reglab/housing_qa huggingface dataset:
NE Code § 44-5257 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5257 - Separate class of business; established; when; limit.

44-5257.  Separate class of business; established; when; limit.(1) A small employer carrier may establish a separate class of business only to reflect substantial differences in expected claims experience or administrative costs related to the following reasons:(a) The small employer carrier uses more than one type of system for the marketing and sale of health benefit plans to small employers;(b) The small employer carrier has acquired a class of business from another small employer carrier; or(c) The small employer carrier provides coverage to one or more association groups that meet the requirements of section 44-760.(2) A small employer carrier may establish up to nine separate classes of business.(3) The director may adopt and promulgate rules and regulations to provide for a period of transition in order for a small employer carrier to come into compliance with subsection (2) of this section in the instance of acquisition of an additional class of business from another small employer carrier.(4) The director may approve the establishment of additional classes of business upon application to the director and a finding by the director that such action would enhance the efficiency and fairness of the small employer marketplace.Source  Laws 1994, LB 1222, § 35.
NE Code § 44-5260.01 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5260.01 - Certification of creditable coverage.

44-5260.01.  Certification of creditable coverage.(1) Small employer carriers shall provide written certification of creditable coverage to individuals in accordance with subsection (2) of this section.(2) The certification of creditable coverage shall be provided:(a) At the time an individual ceases to be covered under the health benefit plan or otherwise becomes covered under a COBRA continuation provision;(b) In the case of an individual who becomes covered under a COBRA continuation provision, at the time the individual ceases to be covered under that provision; and(c) At the time a request is made on behalf of an individual if the request is made not later than twenty-four months after the date of cessation of coverage described in subdivision (2)(a) or (b) of this section, whichever is later.(3) Small employer carriers may provide the certification of creditable coverage required under subdivision (2)(a) of this section at a time consistent with notices required under any applicable COBRA continuation provision.(4) The certificate of creditable coverage required to be provided pursuant to subsection (1) of this section shall contain:(a) Written certification of the period of creditable coverage of the individual under the health benefit plan and the coverage, if any, under the applicable COBRA continuation provision; and(b) The waiting period, if any, and, if applicable, affiliation period imposed with respect to the individual for any coverage under the health benefit plan.(5) To the extent medical care under a group health plan consists of group health insurance coverage, the plan is deemed to have satisfied the certification requirement under subsection (1) of this section if the small employer carrier offering the coverage provides for certification in accordance with subsection (2) of this section.(6)(a) If an individual enrolls in a group health plan that uses the alternative method of counting creditable coverage pursuant to subdivision (4)(c)(iv) of section 44-5260 and the individual provides a certificate of coverage that was provided to the individual pursuant to subsection (3) of this section, on request of the group health plan, the entity that issued the certification to the individual promptly shall disclose to the group health plan information on the classes and categories of health benefits available under the entity's health benefit plan.(b) The entity providing the information pursuant to subdivision (6)(a) of this section may charge the requesting group health plan the reasonable cost of disclosing the information.Source Laws 2002, LB 1139, § 34.
NE Code § 44-5264 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5264 - Basic health benefit plan; required coverage; applicability.

44-5264.  Basic health benefit plan; required coverage; applicability.Except for specified childhood immunizations of children from birth to six years of age, a statute requiring coverage of a health care service or benefit or requiring the reimbursement, utilization, or inclusion of a specific category of licensed health care practitioner shall not apply to a basic health benefit plan delivered or issued for delivery to small employers in this state pursuant to the Small Employer Health Insurance Availability Act.Source  Laws 1994, LB 1222, § 42.
NE Code § 44-5265 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5265 - Rules and regulations.

44-5265.  Rules and regulations.The director shall adopt and promulgate rules and regulations to carry out the Small Employer Health Insurance Availability Act.Source  Laws 1994, LB 1222, § 43.
NE Code § 44-5267 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5267 - Reissuance of health benefit plan; when; director; powers.

44-5267.  Reissuance of health benefit plan; when; director; powers.The director may adopt and promulgate rules and regulations to require small employer carriers, as a condition of transacting business with small employers in this state after January 1, 1995, to reissue a health benefit plan to any small employer whose health benefit plan has been terminated or not renewed by the carrier after six months prior to January 1, 1995. The director may prescribe such terms for the reissuance of coverage as the director finds are reasonable and necessary to provide continuity of coverage to small employers.Source  Laws 1994, LB 1222, § 45.
NE Code § 44-5301 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5301 - Act, how cited.

