reglab/statecodes huggingface dataset:
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,147 - Insolvency; replacement coverage; duty to provide; director; duties.

44-32,147.
Insolvency; replacement coverage; duty to provide; director; duties.
(1) If a health maintenance organization is determined to be insolvent and ordered liquidated by a court of competent jurisdiction, upon such order, all other carriers which participated in the enrollment process with the insolvent health maintenance organization at a group's last regular enrollment period and which are providing coverage for enrollees on the date of the court order shall offer such group's subscribers of the insolvent health maintenance organization a thirty-day enrollment period commencing on the date of the court order. The subscribers transferring from the insolvent health maintenance organization shall be entitled to coverage on the same terms and at the same rates as they would have obtained had they elected the other carrier at the last regular enrollment period.
(2) If no other carrier had been offered to some groups enrolled in the insolvent health maintenance organization or if the director determines that the other health benefit plans lack sufficient health care delivery resources to assure that health care services will be available and accessible to all of the group enrollees of the insolvent health maintenance organization, the director shall allocate equitably the insolvent health maintenance organization's group contracts for such groups among all health maintenance organizations which operate within any portion of the insolvent health maintenance organization's service area, taking into consideration the health care delivery resources of each health maintenance organization. Each health maintenance organization to which a group is allocated shall offer such group the health maintenance organization's existing coverage which is most similar to each group's coverage with the insolvent health maintenance organization at rates determined in accordance with the successor health maintenance organization's existing rating methodology.
(3) The director shall also allocate equitably the insolvent health maintenance organization's individual enrollees who are unable to obtain other coverage among all health maintenance organizations which operate within any portion of the insolvent health maintenance organization's service area, taking into consideration the health care delivery resources of each such health maintenance organization. Each health maintenance organization to which individual enrollees are allocated shall offer such individual enrollees the health maintenance organization's existing coverage for individual or conversion coverage as determined by his or her type of coverage in the insolvent health maintenance organization at rates determined in accordance with the successor health maintenance organization's existing rating methodology. Successor health maintenance organizations which do not offer direct individual enrollment may aggregate all of the allocated individual enrollees into one group for rating and coverage purposes.
Source
Laws 1990, LB 1136, § 56.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,148 - Replacement coverage; requirements.

44-32,148.
Replacement coverage; requirements.
(1) Any carrier providing replacement coverage with respect to group hospital, medical, or surgical expense or service benefits within a period of sixty days from the date of discontinuance of a prior health maintenance organization contract or policy providing such hospital, medical, or surgical expense or service benefits shall immediately cover all enrollees who were validly covered under the previous health maintenance organization contract or policy at the date of discontinuance and who would otherwise be eligible for coverage under the succeeding carrier's contract, regardless of any provisions of the contract relating to active employment, hospital confinement, or pregnancy. Discontinuance shall mean the termination of the contract between the group contract holder and a health maintenance organization due to the insolvency of the health maintenance organization and shall not mean the termination of any agreement between any individual enrollee and the health maintenance organization.
(2) Except to the extent benefits for a condition would have been reduced or excluded under the prior carrier's contract or policy, no provision in a succeeding carrier's contract of replacement coverage which would operate to reduce or exclude benefits on the basis that the condition giving rise to benefits preexisted the effective date of the succeeding carrier's contract shall be applied with respect to those enrollees validly covered under the prior carrier's contract or policy on the date of discontinuance.
Source
Laws 1990, LB 1136, § 57.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,149 - Premium rates.

44-32,149.
Premium rates.
(1) No premium rate may be used until either a schedule of premium rates or methodology for determining premium rates has been filed with and approved by the director. A specific schedule of premium rates or a methodology for determining premium rates shall be established in accordance with actuarial principles for various categories of enrollees. The premium applicable to an enrollee shall not be individually determined based on the status of his or her health. The premium rates shall not be excessive, inadequate, or unfairly discriminatory. A certification by a qualified actuary or other qualified person acceptable to the director as to the appropriateness of the use of the methodology, based on reasonable assumptions, shall accompany the filing along with adequate supporting information.
(2) The director shall approve the schedule of premium rates or methodology for determining premium rates if the requirements of this section are met. If the director disapproves such filing, he or she shall notify the health maintenance organization. In the notice, the director shall specify the reasons for his or her disapproval. A hearing shall be conducted within thirty days after a request in writing by the person filing. If the director does not take action on such schedule or methodology within thirty days of the filing of such schedule or methodology, it shall be deemed approved.
Source
Laws 1990, LB 1136, § 58.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,150 - Insurance Producers Licensing Act; applicability.

