reglab/statecodes huggingface dataset:
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4110.02 - Health care review committee; preferred provider organization; exemption from liability.

44-4110.02.
Health care review committee; preferred provider organization; exemption from liability.
A person who, in good faith and without malice, takes any action or makes any decision or recommendation as a member, agent, or employee of a health care review committee or who furnishes any records, information, or assistance to such a committee shall not be subject to liability for civil damages or any legal action in consequence of such action, nor shall the preferred provider organization which established the committee or the officers, directors, employees, or agents of the preferred provider organization be liable for the activities of any such person. This section shall not be construed to relieve any person of liability arising from treatment of a patient.
Source
Laws 1990, LB 1136, § 102.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4110.03 - Health care review committee; information and records; confidentiality.

44-4110.03.
Health care review committee; information and records; confidentiality.
(1) The information considered by a health care review committee and the records of their actions and proceedings shall be confidential and not subject to subpoena or order to produce except in proceedings before the appropriate state licensing or certifying agency or in an appeal from the committee's findings or recommendations. No member of a health care review committee, no officer, director, or other member of a preferred provider organization or its staff engaged in assisting such committee, and no person assisting or furnishing information to such committee may be subpoenaed to testify in any judicial or quasi-judicial proceeding if such subpoena is based solely on such activities.
(2) Information considered by a health care review committee and the records of its actions and proceedings which are used pursuant to subsection (1) of this section by a state licensing or certifying agency or in an appeal shall be kept confidential and shall be subject to the same provisions concerning discovery and use in legal actions as the original information and records in the possession and control of a health care review committee.
Source
Laws 1990, LB 1136, § 103.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4111 - Contracts with preferred providers; procedure; discrimination prohibited.

44-4111.
Contracts with preferred providers; procedure; discrimination prohibited.
(1) Insurers and participants may contract for health services with preferred providers through a process of competitive bidding or through individual negotiations with preferred providers. After completion of such bidding process or individual negotiations, an insurer or participant may offer to providers the terms and conditions of a preferred provider contract. Providers willing and qualified to meet the terms and conditions of a preferred provider contract offered by an insurer or participant may agree to provide health services pursuant to such contract.
(2) The terms and conditions of the policies or contracts specified in section 44-4109 shall not discriminate against or among health providers. Differences in prices among providers based on individual negotiations with such providers, market conditions, patient mix, method of payment, or price differences among providers in different geographical areas shall not be deemed discrimination.
Source
Laws 1984, LB 902, § 11.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4112 - Mandated providers; opportunity to bid, contract, provide services.

44-4112.
Mandated providers; opportunity to bid, contract, provide services.
Mandated types of providers whose services are required to be made available to insureds pursuant to section 44-513 shall, to the extent required by such section, have the same opportunity to bid and negotiate contracts for health services as a preferred provider or to provide health services as a nonpreferred provider.
Source
Laws 1984, LB 902, § 12.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4113 - Use of nonpreferred providers; effect.

44-4113.
Use of nonpreferred providers; effect.
Insurers and participants in insurance arrangements shall provide for payment for services rendered by nonpreferred providers or providers who have not negotiated a contract with the insurer or participants in the insurance arrangement. Insureds under an insurance arrangement shall use the preferred providers who have contracted with the group to obtain coverage under the plan at the least direct expense to the insured. Insureds selecting nonpreferred providers may be held financially responsible for the difference between the benefits available under a preferred provider contract and the charges of the nonpreferred provider and may be subject to larger coinsurance or deductible provisions. Under a prepaid dental service plan as defined in section 44-3802, a participant's premium contribution for health services provided by nonpreferred providers to an insured shall be an amount equal to the participant's contribution pursuant to a preferred provider contract.
Source
Laws 1984, LB 902, § 13.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4201 - Act, how cited.

44-4201.
Act, how cited.
Sections 44-4201 to 44-4235 shall be known and may be cited as the Comprehensive Health Insurance Pool Act.
Source
Laws 1985, LB 391, § 1;
Laws 1997, LB 862, § 20;
Laws 2001, LB 360, § 20;
Laws 2004, LB 1047, § 9;
Laws 2009, LB358, § 1.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4202 - Legislative purpose and intent.

44-4202.
Legislative purpose and intent.
It is the purpose and intent of the Legislature to provide access to health insurance coverage at an affordable premium to all residents of Nebraska, including those individuals denied coverage due to a preexisting medical condition or whose policy includes a restrictive rider limiting coverage for such a condition. The purpose of the Comprehensive Health Insurance Pool Act is to provide a mechanism to ensure the availability of health insurance coverage to individuals unable to purchase such coverage for a preexisting medical condition either on an individual or group basis directly from an insurer. It is the intent of the Legislature that adequate levels of health insurance coverage be made available to residents of Nebraska who are otherwise considered uninsurable or who are underinsured due to a medical condition creating a high risk. It is the intent of the Comprehensive Health Insurance Pool Act to provide affordable insurance for individuals with such medical conditions by making such health insurance coverage available.
Source
Laws 1985, LB 391, § 2;
Laws 2000, LB 1253, § 2.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4203 - Definitions, where found.

