reglab/statecodes huggingface dataset:
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5231.01 - Bona fide association, defined.

44-5231.01.
Bona fide association, defined.
Bona fide association means, with respect to health insurance coverage offered in this state, an association that meets the following conditions:
(1) Has been actively in existence for at least five years;
(2) Has been formed and maintained in good faith for purposes other than obtaining insurance;
(3) Does not condition membership in the association on a health-status-related factor of an individual, including an employee or a dependent of any employee;
(4) Makes health insurance coverage offered through the association available to any member regardless of a health-status-related factor of the member or individual eligible for coverage through a member; and
(5) Does not make available health insurance coverage offered through the association other than in connection with a member of the association.
Source
Laws 2009, LB192, § 7.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5234 - Case characteristics, defined.

44-5234.
Case characteristics, defined.
Case characteristics shall mean demographic or other objective characteristics of a small employer that are considered by the small employer carrier in the determination of premium rates for the small employer. Claim experience, health status, and duration of coverage shall not be case characteristics for purposes of the Small Employer Health Insurance Availability Act.
Source
Laws 1994, LB 1222, § 12.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5237.01 - Creditable coverage, defined.

44-5237.01.
Creditable coverage, defined.
(1) Creditable coverage shall mean, with respect to an individual, coverage of the individual under any of the following:
(a) A group health plan;
(b) Health insurance coverage;
(c) Part A or Part B of Title XVIII of the Social Security Act;
(d) Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq., other than coverage consisting solely of benefits under section 1928 of the act, 42 U.S.C. 1396s;
(e) 10 U.S.C. chapter 55, as such chapter existed on January 1, 2003;
(f) A medical care program of the Indian Health Service or of a tribal organization;
(g) A state health benefits risk pool;
(h) A health plan offered under 5 U.S.C. 8901 et seq.;
(i) A public health plan as defined under regulations promulgated by the federal Secretary of Health and Human Services; and
(j) A health benefit plan under 22 U.S.C. 2504.
(2) Creditable coverage shall not include any coverage that occurs before a significant break in coverage. For purposes of this section, a significant break in coverage shall mean any period of sixty-three consecutive days during all of which the individual does not have any creditable coverage, except that neither a waiting period nor an affiliation period shall be taken into account in determining a significant break in coverage.
(3) Creditable coverage shall not include coverage consisting solely of coverage of excepted benefits as that term is defined in the federal Health Insurance Portability and Accountability Act of 1996, 29 U.S.C. 1191b, and regulations adopted pursuant to the act and in effect on April 19, 1998.
Source
Laws 1997, LB 862, § 33;
Laws 1998, LB 1035, § 11;
Laws 2003, LB 6, § 2.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5238 - Dependent, defined.

44-5238.
Dependent, defined.
Dependent shall mean a spouse, an unmarried child under the age of nineteen years, an unmarried child who is a full-time student under the age of twenty-three years and who is financially dependent upon the parent, and an unmarried child of any age who is medically certified as disabled and dependent upon the parent.
Source
Laws 1994, LB 1222, § 16.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5240 - Eligible employee, defined.

44-5240.
Eligible employee, defined.
Eligible employee shall mean an employee who works on a full-time basis and has a normal workweek of thirty or more hours. The term shall include a sole proprietor, a partner of a partnership, a member of a limited liability company, and an independent contractor, if the sole proprietor, partner, member, or independent contractor is included as an employee under a health benefit plan of a small employer, but shall not include an employee who works on a part-time, temporary, or substitute basis.
Source
Laws 1994, LB 1222, § 18.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5241 - Established geographic service area, defined.

44-5241.
Established geographic service area, defined.
Established geographic service area shall mean a geographic area, as approved by the director and based on the carrier's certificate of authority to transact insurance business in this state, within which the carrier is authorized to provide coverage.
Source
Laws 1994, LB 1222, § 19.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5241.01 - Governmental plan, defined.

44-5241.01.
Governmental plan, defined.
Governmental plan shall mean a plan as defined under 29 U.S.C. 1002 and any plan maintained for its employees by the United States Government or by any agency or instrumentality of the United States Government.
Source
Laws 1997, LB 862, § 34.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5241.02 - Group health plan, defined.

44-5241.02.
Group health plan, defined.
Group health plan shall mean an employee welfare benefit plan as defined by 29 U.S.C. 1002 to the extent that the plan provides any hospital, surgical, or medical expense benefits to employees or their dependents, as defined under the terms of the plan, directly or through insurance, reimbursement, or otherwise.
Source
Laws 1997, LB 862, § 35.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5242 - Health benefit plan, defined.

