reglab/statecodes huggingface dataset:
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-712 - Sickness and accident insurance; good faith estimate; requirements; effect.

44-712.
Sickness and accident insurance; good faith estimate; requirements; effect.
(1) Any individual or group sickness and accident insurance policy or subscriber contract, any hospital, medical, or surgical expense-incurred policy, and any prepaid dental service plan that is issued for delivery, delivered, or renewed in this state, except policies that provide coverage for a specified disease or other limited-benefit coverage and health maintenance organization contracts, that provides for payment of claims based upon a specific methodology including, but not limited to, usual and customary charges, reasonable and customary charges, maximum benefit allowance, or charges based upon the prevailing rate in the community, shall provide that, upon request, a policyholder, certificate holder, covered dependent, or authorized representative shall be provided a written statement that includes a good faith estimate of the dollar amount of the allowable benefit for a service or procedure if the request includes information regarding any service or procedure to be performed by a nonpreferred provider, including any service or procedure code number or diagnosis related group provided by the health care provider and the health care provider's estimated charge.
(2) A statement requested pursuant to this section shall be sent to the policyholder, certificate holder, covered dependent, or authorized representative within ten business days after receipt of the request from the policyholder, certificate holder, covered dependent, or authorized representative.
(3) The insurer or other entity that provides a statement pursuant to and in compliance with this section shall not be bound by a good faith estimate, except that a pattern of providing estimates that vary significantly from the ultimate payment shall be an unfair claims settlement practice subject to the Unfair Insurance Claims Settlement Practices Act.
Source
Laws 1999, LB 326, § 5.
Cross References
Unfair Insurance Claims Settlement Practices Act, see section 44-1536.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-714 - Health benefit plan; plan sponsor; electronic delivery of communications; consent on behalf of covered person; conditions.

44-714.
Health benefit plan; plan sponsor; electronic delivery of communications; consent on behalf of covered person; conditions.
(1) For purposes of this section:
(a) Health benefit plan means a policy, a contract, a certificate, or an agreement entered into, offered by, or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including a vision or dental benefit plan. Health benefit plan shall not include any coverage pursuant to a liability insurance policy, including medical payments insurance issued as a supplement to a liability insurance policy, or a workers' compensation insurance policy; and
(b) Plan sponsor means:
(i) In the case of a health benefit plan established or maintained by a single employer, the employer;
(ii) In the case of a health benefit plan established or maintained by an employee organization, the employee organization; or
(iii) In the case of a health benefit plan established or maintained by two or more employers or jointly by one or more employers and one or more employee organizations, the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the benefit plan.
(2) The plan sponsor of a health benefit plan may, on behalf of covered persons in the plan, provide the consent to the delivery of all communications related to the plan by electronic means and to the electronic delivery of any health insurance identification card if, before consenting on behalf of a covered person, a plan sponsor:
(a) Confirms that the covered person routinely uses electronic communications during the normal course of employment;
(b) Provides the covered person an opportunity to opt out of delivery by electronic means; and
(c) Follows all federal and state laws relating to the electronic delivery of such information or documents.
Source
Laws 2023, LB92, § 87.
Operative Date: September 2, 2023
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-736 - Sickness and accident insurance; extended disability benefit; how construed.

44-736.
Sickness and accident insurance; extended disability benefit; how construed.
Any policy of sickness and accident insurance may contain a provision for paying an extended disability benefit upon the insured's death from any cause, which benefit shall not be construed as life insurance.
Source
Laws 1947, c. 164, § 5(3), p. 462;
Laws 1957, c. 188, § 18, p. 658;
Laws 1989, LB 92, § 149.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-749 - Sickness and accident insurance; discrimination prohibited; differences permitted.

44-749.
Sickness and accident insurance; discrimination prohibited; differences permitted.
No sickness and accident insurer shall make or permit any unfair discrimination between individuals of substantially the same hazard in the amount of premium rates charged for any policy or contract of such insurance or in the benefits payable thereunder. This section shall not prohibit different premium rates, different benefits, or different underwriting procedure for individuals insured under group, family expense, franchise, or blanket plans of insurance. This section shall not limit the negotiation of preferred provider policies and contracts under sections 44-4101 to 44-4113.
Source
Laws 1947, c. 164, § 10, p. 465;
Laws 1984, LB 902, § 16;
Laws 1989, LB 92, § 150;
Laws 1995, LB 473, § 2.
Annotations
Forbidden discrimination not present where group policy, under which husband, as member, and wife were insured, extended permanent total disability indemnity coverage only to husband; even if present wife would not be able to recover. Simmons v. Continental Cas. Co., 410 F.2d 881 (8th Cir. 1969).
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-755 - Industrial sickness and accident insurance, defined.