44-4203.
Definitions, where found.
For the purposes of the Comprehensive Health Insurance Pool Act, the definitions found in sections 44-4204 to 44-4215.02 shall be used.
Source
Laws 1985, LB 391, § 3;
Laws 1997, LB 862, § 21;
Laws 2000, LB 1253, § 3;
Laws 2001, LB 360, § 21;
Laws 2004, LB 1047, § 10.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4204 - Agent or insurance agent, defined.

44-4204.
Agent or insurance agent, defined.
Agent or insurance agent means any person licensed as an insurance agent by the department and duly appointed and authorized by an insurer to solicit applications for insurance and to discharge such other duties as may be vested in or required of the agent by the insurer.
Source
Laws 1985, LB 391, § 4;
Laws 2000, LB 1253, § 4.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4205 - Benefits plan, defined.

44-4205.
Benefits plan, defined.
Benefits plan means the coverages to be offered by the pool to eligible individuals meeting the requirements of section 44-4221.
Source
Laws 1985, LB 391, § 5;
Laws 2000, LB 1253, § 5.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4206.02 - Creditable coverage, defined.

44-4206.02.
Creditable coverage, defined.
(1) Creditable coverage means, with respect to an individual, coverage of the individual under any of the following:
(a) A group health plan;
(b) Health insurance coverage;
(c) Medicare;
(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 does not include any coverage that occurs before a significant break in coverage. For purposes of this section, a significant break in coverage means 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 does 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, § 23;
Laws 1998, LB 1035, § 6;
Laws 2000, LB 1253, § 8;
Laws 2003, LB 6, § 1.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4208.01 - Governmental plan, defined.

44-4208.01.
Governmental plan, defined.
Governmental plan means 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, § 24;
Laws 2000, LB 1253, § 11.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4208.02 - Group health plan, defined.

44-4208.02.
Group health plan, defined.
Group health plan means 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, § 25;
Laws 2000, LB 1253, § 12.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4209 - Health insurance, defined.

44-4209.
Health insurance, defined.
Health insurance means any hospital, surgical, or medical expense-incurred policy or health maintenance organization contract. Health insurance does not include (1) accident-only, disability income, hospital confinement indemnity, dental, or credit insurance, (2) coverage issued as a supplement to liability insurance, (3) medicare or insurance provided as a supplement to medicare, (4) insurance arising from workers' compensation provisions, (5) automobile medical payment insurance, (6) any other specific limited coverage, or (7) insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in any liability insurance policy.
Source
Laws 1985, LB 391, § 9;
Laws 1989, LB 92, § 266;
Laws 2000, LB 1253, § 13.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4210 - Insurer, defined.

44-4210.
Insurer, defined.
Insurer means any insurance company as defined in section 44-103 or health maintenance organization as defined in section 44-32,105 authorized to transact health insurance business in the State of Nebraska.
Source
Laws 1985, LB 391, § 10;
Laws 1989, LB 92, § 267;
Laws 1990, LB 1136, § 104;
Laws 2000, LB 1253, § 14.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4211 - Medicare, defined.

44-4211.
Medicare, defined.
Medicare means coverage under parts A and B of Title XVIII of the Social Security Act, 42 U.S.C. 1395 et seq., as amended.
Source
Laws 1985, LB 391, § 11;
Laws 2000, LB 1253, § 15.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4214 - Plan of operation, defined.

44-4214.
Plan of operation, defined.
Plan of operation means the plan of operation of the pool, including articles, bylaws, and operating rules, submitted by the board pursuant to section 44-4218.
Source
Laws 1985, LB 391, § 14;
Laws 2000, LB 1253, § 18.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4215.02 - Qualified trade adjustment assistance eligible individual, defined.

44-4215.02.
Qualified trade adjustment assistance eligible individual, defined.
Qualified trade adjustment assistance eligible individual shall mean an individual who is eligible for the credit for health insurance costs under section 35 of the Internal Revenue Code.
Source
Laws 2004, LB 1047, § 11.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4217 - Board; pool administrator; selection.