44-5242.
Health benefit plan, defined.
(1) Health benefit plan shall mean any hospital or medical policy or certificate, major medical expense insurance, or health maintenance organization subscriber contract.
(2) Health benefit plan shall not include one or more, or any combination, of the following:
(a) Coverage only for accident or disability income insurance, or any combination thereof;
(b) Coverage issued as a supplement to liability insurance;
(c) Liability insurance, including general liability insurance and automobile liability insurance;
(d) Workers' compensation or similar insurance;
(e) Automobile medical payment insurance;
(f) Credit-only insurance;
(g) Coverage for onsite medical clinics; and
(h) Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
(3) Health benefit plan shall not include the following benefits if they are provided under a separate policy, certificate, or contract of insurance or are otherwise not an integral part of the plan:
(a) Limited-scope dental or vision benefits;
(b) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof; and
(c) Such other similar, limited benefits as are specified in federal regulations.
(4) Health benefit plan shall not include the following benefits if the benefits are provided under a separate policy, certificate, or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health benefit plan maintained by the same plan sponsor, and such benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor:
(a) Coverage only for a specified disease or illness; and
(b) Hospital indemnity or other fixed indemnity insurance.
(5) Health benefit plan shall not include the following if it is offered as a separate policy, certificate, or contract of insurance:
(a) Medicare supplemental health insurance as defined under section 1882(g)(1) of the Social Security Act;
(b) Coverage supplemental to the coverage provided under 10 U.S.C. chapter 55, as such chapter existed on January 1, 2003; and
(c) Similar supplemental coverage provided to coverage under a group health plan.
Source
Laws 1994, LB 1222, § 20;
Laws 1997, LB 862, § 36;
Laws 2003, LB 6, § 3.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5242.01 - Health carrier or carrier, defined.

44-5242.01.
Health carrier or carrier, defined.
Health carrier or carrier shall mean any entity that provides health insurance in this state. Health carrier or carrier shall include an insurance company, a fraternal benefit society, a health maintenance organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation.
Source
Laws 1994, LB 1222, § 11;
R.S.Supp.,1996, § 44-5233;
Laws 1997, LB 862, § 37.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5242.02 - Health-status-related factor, defined.

44-5242.02.
Health-status-related factor, defined.
Health-status-related factor shall mean any of the following factors:
(1) Health status;
(2) Medical condition, including both physical and mental illnesses;
(3) Claims experience;
(4) Receipt of health care;
(5) Medical history;
(6) Genetic information;
(7) Evidence of insurability, including conditions arising out of acts of domestic violence; and
(8) Disability.
Source
Laws 1997, LB 862, § 38.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5242.03 - Health maintenance organization, defined.

44-5242.03.
Health maintenance organization, defined.
Health maintenance organization means a person that 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 or both.
Source
Laws 2002, LB 1139, § 32.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5244 - Late enrollee, defined.

44-5244.
Late enrollee, defined.
Late enrollee shall mean an eligible employee or dependent who requests enrollment in a health benefit plan of a small employer following the initial enrollment period during which the individual is entitled to enroll under the terms of the health benefit plan if the initial enrollment period is a period of at least thirty days. An eligible employee or dependent shall not be considered a late enrollee if:
(1) The individual meets the following:
(a) The individual was covered under creditable coverage at the time of the initial enrollment;
(b) The individual lost coverage under creditable coverage as a result of termination of employment or eligibility, reduction in the number of hours of employment, the involuntary termination of the creditable coverage, the death of a spouse, divorce, or legal separation; and
(c) The individual requests enrollment within thirty days after termination of the creditable coverage;
(2) The individual is employed by an employer which offers multiple health benefit plans and the individual elects a different plan during an open enrollment period;
(3) A court has ordered coverage be provided for a spouse or a minor or dependent child under a covered employee's health benefit plan and the request for enrollment is made within thirty days after issuance of the court order; or
(4) The individual had coverage under a COBRA continuation provision and the coverage under that provision was exhausted.
Source
Laws 1994, LB 1222, § 22;
Laws 1997, LB 862, § 39.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5244.01 - Medical care, defined.

44-5244.01.
Medical care, defined.
Medical care shall mean amounts paid for:
(1)(a) The diagnosis, care, mitigation, treatment, or prevention of disease or (b) the purpose of affecting any structure or function of the body;
(2) Transportation primarily for and essential to medical care referred to in subdivision (1) of this section; and
(3) Insurance covering medical care referred to in subdivisions (1) and (2) of this section.
Source
Laws 1997, LB 862, § 40.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5244.02 - Network plan, defined.

44-5244.02.
Network plan, defined.
Network plan shall mean health insurance coverage offered by a health carrier under which the financing and delivery of medical care including items and services paid for as medical care are provided, in whole or in part, through a defined set of providers under contract with the health carrier.
Source
Laws 1997, LB 862, § 41.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5245 - New business premium rate, defined.