44-755.
Industrial sickness and accident insurance, defined.
The term industrial sickness and accident insurance as used herein means sickness and accident insurance under individual policies for which the premium is payable weekly, and includes any such policy which covers sickness only or accident only.
Source
Laws 1947, c. 164, § 14(1), p. 467.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-756 - Industrial sickness and accident insurance; insurers authorized to write.

44-756.
Industrial sickness and accident insurance; insurers authorized to write.
Any insurer authorized to write sickness and accident insurance in this state shall have power to issue policies of industrial sickness and accident insurance.
Source
Laws 1947, c. 164, § 14(2), p. 467;
Laws 1989, LB 92, § 151.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-757 - Industrial sickness and accident insurance; required statement on policy.

44-757.
Industrial sickness and accident insurance; required statement on policy.
No policy of industrial sickness and accident insurance may be delivered or issued for delivery in this state unless it has printed thereon the words industrial policy.
Source
Laws 1947, c. 164, § 14(3), p. 467.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-758 - Industrial sickness and accident insurance; standard provisions applicable; provisions prohibited; permissive provisions.

44-758.
Industrial sickness and accident insurance; standard provisions applicable; provisions prohibited; permissive provisions.
Each policy of industrial sickness and accident insurance shall be subject to the provisions of sections 44-709 to 44-767, except that no such policy shall be required to contain any of the provisions set forth in sections 44-710.03 and 44-710.04. No such policy shall contain any provision relative to notice of proof of loss, the time for paying benefits, or the time within which suit may be brought upon the policy, which in the opinion of the Director of Insurance is less favorable to the insured than would be permitted by such standard provisions. Such policy may contain a provision that upon proper written request a named beneficiary shall be designated in or by endorsement on the policy to receive the proceeds thereof on the death of the insured, and there shall be reserved to the insured the power to change the beneficiary at any time by written notice to the insurer at its home office, accompanied by the policy for endorsement of the change thereon by the insurer. The insurer shall have the right to refuse to designate a beneficiary if evidence satisfactory to the company of such beneficiary's insurable interest in the life of the insured is not furnished on request. Any such policy may provide in substance that any payment thereunder may be made to the insured or to the insured's estate or to any relative by blood or connection by marriage of the insured or, to the extent of such portion of any payment under the policy as may reasonably appear to the insurer to be due to such person, to any other person equitably entitled thereto by reason of having incurred expense occasioned by the maintenance or illness or burial of the insured, except that if the policy is in force at the death of the insured, the proceeds thereof shall be payable to the named beneficiary if living, but upon the expiration of fifteen days after the death of the insured, unless proof of claim in the manner and form required by the policy, accompanied by the policy for surrender, has theretofore been made by such beneficiary, the insurer may pay to any other person permitted by the policy.
Source
Laws 1947, c. 164, § 14(4), p. 467;
Laws 1957, c. 188, § 19, p. 659;
Laws 1989, LB 92, § 152.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-759 - Sickness and accident insurance on a franchise plan, defined.

44-759.
Sickness and accident insurance on a franchise plan, defined.
Sickness and accident insurance on a franchise plan is hereby declared to be that form of sickness and accident insurance issued to (1) five or more employees of any corporation, partnership, limited liability company, individual employer, or governmental corporation or agency or department thereof or (2) ten or more members of any trade or professional association or of a labor union or of any other association having had an active existence for at least two years where such association or union has a constitution or bylaws and is formed in good faith for purposes other than that of obtaining insurance, if such persons, with or without their dependents, are issued the same form of an individual policy varying only as to amounts and kinds of coverage applied for by such persons.
Source
Laws 1947, c. 164, § 15, p. 468;
Laws 1993, LB 121, § 226.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-760 - Group sickness and accident insurance, defined.

