reglab/statecodes huggingface dataset:
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4515 - Applicants; rights.

44-4515.
Applicants; rights.
Long-term care insurance applicants shall have the right to return the policy or certificate within thirty days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. Long-term care insurance policies and certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the applicant has the right to return the policy or certificate within thirty days of its delivery and to have the premium refunded if, after examination of the policy or certificate other than a certificate issued to a group as defined in subdivision (1) of section 44-4508, the applicant is not satisfied for any reason.
Source
Laws 1987, LB 416, § 15;
Laws 1989, LB 295, § 2;
Laws 1992, LB 1006, § 48.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4517 - Compliance with act.

44-4517.
Compliance with act.
Any policy or rider advertised, marketed, or offered as long-term care insurance or nursing home insurance shall comply with the Long-Term Care Insurance Act.
Source
Laws 1987, LB 416, § 17;
Laws 1992, LB 1006, § 50.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4517.01 - Policy or certificate; claim denial; grounds; exception; issuance restriction.

44-4517.01.
Policy or certificate; claim denial; grounds; exception; issuance restriction.
(1) For a policy or certificate that has been in force for less than six months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for coverage.
(2) For a policy or certificate that has been in force for at least six months but less than two years, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is both material to the acceptance for coverage and which pertains to the condition for which benefits are sought.
(3) After a policy or certificate has been in force for two years it is not contestable upon the grounds of misrepresentation alone. Such policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.
(4)(a) No long-term care insurance policy or certificate may be field issued based on medical or health status.
(b) For purposes of this section, field issued means a policy or certificate issued by an agent or a third-party administrator pursuant to the underwriting authority granted to the agent or third-party administrator by an insurer.
(5) If an insurer has paid benefits under a long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded.
(6) In the event of the death of the insured, this section shall not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. In this situation, the remaining death benefits under these policies shall be governed by section 44-502. In all other situations, this section shall apply to life insurance policies that accelerate benefits for long-term care.
Source
Laws 1999, LB 323, § 2.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4517.02 - Policy or certificate; nonforfeiture benefits.

44-4517.02.
Policy or certificate; nonforfeiture benefits.
(1) Except as provided in subsection (2) of this section, a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate including a nonforfeiture benefit. The offer of a nonforfeiture benefit may be in the form of a rider that is attached to the policy.
(2) When a group long-term care insurance policy is issued, the offer required in subsection (1) of this section shall be made to the group policyholder. However, if the policy is issued as group long-term care insurance, other than to a continuing care retirement community or other similar entity, the offering shall be made to each proposed certificate holder.
(3) The director shall adopt and promulgate rules and regulations specifying the type or types of nonforfeiture benefits to be offered as part of long-term care insurance policies and certificates and the standards for nonforfeiture benefits.
Source
Laws 1999, LB 323, § 3.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4518 - Director; duties.

44-4518.
Director; duties.
The director shall adopt and promulgate rules and regulations to promote premium adequacy, to protect the policyholder in the event of substantial rate increases, and to establish minimum standards for marketing practices, agent compensation, agent testing, penalties, and reporting practices for long-term care insurance.
Source
Laws 1992, LB 1006, § 51;
Laws 1999, LB 323, § 4.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4519 - Rules and regulations.

44-4519.
Rules and regulations.
The director may adopt and promulgate rules and regulations to carry out the Long-Term Care Insurance Act, including minimum standards for insurance producer training.
Source
Laws 1992, LB 1006, § 53;
Laws 2007, LB117, § 11.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4520 - Violations; administrative penalty.

44-4520.
Violations; administrative penalty.
In addition to any other penalties provided by the laws of this state, any insurer or agent found by the director to have violated the Long-Term Care Insurance Act or any rule or regulation shall be subject to an administrative penalty of up to three times the amount of any commissions paid for each policy involved in the violation or up to ten thousand dollars, whichever is greater.
Source
Laws 1992, LB 1006, § 52.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4602 - Act; purposes.

44-4602.
Act; purposes.
(1) The Pharmacy Benefit Manager Licensure and Regulation Act establishes the standards and criteria for the licensure and regulation of pharmacy benefit managers providing a claims processing service or other prescription drug or device service for a health benefit plan.
(2) The purposes of the act are to:
(a) Promote, preserve, and protect public health, safety, and welfare through effective regulation and licensure of pharmacy benefit managers;
(b) Promote the solvency of the commercial health insurance industry, the regulation of which is reserved to the states by the federal McCarran-Ferguson Act, 15 U.S.C. 1011 to 1015, as such act and sections existed on January 1, 2022, as well as provide for consumer savings and encourage fairness in prescription drug benefits;
(c) Provide for powers and duties of the director; and
(d) Prescribe monetary penalties for violations of the Pharmacy Benefit Manager Licensure and Regulation Act.
Source
Laws 2022, LB767, § 2.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4603 - Terms, defined.