44-5245.
New business premium rate, defined.
New business premium rate shall mean, for each class of business as to a rating period, the lowest premium rate charged or offered or which could have been charged or offered by the small employer carrier to small employers with similar case characteristics for newly issued health benefit plans with the same or similar coverage.
Source
Laws 1994, LB 1222, § 23.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5246.02 - Preexisting condition, defined.

44-5246.02.
Preexisting condition, defined.
Preexisting condition means a condition whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the six-month period ending on the enrollment date. Genetic information shall not be treated as a condition for which a preexisting condition exclusion may be imposed in the absence of a diagnosis of the condition related to such information.
Source
Laws 1997, LB 862, § 43;
Laws 2000, LB 1253, § 36.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5252 - Restricted network provision, defined.

44-5252.
Restricted network provision, defined.
Restricted network provision shall mean any provision of a health benefit plan that conditions the payment of benefits, in whole or in part, on the use of health care providers that have entered into contractual arrangement with the carrier to provide health care services to covered individuals.
Source
Laws 1994, LB 1222, § 30.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5253 - Small employer, defined.

44-5253.
Small employer, defined.
Small employer shall mean any person, political subdivision, firm, corporation, limited liability company, partnership, or association that is actively engaged in business that, on at least fifty percent of its working days during the preceding calendar quarter, employed at least two and no more than fifty eligible employees, the majority of whom were employed within this state. In determining the number of eligible employees, companies that are affiliated companies or that are eligible to file a combined tax return for purposes of state taxation shall be considered one employer.
Source
Laws 1994, LB 1222, § 31;
Laws 1995, LB 837, § 2;
Laws 1997, LB 862, § 44.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5255 - Standard health benefit plan, defined.

44-5255.
Standard health benefit plan, defined.
Standard health benefit plan shall mean a health benefit plan regulated by the Department of Insurance.
Source
Laws 1994, LB 1222, § 33;
Laws 2009, LB154, § 10;
Laws 2017, LB644, § 8.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5255.01 - Waiting period, defined.

44-5255.01.
Waiting period, defined.
Waiting period means the period that must pass with respect to an individual before the individual is eligible to be covered for benefits under the terms of the health benefit plan. If an individual enrolls as a late enrollee or on a special enrollment date, any period before such late or special enrollment is not a waiting period.
Source
Laws 2000, LB 1253, § 37.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5257 - Separate class of business; established; when; limit.

44-5257.
Separate class of business; established; when; limit.
(1) A small employer carrier may establish a separate class of business only to reflect substantial differences in expected claims experience or administrative costs related to the following reasons:
(a) The small employer carrier uses more than one type of system for the marketing and sale of health benefit plans to small employers;
(b) The small employer carrier has acquired a class of business from another small employer carrier; or
(c) The small employer carrier provides coverage to one or more association groups that meet the requirements of section 44-760.
(2) A small employer carrier may establish up to nine separate classes of business.
(3) The director may adopt and promulgate rules and regulations to provide for a period of transition in order for a small employer carrier to come into compliance with subsection (2) of this section in the instance of acquisition of an additional class of business from another small employer carrier.
(4) The director may approve the establishment of additional classes of business upon application to the director and a finding by the director that such action would enhance the efficiency and fairness of the small employer marketplace.
Source
Laws 1994, LB 1222, § 35.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5260.01 - Certification of creditable coverage.

44-5260.01.
Certification of creditable coverage.
(1) Small employer carriers shall provide written certification of creditable coverage to individuals in accordance with subsection (2) of this section.
(2) The certification of creditable coverage shall be provided:
(a) At the time an individual ceases to be covered under the health benefit plan or otherwise becomes covered under a COBRA continuation provision;
(b) In the case of an individual who becomes covered under a COBRA continuation provision, at the time the individual ceases to be covered under that provision; and
(c) At the time a request is made on behalf of an individual if the request is made not later than twenty-four months after the date of cessation of coverage described in subdivision (2)(a) or (b) of this section, whichever is later.
(3) Small employer carriers may provide the certification of creditable coverage required under subdivision (2)(a) of this section at a time consistent with notices required under any applicable COBRA continuation provision.
(4) The certificate of creditable coverage required to be provided pursuant to subsection (1) of this section shall contain:
(a) Written certification of the period of creditable coverage of the individual under the health benefit plan and the coverage, if any, under the applicable COBRA continuation provision; and
(b) The waiting period, if any, and, if applicable, affiliation period imposed with respect to the individual for any coverage under the health benefit plan.
(5) To the extent medical care under a group health plan consists of group health insurance coverage, the plan is deemed to have satisfied the certification requirement under subsection (1) of this section if the small employer carrier offering the coverage provides for certification in accordance with subsection (2) of this section.
(6)(a) If an individual enrolls in a group health plan that uses the alternative method of counting creditable coverage pursuant to subdivision (4)(c)(iv) of section 44-5260 and the individual provides a certificate of coverage that was provided to the individual pursuant to subsection (3) of this section, on request of the group health plan, the entity that issued the certification to the individual promptly shall disclose to the group health plan information on the classes and categories of health benefits available under the entity's health benefit plan.
(b) The entity providing the information pursuant to subdivision (6)(a) of this section may charge the requesting group health plan the reasonable cost of disclosing the information.
Source
Laws 2002, LB 1139, § 34.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5264 - Basic health benefit plan; required coverage; applicability.