44-32,150.
Insurance Producers Licensing Act; applicability.
The Insurance Producers Licensing Act shall apply to health maintenance organization producers except to the extent that the director determines that the nature of health maintenance organizations renders application of the act clearly inappropriate.
Source
Laws 1990, LB 1136, § 59.
Cross References
Insurance Producers Licensing Act, see section 44-4047.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,151 - Powers of insurers.

44-32,151.
Powers of insurers.
(1) An insurer licensed in this state may, either directly or through a subsidiary or affiliate, organize and operate a health maintenance organization under the Health Maintenance Organization Act. Any two or more such insurers or subsidiaries or affiliates thereof may jointly organize and operate a health maintenance organization. The business of insurance shall include the providing of health care by a health maintenance organization owned or operated by an insurer or a subsidiary thereof.
(2) An insurer may contract with a health maintenance organization to provide insurance or similar protection against the cost of health care services provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations. The enrollees of a health maintenance organization shall constitute a permissible group under the insurance laws of this state. An insurer may make benefit payments to health maintenance organizations for health care services rendered by providers under such contracts.
Source
Laws 1990, LB 1136, § 60.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,152 - Examinations; expenses.

44-32,152.
Examinations; expenses.
(1) The Director of Insurance may make an examination of the affairs of any health maintenance organization in accordance with the Insurers Examination Act and any provider with whom such health maintenance organization has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this state. The Department of Health and Human Services may make an examination concerning the quality assurance program of any health maintenance organization and any provider with whom such health maintenance organization has contracts, agreements, or other arrangements 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 three years.
(2) Every health maintenance organization and provider shall submit its books and records for an examination and in every way facilitate the completion of the examination. For the purpose of an examination, the Director of Insurance and the Department of Health and Human Services may administer oaths to and examine the officers and agents of the health maintenance organization and the principals of a provider concerning the business. An examination shall not involve the confidential communications between physicians and patients.
(3) The expenses of an examination shall be assessed against the health maintenance organization being examined and remitted to the Director of Insurance or the Department of Health and Human Services for whom the examination is being conducted in the manner provided in the Insurers Examination Act.
(4) In lieu of an examination, the Director of Insurance or the Department of Health and Human Services may accept the report of an examination made by the insurance commissioner, insurance director, insurance superintendent, or equivalent official or director of health or equivalent official of another state.
Source
Laws 1990, LB 1136, § 61;
Laws 1993, LB 583, § 90;
Laws 1996, LB 1044, § 251;
Laws 2007, LB296, § 190.
Cross References
Insurers Examination Act, see section 44-5901.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,153 - Certificate of authority; suspension, revocation, or denial; grounds.

44-32,153.
Certificate of authority; suspension, revocation, or denial; grounds.
If the Director of Insurance finds that any of the conditions listed in this section exist, any certificate of authority issued under the Health Maintenance Organization Act may be suspended or revoked or any application for a certificate of authority may be denied:
(1) The health maintenance organization is operating significantly in contravention of its basic organizational document or in a manner contrary to that described in any other information submitted under section 44-32,117 unless amendments to such submissions have been filed with and approved by the director;
(2) The health maintenance organization issues an evidence of coverage or uses a schedule of charges for health care services which does not comply with the requirements of sections 44-32,129 to 44-32,133 and 44-32,149;
(3) The health maintenance organization does not provide or arrange for basic health care services;
(4) The Department of Health and Human Services certifies to the Director of Insurance that:
(a) The health maintenance organization does not meet the requirements of subsection (2) of section 44-32,119; or
(b) The health maintenance organization is unable to fulfill its obligations to furnish health care services;
(5) The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees;
(6) The health maintenance organization has failed to correct, within the time prescribed by section 44-32,154, any deficiency occurring due to such health maintenance organization's prescribed minimum net worth being impaired;
(7) The health maintenance organization has failed to implement grievance procedures in a reasonable manner to resolve valid complaints;
(8) The health maintenance organization or any person on its behalf has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive, or unfair manner;
(9) The continued operation of the health maintenance organization would be hazardous to its enrollees; or
(10) The health maintenance organization has otherwise failed substantially to comply with the act.
Source
Laws 1990, LB 1136, § 62;
Laws 1996, LB 1044, § 252;
Laws 2007, LB296, § 191.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,154 - Deficiency in net worth; impaired condition; director; powers.