44-4603.
Terms, defined.
For purposes of the Pharmacy Benefit Manager Licensure and Regulation Act:
(1) Auditing entity means a pharmacy benefit manager or any person that represents a pharmacy benefit manager in conducting an audit for compliance with a contract between the pharmacy benefit manager and a pharmacy;
(2) Claims processing service means an administrative service performed in connection with the processing and adjudicating of a claim relating to a pharmacist service that includes:
(a) Receiving a payment for a pharmacist service; or
(b) Making a payment to a pharmacist or pharmacy for a pharmacist service;
(3) Covered person means a member, policyholder, subscriber, enrollee, beneficiary, dependent, or other individual participating in a health benefit plan;
(4) Director means the Director of Insurance;
(5) Health benefit plan means a policy, contract, certificate, or agreement entered into, offered, or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of a physical, mental, or behavioral health care service;
(6) Health carrier has the same meaning as in section 44-1303;
(7) Other prescription drug or device service means a service other than a claims processing service, provided directly or indirectly, whether in connection with or separate from a claims processing service, including, but not limited to:
(a) Negotiating a rebate, discount, or other financial incentive or arrangement with a drug company;
(b) Disbursing or distributing a rebate;
(c) Managing or participating in an incentive program or arrangement for a pharmacist service;
(d) Negotiating or entering into a contractual arrangement with a pharmacist or pharmacy;
(e) Developing and maintaining a formulary;
(f) Designing a prescription benefit program; or
(g) Advertising or promoting a service;
(8) Pharmacist has the same meaning as in section 38-2832;
(9) Pharmacist service means a product, good, or service or any combination thereof provided as a part of the practice of pharmacy;
(10) Pharmacy has the same meaning as in section 71-425;
(11)(a) Pharmacy benefit manager means a person, business, or entity, including a wholly or partially owned or controlled subsidiary of a pharmacy benefit manager, that provides a claims processing service or other prescription drug or device service for a health benefit plan to a covered person who is a resident of this state; and
(b) Pharmacy benefit manager does not include:
(i) A health care facility licensed in this state;
(ii) A health care professional licensed in this state;
(iii) A consultant who only provides advice as to the selection or performance of a pharmacy benefit manager; or
(iv) A health carrier to the extent that it performs any claims processing service or other prescription drug or device service exclusively for its enrollees; and
(12) Plan sponsor has the same meaning as in section 44-2702.
Source
Laws 2022, LB767, § 3.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4604 - Act; applicability; how construed; licensure conditions; contract requirements.

44-4604.
Act; applicability; how construed; licensure conditions; contract requirements.
(1) The Pharmacy Benefit Manager Licensure and Regulation Act applies to any contract or health benefit plan issued, renewed, recredentialed, amended, or extended on or after January 1, 2023, including any health carrier that performs a claims processing service or other prescription drug or device service through a third party.
(2) As a condition of licensure, any contract in existence on the date a pharmacy benefit manager receives its license to do business in this state shall comply with the requirements of the act.
(3) Nothing in the act is intended or shall be construed to conflict with existing relevant federal law.
Source
Laws 2022, LB767, § 4.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4605 - License, required; application; fee; refusal to issue or renew; grounds; renewal; application; fee.

44-4605.
License, required; application; fee; refusal to issue or renew; grounds; renewal; application; fee.
(1) A person shall not establish or operate as a pharmacy benefit manager in this state for a health benefit plan without first obtaining a license from the director under the Pharmacy Benefit Manager Licensure and Regulation Act.
(2) The director may adopt and promulgate rules and regulations establishing the licensing application, financial, and reporting requirements for pharmacy benefit managers under the act.
(3) A person applying for a pharmacy benefit manager license shall submit an application for licensure in the form and manner prescribed by the director.
(4) A person submitting an application for a pharmacy benefit manager license shall include with the application a nonrefundable application fee. The director shall establish the nonrefundable application fee in an amount not to exceed five hundred dollars.
(5) The director may refuse to issue or renew a license if the director determines that the applicant or any individual responsible for the conduct of affairs of the applicant is not competent, trustworthy, financially responsible, or of good personal and business reputation, has been found to have violated the insurance laws of this state or any other jurisdiction, or has had an insurance or other certificate of authority or license denied or revoked for cause by any jurisdiction.
(6)(a) Unless surrendered, suspended, or revoked by the director, a license issued under this section is valid as long as the pharmacy benefit manager continues to do business in this state and remains in compliance with the provisions of the act and any applicable rules and regulations, including the completion of a renewal application on a form prescribed by the director and payment of an annual license renewal fee. The director shall establish the annual license renewal fee in an amount not to exceed two hundred fifty dollars.
(b) Such application and renewal fee shall be received by the director on or before thirty days prior to the anniversary of the effective date of the pharmacy benefit manager's initial or most recent license.
Source
Laws 2022, LB767, § 5.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4608 - Contract; pharmacy benefit manager; cost price list; duties; disputes; procedures.