44-760.
Group sickness and accident insurance, defined.
Group sickness and accident insurance is hereby declared to be that form of sickness and accident insurance covering groups of persons, with or without their dependents, and issued upon the following basis:
(1) Under a policy issued to an employer, who shall be deemed the policyholder, insuring at least two employees of such employer, for the benefit of persons other than the employer. The term employees shall be deemed to include the officers, managers, and employees of the employer, the partners if the employer is a partnership, the members if the employer is a limited liability company, the officers, managers, and employees of subsidiary or affiliated corporations of a corporate employer, and the individual proprietors, partners, and employees of individuals and firms, the business of which is controlled by the insured employer through stock ownership, contract, or otherwise. The policy may provide that the term employees shall include retired employees. The term employer may be deemed to include any municipal or governmental corporation, unit, agency, or department thereof and the proper officers, as such, of any unincorporated municipality or department thereof, as well as private individuals, partnerships, limited liability companies, and corporations;
(2) Under a policy issued to an association, including a labor union, which has a constitution and bylaws and which has been organized and is maintained in good faith for purposes other than that of obtaining insurance, insuring at least twenty-five members of the association for the benefit of persons other than the association or its officers or trustees, as such;
(3) Under a policy issued to any other substantially similar group which, in the discretion of the director, may be subject to the issuance of a group sickness and accident policy or contract;
(4) Under a policy issued to any other group as authorized by Chapter 44, article 16; or
(5) Under a health benefit policy issued to an association consisting solely of Nebraska residents which has a constitution and bylaws and which insures at least twenty-five or more of the members of the association. For purposes of this subdivision, policy shall not include accident-only, credit, dental, vision, medicare supplement, long-term care, or disability income insurance, coverage issued as a supplement to liability insurance, workers' compensation or similar insurance, specified disease insurance, hospital confinement indemnity insurance, or limited-benefit health insurance.
Source
Laws 1947, c. 164, § 16(1), p. 468;
Laws 1951, c. 144, § 1, p. 585;
Laws 1959, c. 210, § 1, p. 730;
Laws 1993, LB 121, § 227;
Laws 1994, LB 1222, § 51;
Laws 1997, LB 862, § 19.
Annotations
Group accident policy may insure eligible members of family including wife. Simmons v. Continental Cas. Co., 410 F.2d 881 (8th Cir. 1969).
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-762 - Blanket sickness and accident insurance, defined.

44-762.
Blanket sickness and accident insurance, defined.
Blanket sickness and accident insurance is hereby declared to be that form of sickness and accident insurance covering special groups of persons as enumerated in one of the following subsections (1) to (5):
(1) Under a policy or contract issued to any common carrier, which shall be deemed the policyholder, covering a group defined as all persons who may become passengers on such common carrier.
(2) Under a policy or contract issued to an employer, who shall be deemed the policyholder, covering any group of employees defined by reference to exceptional hazards incident to such employment.
(3) Under a policy or contract issued to a college, school, or other institution of learning or to the head or principal thereof, who or which shall be deemed the policyholder, covering students or teachers.
(4) Under a policy or contract issued in the name of any volunteer fire department, first-aid, or other such volunteer group, which shall be deemed the policyholder, covering all of the members of such department or group.
(5) Under a policy or contract issued to any other substantially similar group which, in the discretion of the Director of Insurance, may be subject to the issuance of a blanket sickness and accident policy or contract.
Source
Laws 1947, c. 164, § 17(1), p. 470.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-763 - Blanket sickness and accident insurance; individual application not required; individual certificate unnecessary.

44-763.
Blanket sickness and accident insurance; individual application not required; individual certificate unnecessary.
An individual application shall not be required from a person covered under a blanket policy or contract of sickness and accident insurance nor shall it be necessary for the insurer to furnish each person a certificate.
Source
Laws 1947, c. 164, § 17(2), p. 470;
Laws 1989, LB 92, § 154.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-764 - Blanket sickness and accident insurance; benefits, how payable.

44-764.
Blanket sickness and accident insurance; benefits, how payable.
All benefits under any blanket policy of sickness and accident insurance shall be payable to the person insured, to his or her designated beneficiary or beneficiaries, or to his or her estate, except that if the person insured is minor, such benefits may be made payable to his or her parent, guardian, or other person actually supporting him or her. All or a portion of any benefits payable under such a policy on account of hospital, nursing, medical, or surgical services may, at the insurer's option, be paid directly to the hospital or person rendering such services, but it shall not be required that the services be rendered by a particular hospital or person.
Source
Laws 1947, c. 164, § 17(3), p. 471;
Laws 1989, LB 92, § 155.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-765 - Blanket sickness and accident insurance; legal liability of policyholders not affected.