44-5264.
Basic health benefit plan; required coverage; applicability.
Except for specified childhood immunizations of children from birth to six years of age, a statute requiring coverage of a health care service or benefit or requiring the reimbursement, utilization, or inclusion of a specific category of licensed health care practitioner shall not apply to a basic health benefit plan delivered or issued for delivery to small employers in this state pursuant to the Small Employer Health Insurance Availability Act.
Source
Laws 1994, LB 1222, § 42.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5267 - Reissuance of health benefit plan; when; director; powers.

44-5267.
Reissuance of health benefit plan; when; director; powers.
The director may adopt and promulgate rules and regulations to require small employer carriers, as a condition of transacting business with small employers in this state after January 1, 1995, to reissue a health benefit plan to any small employer whose health benefit plan has been terminated or not renewed by the carrier after six months prior to January 1, 1995. The director may prescribe such terms for the reissuance of coverage as the director finds are reasonable and necessary to provide continuity of coverage to small employers.
Source
Laws 1994, LB 1222, § 45.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5302 - Legislative findings and declarations.

44-5302.
Legislative findings and declarations.
The Legislature finds and declares that there is a significant number of Nebraskans who lack health insurance and that these uninsured people include many individuals and families who cannot afford the rising cost of medical care but do not qualify for the various income-based assistance programs. The lack of financial means of uninsured people and families to pay for their medical care leaves health care providers with uncollectible debts which are transferred to other patients and to insurers. It is the purpose and intent of the Legislature to provide a mechanism to allow insurers to provide basic levels of health insurance to those people who are uninsured and are not qualified for income-based assistance programs.
Source
Laws 1991, LB 419, § 30;
Laws 2009, LB445, § 1.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5303 - Terms, defined.

44-5303.
Terms, defined.
For purposes of the Health Insurance Access Act:
(1) Insurer shall mean any insurance company as defined in section 44-103 authorized to transact health insurance business in the State of Nebraska or a health maintenance organization which has obtained a valid certificate of authority;
(2) Medicare shall mean parts A, B, C, and D of Title XVIII of the Social Security Act, 42 U.S.C. 1395 et seq., as amended;
(3) Provider shall mean any physician or hospital who is licensed or authorized in this state to furnish medical care or hospitalization to any individual;
(4) Spell of illness shall mean a continuous period as a hospital inpatient or successive periods as a hospital inpatient when the date of discharge and the following date of admission are less than sixty consecutive days apart; and
(5) Uninsured access coverage shall mean a policy of sickness and accident insurance or a contract for health care services covering individuals, with or without their dependents, issued by an insurer subject to the limitations and requirements in the act.
Source
Laws 1991, LB 419, § 31;
Laws 2009, LB445, § 2.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5304 - Policies and contracts; applicability of other laws.

44-5304.
Policies and contracts; applicability of other laws.
Policies of sickness and accident insurance and contracts for health care services issued pursuant to the Health Insurance Access Act shall be subject to all applicable provisions of Chapter 44 except as otherwise provided in such chapter.
Source
Laws 1991, LB 419, § 32.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5305 - Policy or contract; eligibility.

44-5305.
Policy or contract; eligibility.
(1) An uninsured access coverage policy or contract shall limit eligibility to individuals or families who are not eligible for medicare or any other medical assistance program, including, but not limited to, the program established pursuant to the Medical Assistance Act.
(2) The uninsured access coverage policy or contract shall allow a transfer to a designated type of individual policy or contract without evidence of insurability and without interruption in coverage subject to payment of premiums. Each uninsured access coverage policy or contract shall specify the type of individual policy or contract to which an insured person may transfer.
Source
Laws 1991, LB 419, § 33;
Laws 2006, LB 1248, § 65;
Laws 2009, LB445, § 3.
Cross References
Medical Assistance Act, see section 68-901.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5306 - Policy or contract; eligibility; limitations.

44-5306.
Policy or contract; eligibility; limitations.
(1) An individual or a family member shall not be eligible for initial or continued coverage under an uninsured access coverage policy or contract if he or she:
(a) Is eligible as an employee or dependent for group insurance coverage sponsored or maintained by an employer; or
(b) Is covered by any other type of hospital, surgical, or medical expense-incurred policy or health maintenance organization contract.
(2) An uninsured access coverage policy or contract may require evidence of insurability but shall not use underwriting guidelines that are more strict than those normally used by the insurer for its regular individual health insurance contracts.
Source
Laws 1991, LB 419, § 34;
Laws 2009, LB445, § 4.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5307 - Policy or contract; benefits required; coverage authorized; prohibitions.