44-4608.
Contract; pharmacy benefit manager; cost price list; duties; disputes; procedures.
(1) With respect to each contract and contract renewal between a pharmacy benefit manager and a pharmacy, the pharmacy benefit manager shall:
(a) Update any maximum allowable cost price list at least every seven business days, noting any price change from the previous list, and provide a means by which a network pharmacy may promptly review a current price in an electronic, print, or telephonic format within one business day of any such change at no cost to the pharmacy;
(b) Maintain a procedure to eliminate a product from the maximum allowable cost price list in a timely manner to remain consistent with any change in the marketplace; and
(c) Make the maximum allowable cost price list available to each contracted pharmacy in a format that is readily accessible and usable to the contracted pharmacy.
(2) A pharmacy benefit manager shall not place a prescription drug on a maximum allowable cost price list unless the drug is available for purchase by pharmacies in this state from a national or regional drug wholesaler and is not obsolete.
(3) Each contract between a pharmacy benefit manager and a pharmacy shall include a process to appeal, investigate, and resolve disputes regarding any maximum allowable cost price. The process shall include:
(a) A fifteen-business-day limit on the right to appeal following submission of an initial claim by a pharmacy;
(b) A requirement that any appeal be investigated and resolved within seven business days after the appeal is received by the pharmacy benefit manager; and
(c) A requirement that the pharmacy benefit manager provide a reason for any denial of an appeal and identify the national drug code for the drug that may be purchased by the pharmacy at a price at or below the price on the maximum allowable cost price list as determined by the pharmacy benefit manager.
(4) If an appeal is determined to be valid by the pharmacy benefit manager, the pharmacy benefit manager shall:
(a) Make an adjustment in the drug price no later than one day after the appeal is resolved; and
(b) Permit the appealing pharmacy to reverse and rebill the claim in question, using the date of the original claim.
Source
Laws 2022, LB767, § 8.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4609 - Pharmacy benefit manager; 340B entity; 340B contract pharmacy; treatment; discrimination, prohibited.

44-4609.
Pharmacy benefit manager; 340B entity; 340B contract pharmacy; treatment; discrimination, prohibited.
(1) A pharmacy benefit manager that reimburses a 340B entity or a 340B contract pharmacy for a drug that is subject to an agreement under 42 U.S.C. 256b shall not reimburse the 340B entity or the 340B contract pharmacy for the pharmacy-dispensed drug at a rate lower than that paid for the same drug to similarly situated pharmacies that are not 340B entities or 340B contract pharmacies, and shall not assess any fee, chargeback, or other adjustment upon the 340B entity or 340B contract pharmacy on the basis that the 340B entity or 340B contract pharmacy participates in the program set forth in 42 U.S.C. 256b.
(2) A pharmacy benefit manager shall not discriminate against a 340B entity or 340B contract pharmacy in a manner that prevents or interferes with a covered individual's choice to receive such drug from the corresponding 340B entity or 340B contract pharmacy.
(3) For purposes of this section:
(a) 340B contract pharmacy means any pharmacy under contract with a 340B entity to dispense drugs on behalf of such 340B entity; and
(b) 340B entity means an entity participating in the federal 340B drug discount program, as described in 42 U.S.C. 256b.
Source
Laws 2022, LB767, § 9.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4610 - Pharmacy benefit manager; specialty pharmacy network; exclusions.

44-4610.
Pharmacy benefit manager; specialty pharmacy network; exclusions.
A pharmacy benefit manager shall not exclude a Nebraska pharmacy from participation in the pharmacy benefit manager's specialty pharmacy network if:
(1) The pharmacy holds a specialty pharmacy accreditation from a nationally recognized independent accrediting organization; and
(2) The pharmacy is willing to accept the terms and conditions of the pharmacy benefit manager's agreement with the pharmacy benefit manager's specialty pharmacies.
Source
Laws 2022, LB767, § 10.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4611 - Act; enforcement; director; powers and duties; monetary penalty.