44-32,154.
Deficiency in net worth; impaired condition; director; powers.
(1) Whenever the director finds that the net worth maintained by any health maintenance organization is less than the minimum net worth required to be maintained by section 44-32,138, he or she shall give written notice to the health maintenance organization of the amount of the deficiency and require (a) filing of a plan for correction of the deficiency acceptable to the director and (b) correction of the deficiency within a reasonable time, not to exceed sixty days, unless an extension of time, not to exceed sixty additional days, is granted by the director. Such a deficiency shall be an impairment, and failure to correct the impairment in the prescribed time shall be grounds for suspension or revocation of the certificate of authority or for placing the health maintenance organization in supervision, rehabilitation, liquidation, or conservation.
(2) Unless allowed by the director, no health maintenance organization or person acting on its behalf may, directly or indirectly, renew, issue, or deliver any certificate, agreement, or contract of coverage in this state for which a premium is charged or collected when the health maintenance organization writing such coverage is impaired and the impairment is known to the health maintenance organization or such person. The existence of an impairment shall not prevent the issuance or renewal of a certificate, agreement, or contract when the enrollee exercises an option granted under the plan to obtain a new, renewed, or converted coverage.
Source
Laws 1990, LB 1136, § 63.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,155 - Certificate of authority; suspension, revocation, or denial; administrative penalty; procedure.

44-32,155.
Certificate of authority; suspension, revocation, or denial; administrative penalty; procedure.
A certificate of authority shall be suspended or revoked, an application for a certificate of authority denied, or an administrative penalty imposed pursuant to section 44-32,164 only after compliance with the requirements of sections 44-32,156 to 44-32,158.
Source
Laws 1990, LB 1136, § 64.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,156 - Suspension, revocation, denial, or administrative penalty; order; hearing.

44-32,156.
Suspension, revocation, denial, or administrative penalty; order; hearing.
Suspension or revocation of a certificate of authority, the denial of an application for a certificate, or the imposition of an administrative penalty shall be by written order and shall be sent by the Director of Insurance to the health maintenance organization or applicant by certified or registered mail and to the Department of Health and Human Services. The written order shall state the grounds, charges, or conduct on which the suspension, revocation, denial, or administrative penalty is based. The health maintenance organization or applicant may in writing request a hearing within thirty days from the date of mailing of the order. If no written request is made, such order shall be final upon the expiration of thirty days.
Source
Laws 1990, LB 1136, § 65;
Laws 1996, LB 1044, § 253;
Laws 2007, LB296, § 192.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,157 - Hearing; notice; decision; appeal.

44-32,157.
Hearing; notice; decision; appeal.
(1) If the health maintenance organization or applicant requests a hearing pursuant to section 44-32,156, the Director of Insurance shall issue a written notice of hearing and send it to the health maintenance organization or applicant by certified or registered mail and to the Department of Health and Human Services stating:
(a) A specific time for the hearing, which may not be less than twenty nor more than thirty days after mailing of the notice of hearing; and
(b) A specific place for the hearing, which may be either in Lancaster County or in the county where the health maintenance organization's or applicant's principal place of business is located.
(2) If a hearing is requested, the chief executive officer of the Department of Health and Human Services or his or her designated representative shall be in attendance and shall participate in the proceedings. The recommendations and findings of the chief executive officer with respect to matters relating to the quality of health care services provided in connection with any decision regarding denial, suspension, or revocation of a certificate of authority shall be conclusive and binding upon the Director of Insurance.
(3) After the hearing or upon failure of the health maintenance organization to appear at such hearing, the Director of Insurance shall take whatever action he or she deems necessary based on written findings and shall mail his or her decision to the health maintenance organization or applicant with a copy to the Department of Health and Human Services. The action of the Director of Insurance and the recommendation and findings of the chief executive officer may be appealed, and the appeal shall be in accordance with the Administrative Procedure Act. The act shall apply to proceedings under this section to the extent it is not in conflict with this section.
Source
Laws 1990, LB 1136, § 66;
Laws 1996, LB 1044, § 254;
Laws 2007, LB296, § 193.
Cross References
Administrative Procedure Act, see section 84-920.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,158 - Certificate of authority; suspension or revocation; effect.

