reglab/statecodes huggingface dataset:
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3106 - Certificate of authority; issued, when; minimum surplus.

44-3106.
Certificate of authority; issued, when; minimum surplus.
No professional association mutual insurance company shall be issued a certificate of authority to do any business in this state until it has filed with the director acceptable evidence that it has and will maintain a minimum surplus aggregating at least five hundred thousand dollars in cash in the investments authorized under the Insurers Investment Act or a letter of credit issued by a Nebraska banking institution in accordance with loan restrictions prescribed by the laws of this state.
Source
Laws 1978, LB 656, § 6;
Laws 1991, LB 237, § 68.
Cross References
Insurers Investment Act, see section 44-5101.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3107 - Certificate of authority; issued, when; minimum number of applications and annual premiums.

44-3107.
Certificate of authority; issued, when; minimum number of applications and annual premiums.
No professional association mutual insurance company shall be issued a certificate of authority to do any business in this state until it has received not less than two hundred applications for insurance, and it shall have received in cash one annual premium for each such application.
Source
Laws 1978, LB 656, § 7.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3108 - Membership in the Nebraska Property and Liability Insurance Guaranty Association; prohibited.

44-3108.
Membership in the Nebraska Property and Liability Insurance Guaranty Association; prohibited.
Any professional association mutual insurance company shall not be a member of the Nebraska Property and Liability Insurance Guaranty Association described in Chapter 44, article 24.
Source
Laws 1978, LB 656, § 8.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3109 - Policy; issued; membership fee.

44-3109.
Policy; issued; membership fee.
Any professional association mutual insurance company may collect, at the time a policy is issued, a membership fee. Such fee shall be in addition to any premium charged for insurance and shall be paid into the company's surplus.
Source
Laws 1978, LB 656, § 9.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3110 - Administrative fee; payment, when; how computed; license; rescission; notice; hearing; appeal.

44-3110.
Administrative fee; payment, when; how computed; license; rescission; notice; hearing; appeal.
(1) In addition to the premium tax prescribed in Chapter 77, article 9, every professional association mutual insurance company licensed pursuant to the Nebraska Professional Association Mutual Insurance Company Act shall, on or before March 1 of each year, pay an administrative fee to the director in the amount of three-tenths of one percent of the gross amount of direct writing premiums received by it during the preceding calendar year for business done in this state.
(2) The computation of the administrative fee shall be made on forms furnished by the Department of Insurance, and the fee shall be forwarded to the department together with a sworn statement by an appropriate officer of the company attesting the accuracy of the fee computation. The department shall furnish such forms prior to the end of the year for which the fees are payable.
(3) The director shall rescind or refuse to reissue the license of any company which fails to remit the administrative fee in conformity with this section. Prior to rescinding such license, the director shall issue an order to the company directing the company to show cause why such rescission should not be made. The director shall give not less than ten days' notice of a rescission hearing before the department. Should the company be aggrieved by such determination, an appeal may be taken, and the appeal shall be in accordance with the Administrative Procedure Act.
Source
Laws 1978, LB 656, § 10;
Laws 1986, LB 1114, § 7;
Laws 1988, LB 352, § 68.
Cross References
Administrative Procedure Act, see section 84-920.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3112 - Act; other provisions applicable.

44-3112.
Act; other provisions applicable.
To the extent applicable and when not in conflict with the Nebraska Professional Association Mutual Insurance Company Act, the provisions of the Nebraska Model Business Corporation Act and Chapters 44 and 77 relating to corporations and insurance shall apply to companies incorporated pursuant to the Nebraska Professional Association Mutual Insurance Company Act.
Source
Laws 1978, LB 656, § 12;
Laws 1989, LB 92, § 219;
Laws 1995, LB 109, § 223;
Laws 2014, LB749, § 289.
Cross References
Nebraska Model Business Corporation Act, see section 21-201.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3294 - Basic health care services, defined.

44-3294.
Basic health care services, defined.
Basic health care services shall include as a minimum the following medically necessary services: Preventive care; emergency care; inpatient and outpatient hospital and physician care; diagnostic laboratory services; diagnostic and therapeutic radiological services; and out-of-area emergency services.
Source
Laws 1990, LB 1136, § 3.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,100 - Evidence of coverage, defined.

44-32,100.
Evidence of coverage, defined.
Evidence of coverage shall mean a statement of the essential features and services of the health maintenance organization coverage which is given to the subscriber by the health maintenance organization or by the group contract holder.
Source
Laws 1990, LB 1136, § 9.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,101 - Extension of benefits, defined.