44-4611.
Act; enforcement; director; powers and duties; monetary penalty.
(1) The director shall enforce compliance with the requirements of the Pharmacy Benefit Manager Licensure and Regulation Act.
(2)(a) Pursuant to the Insurers Examination Act, the director may examine or audit the books and records of a pharmacy benefit manager providing a claims processing service or other prescription drug or device service for a health benefit plan to determine compliance with the act.
(b) Information or data acquired during an examination under subdivision (2)(a) of this section is:
(i) Considered proprietary and confidential;
(ii) Not subject to sections 84-712, 84-712.01, and 84-712.03 to 84-712.09;
(iii) Not subject to subpoena; and
(iv) Not subject to discovery or admissible as evidence in any private civil action.
(3) The director may use any document or information provided pursuant to subsection (3) or (4) of section 44-4606 in the performance of the director's duties to determine compliance with the Pharmacy Benefit Manager Licensure and Regulation Act.
(4) The director may impose a monetary penalty on a pharmacy benefit manager or the health carrier with which a pharmacy benefit manager is contracted for a violation of the Pharmacy Benefit Manager Licensure and Regulation Act. The director shall establish the monetary penalty for a violation of the act in an amount not to exceed one thousand dollars per entity for each violation.
Source
Laws 2022, LB767, § 11.
Cross References
Insurers Examination Act, see section 44-5901.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4702 - Terms, defined.

44-4702.
Terms, defined.
For purposes of the Prepaid Limited Health Service Organization Act:
(1) Director shall mean the Director of Insurance;
(2) Enrollee shall mean an individual, including dependents, who is entitled to limited health services pursuant to a contract with an entity authorized to provide or arrange for such services under the act;
(3) Evidence of coverage shall mean any certificate, agreement, or contract issued pursuant to section 44-4709 setting forth the coverage to which an enrollee is entitled;
(4) Limited health services shall mean dental care services, vision care services, mental health services, substance abuse services, pharmaceutical services, podiatric care services, and such other services as may be determined by the director to be limited health services. Limited health services shall not include hospital, medical, surgical, or emergency services except as such services are provided incident to the limited health services set forth in this subdivision;
(5) Prepaid limited health service organization shall mean any corporation, partnership, limited liability company, or other entity which, in return for a prepayment, undertakes to provide or arrange for the provision of one or more limited health services to enrollees. Prepaid limited health service organization shall not include (a) an entity otherwise authorized pursuant to the laws of this state either to provide any limited health service on a prepayment or other basis or to indemnify for any limited health service, (b) an entity that meets the requirements of section 44-4707, or (c) a provider or entity when providing or arranging for the provision of limited health services pursuant to a contract with a prepaid limited health service organization or with an entity described in subdivision (5)(a) or (b) of this section;
(6) Provider shall mean any physician, dentist, health facility, or other person or institution which is duly licensed or otherwise authorized to deliver or furnish limited health services; and
(7) Subscriber shall mean the person whose employment or other status, except for family dependency, is the basis for entitlement to limited health services pursuant to a contract with an entity authorized to provide or arrange for such services under the act.
Source
Laws 1989, LB 320, § 2;
Laws 1993, LB 121, § 254.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4703 - Certificate of authority; required.

44-4703.
Certificate of authority; required.
No person, corporation, partnership, limited liability company, or other entity may operate a prepaid limited health service organization in this state without obtaining and maintaining a certificate of authority from the director pursuant to the Prepaid Limited Health Service Organization Act.
Source
Laws 1989, LB 320, § 3;
Laws 1993, LB 121, § 255.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4705 - Issuance of certificate of authority; conditions; denial.