44-32,158.
Certificate of authority; suspension or revocation; effect.
(1) When the certificate of authority of a health maintenance organization is suspended, the health maintenance organization shall not, during the period of such suspension, enroll any additional enrollees other than newborn children or other newly acquired dependents of existing enrollees and shall not engage in any advertising or solicitation whatsoever.
(2) When the certificate of authority of a health maintenance organization is revoked, such health maintenance organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of such health maintenance organization. It shall engage in no further advertising or solicitation whatsoever. The director may, by written order, permit such further operation of the health maintenance organization as he or she finds to be in the best interest of enrollees to the end that enrollees will be afforded the greatest practical opportunity to obtain continuing health care coverage.
Source
Laws 1990, LB 1136, § 67.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,159 - Hazardous operation; violations; director; powers.

44-32,159.
Hazardous operation; violations; director; powers.
Whenever the director determines that the financial condition of any health maintenance organization is such that its continued operation might be hazardous to its enrollees or creditors or the general public or that it has violated the Health Maintenance Organization Act, he or she may, after notice and hearing, order the health maintenance organization to take such action as may be reasonably necessary to rectify such condition or violation, including, but not limited to, the following:
(1) Reduce the total amount of present and potential liability for benefits by reinsurance or another method acceptable to the director;
(2) Reduce the volume of new business being accepted;
(3) Reduce expenses by specified methods;
(4) Suspend or limit the writing of new business for a period of time;
(5) Increase the health maintenance organization's capital and surplus by contribution; or
(6) Take such other steps as the director deems appropriate under the circumstances.
The violation by a health maintenance organization of any law of this state to which such health maintenance organization is subject shall be deemed a violation of the act.
Source
Laws 1990, LB 1136, § 68.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,160 - Hazardous operation; violations; uniform standards and criteria; remedies not exclusive.

44-32,160.
Hazardous operation; violations; uniform standards and criteria; remedies not exclusive.
The director may set uniform standards and criteria for early warning that the continued operation of any health maintenance organization might be hazardous to its enrollees or creditors or the general public and standards for evaluating the financial condition of any health maintenance organization, which standards shall be consistent with the purposes expressed in section 44-32,159. The remedies and measures available to the director under such section shall be in addition to, and not in lieu of, the remedies and measures available to the director under the Nebraska Insurers Supervision, Rehabilitation, and Liquidation Act.
Source
Laws 1990, LB 1136, § 69.
Cross References
Nebraska Insurers Supervision, Rehabilitation, and Liquidation Act, see section 44-4862.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,161 - Supervision, rehabilitation, liquidation, or conservation; grounds and procedure applicable.

44-32,161.
Supervision, rehabilitation, liquidation, or conservation; grounds and procedure applicable.
(1) Any supervision, rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the supervision, rehabilitation, liquidation, or conservation of an insurance company and shall be conducted pursuant to the Nebraska Insurers Supervision, Rehabilitation, and Liquidation Act. The director may apply for an order directing him or her to rehabilitate, liquidate, or conserve a health maintenance organization upon any one or more grounds set out in sections 44-4812 and 44-4817 or when in his or her opinion the continued operation of the health maintenance organization would be hazardous either to the enrollees or to the people of this state. Enrollees shall have the same priority in the event of liquidation or rehabilitation as the law provides to policyholders of an insurer.
(2) For purposes of determining the priority of distribution of general assets, claims of enrollees and enrollees' beneficiaries shall have the same priority as established by subdivision (2) of section 44-4842 for policyholders and beneficiaries of insureds of insurance companies. If an enrollee is liable to any provider for services provided pursuant to and covered by the health care plan, that liability shall have the status of an enrollee claim for distribution of general assets. Any provider who is obligated by statute or agreement to hold enrollees harmless from liability for services provided pursuant to and covered by a health care plan shall have the same priority of distribution of the general assets as established by subdivision (5) of section 44-4842.
Source
Laws 1990, LB 1136, § 70;
Laws 2002, LB 1139, § 24.
Cross References
Nebraska Insurers Supervision, Rehabilitation, and Liquidation Act, see section 44-4862.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,163 - Fees; distribution.