44-4217.
Board; pool administrator; selection.
The director shall select the board. The board shall select a pool administrator pursuant to section 44-4223.
Source
Laws 1985, LB 391, § 17;
Laws 1989, LB 279, § 6;
Laws 1992, LB 1006, § 31;
Laws 2000, LB 1253, § 21;
Laws 2011, LB73, § 1.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4218 - Administration of pool; submit plan of operation; procedure.

44-4218.
Administration of pool; submit plan of operation; procedure.
The board shall submit to the department a plan of operation for the pool and any amendments thereto necessary or suitable to assure the fair, reasonable, and equitable administration of the pool. The director shall, after notice and hearing, approve the plan of operation if the plan assures the fair, reasonable, and equitable administration of the pool. The plan of operation shall become effective upon approval in writing by the director consistent with the date on which the coverage under the Comprehensive Health Insurance Pool Act is required to be made available. If the board fails to submit an acceptable plan of operation or fails to submit acceptable amendments to the plan, the director shall, after notice and hearing, adopt and promulgate such reasonable rules and regulations as are necessary or advisable to effectuate the Comprehensive Health Insurance Pool Act pursuant to the Administrative Procedure Act. Such rules and regulations shall continue in force until modified by the director or superseded by a plan submitted by the board and approved by the director.
Source
Laws 1985, LB 391, § 18;
Laws 1992, LB 1006, § 32.
Cross References
Administrative Procedure Act, see section 84-920.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4219 - Plan of operation; contents.

44-4219.
Plan of operation; contents.
In its plan of operation, the board shall:
(1) Establish procedures for the handling and accounting of assets and funds of the pool;
(2) Select a pool administrator in accordance with section 44-4223;
(3) Establish procedures for the selection, replacement, term of office, and qualifications of the directors of the board and rules of procedures for the operation of the board; and
(4) Develop and implement a program to publicize the existence of the pool, the eligibility requirements, and the procedures for enrollment and to maintain public awareness of the pool.
Source
Laws 1985, LB 391, § 19;
Laws 1992, LB 1006, § 33;
Laws 2000, LB 1253, § 22;
Laws 2011, LB73, § 2.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4220 - Board; powers; enumerated.

44-4220.
Board; powers; enumerated.
The board shall have the general powers and authority granted under the laws of this state to insurance companies licensed to transact the business of health insurance and, in addition thereto, the power to carry out the provisions and purposes of the Comprehensive Health Insurance Pool Act, including the specific authority to:
(1)(a) Enter into contracts as are necessary or proper, including the authority, with the approval of the director, to enter into contracts with similar pools from other states for the joint performance of common administrative functions or with persons or other organizations for the performance of administrative functions; and
(b) Enter into contracts, with the approval of the director, with any physician, hospital, or other person licensed or otherwise authorized in this state to furnish health care services for participating in an insurance arrangement as defined in section 44-4104;
(2) Sue or be sued, including taking any legal actions necessary or proper for recovery of any assessments for, on behalf of, or against members;
(3) Take such legal action as necessary to avoid the improper issuance of pool coverage;
(4) Subject to the requirements of section 44-4227, establish appropriate rates and rate schedules, expense allowances, agents' solicitation and referral fees, claim reserves and formulas, and any other actuarial functions appropriate to the operation of the pool;
(5) Issue policies of insurance in accordance with the requirements of the plan of operation and the act and, with the approval of the director, refuse to renew all policy forms for a class of contract and offer a conversion privilege to any covered individual;
(6) Appoint from among members appropriate legal, actuarial, and other committees as necessary to provide technical assistance in the operation of the pool, the policy and other contract design, and any other function within the authority of the pool;
(7) Borrow money to effectuate the purposes of the act. Any notes or other evidence of indebtedness of the pool not in default shall be legal investment for insurers and may be carried as admitted assets; and
(8) Enter into reinsurance agreements and establish rules, conditions, and procedures for reinsuring risks under the act.
Source
Laws 1985, LB 391, § 20;
Laws 1989, LB 279, § 7;
Laws 1990, LB 1136, § 105;
Laws 1992, LB 1006, § 34;
Laws 2000, LB 1253, § 23.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4220.01 - Review of operation; report.

44-4220.01.
Review of operation; report.
Following the close of each calendar year, the board shall conduct a review of the operation of the pool and report to the director the board's recommendations for cost savings in the operation of the pool.
Source
Laws 2009, LB358, § 2.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4222 - Purchase of pool coverage; ineligibility.