44-4705.
Issuance of certificate of authority; conditions; denial.
(1) Following receipt of an application filed pursuant to section 44-4704, the director shall review such application and notify the applicant of deficiencies therein. The director shall issue a certificate of authority if the following conditions are met:
(a) The requirements of section 44-4704 have been fulfilled;
(b) The individuals responsible for the conduct of the affairs of the applicant are competent and trustworthy, possess good reputations, and have had appropriate experience, training, or education;
(c) The applicant is financially responsible and may reasonably be expected to meet its obligations to enrollees and to prospective enrollees. In making this determination, the director may consider:
(i) The financial soundness of the applicant's arrangements for limited health services and the minimum standard rates, deductibles, copayments, and other patient charges used in connection therewith;
(ii) The adequacy of working capital, other sources of funding, and provisions for contingencies;
(iii) Any agreement providing for payment of the cost of the limited health services or for alternative coverage in the event of insolvency of the prepaid limited health service organization; and
(iv) The manner in which the requirements of section 44-4718 have been fulfilled;
(d) The agreements with providers for the provision of limited health services contain the provisions required by section 44-4717; and
(e) Any deficiencies identified by the director have been corrected.
(2) If the certificate of authority is denied, the director shall notify the applicant by certified mail and shall specify the reasons for denial in the notice. The prepaid limited health service organization 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.
Source
Laws 1989, LB 320, § 5.
Cross References
Administrative Procedure Act, see section 84-920.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4706 - Effect on organizations operating without a certificate of authority.

44-4706.
Effect on organizations operating without a certificate of authority.
Within one hundred eighty days after August 25, 1989, every prepaid limited health service organization operating in this state without a certificate of authority shall submit an application for a certificate of authority to the director. Each such organization may continue to operate during the pendency of its application. In the event an application is denied under this section, the applicant shall then be treated as a prepaid limited health service organization whose certificate of authority has been revoked.
Source
Laws 1989, LB 320, § 6.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4707 - Filing requirements for authorized entities; disapproval.

44-4707.
Filing requirements for authorized entities; disapproval.
(1) Any entity authorized pursuant to the laws of this state to operate a health maintenance organization, an accident and health insurance company, or a fraternal benefit society and which is not otherwise authorized pursuant to the laws of this state to offer limited health services on a per capita or fixed prepayment basis may do so by filing for approval with the director the information described in subdivisions (4), (5), (7), (8), (10), (11), (12), and (14) of section 44-4704 and any subsequent material modification or addition thereto.
(2) If the director disapproves the filing, the procedures set forth in subsection (2) of section 44-4705 shall be followed.
Source
Laws 1989, LB 320, § 7.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4708 - Changes in rates or benefits; material modifications; addition of a limited health service; notices; hearing.

44-4708.
Changes in rates or benefits; material modifications; addition of a limited health service; notices; hearing.
(1) A prepaid limited health service organization shall file with the director prior to use a notice of any change in rates, charges, or benefits and of any material modification of any matter or document furnished pursuant to section 44-4704, together with such supporting documents as are necessary to fully explain the change or modification. If the director does not disapprove such filing within thirty days of its filing, such filing shall be deemed approved.
(2) If a prepaid limited health service organization desires to add one or more limited health services, it shall file a notice with the director and, at the same time, shall submit the information required by section 44-4704 if different from that filed with the prepaid limited health service organization's application and shall demonstrate compliance with sections 44-4717, 44-4718, and 44-4724. If the director does not disapprove such filing within thirty days of its filing, such filing shall be deemed approved.
(3) If the director does not approve the change, modification, or addition of a limited health service, the director shall notify the prepaid limited health service organization by certified mail and shall specify the reasons for disapproval in the notice. The prepaid limited health service organization 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.
Source
Laws 1989, LB 320, § 8.
Cross References
Administrative Procedure Act, see section 84-920.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4709 - Evidence of coverage.

44-4709.
Evidence of coverage.
(1) Every subscriber shall be issued an evidence of coverage which shall contain a clear and complete statement of:
(a) The services to which each enrollee is entitled;
(b) Any limitation of the services, kind of services, or benefits to be provided and exclusions, including any deductible, copayment, or other charges;
(c) Where and in what manner information is available as to where and how services may be obtained; and
(d) The method for resolving complaints.
(2) Any amendment to the evidence of coverage may be provided to the subscriber in a separate document.
Source
Laws 1989, LB 320, § 9.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4711 - Construction with other laws.

44-4711.
Construction with other laws.
(1) A prepaid limited health service organization shall be subject to the Unfair Insurance Trade Practices Act and the Unfair Insurance Claims Settlement Practices Act. No other provision of Chapter 44 shall apply unless specifically mentioned in the Prepaid Limited Health Service Organization Act or unless prepaid limited health service organizations are specifically mentioned in the provisions of Chapter 44.
(2) The provision of limited health services by a prepaid limited health service organization or other entity pursuant to the Prepaid Limited Health Service Organization Act shall not be deemed to be the practice of medicine or other healing arts.
(3) Solicitation to arrange for or provide limited health services in accordance with the Prepaid Limited Health Service Organization Act shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals.
(4) A prepaid limited health service organization organized under the laws of this state shall be deemed to be a domestic insurer for purposes of the Insurance Holding Company System Act unless specifically exempted in writing from one or more of the provisions of the act by the director.
Source
Laws 1989, LB 320, § 11;
Laws 1991, LB 236, § 58;
Laws 1991, LB 234, § 38.
Cross References
Insurance Holding Company System Act, see section 44-2120.
Unfair Insurance Claims Settlement Practices Act, see section 44-1536.
Unfair Insurance Trade Practices Act, see section 44-1521.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4712 - Nonduplication of coverage.