44-765.
Blanket sickness and accident insurance; legal liability of policyholders not affected.
Nothing contained in sections 44-762 to 44-765 shall be deemed to affect the legal liability of policyholders for the death of or injury to, any such member of such group.
Source
Laws 1947, c. 164, § 17(4), p. 471.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-766 - Sickness and accident insurance; wrongful delivery of policy; violations; penalties; appeal.

44-766.
Sickness and accident insurance; wrongful delivery of policy; violations; penalties; appeal.
Any person, partnership, limited liability company, or corporation who or which willfully delivers or issues for delivery in this state any policy of sickness and accident insurance on a form which has been disapproved by the Director of Insurance or willfully violates any provision of sections 44-709 to 44-767 or an order of the director made in accordance with sections 44-710 to 44-767 shall forfeit to the people of the state a sum not to exceed one hundred dollars for each such violation which may be recovered by a civil action. The director may after notice and hearing revoke the license of an insurer or agent for any such willful violation. Any person aggrieved by any action of the Director of Insurance may appeal. The appeal shall be in accordance with the Administrative Procedure Act.
Source
Laws 1947, c. 164, § 18, p. 471;
Laws 1957, c. 188, § 20, p. 660;
Laws 1969, c. 359, § 25, p. 1278;
Laws 1988, LB 352, § 55;
Laws 1989, LB 92, § 156;
Laws 1993, LB 121, § 228.
Cross References
Administrative Procedure Act, see section 84-920.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-767 - Sickness and accident insurance; other insurance not affected.

44-767.
Sickness and accident insurance; other insurance not affected.
Nothing in sections 44-709 to 44-767 shall apply to or affect (1) any policy of workers' compensation insurance or any policy of liability insurance with or without supplementary coverage therein, (2) any policy or contract of reinsurance, or (3) life insurance, endowment or annuity contracts, or contracts supplemental thereto which contain only such provisions relating to sickness and accident insurance as (a) provide additional benefits in case of death, dismemberment, or loss of sight by accident and (b) operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or annuity in the event that the insured or annuitant shall become totally and permanently disabled, as defined by the contract or supplemental contract. Sections 44-710.03 to 44-710.09, 44-710.12, and 44-710.16 shall not apply to those forms of sickness and accident policies enumerated in section 44-758 or sections 44-760 to 44-765, except that no such policy shall contain any provision relative to notice or proof of loss, the time for paying benefits, or the time within which suit may be brought upon the policy, which in the opinion of the Director of Insurance is less favorable to the insured than would be permitted by the policy provisions set forth in sections 44-710.03 and 44-710.04.
Source
Laws 1947, c. 164, § 19, p. 471;
Laws 1957, c. 188, § 21, p. 660;
Laws 1969, c. 359, § 26, p. 1278;
Laws 1986, LB 811, § 18;
Laws 1989, LB 92, § 157.
Annotations
In accordance with this section, a group health insurance policy may contain contractual limitations periods so long as they are not "less favorable to the insured than would be permitted" under section 44-710.03. Brodine v. Blue Cross Blue Shield, 272 Neb. 713, 724 N.W.2d 321 (2006).
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-769 - Legislative findings; alcoholism insurance.

44-769.
Legislative findings; alcoholism insurance.
The Legislature hereby declares and finds that alcoholism is a disease which, if untreated, is highly disruptive of family life and employment and costs the state, its political subdivisions, insurers, employers, and taxpayers millions of dollars annually because of highway deaths and injuries, lost wages, lower productivity, welfare and unemployment compensation, greater utilization of health insurance benefits and premature death, alcohol-related crimes, and the corresponding costs to the criminal justice and penal systems. The Legislature further finds that while most health benefit plans pay the high cost of treating the symptoms, injuries, and diseases associated with alcoholism many exclude coverage for treatment of the disease itself or limit coverage to acute portions of hospitals which do not generally treat the disease. The Legislature therefor declares that group subscribers and insureds should have information concerning the scope of alcoholism benefits being offered and access to coverage for treatment of the disease on such terms and conditions as may be agreed upon between the subscriber or insured and the insurer or health maintenance organization.
Source
Laws 1980, LB 646, § 1;
Laws 1989, LB 92, § 158.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-771 - Hospital, defined.

44-771.
Hospital, defined.
Hospital shall mean an institution licensed as a hospital by the Department of Health and Human Services and defined in section 71-419.
Source
Laws 1980, LB 646, § 3;
Laws 1996, LB 1044, § 236;
Laws 2000, LB 819, § 69;
Laws 2007, LB296, § 173.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-772 - Substance abuse treatment center, defined.