44-4222.
Purchase of pool coverage; ineligibility.
(1) An individual shall not be eligible for initial or continued pool coverage if:
(a) He or she is eligible for medicare benefits by reason of age or medical assistance established pursuant to the Medical Assistance Act;
(b) He or she is a resident or inmate of a correctional facility, except that this subdivision shall not apply if such individual is eligible for pool coverage under subdivision (1)(b) of section 44-4221;
(c) He or she has terminated pool coverage unless twelve months have elapsed since such termination, except that this subdivision shall not apply if such individual has received and become ineligible for medical assistance pursuant to the Medical Assistance Act during the immediately preceding twelve months, if such individual is eligible for pool coverage under subdivision (1)(b) of section 44-4221, or if such individual is eligible for waiver of any waiting period or preexisting condition exclusions pursuant to section 44-4228;
(d) The pool has paid out one million dollars in claims for the individual;
(e) He or she is no longer a resident of Nebraska; or
(f) The premium for his or her pool coverage is paid for by a person other than the following:
(i) The individual;
(ii) An individual related to the individual by blood, marriage, or adoption; or
(iii) An entity operating under the federal Ryan White HIV/AIDS Treatment Modernization Act of 2006, Public Law 109-415, as such act existed on August 30, 2009.
(2) Pool coverage shall terminate for any individual on the date the individual becomes ineligible under subsection (1) of this section.
Source
Laws 1985, LB 391, § 22;
Laws 1987, LB 319, § 2;
Laws 1989, LB 279, § 8;
Laws 1990, LB 1136, § 106;
Laws 1992, LB 1006, § 36;
Laws 1997, LB 862, § 27;
Laws 1998, LB 1035, § 8;
Laws 2000, LB 1253, § 25;
Laws 2006, LB 1248, § 62;
Laws 2009, LB358, § 5.
Cross References
Medical Assistance Act, see section 68-901.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4222.01 - Insurer, agent, broker, or third-party administrator; prohibited acts; violation; unfair trade practice.

44-4222.01.
Insurer, agent, broker, or third-party administrator; prohibited acts; violation; unfair trade practice.
(1) No insurer, agent, broker, or third-party administrator shall refer an individual employee to the pool or arrange for an individual employee to apply for pool coverage for the purpose of separating that individual employee from group health insurance coverage in connection with the individual employee's employment.
(2) Any violation of this section shall be an unfair trade practice in the business of insurance subject to the Unfair Insurance Trade Practices Act.
Source
Laws 2009, LB358, § 6.
Cross References
Unfair Insurance Trade Practices Act, see section 44-1521.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4223 - Selection of pool administrator; procedure.

44-4223.
Selection of pool administrator; procedure.
(1) The board shall select a pool administrator through a competitive bidding process to administer the pool. The pool administrator may be an insurer or a third-party administrator authorized to transact business in this state. The board shall evaluate bids submitted on the basis of criteria established by the board which shall include:
(a) The applicant's proven ability to handle individual sickness and accident insurance;
(b) The efficiency of the applicant's claim-paying procedures;
(c) The applicant's estimate of total charges for administering the pool;
(d) The applicant's ability to administer the pool in a cost-effective manner; and
(e) The applicant's ability to negotiate reduced health care provider reimbursement rates for benefits payable under pool coverage for covered services.
(2) The pool administrator shall serve for a period of three years subject to removal for cause. At least one year prior to the expiration of each three-year period of service by a pool administrator, the board shall invite all insurers and third-party administrators authorized to transact business in this state, including the current pool administrator, to submit bids to serve as the pool administrator for the succeeding three-year period. Selection of the pool administrator for the succeeding period shall be made at least six months prior to the end of the current three-year period.
Source
Laws 1985, LB 391, § 23;
Laws 1992, LB 1006, § 37;
Laws 2011, LB73, § 4.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4224 - Pool administrator; duties.

44-4224.
Pool administrator; duties.
The pool administrator shall:
(1) Perform all eligibility verification functions relating to the pool;
(2) Establish a premium billing procedure for collection of premiums from covered individuals on a periodic basis as determined by the board;
(3) Perform all necessary functions to assure timely payment of benefits to covered individuals, including:
(a) Making available information relating to the proper manner of submitting a claim for benefits to the pool and distributing forms upon which submission shall be made; and
(b) Evaluating the eligibility of each claim for payment by the pool;
(4) Submit regular reports to the board regarding the operation of the pool. The frequency, content, and form of the reports shall be determined by the board;
(5) Following the close of each calendar year, report such income and expense items as directed by the board to the board and the department on a form prescribed by the director; and
(6) Be paid as provided in the plan of operation for its expenses incurred in the performance of its services to the pool.
Source
Laws 1985, LB 391, § 24;
Laws 2000, LB 1253, § 26;
Laws 2011, LB73, § 5.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4225 - Board; report; Comprehensive Health Insurance Pool Distributive Fund; created; use; investment; director; funding powers.