44-32,163.
Fees; distribution.
Every health maintenance organization subject to the Health Maintenance Organization Act shall pay to the director the following fees:
(1) For filing an application for a certificate of authority or amendment thereto, three hundred dollars;
(2) For filing an amendment to the organizational documents that requires approval, twenty dollars;
(3) For filing each annual report, two hundred dollars; and
(4) For renewing a certificate of authority, one hundred dollars.
Fees charged under this section shall be distributed one-half to the Director of Insurance and one-half to the Department of Health and Human Services. All fees or other assessments transmitted to the Department of Health and Human Services pursuant to the act shall be remitted to the state treasury for credit to the Health and Human Services Cash Fund. There shall be appropriated from money credited to the fund pursuant to this section such amounts as are available to pay expenses considered incident to the administration of the act.
Source
Laws 1990, LB 1136, § 72;
Laws 1991, LB 703, § 12;
Laws 1996, LB 1044, § 255;
Laws 2007, LB296, § 194.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,164 - Administrative penalty.

44-32,164.
Administrative penalty.
The director may, in lieu of suspension or revocation of a certificate of authority, levy an administrative penalty in an amount not less than five hundred dollars nor more than ten thousand dollars if reasonable notice in writing is given of the intent to levy the penalty and the health maintenance organization has a reasonable time within which to remedy the defect in its operations which gave rise to the penalty citation. The director may augment a penalty by an amount equal to the sum that he or she calculates to be the damages suffered by enrollees or other members of the public.
Source
Laws 1990, LB 1136, § 73.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,165 - Violations; conference; requirements.

44-32,165.
Violations; conference; requirements.
If the Director of Insurance or the Department of Health and Human Services has for any reason cause to believe that any violation of the Health Maintenance Organization Act has occurred or is threatened, the Director of Insurance or the Department of Health and Human Services may give notice to the health maintenance organization and to the representatives or other persons who appear to be involved in such suspected violation to arrange a conference with the alleged violators or their authorized representatives for the purpose of attempting to ascertain the facts relating to such suspected violation and, if it appears that any violation has occurred or is threatened, to arrive at an adequate and effective means of correcting or preventing such violation. Proceedings under this section shall not be governed by any formal procedural requirements and may be conducted in such manner as the Director of Insurance or the Department of Health and Human Services deems appropriate under the circumstances. Unless consented to by the health maintenance organization, no rule or order may result from a conference until the requirements of this section are satisfied.
Source
Laws 1990, LB 1136, § 74;
Laws 1996, LB 1044, § 256;
Laws 2007, LB296, § 195.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,166 - Cease and desist order; hearing; appeal; injunction.

44-32,166.
Cease and desist order; hearing; appeal; injunction.
The director may issue an order directing a health maintenance organization or a representative of a health maintenance organization to cease and desist from engaging in any action or practice in violation of the Health Maintenance Organization Act. Within ten days after service of the cease and desist order, the respondent may request a hearing on the question of whether actions or practices in violation of the act have occurred. Such hearings shall be conducted as provided by the Administrative Procedure Act. The respondent may appeal the decision of the director, and the appeal shall be in accordance with the Administrative Procedure Act. If the director elects not to issue a cease and desist order or in the event of noncompliance with a cease and desist order, the director may institute a proceeding to obtain injunctive or other appropriate relief in the district court of Lancaster County.
Source
Laws 1990, LB 1136, § 75.
Cross References
Administrative Procedure Act, see section 84-920.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,167 - Net worth violation; director; powers.

44-32,167.
Net worth violation; director; powers.
If a health maintenance organization fails to comply with the net worth requirement of section 44-32,138, the director may take appropriate action to assure that the continued operation of the health maintenance organization will not be hazardous to its enrollees.
Source
Laws 1990, LB 1136, § 76.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,168 - Insurance laws; when applicable.

44-32,168.
Insurance laws; when applicable.
Except as otherwise provided in Chapter 44 or the Health Maintenance Organization Act, the insurance laws shall not be applicable to any health maintenance organization granted a certificate of authority under the act. This section shall not apply to an insurer licensed and regulated pursuant to the insurance laws except with respect to its activities authorized and regulated pursuant to the act.
Source
Laws 1990, LB 1136, § 77.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,169 - Solicitation of enrollees; other law; how construed.

44-32,169.
Solicitation of enrollees; other law; how construed.
Solicitation of enrollees by a health maintenance organization granted a certificate of authority or its representatives shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals.
Source
Laws 1990, LB 1136, § 78.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,170 - Practice of medicine; laws not applicable.