44-4712.
Nonduplication of coverage.
Notwithstanding any other law of this state, no prepaid limited health service organization, health maintenance organization, accident and health insurance company, or fraternal benefit society shall be required to include, in any contract or policy issued to a group, any coverage that would duplicate the coverage for limited health services, whether in the form of services, supplies, or reimbursement, which is provided in accordance with the Prepaid Limited Health Service Organization Act under a contract or policy issued to the same group or to a part of that group by a prepaid limited health service organization, a health maintenance organization, an accident and health insurance company, or a fraternal benefit society.
Source
Laws 1989, LB 320, § 12.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4713 - Complaint system.

44-4713.
Complaint system.
Every prepaid limited health service organization shall establish and maintain a complaint system to provide reasonable procedures for the resolution of written complaints initiated by enrollees or providers. This section shall not be construed to preclude an enrollee or a provider from filing a complaint with the director or as limiting the director's ability to investigate such complaints.
Source
Laws 1989, LB 320, § 13.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4714 - Examination of organization.

44-4714.
Examination of organization.
(1) The director may make an examination of the affairs of any prepaid limited health service organization as often as is reasonably necessary for the protection of the interests of the people of this state but not less frequently than once every four years.
(2) Every prepaid limited health service organization shall make its relevant books and records available for such examination and in every way cooperate with the director to facilitate such examination.
(3) The expenses of examinations under this section shall be charged to the prepaid limited health service organization being examined, and the prepaid limited health service organization shall remit the charges to the director.
(4) In lieu of such examination, the director may accept the report of an examination made by the chief administrative officer of an insurance department of another state.
Source
Laws 1989, LB 320, § 14.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4716 - Agents.

44-4716.
Agents.
No individual may apply, procure, negotiate, or place for others any policy or contract of a prepaid limited health service organization unless that individual holds a license pursuant to the Insurance Producers Licensing Act to sell accident and health insurance policies or health maintenance organization contracts.
Source
Laws 1989, LB 320, § 16.
Cross References
Insurance Producers Licensing Act, see section 44-4047.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4717 - Provider agreements.

44-4717.
Provider agreements.
All contracts with providers or with entities subcontracting for the provision of limited health services to enrollees on a prepayment or other basis shall contain or shall be construed to contain the following terms and conditions:
(1) In the event the prepaid limited health service organization fails to pay for limited health services for any reason whatsoever, including, but not limited to, insolvency or breach of this contract, the enrollees shall not be liable to the provider for any sums owed to the provider under this contract;
(2) No provider or an agent, trustee, or assignee thereof may maintain an action at law or attempt to collect from the enrollee sums owed to the provider by the prepaid limited health service organization;
(3) These provisions shall not prohibit collection of copayments from enrollees;
(4) These provisions shall survive the termination of this contract, regardless of the reason giving rise to the termination;
(5) Termination of this contract shall not release the provider from the obligations and duties imposed by this contract to complete procedures in progress on enrollees then receiving treatment for a specific condition for a period not to exceed thirty days at the same schedule of copayment or other applicable charge in effect upon the effective date of termination of this contract; and
(6) Any amendment to the provisions of this contract shall be submitted to and be approved by the director prior to becoming effective.
Source
Laws 1989, LB 320, § 17.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4719 - Officers and employees; fidelity bond or deposit.

44-4719.
Officers and employees; fidelity bond or deposit.
(1) A prepaid limited health service organization shall maintain in force a fidelity bond in its own name on its officers and employees in an amount not less than fifty thousand dollars or in any other amount prescribed by the director. Except as otherwise provided by subsection (2) of this section, the bond shall be issued by an insurance company that is licensed to do business in this state, or if the fidelity bond required by this subsection is not available from an insurance company that holds a certificate of authority in this state, a fidelity bond procured by a surplus lines licensee resident in this state in compliance with section 44-5504 shall satisfy the requirements of this subsection.
(2) In lieu of the bond specified in subsection (1) of this section, a prepaid limited health service organization may deposit with the director fifty thousand dollars in cash or securities or other investments of the types set forth in section 44-4715. Such a deposit shall be maintained in joint custody with the director in the amount and subject to the same conditions required for a bond under this section.
Source
Laws 1989, LB 320, § 19;
Laws 1992, LB 1006, § 54.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4720 - Reports required; contents; fine.