44-4225.
Board; report; Comprehensive Health Insurance Pool Distributive Fund; created; use; investment; director; funding powers.
(1) Following the close of each calendar year, the board shall report the board's determination of the paid and incurred losses for the year, taking into account investment income and other appropriate gains and losses. The board shall distribute copies of the report to the director, the Governor, and each member of the Legislature. The report submitted to each member of the Legislature shall be submitted electronically.
(2) The Comprehensive Health Insurance Pool Distributive Fund is created. Commencing with the premium and related retaliatory taxes for the taxable year ending December 31, 2001, and for each taxable year thereafter, any premium and related retaliatory taxes imposed by section 44-150 or 77-908 paid by insurers writing health insurance in this state, except as otherwise set forth in subdivisions (1) and (2) of section 77-912, shall be remitted to the State Treasurer for credit to the fund. The fund shall be used for the operation of and payment of claims made against the pool. Any money in the fund available for investment shall be invested by the state investment officer pursuant to the Nebraska Capital Expansion Act and the Nebraska State Funds Investment Act.
(3) The board shall make periodic estimates of the amount needed from the fund for payment of losses resulting from claims, including a reasonable reserve, and administrative, organizational, and interim operating expenses and shall notify the director of the amount needed and the justification of the board for the request.
(4) The director shall approve all withdrawals from the fund and may determine when and in what amount any additional withdrawals may be necessary from the fund to assure the continuing financial stability of the pool.
(5) No later than May 1, 2002, and each May 1 thereafter, after funding of the net loss from operation of the pool for the prior premium and related retaliatory tax year, taking into account the policyholder premiums, account investment income, claims, costs of operation, and other appropriate gains and losses, the director shall transmit any money remaining in the fund as directed by section 77-912, disregarding the provisions of subdivisions (1) through (3) of such section. Interest earned on money in the fund shall be credited proportionately in the same manner as premium and related retaliatory taxes set forth in section 77-912.
Source
Laws 1985, LB 391, § 25;
Laws 1991, LB 419, § 3;
Laws 1992, LB 1006, § 38;
Laws 2000, LB 1253, § 27;
Laws 2011, LB73, § 6;
Laws 2012, LB782, § 54.
Cross References
Nebraska Capital Expansion Act, see section 72-1269.
Nebraska State Funds Investment Act, see section 72-1260.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4226 - Major medical expense coverage required; considerations.

44-4226.
Major medical expense coverage required; considerations.
(1) The pool shall offer major medical expense coverage to every eligible individual. The pool coverage, its schedule of benefits, and exclusions and other limitations shall be established through rules and regulations adopted and promulgated by the director taking into consideration the advice and recommendations of the members.
(2) In establishing the pool coverage, the director shall take into consideration the levels of individual health insurance coverage provided in the state and such medical economic factors as may be deemed appropriate and shall determine benefit levels, deductibles, coinsurance and stop-loss factors, exclusions, and limitations determined to be generally reflective of and commensurate with individual health insurance coverage provided by the ten insurers writing the largest amount of individual health insurance coverage in the state.
(3) Pool coverage established under this section shall provide both an appropriate high and low deductible to be selected by the pool applicant. The deductibles and coinsurance and stop-loss factors may be adjusted annually according to the medical component of the Consumer Price Index.
Source
Laws 1985, LB 391, § 26;
Laws 1992, LB 1006, § 39;
Laws 2000, LB 1253, § 28;
Laws 2009, LB358, § 7.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4229 - Reduction of benefits; when.

44-4229.
Reduction of benefits; when.
Benefits otherwise payable under pool coverage shall be reduced by all amounts paid or payable through any other health insurance or insurance arrangement and by all hospital and medical expense benefits paid or payable under any workers' compensation coverage, automobile medical payment or liability insurance whether provided on the basis of fault or nonfault, or any state or federal law or program.
Source
Laws 1985, LB 391, § 29.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4230 - Recovery of noncovered expenses; cause of action; subrogation.

44-4230.
Recovery of noncovered expenses; cause of action; subrogation.
The pool shall have a cause of action against a covered individual for the recovery of the amount of benefits paid which are not for covered expenses. Benefits due from the pool may be reduced or refused as a setoff against any amount recoverable under this section. The pool shall have a right of subrogation to any payments made to a covered individual by another person or his or her insurer on account of an injury caused by such other person's wrongful act or negligence.
Source
Laws 1985, LB 391, § 30;
Laws 1990, LB 1136, § 109;
Laws 2000, LB 1253, § 31.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4231 - Pool; limitation on liability.

44-4231.
Pool; limitation on liability.
Participation in the pool as members, the establishment of rates, forms, or procedures, or any other joint or collective action required by the Comprehensive Health Insurance Pool Act shall not be the basis of any cause of action, criminal or civil liability, or penalty against the pool or any of its members or the board.
Source
Laws 1985, LB 391, § 31;
Laws 1992, LB 1006, § 41.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4233 - Member; offset tax liability.