44-772.
Substance abuse treatment center, defined.
Substance abuse treatment center shall mean an institution licensed as a substance abuse treatment center by the Department of Health and Human Services, which provides a program for the inpatient or outpatient treatment of alcoholism pursuant to a written treatment plan approved and monitored by a physician and which is affiliated with a hospital under a contractual agreement with an established system for patient referral.
Source
Laws 1980, LB 646, § 4;
Laws 1985, LB 209, § 1;
Laws 1985, LB 253, § 1;
Laws 1996, LB 1044, § 237;
Laws 1996, LB 1155, § 17;
Laws 2000, LB 819, § 70;
Laws 2007, LB296, § 174;
Laws 2018, LB1034, § 47.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-773 - Outpatient program, defined.

44-773.
Outpatient program, defined.
Outpatient program shall refer to a program which is licensed or certified by the Department of Health and Human Services or the Division of Behavioral Health of the Department of Health and Human Services to provide specified services to persons suffering from the disease of alcoholism.
Source
Laws 1980, LB 646, § 5;
Laws 1995, LB 275, § 3;
Laws 1996, LB 1044, § 238;
Laws 1996, LB 1155, § 18;
Laws 2004, LB 1083, § 96;
Laws 2007, LB296, § 175.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-774 - Certified, defined.

44-774.
Certified, defined.
Certified shall mean approved by the Division of Behavioral Health of the Department of Health and Human Services to render specific types or levels of care to the person suffering from the disease of alcoholism.
Source
Laws 1980, LB 646, § 6;
Laws 1995, LB 275, § 4;
Laws 1996, LB 1044, § 239;
Laws 2004, LB 1083, § 97;
Laws 2007, LB296, § 176.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-776 - Primary treatment, defined.

44-776.
Primary treatment, defined.
Primary treatment shall mean inpatient treatment rendered in a structured and scheduled setting to prevent further ingestion of alcoholic beverages, to relieve the pain of the withdrawal syndrome, and to provide intensive therapy or rehabilitation, when such treatment is rendered in a hospital or a substance abuse treatment center which is certified or accredited to render such care.
Source
Laws 1980, LB 646, § 8;
Laws 1996, LB 1155, § 19.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-777 - Outpatient treatment, defined.

44-777.
Outpatient treatment, defined.
Outpatient treatment shall mean counseling and therapy provided on a nonresidential basis when such treatment is rendered in or through a hospital, a substance abuse treatment center, or an outpatient program which is certified or accredited to render such care.
Source
Laws 1980, LB 646, § 9;
Laws 1996, LB 1155, § 20.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-778 - Basic coverage for treatment of alcoholism, defined.

44-778.
Basic coverage for treatment of alcoholism, defined.
Basic coverage for treatment of alcoholism shall mean coverage for primary and outpatient treatment consisting of not less than (1) thirty days of inpatient coverage for the primary treatment of alcoholism in any three-hundred-sixty-five-day benefit period with at least two such inpatient treatment periods available during the lifetime of the policy, and (2) sixty outpatient treatment visits during the lifetime of the policy.
Source
Laws 1980, LB 646, § 10.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-779 - Group sickness and accident insurance; coverage for the treatment of alcoholism; requirements.

44-779.
Group sickness and accident insurance; coverage for the treatment of alcoholism; requirements.
After January 1, 1981, all policies or contracts of group sickness and accident insurance written or issued by insurance companies and all group contracts or certificates written or issued by a health maintenance organization as to which there is a premium change or which are delivered or issued for delivery in this state, which do not provide at least basic coverage for the treatment of alcoholism, shall be subject to the following:
(1) The written sales and advertising literature, the descriptive brochures, and the exclusion sections of such policy, contract, or certificate shall contain a notice in all capital letters in the following language or in words of similar effect as approved by the Director of Insurance: This agreement does not provide basic coverage for the treatment of alcoholism. Coverage for treatment of alcoholism is available if you specifically request it and then only upon such terms and conditions as you and the company agree;
(2) The written sales and advertising literature, the descriptive brochures, and such policy, contract, or subscription agreement itself shall not, in describing the plan, contract, coverage, or benefits, use the words comprehensive;
(3) The definition of a facility, program, or agency in or through which covered alcoholism services may be rendered contained in any optional coverage shall not be more restrictive than the definitions contained in sections 44-771 to 44-775 if the effect of such definitions would be to limit, deny, or withhold benefits which would be available if the definitions used in sections 44-769 to 44-781 were applied;
(4) Such policy, contract, or subscription agreement shall provide benefits to any person covered thereunder for the treatment of alcoholism under such terms and conditions as may be agreed upon between the subscriber or insured and the insurer or health maintenance organization; and
(5) In the case of policies, contracts, and subscription agreements issued before January 1, 1981, as to which there is a premium change after January 1, 1981, the notification requirements of this section may be met by written endorsement to such policy, contract, or subscription agreement.
Source
Laws 1980, LB 646, § 11;
Laws 1989, LB 92, § 159.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-780 - Basic coverage for treatment of alcoholism; when considered available.