44-5307.
Policy or contract; benefits required; coverage authorized; prohibitions.
(1) An uninsured access coverage policy or contract may include hospital-only and surgical-only benefits which shall mean:
(a) Inhospital benefits for not less than thirty continuous days nor more than ninety continuous days for each spell of illness; and
(b) Surgical benefits for both inpatient and outpatient surgery.
(2) An uninsured access coverage policy or contract may include prescription drug benefit coverage.
(3) An uninsured access coverage policy or contract may include preventative health care coverage, including, but not limited to, primary care physician visits, immunizations for adults and children, laboratory and X-ray procedures, and preventative cancer screenings such as mammograms, cervical cancer screenings, and noninvasive colorectal or prostate screenings.
(4) An uninsured access coverage policy or contract may not:
(a) Use a definition of spell of illness more restrictive than the definition found in section 44-5303; or
(b) Use a definition of preexisting condition more restrictive than the definition normally used by the insurer for its regular individual health insurance contracts.
(5) Every uninsured access coverage policy or contract shall provide that the benefit payment shall be accepted as payment in full by the provider and there shall be no deductible or coinsurance charged to the insured.
Source
Laws 1991, LB 419, § 35;
Laws 2009, LB445, § 5.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5308 - Policy or contract; contents required.

44-5308.
Policy or contract; contents required.
Each uninsured access coverage policy or contract shall include:
(1) A reasonable description of the geographic area or areas to be served; and
(2) A listing of the providers who have a contract with the insurers to furnish health care services.
Source
Laws 1991, LB 419, § 36.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5309 - Policy or contract; exemption from mandated benefits.

44-5309.
Policy or contract; exemption from mandated benefits.
Notwithstanding any other provision of law, every uninsured access coverage policy or contract shall be exempt from any and all mandated benefits which require coverage of any type of services or conditions.
Source
Laws 1991, LB 419, § 37.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5310 - Issuing insurer; powers.

44-5310.
Issuing insurer; powers.
An insurer issuing an uninsured access coverage policy or contract may enter into contracts to arrange for health services by certain providers, may limit the number and types of providers with which it contracts, and shall not be required to provide benefits for services furnished by providers who do not contract with the insurer.
Source
Laws 1991, LB 419, § 38.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5416 - Act, how cited.

44-5416.
Act, how cited.
Sections 44-5416 to 44-5431 shall be known and may be cited as the Utilization Review Act.
Source
Laws 1992, LB 428, § 1;
R.S.1943, (1993), § 44-5401;
Laws 1998, LB 1162, § 1.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5417 - Purpose of act.

44-5417.
Purpose of act.
The purpose of the Utilization Review Act is to establish requirements and standards of operation for certification of medical utilization review agents. It is proper for the state to oversee utilization review agents as a part of the state's regulation and supervision of the business of insurance and to encourage effective, efficient, and consistent utilization review.
Source
Laws 1992, LB 428, § 2;
R.S.1943, (1993), § 44-5402;
Laws 1998, LB 1162, § 2.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5419 - Utilization review agent; certificate required; term.

44-5419.
Utilization review agent; certificate required; term.
On or after July 1, 1993, a utilization review agent may not conduct utilization review upon a covered person in this state unless the agent is granted a certificate by the director. Certificates granted under the Utilization Review Act shall be valid for two years from the date of issuance.
Source
Laws 1992, LB 428, § 9;
R.S.1943, (1993), § 44-5409;
Laws 1998, LB 1162, § 4.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5420 - Certificate; application; fee.

44-5420.
Certificate; application; fee.
(1) An applicant for a certificate as a utilization review agent shall submit an application to the department upon a form which may be obtained from the department. The application shall be signed and verified by the applicant.
Along with the application, the applicant shall pay the application fee of three hundred dollars.
(2) As a part of the application, the applicant shall submit the following:
(a) Documentation that the applicant has received approval or accreditation by the American Accreditation HealthCare Commission/URAC, or a similar organization which has standards for utilization review agents that are substantially similar to the standards of the American Accreditation HealthCare Commission/URAC, and which has been approved by the director;
(b) A statement of the street and mailing address of the entity, telephone number of the entity, and a list of the principal officers of the entity responsible for its operation, management, and control; and
(c) Such other reasonable information or documentation as the department requires for enforcement of the Utilization Review Act.
Source
Laws 1992, LB 428, § 10;
R.S.1943, (1993), § 44-5410;
Laws 1998, LB 1162, § 5.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5421 - Certificate; director; grant or deny; notice and hearing requirements.