44-4233.
Member; offset tax liability.
(1) Any member subject to premium and related retaliatory tax liability imposed by section 44-150 or 77-908 may offset assessments paid to the pool by such member against its tax liability in the year of payment or subsequent years. The member may offset such paid assessments against (a) subsequent premium tax prepayments imposed by section 77-918, (b) subsequent premium tax payments imposed by section 77-908, and (c) related retaliatory tax liability imposed by section 44-150. Prior to January 1, 2004, no individual member shall be subject to any liability of the pool in excess of its premium and related retaliatory tax liability which may be offset under this section.
(2) Commencing with assessments imposed or paid in 1991 and for all subsequent years prior to January 1, 2004, whenever it reasonably appears to the satisfaction of the board that a member has during a calendar year paid assessments that exceed that member's premium and related retaliatory tax liability for that calendar year, the board shall, upon request from such member, order the refund to that member of the amount of the assessment that exceeded that member's premium and related retaliatory tax liability. A member's request for a refund shall be filed with the board not later than thirty days after the due date of the member's premium tax return filed with the department. If the refund is not made by the board within thirty days after receipt of the refund request, the member may within thirty days thereafter initiate a suit in district court for the amount claimed. The suit shall be heard by the district court de novo. In the event that an assessment against a member is limited by reason of that member's premium and related retaliatory tax liability, the amount by which the assessment is limited may be assessed against the other members in a manner consistent with the basis for assessments specified in subsection (3) of section 44-4225.
Source
Laws 1985, LB 391, § 33;
Laws 1986, LB 1114, § 8;
Laws 1987, LB 302, § 7;
Laws 1992, LB 835, § 2;
Laws 1992, LB 1006, § 42;
Laws 1993, LB 10, § 1;
Laws 1995, LB 837, § 1;
Laws 1997, LB 55, § 3;
Laws 1997, LB 862, § 29;
Laws 1999, LB 355, § 6;
Laws 2000, LB 1253, § 32.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4235 - Insurer; notice required.

44-4235.
Insurer; notice required.
Every insurer shall include a notice of the existence of the pool in (1) any rejection of an application for health insurance coverage for reasons of the health of the applicant and (2) any restrictive health insurance rider issued on or after January 1, 1999.
Source
Laws 1985, LB 391, § 35;
Laws 1992, LB 1006, § 43;
Laws 1998, LB 1063, § 4.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4302 - Legislative findings.

44-4302.
Legislative findings.
The Legislature hereby finds and declares that protection against losses due to liability and damage or loss of property and provision of employee benefit plans is essential to the proper functioning of state and local government. The resources of state and local governmental agencies are often burdened by the securing of necessary insurance protection and employee benefits through standard insurance carriers. In addition, the Legislature finds that benefits can be derived through pooling of purchasing by state and local government. Proper risk management requires the spreading of risk so as to minimize fluctuation in insurance needs. The Legislature further finds that all contributions of financial and administrative resources made by state and local governmental agencies pursuant to an agreement authorized by the Intergovernmental Risk Management Act are made for a public and governmental purpose.
Source
Laws 1987, LB 398, § 2;
Laws 2001, LB 664, § 1.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4304 - Risk management pool; agreements authorized.

44-4304.
Risk management pool; agreements authorized.
(1) Any two or more public agencies may make and execute an agreement providing for joint and cooperative action in accordance with the Intergovernmental Risk Management Act to form, become members of, and operate a risk management pool for the purpose of providing to members risk management services and insurance coverages in the form of group self-insurance or standard insurance, including any combination of group self-insurance and standard insurance, to protect members against losses arising from any of the following:
(a) General liability;
(b) Damage, destruction, or loss of real or personal property, including, but not limited to, loss of use or occupancy, and loss of income or extra expense resulting from loss of use or occupancy;
(c) Errors and omissions liability; and
(d) Workers' compensation liability.
(2) Any two or more public agencies, other than school districts and educational service units, may make and execute an agreement providing for joint and cooperative action in accordance with the act to form, become members of, and operate a risk management pool for the purpose of providing to members risk management services and insurance coverages in the form of group self-insurance or standard insurance, including any combination of group self-insurance and standard insurance, to provide health, dental, accident, and life insurance to member's employees and officers.
Source
Laws 1987, LB 398, § 4;
Laws 2001, LB 664, § 3.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4305 - Risk management pool; powers.

