-32,128 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,128 - Patient record system; requirements.

44-32,128.  Patient record system; requirements.Each health maintenance organization shall ensure the use and maintenance of an adequate patient record system which facilitates documentation and retrieval of clinical information for the purpose of the health maintenance organization evaluating continuity and coordination of patient care and assessing the quality of health and medical care provided to enrollees. Enrollee clinical records shall be available to the Department of Health and Human Services or an authorized designee for examination and review to ascertain compliance with section 44-32,127 or as deemed necessary by the department.Source   Laws 1990, LB 1136, § 37;   Laws 1996, LB 1044, § 248;  Laws 2007, LB296, § 187.
NE Code § 44-32,129 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,129 - Group and individual contracts; required provisions.

44-32,129.  Group and individual contracts; required provisions.Every group and individual contract holder shall be entitled to a group or individual contract. The contract shall not contain provisions or statements which are unjust, unfair, inequitable, misleading, or deceptive or which encourage misrepresentation as described by section 44-1525. The contract shall contain a clear statement of the following:(1) Name and address of the health maintenance organization;(2) Eligibility requirements;(3) Benefits and services within the service area;(4) Emergency care benefits and services;(5) Out-of-area benefits and services, if any;(6) Copayments, deductibles, or other out-of-pocket expenses;(7) Limitations and exclusions;(8) Enrollee termination;(9) Enrollee reinstatement, if any;(10) Claims procedures;(11) Enrollee grievance procedures;(12) Continuation of coverage;(13) Conversion;(14) Extension of benefits, if any;(15) Coordination of benefits, if applicable;(16) Subrogation, if any;(17) Description of the service area;(18) Entire contract provision;(19) Term of coverage;(20) Cancellation of group or individual contract holder;(21) Renewal;(22) Reinstatement of group or individual contract holder, if any;(23) Grace period; and(24) Conformity with state law.An evidence of coverage may be filed as part of the group contract to describe the provisions required in subdivisions (1) through (17) of this section.Source  Laws 1990, LB 1136, § 38.
NE Code § 44-32,130 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,130 - Group and individual contracts; additional required provisions.

44-32,130.  Group and individual contracts; additional required provisions.(1) An individual contract shall provide a ten-day period to examine and return the contract and have the premium refunded. If services were received during the ten-day period and the person returns the contract to receive a refund of the premium paid, he or she shall pay for such services.(2) A group or individual contract shall permit enrollees to voluntarily terminate enrollment for any reason at any time.(3) A group contract shall permit enrollees to convert to individual enrollment upon termination of enrollment in the group.(4) A group contract shall not contain provisions that are in conflict with sections 44-3,144 to 44-3,150.Source   Laws 1990, LB 1136, § 39;   Laws 1994, LB 1224, § 80.
NE Code § 44-32,131 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,131 - Subscriber; receive evidence of coverage; contents.

44-32,131.  Subscriber; receive evidence of coverage; contents.Every subscriber shall receive an evidence of coverage from the group contract holder or the health maintenance organization. The evidence of coverage shall not contain provisions or statements which are unfair, unjust, inequitable, misleading, or deceptive or which encourage misrepresentation as described by section 44-1525. The evidence of coverage shall contain a clear statement of the provisions required in subdivisions (1) through (17) of section 44-32,129.Source  Laws 1990, LB 1136, § 40.
NE Code § 44-32,132 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,132 - Forms; readability standards; filing requirements.

44-32,132.  Forms; readability standards; filing requirements.The director may establish readability standards for individual contract, group contract, and evidence of coverage forms. No group or individual contract, evidence of coverage, or amendment thereto shall be delivered or issued for delivery in this state unless its form has been filed with and approved by the director. If an evidence of coverage issued pursuant to and incorporated in a contract issued in this state is intended for delivery in another state and the evidence of coverage has been approved for use in the state in which it is to be delivered, the evidence of coverage shall not need to be submitted to the director for approval. The director may require the submission of whatever relevant information he or she deems necessary in determining whether to approve or disapprove a filing.Source  Laws 1990, LB 1136, § 41.
NE Code § 44-32,133 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-32,133 - Forms; filing; when; disapproval or withdrawal of approval; notice; hearing.

44-32,133.  Forms; filing; when; disapproval or withdrawal of approval; notice; hearing.(1) Every form required to be filed with the director shall be filed not less than thirty days prior to delivery or issuance for delivery in this state. At any time during the thirty-day period, the director may extend the period for review for an additional thirty days. Notice of an extension shall be in writing. At the end of the review period, the form shall be deemed approved if the director has taken no action. The person filing shall notify the director in writing prior to using a form that is deemed approved. At any time, after thirty days' notice and for cause shown, the director may withdraw approval of any form. The withdrawal shall be effective at the end of the thirty days.(2) When a filing is disapproved or approval of a form is withdrawn, the director shall give the health maintenance organization written notice of the reasons for disapproval or withdrawal and in the notice shall inform the health maintenance organization that within thirty days of receipt of the notice the health maintenance organization may request a hearing. A hearing shall be conducted within thirty days after the director has received the request for hearing.Source  Laws 1990, LB 1136, § 42.