44-780.
Basic coverage for treatment of alcoholism; when considered available.
An insurance company or health maintenance organization will be considered to be providing basic coverage for treatment of alcoholism if it makes benefits available for the treatment described in section 44-778 on terms involving durational limits, dollar limits, deductibles, and coinsurance which are no less favorable than the terms on which it makes benefits available for the treatment of physical illness generally.
Source
Laws 1980, LB 646, § 12;
Laws 1989, LB 92, § 160.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-781 - Coverage for treatment of alcoholism; benefits available.

44-781.
Coverage for treatment of alcoholism; benefits available.
An insurance company or health maintenance organization which does not provide basic coverage for treatment of alcoholism may nevertheless provide different or lesser benefits. Nothing in sections 44-769 to 44-781 is intended to limit any insurance company or health maintenance organization from providing more coverage for the treatment of alcoholism than is described in section 44-778.
Source
Laws 1980, LB 646, § 13;
Laws 1989, LB 92, § 161.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-782 - Health insurance provider; coverage of mental or nervous disorders; requirements.

44-782.
Health insurance provider; coverage of mental or nervous disorders; requirements.
No insurance company, health maintenance organization, or other health insurance provider shall deny payment for treatment of mental or nervous disorders under a policy, contract, certificate, or other evidence of coverage issued or delivered in Nebraska on the basis that the hospital or state institution licensed as a hospital by the Department of Health and Human Services and defined in section 71-419 providing such treatment is publicly funded and charges are reduced or no fee is charged depending on the patient's ability to pay.
Source
Laws 1985, LB 487, § 1;
Laws 1989, LB 92, § 162;
Laws 1996, LB 1044, § 240;
Laws 2000, LB 819, § 71;
Laws 2007, LB296, § 177.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-783 - Health insurance insurer; choice of pharmacy; limitation; when.

44-783.
Health insurance insurer; choice of pharmacy; limitation; when.
(1) If any insurer authorized to transact the business of health insurance in this state reasonably determines that an insured's utilization of prescription medications has been excessive and has not been medically necessary as defined by the insured's coverage, the insurer may reserve the right to limit such insured to a pharmacy of the insured's choice for obtaining prescription drug benefits. If the insured's coverage is through a preferred provider organization, the insurer or preferred provider organization may limit the insured to a preferred provider pharmacy of the insured's choice. If an insured has been so limited, the insurer or preferred provider organization shall not be required to provide benefits for prescriptions obtained from any other pharmacy. The insurer or preferred provider organization may require that the insured provide written notification to the insurer or preferred provider organization of the insured's choice of pharmacy.
(2) The action by the insurer or preferred provider organization limiting an insured to one pharmacy of the insured's choice may be effective as of the date specified in a written notice to the insured. Such written notice shall be sent to the insured at his or her last-known address as shown by the records of the insurer or preferred provider organization by certified or registered mail and shall inform the insured that he or she is required to select one pharmacy for obtaining prescription drug benefits. The terms of the written notice shall allow the insured at least seven days to notify the insurer or preferred provider organization of his or her choice of pharmacy.
Source
Laws 1993, LB 536, § 19.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-784 - Coverage for childhood immunizations; requirements.