44-4305.
Risk management pool; powers.
(1) Any risk management pool organized pursuant to the Intergovernmental Risk Management Act, whether or not a body corporate, shall have the power to sue and be sued, make contracts, hold and dispose of real and personal property, borrow money, contract debt, and pledge any pool assets in the name of the pool.
(2) The power to make contracts prescribed in subsection (1) of this section shall specifically include the power to establish the risk management pool as a separate legal or administrative entity.
Source
Laws 1987, LB 398, § 5.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4306 - Risk management pool; agreement; contents.

44-4306.
Risk management pool; agreement; contents.
Any agreement entered into for the purpose of establishing and operating a risk management pool shall provide:
(1) A financial plan setting forth in general terms the:
(a) Types of insurance coverage to be offered by the pool, applicable deductible levels, and maximum level of claims which the pool will self-insure;
(b) Amount of cash reserves to be set aside for the payment of claims;
(c) Amount of standard insurance to be purchased by the pool to provide coverage over and above the claims which are not to be satisfied directly from the pool's resources; and
(d) Amount of aggregate excess insurance coverage and specific excess insurance coverage to be purchased in a given fiscal period; and
(2) A plan of management setting forth:
(a) The means of establishing the governing authority of the pool. (i) The governing authority shall be a board of directors who are elected or appointed officials of member public agencies. (ii) The number of members of the board who are either elected or appointed officials of member public agencies shall not be less than the requisite number of members needed to transact all the business of the pool;
(b) The responsibility of the board of directors with regard to fixing annual contributions to the pool from members, maintaining reserves, levying and collecting from members assessments for deficiencies, disposing of surpluses, and administering the pool in the event of termination or insolvency;
(c) A procedure by which new members may be admitted to and existing members may leave the pool. The procedure shall permit members to withdraw from participation in a pool. Withdrawal shall not affect the obligations of the withdrawing member under any contract or agreement with the pool or impair the payment of any outstanding bonds or any interest on such bonds;
(d) The identification of funds and reserves by exposure area;
(e) A provision requiring that all claims shall be paid promptly;
(f) A provision requiring that no part of the net earnings or assets of the pool shall inure to the benefit of any private person;
(g) A provision requiring that, upon dissolution of the pool, all of the assets of the pool will vest in member public agencies in the manner set forth in the plan of management;
(h) A system or program of loss control; and
(i) Any other standards, procedures, or practices necessary or desirable for the continued operation of the pool.
Source
Laws 1987, LB 398, § 6.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4307 - Certificate of authority; issuance; fee.

44-4307.
Certificate of authority; issuance; fee.
(1) A risk management pool shall not provide any form of group self-insurance to its members until it has received a certificate of authority to do so from the Department of Insurance. Such certificate shall expire on the last day of April in each year and shall be renewed annually thereafter if the risk management pool has continued to comply with the Intergovernmental Risk Management Act and the rules and regulations of the Department of Insurance adopted and promulgated thereunder.
(2) The Department of Insurance shall issue a certificate of authority to a risk management pool if the Director of Insurance determines:
(a) That the pool's financial plan and plan of management and any amendments thereto satisfy the requirements of section 44-4306;
(b) That the pool has adequate surplus and reserves and will receive adequate financial contributions from its members in order to operate in a manner which is not hazardous to the public; and
(c) That any individual, corporation, partnership, limited liability company, or other entity engaged by the pool to provide services in connection with its management or operation is capable of running the affairs of the pool, is of good character and known business ability, and has a practical knowledge of the executive duties of conducting a risk management pool.
(3) The filing fee for a certificate of authority issued pursuant to the Intergovernmental Risk Management Act shall be one thousand dollars.
Source
Laws 1987, LB 398, § 7;
Laws 1989, LB 92, § 268;
Laws 1993, LB 121, § 253.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4308 - Rules and regulations.

44-4308.
Rules and regulations.
The Department of Insurance may adopt and promulgate reasonable rules and regulations (1) requiring a risk management pool to maintain reserves similar to those required of a domestic insurance company offering the same coverage as the group self-insurance coverage offered by a pool to its members, (2) requiring prior approval by the Director of Insurance before a risk management pool distributes dividends to its members in order to ensure that adequate reserves will be maintained, (3) requiring a risk management pool to process and act upon claims in accordance with the guidelines applicable for domestic insurance companies, and (4) requiring the pool to notify the Department of Insurance thirty days in advance of any change in the contribution level of the members, of any change in the coverages offered by the pool, and of any amendments to the agreement establishing the pool.
Source
Laws 1987, LB 398, § 8.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4309 - Risk management pool; termination of participation; effect.