44-4720.
Reports required; contents; fine.
(1) Every prepaid limited health service organization shall file with the director annually, on or before March 1, a report verified by at least two principal officers covering the preceding calendar year.
(2) Such report shall be on forms prescribed by the director and shall include:
(a) A financial statement of the organization, including its balance sheet, income statement, and statement of changes in financial position for the preceding year, audited by an independent certified public accountant, or the director may in lieu of such statement accept a consolidated audited financial statement of its parent company audited by an independent certified public accountant, attached to which shall be consolidating financial statements of the prepaid limited health service organization;
(b) Any material changes in the information submitted pursuant to section 44-4704;
(c) The number of subscribers at the beginning of the year, the number of subscribers as of the end of the year, and the number of enrollments terminated during the year; and
(d) Such other information relating to the performance of the prepaid limited health service organization as is necessary to enable the director to carry out his or her duties under the Prepaid Limited Health Service Organization Act.
(3) The director may require more frequent reports containing such information as is necessary to enable the director to carry out his or her duties under the act.
(4) The director may assess a fine of up to one hundred dollars per day for each day any required report is late, and the director may suspend the organization's certificate of authority pending the proper filing of the required report by the organization.
Source
Laws 1989, LB 320, § 20.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4722 - Violations; cease and desist order; penalty.

44-4722.
Violations; cease and desist order; penalty.
In lieu of any penalty specified elsewhere in the Prepaid Limited Health Service Organization Act or when no penalty is specifically provided, whenever any prepaid limited health service organization or other person, corporation, partnership, limited liability company, or entity subject to the act has been found, pursuant to the Administrative Procedure Act, to have violated any provision of the Prepaid Limited Health Service Organization Act, the director may:
(1) Issue and cause to be served upon the organization, person, or other entity charged with the violation a copy of such findings and an order requiring such organization, person, or other entity to cease and desist from engaging in the act or practice which constitutes the violation; and
(2) Impose a monetary penalty of not more than one thousand dollars for each violation but not to exceed an aggregate penalty of ten thousand dollars.
Source
Laws 1989, LB 320, § 22;
Laws 1993, LB 121, § 257.
Cross References
Administrative Procedure Act, see section 84-920.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4723 - Supervision, rehabilitation, conservation, or liquidation; proceedings authorized.

44-4723.
Supervision, rehabilitation, conservation, or liquidation; proceedings authorized.
Any supervision, rehabilitation, conservation, or liquidation of a prepaid limited health service organization shall be deemed to be the supervision, rehabilitation, conservation, or liquidation of an insurance company and shall be conducted pursuant to the Nebraska Insurers Supervision, Rehabilitation, and Liquidation Act. No prepaid limited health service organization shall be subject to the insurance laws, rules, and regulations governing insurance insolvency guaranty funds, nor shall any insurance insolvency guaranty fund provide protection to any individuals entitled to receive limited health services from a prepaid limited health service organization.
Source
Laws 1989, LB 320, § 23;
Laws 1989, LB 319, § 79.
Cross References
Nebraska Insurers Supervision, Rehabilitation, and Liquidation Act, see section 44-4862.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4724 - Fees.

44-4724.
Fees.
Every prepaid limited health service organization subject to the Prepaid Limited Health Service Organization Act shall pay to the director the following fees:
(1) For filing an application for certificate of authority or amendment thereto, one hundred dollars;
(2) For filing a change in rates, charges, or benefits, material modification of any matter or document, or addition of a limited health service, fifty dollars;
(3) For filing each annual report, fifty dollars; and
(4) For filing periodic reports as required by the director, fifty dollars.
Source
Laws 1989, LB 320, § 24.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4725 - Confidentiality; exceptions.