44-784.
Coverage for childhood immunizations; requirements.
Notwithstanding section 44-3,131, any expense-incurred group sickness and accident insurance policy, certificate, or subscriber contract delivered, issued for delivery, or renewed after January 1, 1995, or any expense-incurred individual sickness and accident insurance policy, certificate, or subscriber contract delivered or issued for delivery after such date that provides coverage for a dependent child under six years of age shall provide coverage for childhood immunizations. Benefits for childhood immunizations shall be exempt from any deductible provision contained in the applicable policy. Copayment, coinsurance, and dollar-limit provisions applicable to other medical services may be applied to the childhood immunization benefits. This section shall not apply to any individual or group policies that provide coverage for a specified disease, accident-only coverage, hospital indemnity coverage, medicare supplement coverage, long-term care coverage, or other limited-benefit coverage.
For purposes of this section, childhood immunizations shall mean the complete set of vaccinations for children from birth to six years of age for immunization against measles, mumps, rubella, poliomyelitis, diphtheria, pertussis, tetanus, and haemophilus influenzae type B.
Source
Laws 1994, LB 1222, § 46;
Laws 2007, LB63, § 1.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-786 - Obstetricians/gynecologists as primary care physicians; requirements.

44-786.
Obstetricians/gynecologists as primary care physicians; requirements.
On or after July 1, 1996, any entity which offers any individual or group sickness and accident insurance policy, subscriber contract, health maintenance organization contract, or hospital, medical, or surgical expense-incurred policy which is delivered, issued for delivery, or renewed in this state shall include obstetricians/gynecologists as primary care physicians if they otherwise qualify as a primary care physician pursuant to the credentialing or recredentialing standards of that entity and they perform all of the functions of a primary care physician according to the terms and conditions of such entity's primary care physician contract.
Source
Laws 1996, LB 532, § 1.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-789 - Coverage for bone or joint treatment; requirements.

44-789.
Coverage for bone or joint treatment; requirements.
Notwithstanding section 44-3,131, no group policy of accident or health insurance, health services plan, or health maintenance organization subscription shall be offered for sale in this state on or after January 1, 2009, unless such policy, plan, subscription, or contract which specifically provides coverage for surgical and nonsurgical treatment involving a bone or joint of the skeletal structure includes the option to provide coverage, for an additional premium and subject to the insurer's standard of insurability, for the reasonable and necessary medical treatment of temporomandibular joint disorder and craniomandibular disorder. The purchaser of the group policy of accident or health insurance, health services plan, or health maintenance organization subscription shall accept or reject the coverage in writing on the application or an amendment thereto for the master group policy of accident or health insurance, health services plan, or health maintenance organization subscription. Benefits may be subject to the same preexisting conditions, limitations, deductibles, copayments, and coinsurance that generally apply to any other sickness. The maximum lifetime benefits for temporomandibular joint disorder and craniomandibular disorder treatment shall be no less than two thousand five hundred dollars. Nothing in this section shall prevent an insurer from including such coverage for temporomandibular joint disorder and craniomandibular disorder as part of a policy's basic coverage instead of offering optional coverage.
Source
Laws 1998, LB 1162, § 82;
Laws 2008, LB855, § 5.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-790.01 - Covered prescription insulin drug; maximum payment; ensure access; requirements.

44-790.01.
Covered prescription insulin drug; maximum payment; ensure access; requirements.
(1) Except as provided in subsection (3) of this section, beginning January 1, 2024, and notwithstanding section 44-3,131, (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, which provides reimbursement for prescription insulin drugs shall limit the total amount that a covered individual is required to pay for each covered prescription insulin drug on the policy's, contract's, or plan's lowest brand or generic tier to a maximum of thirty-five dollars per thirty-day supply of insulin, regardless of the amount needed.
(2) Nothing in this section prevents a policy, contract, or plan from reducing the total amount that a covered individual is required to pay for each covered prescription insulin drug to an amount less than the maximum specified in subsection (1) of this section.
(3) If, due to a national shortage of an insulin drug, a covered individual cannot access a covered prescription insulin drug on the lowest brand or generic tier of the policy, contract, or plan, the policy, contract, or plan shall ensure access to an insulin drug at a maximum of thirty-five dollars per thirty-day supply, until such time that the national shortage ends to prevent disruptions in patient access to insulin.
(4) For purposes of this section, prescription insulin drug means a prescription drug that contains insulin and is used to treat diabetes.
Source
Laws 2023, LB92, § 86.
Operative Date: September 2, 2023
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-791 - Mental health conditions; legislative findings.