44-4309.
Risk management pool; termination of participation; effect.
(1) A member of a risk management pool may voluntarily terminate its participation in the pool by giving written notice to the other members of the pool and the Director of Insurance at least ninety days prior to the desired termination date. Such voluntary termination shall be approved by the Director of Insurance if he or she finds that the terminating member and the remaining members of the pool are in good standing and have met all requirements of the laws of this state, any rules or regulations adopted and promulgated by the Department of Insurance pursuant to the Intergovernmental Risk Management Act, and any bylaws of the risk management pool.
(2) A member of a risk management pool may be involuntarily terminated as a member of the pool if the Director of Insurance finds, after due notice and hearing, that the member (a) has failed to pay any contribution or assessment due to the pool, (b) has failed to discharge any other obligation it owes to the pool, or (c) has failed to comply with any laws of this state, any rules or regulations adopted and promulgated by the Department of Insurance pursuant to the Intergovernmental Risk Management Act, or any bylaw of the risk management pool. Such hearing may be initiated by the Director of Insurance on his or her own initiative or at the request of the pool's board of directors.
(3) Any member of a risk management pool which voluntarily terminates its membership in the pool or which is involuntarily terminated as a member of the pool shall nevertheless remain liable subsequent to the date of termination for all contractual obligations it has entered into with the pool on or before the date of termination.
Source
Laws 1987, LB 398, § 9.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4310 - Risk management pool; report; examination.

44-4310.
Risk management pool; report; examination.
(1) On or before March 1 of each year after a risk management pool has received a certificate of authority as prescribed in section 44-4307, it shall make and file with the Department of Insurance a report of its affairs and operations during the last preceding calendar year. Such report shall be made in such form and shall contain such information as the Director of Insurance may by rule or regulation prescribe in order to protect the public interest and the interests of the members of the pool. Upon application to and approval by the director, an individual pool may make and file the report on or before a date other than March 1 for a different twelve-month period in order to correspond with the applicable fiscal year established by the pool. The director may require any individual pool to file additional periodic reports as he or she may find to be reasonably necessary and appropriate to protect and inform members of the pool and the public, to insure solvency of the pool, and to insure fair dealings in the investments of the pool.
(2) The department shall examine the business affairs, records, and assets of each pool once every four years to assure that the pool is financially sound. The department may examine a pool sooner than four years from the preceding examination if the director has reason to believe that the pool is not financially sound. Any examination conducted by the department pursuant to this subsection shall be at the expense of the pool being examined.
Source
Laws 1987, LB 398, § 10;
Laws 1997, LB 170, § 1.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4311 - Risk management pool; dissolution.

44-4311.
Risk management pool; dissolution.
A risk management pool shall not be voluntarily dissolved or otherwise cease to function without written approval by the Director of Insurance after he or she has determined that all claims and other legal obligations of the pool have been paid or that adequate provisions for such payment have been made.
Source
Laws 1987, LB 398, § 11.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4312 - Risk management pool; deficiency; assessment required.

44-4312.
Risk management pool; deficiency; assessment required.
(1) If the assets of a risk management pool are at any time insufficient to enable the pool to discharge its liabilities and other obligations and to maintain adequate reserves and surpluses in accordance with reasonable determinations by the Department of Insurance, the pool shall make up the deficiency or the Director of Insurance shall order the pool to levy an assessment upon its members in an amount necessary to make up the deficiency.
(2) If the risk management pool fails to make up a deficiency or to make the required assessment of its members pursuant to subsection (1) of this section within thirty days after the Director of Insurance orders it to do so or if the deficiency is not fully made up within sixty days after the date on which such assessment is made or within such longer period of time as may be specified by the Director of Insurance, the pool shall be proceeded against in the same manner as provided for domestic insurers. The Director of Insurance shall have the same powers, duties, and limitations in such proceeding as are provided for in a proceeding against a domestic insurer.
(3) If the liquidation of a risk management pool is ordered, an assessment shall be levied upon its members for such amount as the Director of Insurance determines is necessary to discharge all liabilities of the pool, including the reasonable costs of liquidation.
Source
Laws 1987, LB 398, § 12.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4313 - Risk management pool; investment of funds.

44-4313.
Risk management pool; investment of funds.
The capital, surplus, and other funds, or any part thereof, of any risk management pool may be invested as authorized under the Insurers Investment Act for an insurer.
Source
Laws 1987, LB 398, § 13;
Laws 1988, LB 1220, § 3;
Laws 1991, LB 237, § 70;
Laws 2001, LB 664, § 4.
Cross References
Insurers Investment Act, see section 44-5101.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-4314 - Rules and regulations.

44-4314.
Rules and regulations.
The Department of Insurance may, after notice and hearing, adopt and promulgate such reasonable rules and regulations as may be necessary or proper to carry out the provisions of sections 44-4306 to 44-4314, 44-4319, and 44-4320.
Source
Laws 1987, LB 398, § 14.