44-32,101.
Extension of benefits, defined.
Extension of benefits shall mean the continuation of coverage under a particular benefit provided under a contract following termination with respect to an enrollee who is totally disabled on the date of termination.
Source
Laws 1990, LB 1136, § 10.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,102 - Grievance, defined.

44-32,102.
Grievance, defined.
Grievance shall mean a written complaint submitted in accordance with the health maintenance organization's formal grievance procedure by or on behalf of the enrollee regarding any aspect of the health maintenance organization relative to the enrollee.
Source
Laws 1990, LB 1136, § 11.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,105 - Health maintenance organization, defined.

44-32,105.
Health maintenance organization, defined.
Health maintenance organization shall mean any person who undertakes to provide or arrange for the delivery of basic health care services to enrollees on a prepaid basis except for enrollee responsibility for copayments or deductibles.
Source
Laws 1990, LB 1136, § 14.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,106 - Health maintenance organization producer, defined.

44-32,106.
Health maintenance organization producer, defined.
Health maintenance organization producer shall mean a person licensed under subdivision (1)(b) of section 44-4054 who solicits, negotiates, effects, procures, delivers, renews, or continues a policy or contract for health maintenance organization membership, or who takes or transmits a membership fee or premium for such a policy or contract, other than for himself or herself, or who advertises or otherwise holds himself or herself out to the public as such.
Source
Laws 1990, LB 1136, § 15;
Laws 2008, LB855, § 20.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,108 - Insolvent or insolvency, defined.

44-32,108.
Insolvent or insolvency, defined.
Insolvent or insolvency shall mean that the health maintenance organization has been declared insolvent and placed under an order of liquidation by a court of competent jurisdiction.
Source
Laws 1990, LB 1136, § 17.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 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.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,134 - Filings; required.

44-32,134.
Filings; required.
(1) Every health maintenance organization shall file annually, on or before March 1, an annual financial statement with the Director of Insurance, with a copy to the Department of Health and Human Services, covering the preceding calendar year. The annual financial statement shall be on forms prescribed by the Director of Insurance and shall be prepared in accordance with annual statement instructions and accounting practices and procedures manuals as prescribed by the director which conform substantially to the annual statement instructions and the Accounting Practices and Procedures Manuals of the National Association of Insurance Commissioners.
(2) Every health maintenance organization shall file annually, on or before March 1, with the Director of Insurance, with a copy to the department:
(a) A list of the providers who have executed a contract that complies with section 44-32,141; and
(b) A description of the grievance procedures, the total number of grievances handled through such procedures, a compilation of the causes underlying those grievances, and a summary of the final disposition of those grievances.
(3) Every health maintenance organization shall file annually, on or before June 1, audited financial statements with the Director of Insurance, with a copy to the department.
(4) The Director of Insurance may require such additional reports as are deemed necessary and appropriate to carry out his or her duties under the Health Maintenance Organization Act.
Source
Laws 1990, LB 1136, § 43;
Laws 1996, LB 1044, § 249;
Laws 2000, LB 930, § 9;
Laws 2007, LB296, § 188.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,135 - Information to subscribers and enrollees.

44-32,135.
Information to subscribers and enrollees.
Each health maintenance organization shall provide a list of providers to its subscribers upon enrollment and reenrollment. Each health maintenance organization shall provide notice within thirty days of any material change in the operation of the health maintenance organization to its subscribers if the change affects the subscribers directly. An enrollee shall be notified in writing by the health maintenance organization of the termination of the primary care provider who provided health care services to that enrollee. The health maintenance organization shall provide assistance to the enrollee in transferring to another participating provider. Each health maintenance organization shall provide to subscribers information on how services may be obtained and where additional information on access to services can be obtained and a toll-free telephone number for calls within the service area.
Source
Laws 1990, LB 1136, § 44.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,136 - Grievance procedure.

44-32,136.
Grievance procedure.
Each health maintenance organization shall establish and maintain a grievance procedure to provide for the resolution of grievances initiated by enrollees. The procedure shall be approved by the Director of Insurance after consultation with the Department of Health and Human Services. The Director of Insurance or the department may examine the grievance procedure. The health maintenance organization shall maintain records regarding grievances received since the date of the last examination.
Source
Laws 1990, LB 1136, § 45;
Laws 1996, LB 1044, § 250;
Laws 2007, LB296, § 189.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,137 - Investments.