44-4725.
Confidentiality; exceptions.
(1) Any information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person or from any provider by any prepaid limited health service organization and any contract submitted pursuant to the requirements of the Prepaid Limited Health Service Organization Act shall be held in confidence and shall not be disclosed to any person except:
(a) To the extent that it may be necessary to carry out the purposes of the act;
(b) Upon the express consent of the enrollee, applicant, provider, or prepaid limited health service organization, whichever is applicable;
(c) Pursuant to statute or court order for the production of evidence or the discovery thereof; or
(d) In the event of claim or litigation in which such data or information is relevant.
(2) With respect to any information pertaining to the diagnosis, treatment, or health of any enrollee or applicant, a prepaid limited health service organization shall be entitled to claim any statutory privileges against disclosure which the provider who furnished such information to the prepaid limited health service organization is entitled to claim.
(3) Any information provided to the director which constitutes a trade secret, is privileged information, or is part of an investigation or examination by the director shall be held in confidence.
Source
Laws 1989, LB 320, § 25.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4726 - Taxes.

44-4726.
Taxes.
(1) The same taxes provided for in section 44-32,180 shall be imposed upon each prepaid limited health service organization, and such organizations also shall be entitled to the same tax deductions, reductions, abatements, and credits that health maintenance organizations are entitled to receive.
(2) Any capitation payment made in accordance with the Medical Assistance Act shall be excluded from computation of any tax obligation imposed by subsection (1) of this section.
Source
Laws 1989, LB 320, § 26;
Laws 1990, LB 1136, § 110;
Laws 1996, LB 969, § 8;
Laws 2002, Second Spec. Sess., LB 9, § 2;
Laws 2006, LB 1248, § 64;
Laws 2010, LB698, § 2.
Cross References
Medical Assistance Act, see section 68-901.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4801 - Purpose of act.

44-4801.
Purpose of act.
The purpose of the Nebraska Insurers Supervision, Rehabilitation, and Liquidation Act is to protect the interests of insureds, claimants, creditors, and the public with minimum interference with the normal prerogatives of the owners and managers of insurers through:
(1) Early detection of any potentially dangerous condition in an insurer and prompt application of appropriate corrective measures;
(2) Improved methods for rehabilitating insurers involving the cooperation and management expertise of the insurance industry;
(3) Enhanced efficiency and economy of liquidation, through clarification of the law, to minimize legal uncertainty and litigation;
(4) Equitable apportionment of any unavoidable loss;
(5) Lessening the problems of interstate rehabilitation and liquidation by facilitating cooperation between states in the liquidation process and by extending the scope of personal jurisdiction over debtors of the insurer outside this state;
(6) Regulation of the insurance business by the impact of the law relating to delinquency procedures and substantive rules on the entire insurance business; and
(7) Providing for a comprehensive scheme for the supervision, rehabilitation, and liquidation of insurers and those subject to the act as part of the regulation of the business of insurance, insurance industry, and insurers in this state. Proceedings in cases of insurer insolvency and delinquency are deemed an integral aspect of the business of insurance and are of vital public interest and concern.
The act shall be liberally construed to effect the purposes enumerated in this section and shall not be interpreted to limit the powers granted the director by other provisions of the law.
Source
Laws 1989, LB 319, § 1;
Laws 1991, LB 236, § 59.
Annotations
Proceedings under the Nebraska Insurers Supervision, Rehabilitation, and Liquidation Act are equitable in nature, and therefore, the liquidation court's determinations of claims disputes are reviewed de novo on the record. State ex rel. Wagner v. Amwest Sur. Ins. Co., 274 Neb. 121, 738 N.W.2d 813 (2007).
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4802 - Act; applicability.

44-4802.
Act; applicability.
The proceedings authorized by the Nebraska Insurers Supervision, Rehabilitation, and Liquidation Act may be applied to:
(1) All insurers who are doing or have done an insurance business in this state and against whom claims arising from that business may exist now or in the future;
(2) All insurers who purport to do an insurance business in this state;
(3) All insurers who have insureds who are residents of this state;
(4) All other persons organized or in the process of organizing with the intent to do an insurance business in this state;
(5) All fraternal benefit societies subject to Chapter 44, article 10;
(6) All title insurers subject to the Title Insurers Act;
(7) All health maintenance organizations subject to the Health Maintenance Organization Act;
(8) All legal service insurance corporations subject to Chapter 44, article 33;
(9) All prepaid dental service corporations subject to Chapter 44, article 38; and
(10) All prepaid limited health service organizations subject to the Prepaid Limited Health Service Organization Act.
Source
Laws 1989, LB 319, § 2;
Laws 1990, LB 984, § 3;
Laws 1990, LB 1136, § 111;
Laws 1991, LB 235, § 57;
Laws 1997, LB 53, § 49.
Cross References
Health Maintenance Organization Act, see section 44-3292.
Prepaid Limited Health Service Organization Act, see section 44-4701.
Title Insurers Act, see section 44-1978.