44-5421.
Certificate; director; grant or deny; notice and hearing requirements.
The director shall grant or deny a certificate within forty-five days of receipt of a completed application under section 44-5420. The director shall deny a certificate if the applicant does not meet the requirements of the Utilization Review Act. If a certificate is denied, the director shall notify the applicant by certified mail and shall specify the reasons for denial in the notice. The applicant shall have ten days from the date of receipt of the notice to request a hearing before the director pursuant to the Administrative Procedure Act, or he or she may reapply and respond to the reasons for the denial.
Source
Laws 1992, LB 428, § 11;
R.S.1943, (1993), § 44-5411;
Laws 1998, LB 1162, § 6.
Cross References
Administrative Procedure Act, see section 84-920.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5423 - Utilization review agent; notify director of changes; when.

44-5423.
Utilization review agent; notify director of changes; when.
A utilization review agent shall notify the director within five working days of any change of the agent's approval or accreditation status or of any material change in the information contained in the agent's application or renewal or that the agent no longer meets the requirements of the Utilization Review Act.
Source
Laws 1992, LB 428, § 13;
R.S.1943, (1993), § 44-5413;
Laws 1998, LB 1162, § 8.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5424 - Certificates; renewal; fee.

44-5424.
Certificates; renewal; fee.
Certificates granted under the Utilization Review Act may be renewed prior to their expiration date upon the filing of the following with the department (1) a renewal fee of one hundred dollars, (2) a statement detailing any changes in the information or documentation filed with the initial application, and (3) such other reasonable information as the department requires for enforcement of the act.
Source
Laws 1992, LB 428, § 14;
R.S.1943, (1993), § 44-5414;
Laws 1998, LB 1162, § 9.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5425 - Health carrier; oversight of utilization review activities.

44-5425.
Health carrier; oversight of utilization review activities.
A health carrier shall be responsible for monitoring all utilization review activities carried out by, or on behalf of, the health carrier and for ensuring that all requirements of the Utilization Review Act and applicable rules and regulations are met. The health carrier shall also ensure that appropriate personnel have operational responsibility for the conduct of the health carrier's utilization review program.
Source
Laws 1998, LB 1162, § 10.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5426 - Utilization review program; use of clinical review criteria.

44-5426.
Utilization review program; use of clinical review criteria.
A utilization review program shall use documented clinical review criteria that are based on sound clinical evidence and are evaluated periodically to assure ongoing efficacy. A health carrier may develop its own clinical review criteria, or it may purchase or license clinical review criteria from qualified vendors. A health carrier shall make available its clinical review criteria upon request to authorized government agencies.
Source
Laws 1998, LB 1162, § 11.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5427 - Description of review procedures; toll-free number.

44-5427.
Description of review procedures; toll-free number.
(1) In the certificate of coverage or member handbook provided to covered persons, a health carrier shall include a clear and comprehensive description of its utilization review procedures, including the procedures for obtaining review of adverse determinations, and a statement of rights and responsibilities of covered persons with respect to those procedures.
(2) A health carrier shall include a summary of its utilization review procedures in enrollment materials intended for prospective covered persons.
(3) A health carrier shall print on its membership cards a toll-free telephone number to call for utilization review decisions.
Source
Laws 1998, LB 1162, § 12.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5428 - Agent violation; notice; hearing.

44-5428.
Agent violation; notice; hearing.
If the director finds that any utilization review agent doing business in this state is engaging in any violation of the Utilization Review Act and that a proceeding in respect thereto would be in the public interest, he or she shall issue and serve upon such utilization review agent a statement of the charges in that respect and a notice of hearing thereon, which notice shall set a hearing date not less than ten days after the date of the notice.
Source
Laws 1998, LB 1162, § 13.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5429 - Violation; penalty.

44-5429.
Violation; penalty.
If, after the hearing, the director finds a utilization review agent has violated the Utilization Review Act, the director shall reduce his or her findings to writing and shall issue and cause to be served upon the utilization review agent charged with the violation a copy of the findings and an order requiring the utilization review agent to cease and desist from engaging in the violation and the director may order any one or more of the following:
(1) Payment of a monetary penalty of not more than one thousand dollars for each violation, not to exceed an aggregate penalty of thirty thousand dollars, unless the violation was committed flagrantly and in conscious disregard of the Utilization Review Act, in which case the penalty shall not be more than fifteen thousand dollars for each violation, not to exceed an aggregate penalty of one hundred fifty thousand dollars; and
(2) Suspension or revocation of the utilization review agent's license to do business in this state if the utilization review agent knew or reasonably should have known it was in violation of the act.
Source
Laws 1998, LB 1162, § 14.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5430 - Violation of cease and desist order; penalty.