44-32,170.
Practice of medicine; laws not applicable.
Any health maintenance organization authorized under the Health Maintenance Organization Act shall not be deemed to be practicing medicine and shall be exempt from the Medicine and Surgery Practice Act relating to the practice of medicine.
Source
Laws 1990, LB 1136, § 79;
Laws 2007, LB463, § 1138.
Cross References
Medicine and Surgery Practice Act, see section 38-2001.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,171 - Applications, filings, and reports; public documents; exception.

44-32,171.
Applications, filings, and reports; public documents; exception.
All applications, filings, and reports required under the Health Maintenance Organization Act shall be treated as public documents except those which are trade secrets or privileged or confidential quality assurance, commercial, or financial information other than any annual financial statement that may be required under section 44-32,134.
Source
Laws 1990, LB 1136, § 80.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,172 - Confidential information; disclosure prohibited; exception.

44-32,172.
Confidential information; disclosure prohibited; exception.
Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except (1) to the extent that it may be necessary to carry out the purposes of the Health Maintenance Organization Act, (2) upon the express consent of the enrollee or applicant, (3) pursuant to statute or court order for the production of evidence or the discovery thereof, or (4) in the event of a claim or litigation between such person and the health maintenance organization in which such data or information is pertinent. A health maintenance organization shall be entitled to claim any statutory privileges against such disclosure which the provider who furnished such information to the health maintenance organization is entitled to claim.
Source
Laws 1990, LB 1136, § 81.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,173 - Health care review committee; health maintenance organization; exemption from liability.

44-32,173.
Health care review committee; health maintenance 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 health maintenance organization which established such committee or the officers, directors, employees, or agents of such health maintenance 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, § 82.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,174 - Health care review committee; information and records; confidentiality.

44-32,174.
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 health maintenance 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, § 83.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,175 - Quality assurance; access to records and information.

44-32,175.
Quality assurance; access to records and information.
To fulfill its quality assurance obligations, a health maintenance organization shall have access to treatment records and other information pertaining to the diagnosis, treatment, or health status of any enrollee.
Source
Laws 1990, LB 1136, § 84.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,176 - Department of Health and Human Services; contracts authorized.

44-32,176.
Department of Health and Human Services; contracts authorized.
The Department of Health and Human Services, in carrying out obligations under the Health Maintenance Organization Act, may contract with qualified persons to make recommendations concerning the determinations required to be made. Such recommendations may be accepted in full or in part by the department.
Source
Laws 1990, LB 1136, § 85;
Laws 1996, LB 1044, § 257;
Laws 2007, LB296, § 196.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,177 - Health maintenance organization; acquisition, merger, and consolidation; procedure.

44-32,177.
Health maintenance organization; acquisition, merger, and consolidation; procedure.
No person shall (1) make a tender for or a request or invitation for tenders of, (2) enter into an agreement to exchange securities for, or (3) acquire in the open market or otherwise any voting security of a health maintenance organization or enter into any other agreement if, after the consummation thereof, that person would, directly or indirectly, or by conversion or by exercise of any right to acquire, be in control of the health maintenance organization, and no person shall enter into an agreement to merge or consolidate with or otherwise to acquire control of a health maintenance organization unless, at the time any offer, request, or invitation is made or any agreement is entered into or prior to the acquisition of the securities if no offer or agreement is involved, the person has filed with the director and has sent to the health maintenance organization information required by subsection (4) of section 44-2126 and the offer, request, invitation, agreement, or acquisition has been approved by the director. Approval by the director shall be governed by the Insurance Holding Company System Act.
Source
Laws 1990, LB 1136, § 86;
Laws 1991, LB 236, § 34;
Laws 2012, LB887, § 20.
Cross References
Insurance Holding Company System Act, see section 44-2120.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,178 - Coordination of benefits.

44-32,178.
Coordination of benefits.
A health maintenance organization may, but shall not be required to, adopt coordination-of-benefits provisions to avoid overinsurance and to provide for the orderly payment of claims when a person is covered by two or more group health insurance or health care plans. If a health maintenance organization adopts coordination-of-benefits provisions, the provisions shall be consistent with the coordination-of-benefits provisions that are in general use in the state for coordinating coverage between two or more group health insurance or health care plans. To the extent necessary for health maintenance organizations to meet their obligations as secondary carriers under the rules for coordination, health maintenance organizations shall make payments for services that are received from nonparticipating providers, provided outside their service areas, or not covered under the terms of their group contracts or evidence of coverage.
Source
Laws 1990, LB 1136, § 87.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-32,179 - Unfair trade and claims settlement practices laws; applicability.