44-5301.  Act, how cited.Sections 44-5301 to 44-5311 shall be known and may be cited as the Health Insurance Access Act.Source  Laws 1991, LB 419, § 29.
NE Code § 44-5302 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5302 - Legislative findings and declarations.

44-5302.  Legislative findings and declarations.The Legislature finds and declares that there is a significant number of Nebraskans who lack health insurance and that these uninsured people include many individuals and families who cannot afford the rising cost of medical care but do not qualify for the various income-based assistance programs. The lack of financial means of uninsured people and families to pay for their medical care leaves health care providers with uncollectible debts which are transferred to other patients and to insurers. It is the purpose and intent of the Legislature to provide a mechanism to allow insurers to provide basic levels of health insurance to those people who are uninsured and are not qualified for income-based assistance programs.Source   Laws 1991, LB 419, § 30;  Laws 2009, LB445, § 1.
NE Code § 44-5303 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5303 - Terms, defined.

44-5303.  Terms, defined.For purposes of the Health Insurance Access Act:(1) Insurer shall mean any insurance company as defined in section 44-103 authorized to transact health insurance business in the State of Nebraska or a health maintenance organization which has obtained a valid certificate of authority;(2) Medicare shall mean parts A, B, C, and D of Title XVIII of the Social Security Act, 42 U.S.C. 1395 et seq., as amended;(3) Provider shall mean any physician or hospital who is licensed or authorized in this state to furnish medical care or hospitalization to any individual;(4) Spell of illness shall mean a continuous period as a hospital inpatient or successive periods as a hospital inpatient when the date of discharge and the following date of admission are less than sixty consecutive days apart; and(5) Uninsured access coverage shall mean a policy of sickness and accident insurance or a contract for health care services covering individuals, with or without their dependents, issued by an insurer subject to the limitations and requirements in the act.Source   Laws 1991, LB 419, § 31;  Laws 2009, LB445, § 2.
NE Code § 44-5304 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5304 - Policies and contracts; applicability of other laws.

44-5304.  Policies and contracts; applicability of other laws.Policies of sickness and accident insurance and contracts for health care services issued pursuant to the Health Insurance Access Act shall be subject to all applicable provisions of Chapter 44 except as otherwise provided in such chapter.Source  Laws 1991, LB 419, § 32.
NE Code § 44-5305 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5305 - Policy or contract; eligibility.

44-5305.  Policy or contract; eligibility.(1) An uninsured access coverage policy or contract shall limit eligibility to individuals or families who are not eligible for medicare or any other medical assistance program, including, but not limited to, the program established pursuant to the Medical Assistance Act.(2) The uninsured access coverage policy or contract shall allow a transfer to a designated type of individual policy or contract without evidence of insurability and without interruption in coverage subject to payment of premiums. Each uninsured access coverage policy or contract shall specify the type of individual policy or contract to which an insured person may transfer.Source   Laws 1991, LB 419, § 33;  Laws 2006, LB 1248, § 65;  Laws 2009, LB445, § 3. Cross References  Medical Assistance Act, see section 68-901.
NE Code § 44-5306 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5306 - Policy or contract; eligibility; limitations.

44-5306.  Policy or contract; eligibility; limitations.(1) An individual or a family member shall not be eligible for initial or continued coverage under an uninsured access coverage policy or contract if he or she:(a) Is eligible as an employee or dependent for group insurance coverage sponsored or maintained by an employer; or(b) Is covered by any other type of hospital, surgical, or medical expense-incurred policy or health maintenance organization contract.(2) An uninsured access coverage policy or contract may require evidence of insurability but shall not use underwriting guidelines that are more strict than those normally used by the insurer for its regular individual health insurance contracts.Source   Laws 1991, LB 419, § 34;  Laws 2009, LB445, § 4.
NE Code § 44-5307 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5307 - Policy or contract; benefits required; coverage authorized; prohibitions.

44-5307.  Policy or contract; benefits required; coverage authorized; prohibitions.(1) An uninsured access coverage policy or contract may include hospital-only and surgical-only benefits which shall mean:(a) Inhospital benefits for not less than thirty continuous days nor more than ninety continuous days for each spell of illness; and(b) Surgical benefits for both inpatient and outpatient surgery.(2) An uninsured access coverage policy or contract may include prescription drug benefit coverage.(3) An uninsured access coverage policy or contract may include preventative health care coverage, including, but not limited to, primary care physician visits, immunizations for adults and children, laboratory and X-ray procedures, and preventative cancer screenings such as mammograms, cervical cancer screenings, and noninvasive colorectal or prostate screenings.(4) An uninsured access coverage policy or contract may not:(a) Use a definition of spell of illness more restrictive than the definition found in section 44-5303; or(b) Use a definition of preexisting condition more restrictive than the definition normally used by the insurer for its regular individual health insurance contracts.(5) Every uninsured access coverage policy or contract shall provide that the benefit payment shall be accepted as payment in full by the provider and there shall be no deductible or coinsurance charged to the insured.Source   Laws 1991, LB 419, § 35;  Laws 2009, LB445, § 5.
NE Code § 44-5308 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5308 - Policy or contract; contents required.