44-5430.
Violation of cease and desist order; penalty.
Any utilization review agent who violates a cease and desist order of the director under section 44-5429 may after notice and hearing and upon order of the director be subject to:
(1) A monetary penalty of not more than thirty thousand dollars for each violation, not to exceed an aggregate penalty of one hundred fifty thousand dollars; and
(2) Suspension or revocation of the utilization review agent's license to do business in this state.
Source
Laws 1998, LB 1162, § 15.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5501 - Act, how cited.

44-5501.
Act, how cited.
Sections 44-5501 to 44-5515 shall be known and may be cited as the Surplus Lines Insurance Act.
Source
Laws 1992, LB 1006, § 1;
Laws 2007, LB117, § 21;
Laws 2019, LB469, § 1.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5503 - Surplus lines license; issuance.

44-5503.
Surplus lines license; issuance.
The department, in consideration of the payment of the license fee, may issue a surplus lines license, revocable at any time, to any individual who currently holds an insurance producer license or to a foreign or domestic corporation. The corporate surplus lines license shall list all officers or employees of the corporation who currently hold an insurance producer license or meet the requirements for an individual surplus lines license and who have authority to transact surplus lines business on behalf of the corporation. Only individuals listed on the corporate surplus lines license shall transact surplus lines business on behalf of the corporate licensee. If the applicant is an individual, the application for the license shall include the applicant's social security number. The director may utilize the national insurance producer database of the National Association of Insurance Commissioners, or any other equivalent uniform national database, for the licensure of an individual or an entity as a surplus lines producer and for renewal of such license.
Source
Laws 1913, c. 154, § 25, p. 408;
R.S.1913, § 3161;
Laws 1919, c. 190, tit. V, art. III, § 18, p. 587;
C.S.1922, § 7762;
C.S.1929, § 44-218;
R.S.1943, § 44-139;
Laws 1955, c. 168, § 3, p. 479;
Laws 1978, LB 836, § 1;
Laws 1989, LB 92, § 29;
R.S.Supp.,1990, § 44-139;
Laws 1992, LB 1006, § 3;
Laws 1997, LB 752, § 113;
Laws 2001, LB 51, § 38;
Laws 2002, LB 1139, § 36;
Laws 2011, LB70, § 2.
Annotations
Insurance companies and agents are forbidden to procure or effect fire insurance in companies not licensed to write it. Naeve v. Shea, 128 Neb. 374, 258 N.W. 666 (1935).
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5504 - Nonadmitted insurer; surplus lines license; application; fee; expiration; renewal.

44-5504.
Nonadmitted insurer; surplus lines license; application; fee; expiration; renewal.
(1) No person, other than an exempt commercial purchaser, shall place, procure, or effect insurance for or on behalf of an insured whose home state is the State of Nebraska in any nonadmitted insurer until such person has first been issued a surplus lines license from the department as provided in section 44-5503.
(2) Application for a surplus lines license shall be made to the department on forms designated and furnished by the department and shall be accompanied by a license fee as established by the director not to exceed two hundred fifty dollars for each individual and corporate surplus lines license.
(3)(a) All corporate surplus lines licenses shall expire on April 30 of each year, and all individual surplus lines licenses shall expire on the licensee's birthday in the first year after issuance in which his or her age is divisible by two, and all individual surplus lines licenses may be renewed within the ninety-day period before their expiration dates and all individual surplus lines licenses also may be renewed within the thirty-day period after their expiration dates upon payment of a late renewal fee as established by the director not to exceed two hundred dollars in addition to the applicable fee otherwise required for renewal of individual surplus lines licenses as established by the director pursuant to subsection (2) of this section. All individual surplus lines licenses renewed within the thirty-day period after their expiration dates pursuant to this subdivision shall be deemed to have been renewed before their expiration dates. The department shall establish procedures for the renewal of surplus lines licenses.
(b) Every licensee shall notify the department within thirty days of any changes in the licensee's residential or business address.
Source
Laws 1913, c. 154, § 25, p. 408;
R.S.1913, § 3161;
Laws 1919, c. 190, tit. V, art. III, § 18, p. 587;
C.S.1922, § 7762;
C.S.1929, § 44-218;
R.S.1943, § 44-140;
Laws 1978, LB 836, § 2;
Laws 1984, LB 801, § 47;
Laws 1989, LB 92, § 30;
R.S.Supp.,1990, § 44-140;
Laws 1992, LB 1006, § 4;
Laws 1999, LB 260, § 15;
Laws 2002, LB 1139, § 37;
Laws 2007, LB117, § 23;
Laws 2011, LB70, § 3.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5505 - Nonadmitted insurer; surplus lines licensee; record of business; contents; how kept.