44-791.
Mental health conditions; legislative findings.
The Legislature finds that mental health conditions affect a significant number of Nebraskans. Mental health conditions, like severe physical injuries or illness, can be life-altering and debilitating in nature. If properly treated and managed by mental health professionals, persons with mental health conditions can and do lead full and productive lives. However, without such treatment or management, many mental health conditions will progressively deteriorate and negatively impact upon a person's livelihood, social relationships, and physical health.
The Legislature also finds that many persons with mental health conditions either do not seek treatment or do not complete or maintain such treatment programs. Treatment options are not underutilized due to the scarcity of professional resources or the lack of desire on the part of persons with mental health conditions, but rather treatment has become unaffordable as the result of the rising health care costs combined with a lack of insurance coverage for mental health conditions. The associated societal and monetary costs of providing no treatment or untimely treatment to persons with mental health conditions are great. It is the intent of sections 44-791 to 44-795 that persons with group health insurance plans providing coverage for mental health conditions be provided with a minimum level of coverage.
Source
Laws 1999, LB 355, § 1.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-793 - Mental health conditions; coverage; requirements.

44-793.
Mental health conditions; coverage; requirements.
(1) On or after January 1, 2000, notwithstanding section 44-3,131, any health insurance plan delivered, issued, or renewed in this state (a) if coverage is provided for treatment of mental health conditions other than alcohol or substance abuse, (i) shall not establish any rate, term, or condition that places a greater financial burden on an insured for access to treatment for a serious mental illness than for access to treatment for a physical health condition, (ii) shall not establish any rate, term, or condition that places a greater financial burden on an insured for accessing treatment for a mental health condition using telehealth services as defined in section 44-312, (iii) shall provide, at a minimum, a reimbursement rate for accessing treatment for a mental health condition using telehealth services that is the same as the rate for a comparable treatment provided or supervised in person, and (iv) if an out-of-pocket limit is established for physical health conditions, shall apply such out-of-pocket limit as a single comprehensive out-of-pocket limit for both physical health conditions and mental health conditions, or (b) if no coverage is to be provided for treatment of mental health conditions, shall provide clear and prominent notice of such noncoverage in the plan.
(2) If a health insurance plan provides coverage for serious mental illness, the health insurance plan shall cover health care rendered for treatment of serious mental illness (a) by a mental health professional, (b) by a person authorized by the rules and regulations of the Department of Health and Human Services to provide treatment for mental illness, (c) using telehealth services as defined in section 44-312, (d) in a mental health center as defined in section 71-423, or (e) in any other health care facility licensed under the Health Care Facility Licensure Act that provides a program for the treatment of a mental health condition pursuant to a written plan. The issuer of a health insurance plan may require a health care provider under this subsection to enter into a contract as a condition of providing benefits.
(3) The Director of Insurance may disapprove any plan that the director determines to be inconsistent with the purposes of this section.
Source
Laws 1999, LB 355, § 3;
Laws 2000, LB 819, § 72;
Laws 2007, LB296, § 178;
Laws 2021, LB487, § 1.
Cross References
Health Care Facility Licensure Act, see section 71-401.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-794 - Mental health conditions; sections; how construed.

44-794.
Mental health conditions; sections; how construed.
(1) Sections 44-791 to 44-795 shall not be construed to:
(a) Require a health insurance plan to provide coverage for mental health conditions or serious mental illnesses;
(b) Require a health insurance plan to provide the same rates, terms, or conditions between treatments for serious mental illnesses and preventative care;
(c) Prohibit a health insurance plan from providing separate reimbursement rates and service delivery systems, including, but not limited to, mental health carve-out programs even if the plan does not provide similar options for the treatment of physical health conditions. A health insurance plan provided in compliance with section 44-793 shall not be construed to violate the Managed Care Plan Network Adequacy Act; or
(d) Prohibit a health insurance plan from managing the provision of benefits through common methods, including, but not limited to, preadmission screening, prior authorization of services, or other mechanisms designed to limit coverage to services for mental health conditions that are deemed to be medically necessary and clinically appropriate.
(2) A health insurance plan does not violate section 44-793 if the plan applies different rates, terms, and conditions or excludes entirely from coverage the following:
(a) Marital, family, educational, developmental, or training services;
(b) Care that is substantially custodial in nature;
(c) Services and supplies that are not medically necessary or clinically appropriate; or
(d) Experimental treatments.
(3) A health insurance plan may use a case management program or managed care organization to evaluate, determine, and provide or arrange for medically necessary and clinically appropriate care and treatment of each person with a mental health condition or serious mental illness who is covered by the plan.
(4) A health insurance plan shall not be required to offer coverage for nonemergency services rendered outside its network of contracted providers.
Source
Laws 1999, LB 355, § 4.
Cross References
Managed Care Plan Network Adequacy Act, see section 44-7101.
2023 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.