44-5308.  Policy or contract; contents required.Each uninsured access coverage policy or contract shall include:(1) A reasonable description of the geographic area or areas to be served; and(2) A listing of the providers who have a contract with the insurers to furnish health care services.Source  Laws 1991, LB 419, § 36.
NE Code § 44-5309 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5309 - Policy or contract; exemption from mandated benefits.

44-5309.  Policy or contract; exemption from mandated benefits.Notwithstanding any other provision of law, every uninsured access coverage policy or contract shall be exempt from any and all mandated benefits which require coverage of any type of services or conditions.Source  Laws 1991, LB 419, § 37.
NE Code § 44-5310 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5310 - Issuing insurer; powers.

44-5310.  Issuing insurer; powers.An insurer issuing an uninsured access coverage policy or contract may enter into contracts to arrange for health services by certain providers, may limit the number and types of providers with which it contracts, and shall not be required to provide benefits for services furnished by providers who do not contract with the insurer.Source  Laws 1991, LB 419, § 38.
NE Code § 44-5311 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5311 - Rules and regulations.

44-5311.  Rules and regulations.The Director of Insurance may adopt and promulgate rules and regulations to carry out the Health Insurance Access Act.Source  Laws 1991, LB 419, § 39.
NE Code § 44-5401 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5401 - Transferred to section 44-5416.

44-5401.  Transferred to section 44-5416.
NE Code § 44-5402 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5402 - Transferred to section 44-5417.

44-5402.  Transferred to section 44-5417.
NE Code § 44-5409 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5409 - Transferred to section 44-5419.

44-5409.  Transferred to section 44-5419.
NE Code § 44-5410 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5410 - Transferred to section 44-5420.

44-5410.  Transferred to section 44-5420.
NE Code § 44-5411 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5411 - Transferred to section 44-5421.

44-5411.  Transferred to section 44-5421.
NE Code § 44-5412 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5412 - Transferred to section 44-5422.

44-5412.  Transferred to section 44-5422.
NE Code § 44-5413 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5413 - Transferred to section 44-5423.

44-5413.  Transferred to section 44-5423.
NE Code § 44-5414 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5414 - Transferred to section 44-5424.

44-5414.  Transferred to section 44-5424.
NE Code § 44-5416 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5416 - Act, how cited.

44-5416.  Act, how cited.Sections 44-5416 to 44-5431 shall be known and may be cited as the Utilization Review Act.Source   Laws 1992, LB 428, § 1;   R.S.1943, (1993), § 44-5401;   Laws 1998, LB 1162, § 1.
NE Code § 44-5417 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5417 - Purpose of act.

44-5417.  Purpose of act.The purpose of the Utilization Review Act is to establish requirements and standards of operation for certification of medical utilization review agents. It is proper for the state to oversee utilization review agents as a part of the state's regulation and supervision of the business of insurance and to encourage effective, efficient, and consistent utilization review.Source   Laws 1992, LB 428, § 2;   R.S.1943, (1993), § 44-5402;   Laws 1998, LB 1162, § 2.
NE Code § 44-5419 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5419 - Utilization review agent; certificate required; term.

44-5419.  Utilization review agent; certificate required; term.On or after July 1, 1993, a utilization review agent may not conduct utilization review upon a covered person in this state unless the agent is granted a certificate by the director. Certificates granted under the Utilization Review Act shall be valid for two years from the date of issuance.Source   Laws 1992, LB 428, § 9;   R.S.1943, (1993), § 44-5409;   Laws 1998, LB 1162, § 4.
NE Code § 44-5420 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5420 - Certificate; application; fee.