44-5505.
Nonadmitted insurer; surplus lines licensee; record of business; contents; how kept.
Each surplus lines licensee shall keep in the licensee's office a true and complete record of the business transacted by the licensee showing (1) the exact amount of insurance or limits of exposure, (2) the gross premiums charged therefor, (3) the return premium paid thereon, (4) the rate of premium charged for such insurance, (5) the date of such insurance and terms thereof, (6) the name and address of the nonadmitted insurer writing such insurance, (7) a copy of the declaration page of each policy and a copy of each policy form issued by the licensee, (8) a copy of the written statement described in subdivision (1)(c) of section 44-5510 or, in lieu thereof, a copy of the application containing such written statement, (9) the name of the insured, (10) the address of the principal residence of the insured or the address at which the insured maintains its principal place of business, (11) a brief and general description of the risk or exposure insured and where located, (12) documentation showing that the nonadmitted insurer writing such insurance complies with the requirements of section 44-5508, and (13) such other facts and information as the department may direct and require. Such records shall be kept by the licensee in the licensee's office within the state for not less than five years and shall at all times be open and subject to the inspection and examination of the department or its officers. The expense of any examination shall be paid by the licensee.
Source
Laws 1913, c. 154, § 25, p. 409;
R.S.1913, § 3161;
Laws 1919, c. 190, tit. V, art. III, § 18, p. 588;
C.S.1922, § 7762;
C.S.1929, § 44-218;
R.S.1943, § 44-141;
Laws 1978, LB 836, § 3;
Laws 1989, LB 92, § 31;
R.S.Supp.,1990, § 44-141;
Laws 1992, LB 1006, § 5;
Laws 2005, LB 119, § 20;
Laws 2011, LB70, § 4.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5506 - Surplus lines licensee; quarterly statement; tax payment.

44-5506.
Surplus lines licensee; quarterly statement; tax payment.
(1) Every surplus lines licensee transacting business under the Surplus Lines Insurance Act shall, on or before March 1 for the quarter ending the preceding December 31, June 1 for the quarter ending the preceding March 31, September 1 for the quarter ending the preceding June 30, and December 1 for the quarter ending the preceding September 30 of each year, make and file with the department a verified statement upon a form prescribed by the department or a designee of the director which shall exhibit the true amount of all such business transacted during that period.
(2)(a) Every surplus lines licensee transacting business under the Surplus Lines Insurance Act shall collect and pay to the director or the director's designee, at the time the statement required under subsection (1) of this section is filed, a sum based on the total gross premiums charged, less any return premiums, for surplus lines insurance provided by the licensee pursuant to the license on behalf of an insured whose home state is the State of Nebraska. In no event shall such taxes be determined on a retaliatory basis pursuant to section 44-150.
(b) The sum payable shall be computed based on an amount equal to three percent of the premiums for insurance that covers properties, risks, or exposures located or to be performed in the United States, to be remitted to the State Treasurer in accordance with section 77-912.
(c) The surplus lines licensee is prohibited from rebating, for any reason, any portion of the tax.
Source
Laws 1913, c. 154, § 25, p. 409;
R.S.1913, § 3161;
Laws 1919, c. 190, tit. V, art. III, § 18, p. 588;
C.S.1922, § 7762;
C.S.1929, § 44-218;
R.S.1943, § 44-142;
Laws 1978, LB 836, § 4;
Laws 1987, LB 302, § 4;
Laws 1989, LB 92, § 32;
R.S.Supp.,1990, § 44-142;
Laws 1992, LB 1006, § 6;
Laws 2011, LB70, § 5;
Laws 2016, LB837, § 1.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-5506.01 - Nonadmitted insurer; certificate of authority; director; powers; provisions applicable.

44-5506.01.
Nonadmitted insurer; certificate of authority; director; powers; provisions applicable.
(1) The director may provide written authority in the form of a certificate of authority to operate as a domestic surplus lines insurer in the State of Nebraska to a nonadmitted insurer domiciled in this state if the director determines that such nonadmitted insurer:
(a) Possesses policyholder surplus of at least fifteen million dollars;
(b) Is an eligible surplus lines insurer in at least one state jurisdiction other than this state; and
(c) Is acting pursuant to a resolution passed by its board of directors seeking to be a domestic surplus lines insurer in this state.
(2) All financial and solvency requirements imposed by Chapter 44 upon a domestic admitted insurer shall apply to a domestic surplus lines insurer unless domestic surplus lines insurers are otherwise specifically exempted.
(3) Policies issued by a domestic surplus lines insurer are not subject to the protections or other requirements of the Nebraska Property and Liability Insurance Guaranty Association Act or the Nebraska Life and Health Insurance Guaranty Association Act.
Source
Laws 2019, LB469, § 3.
Cross References
Nebraska Life and Health Insurance Guaranty Association Act, see section 44-2720.
Nebraska Property and Liability Insurance Guaranty Association Act, see section 44-2418.