44-32,137.
Investments.
With the exception of investments made in accordance with subdivision (1) of section 44-32,122, the investable funds of a health maintenance organization shall be invested only as authorized under the Insurers Investment Act for a domestic life insurance company.
Source
Laws 1990, LB 1136, § 46;
Laws 1991, LB 237, § 69.
Cross References
Insurers Investment Act, see section 44-5101.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,138 - Net worth requirements.

44-32,138.
Net worth requirements.
(1) Before issuing a certificate of authority, the director shall require that the health maintenance organization have an initial net worth of one million five hundred thousand dollars and maintain the minimum net worth required under this section.
(2) Except as provided in subsection (3) of this section, a health maintenance organization shall maintain a minimum net worth equal to the greater of:
(a) One million dollars; or
(b) Two percent of annual premium revenue as reported on the most recent annual financial statement filed with the director on the first one hundred fifty million dollars of premium revenue and one percent of annual premium revenue on the premium revenue in excess of one hundred fifty million dollars.
(3) A health maintenance organization licensed under prior law before July 10, 1990, shall maintain a minimum net worth of:
(a) Twenty-five percent of the amount required by subsection (2) of this section by December 31, 1990;
(b) Fifty percent of the amount required by subsection (2) of this section by December 31, 1991;
(c) Seventy-five percent of the amount required by subsection (2) of this section by December 31, 1992; and
(d) One hundred percent of the amount required by subsection (2) of this section by December 31, 1993.
(4) In determining net worth, no debt shall be considered fully subordinated unless the subordination clause is in a form acceptable to the director. Any interest obligation relating to the repayment of any subordinated debt shall be similarly subordinated. The interest expenses relating to the repayment of any fully subordinated debt shall be considered covered expenses. Any debt incurred by a note meeting the requirements of this subsection and otherwise acceptable to the director shall not be considered a liability and shall be recorded as equity.
Source
Laws 1990, LB 1136, § 47.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,139 - Deposit requirements.

44-32,139.
Deposit requirements.
(1) Except as provided in subsection (2) of this section, each health maintenance organization shall deposit with the director, or at the discretion of the director with any organization or trustee acceptable to him or her through which a custodial or controlled account is utilized, cash, securities, or any combination of cash or securities or other measures that are acceptable to the director which at all times have a value of not less than three hundred thousand dollars.
(2) A health maintenance organization that is in operation under prior law on July 10, 1990, shall make a deposit equal to one hundred fifty thousand dollars for the first year and three hundred thousand dollars for the second year.
(3) The deposit made pursuant to this section shall be an admitted asset of the health maintenance organization in the determination of net worth. All income from a deposit shall be an asset of the health maintenance organization. A health maintenance organization that has made a securities deposit may withdraw that deposit or any part thereof after making a substitute deposit of cash, securities, or any combination of cash or securities or other measures of equal amount and value. Any securities or other measures shall be approved by the director before being deposited or substituted.
(4) The deposit made pursuant to this section shall be used to protect the interests of the health maintenance organization's enrollees and to assure continuation of health care services to enrollees of a health maintenance organization which is in rehabilitation or conservation. The director may use the deposit for administrative costs directly attributable to a receivership or liquidation. If the health maintenance organization is placed in receivership or liquidation, the deposit shall be an asset subject to the Nebraska Insurers Supervision, Rehabilitation, and Liquidation Act.
(5) The director may reduce or eliminate the deposit requirement if the health maintenance organization deposits with the state treasurer, insurance commissioner, insurance director, insurance superintendent, or equivalent official of the state or jurisdiction of domicile for the protection of all subscribers and enrollees of such health maintenance organization, wherever located, cash, acceptable securities, or surety and delivers to the director a certificate to such effect duly authenticated by the appropriate official holding the deposit.
Source
Laws 1990, LB 1136, § 48.
Cross References
Nebraska Insurers Supervision, Rehabilitation, and Liquidation Act, see section 44-4862.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,140 - Liabilities; computation.

44-32,140.
Liabilities; computation.
Every health maintenance organization shall, when determining liabilities, include an amount estimated in the aggregate to provide (1) for any unearned premium, (2) for the payment of all claims for health care expenditures which have been incurred, whether reported or unreported, which are unpaid, and for which such organization is or may be liable, and (3) for the expense of adjustment or settlement of such claims. Such liabilities shall be computed in accordance with rules and regulations adopted and promulgated by the director upon reasonable consideration of the ascertained experience and character of the health maintenance organization.
Source
Laws 1990, LB 1136, § 49.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,141 - Provider contracts; requirements.