44-5420.  Certificate; application; fee.(1) An applicant for a certificate as a utilization review agent shall submit an application to the department upon a form which may be obtained from the department. The application shall be signed and verified by the applicant.Along with the application, the applicant shall pay the application fee of three hundred dollars.(2) As a part of the application, the applicant shall submit the following:(a) Documentation that the applicant has received approval or accreditation by the American Accreditation HealthCare Commission/URAC, or a similar organization which has standards for utilization review agents that are substantially similar to the standards of the American Accreditation HealthCare Commission/URAC, and which has been approved by the director;(b) A statement of the street and mailing address of the entity, telephone number of the entity, and a list of the principal officers of the entity responsible for its operation, management, and control; and(c) Such other reasonable information or documentation as the department requires for enforcement of the Utilization Review Act.Source   Laws 1992, LB 428, § 10;   R.S.1943, (1993), § 44-5410;   Laws 1998, LB 1162, § 5.
NE Code § 44-5421 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5421 - Certificate; director; grant or deny; notice and hearing requirements.

44-5421.  Certificate; director; grant or deny; notice and hearing requirements.The director shall grant or deny a certificate within forty-five days of receipt of a completed application under section 44-5420. The director shall deny a certificate if the applicant does not meet the requirements of the Utilization Review Act. If a certificate is denied, the director shall notify the applicant by certified mail and shall specify the reasons for denial in the notice. The applicant shall have ten days from the date of receipt of the notice to request a hearing before the director pursuant to the Administrative Procedure Act, or he or she may reapply and respond to the reasons for the denial.Source   Laws 1992, LB 428, § 11;   R.S.1943, (1993), § 44-5411;   Laws 1998, LB 1162, § 6.  Cross References  Administrative Procedure Act, see section 84-920.
NE Code § 44-5423 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5423 - Utilization review agent; notify director of changes; when.

44-5423.  Utilization review agent; notify director of changes; when.A utilization review agent shall notify the director within five working days of any change of the agent's approval or accreditation status or of any material change in the information contained in the agent's application or renewal or that the agent no longer meets the requirements of the Utilization Review Act.Source   Laws 1992, LB 428, § 13;   R.S.1943, (1993), § 44-5413;   Laws 1998, LB 1162, § 8.
NE Code § 44-5424 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5424 - Certificates; renewal; fee.

44-5424.  Certificates; renewal; fee.Certificates granted under the Utilization Review Act may be renewed prior to their expiration date upon the filing of the following with the department (1) a renewal fee of one hundred dollars, (2) a statement detailing any changes in the information or documentation filed with the initial application, and (3) such other reasonable information as the department requires for enforcement of the act.Source   Laws 1992, LB 428, § 14;   R.S.1943, (1993), § 44-5414;   Laws 1998, LB 1162, § 9.
NE Code § 44-5425 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5425 - Health carrier; oversight of utilization review activities.

44-5425.  Health carrier; oversight of utilization review activities.A health carrier shall be responsible for monitoring all utilization review activities carried out by, or on behalf of, the health carrier and for ensuring that all requirements of the Utilization Review Act and applicable rules and regulations are met. The health carrier shall also ensure that appropriate personnel have operational responsibility for the conduct of the health carrier's utilization review program.Source  Laws 1998, LB 1162, § 10.
NE Code § 44-5426 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5426 - Utilization review program; use of clinical review criteria.

44-5426.  Utilization review program; use of clinical review criteria.A utilization review program shall use documented clinical review criteria that are based on sound clinical evidence and are evaluated periodically to assure ongoing efficacy. A health carrier may develop its own clinical review criteria, or it may purchase or license clinical review criteria from qualified vendors. A health carrier shall make available its clinical review criteria upon request to authorized government agencies.Source  Laws 1998, LB 1162, § 11.
NE Code § 44-5427 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5427 - Description of review procedures; toll-free number.

44-5427.  Description of review procedures; toll-free number.(1) In the certificate of coverage or member handbook provided to covered persons, a health carrier shall include a clear and comprehensive description of its utilization review procedures, including the procedures for obtaining review of adverse determinations, and a statement of rights and responsibilities of covered persons with respect to those procedures.(2) A health carrier shall include a summary of its utilization review procedures in enrollment materials intended for prospective covered persons.(3) A health carrier shall print on its membership cards a toll-free telephone number to call for utilization review decisions.Source  Laws 1998, LB 1162, § 12.
NE Code § 44-5428 (2021)
2021 Nebraska Revised Statutes|Chapter 44 - Insurance|44-5428 - Agent violation; notice; hearing.

44-5428.  Agent violation; notice; hearing.If the director finds that any utilization review agent doing business in this state is engaging in any violation of the Utilization Review Act and that a proceeding in respect thereto would be in the public interest, he or she shall issue and serve upon such utilization review agent a statement of the charges in that respect and a notice of hearing thereon, which notice shall set a hearing date not less than ten days after the date of the notice.Source  Laws 1998, LB 1162, § 13.