44-32,141.
Provider contracts; requirements.
Every contract between a health maintenance organization and a participating provider shall be in writing and shall provide that, if the health maintenance organization fails to pay for health care services as set forth in the contract, the subscriber or enrollee will not be liable to the provider for any sum owed by the health maintenance organization. If the contract has not been reduced to writing or fails to contain the provision required by this section, the participating provider shall not collect or attempt to collect from the subscriber or enrollee sums owed by the health maintenance organization. No participating provider, or agent, trustee, or assignee of a participating provider, may maintain any action at law against a subscriber or enrollee to collect sums owed by the health maintenance organization.
Source
Laws 1990, LB 1136, § 50.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,142 - Provider agreement; notice of termination.

44-32,142.
Provider agreement; notice of termination.
An agreement to provide health care services between a provider and a health maintenance organization shall require that, if the provider terminates the agreement, the provider will give the health maintenance organization at least sixty days' notice of termination.
Source
Laws 1990, LB 1136, § 51.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,143 - Insolvency; plan required.

44-32,143.
Insolvency; plan required.
The director shall require that each health maintenance organization have a plan for handling insolvency which allows for continuation of benefits for the duration of the contract period for which premiums have been paid and continuation of benefits to members who are confined on the date of insolvency in an inpatient facility until their discharge or expiration of benefits. The director may require:
(1) Insurance to cover the expenses to be paid for continued benefits after an insolvency;
(2) Provisions in provider contracts that obligate the provider to provide services for the duration of the period after the health maintenance organization's insolvency for which premium payment has been made and until the enrollees' discharge from inpatient facilities;
(3) Insolvency reserves;
(4) Acceptable letters of credit; and
(5) Any other arrangements to assure that benefits are continued as specified in this section.
Source
Laws 1990, LB 1136, § 52.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,144 - Uncovered expenditures insolvency deposit.

44-32,144.
Uncovered expenditures insolvency deposit.
(1) If uncovered expenditures exceed ten percent of the total health care expenditures of a health maintenance organization for the previous calendar quarter, the health maintenance organization shall place an uncovered expenditures insolvency deposit of cash or securities that are acceptable to the director with the director or with any organization or trustee acceptable to the director through which a custodial or controlled account is maintained. Such deposit shall at all times have a fair market value in an amount of one hundred twenty percent of the health maintenance organization's outstanding liability for uncovered expenditures for enrollees in this state, including incurred but not reported claims. The fair market value of the deposit shall be calculated as of the first day of the month and maintained for the remainder of the month. If a health maintenance organization is not otherwise required to file a quarterly report, it shall file a report within forty-five days of the end of the calendar quarter with information sufficient to demonstrate compliance with this section.
(2) The deposit required under this section shall be in addition to the deposit required under section 44-32,139 and shall be an admitted asset of the health maintenance organization in the determination of net worth. All income from such deposits or trust accounts shall be assets of the health maintenance organization and may be withdrawn quarterly with the approval of the director.
(3) A health maintenance organization that has made a deposit may withdraw that deposit or any part of the deposit if (a) a substitute deposit of cash or securities of equal amount and value is made, (b) the fair market value of the deposit exceeds the amount of the required deposit, or (c) the required deposit is reduced or eliminated. Deposits, substitutions, or withdrawals may be made only with the prior written approval of the director.
Source
Laws 1990, LB 1136, § 53.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,145 - Uncovered expenditures insolvency deposit; use.

44-32,145.
Uncovered expenditures insolvency deposit; use.
The deposit required under section 44-32,144 shall be in trust and may be used only by the director for administrative costs associated with administering the deposit and payment of claims of enrollees of this state for uncovered expenditures. Claims for uncovered expenditures shall be paid on a pro rata basis based on assets available to pay such ultimate liability for incurred uncovered expenses. Partial distribution may be made pending final distribution. Any amount of the deposit remaining shall be paid into the liquidation or receivership of the health maintenance organization. The director may prescribe the time, manner, and form for filing claims under this section.
Source
Laws 1990, LB 1136, § 54.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,146 - Uncovered expenditures; reports.

44-32,146.
Uncovered expenditures; reports.
The director may require a health maintenance organization to file annual or quarterly, or more frequent, reports of uncovered expenditures and liability for uncovered expenditures. The director may require that the reports include an audit opinion.
Source
Laws 1990, LB 1136, § 55.