44-32,179.
Unfair trade and claims settlement practices laws; applicability.
The Unfair Insurance Trade Practices Act and the Unfair Insurance Claims Settlement Practices Act shall apply to health maintenance organizations except to the extent that the director determines the nature of health maintenance organizations renders application of either act clearly inappropriate.
Source
Laws 1990, LB 1136, § 88;
Laws 1991, LB 234, § 32.
Cross References
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 › 44-32,180 - Taxation.

44-32,180.
Taxation.
(1) Any health maintenance organization subject to the Health Maintenance Organization Act shall also be subject to (a) the premium taxation provisions of Chapter 77, article 9, to the extent that the direct writing premiums are not otherwise subject to taxation under such article and (b) the retaliatory taxation provisions of section 44-150.
(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 1990, LB 1136, § 89;
Laws 1996, LB 969, § 2;
Laws 2002, Second Spec. Sess., LB 9, § 1;
Laws 2006, LB 1248, § 60;
Laws 2010, LB698, § 1.
Cross References
Medical Assistance Act, see section 68-901.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3301 - Sections; how interpreted.

44-3301.
Sections; how interpreted.
Sections 44-3301 to 44-3327 shall be interpreted liberally to (1) encourage the development of more effective and economical ways of providing legal services, (2) ease the burden of necessary legal expenses, and (3) aid in maintaining a high level of competence and adherence to professional standards in the performance of legal services.
Source
Laws 1979, LB 52, § 1.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3302 - Terms, defined.

44-3302.
Terms, defined.
As used in sections 44-3301 to 44-3327, unless the context otherwise requires:
(1) Director shall mean the Director of Insurance;
(2) Department shall mean the Department of Insurance;
(3) Insurer shall mean any person, as defined in section 49-801, authorized to conduct an insurance business as an insurer in this state, including corporations organized under sections 44-3312 and 44-3313; and
(4) Legal expense insurance shall mean the assumption of a contractual obligation to pay or reimburse for specified legal services or specified legal expenses, in consideration of a specified payment for an interval of time, regardless of whether the payment is made by the beneficiaries individually or by a third person for them, in such a manner that the total cost incurred by assuming the obligation is to be spread directly or indirectly among a group of persons. Legal expense insurance includes arrangements that create reasonable expectations of enforceable rights, but does not include the provision of or reimbursement for legal services incidental to other insurance coverages. The payment of only an administrative fee to an attorney shall not be considered payment or reimbursement for specified legal services or specified legal expenses for the purposes of this definition.
Source
Laws 1979, LB 52, § 2;
Laws 2019, LB26, § 1.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3303 - Insurance laws; situations; not applicable.

44-3303.
Insurance laws; situations; not applicable.
The insurance laws of this state, including sections 44-3301 to 44-3327, do not apply to:
(1) Retainer contracts made by attorneys at law with individual clients with fees based on estimates of the nature and amount of services to be provided to the specific client and similar contracts made with a group of clients involved in the same or closely related legal matters;
(2) Plans providing no benefits other than consultation and advice in connection with or in combination with referral services;
(3) The furnishing of limited legal assistance on an informal basis, involving neither an express contractual obligation nor reasonable expectations, in the context of an employment, membership, education, or similar relationship;
(4) The furnishing of legal assistance by labor unions and other employee organizations to their members in matters relating to employment or occupation;
(5) Employee welfare benefit plans to the extent that state laws are superseded by Section 514 of the Employee Retirement Income Security Act of 1974;
(6) Automobile club service contracts which supply incidental or limited legal services or reimbursement for legal services in automobile related matters; and
(7) Plans that do not include the assumption of risk or obligation to pay or reimburse for specified legal services or specified legal expenses. The payment of only an administrative fee to an attorney shall not be considered payment or reimbursement for specified legal services or a specified legal expense.
Source
Laws 1979, LB 52, § 3;
Laws 2019, LB26, § 2.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3304 - Legal expense insurance business; authorization by director; exceptions.

44-3304.
Legal expense insurance business; authorization by director; exceptions.
(1) No person may conduct a legal expense insurance business in this state unless authorized to do so by the director.
(2) Subsection (1) of this section shall not apply to any person issuing group, blanket, or franchise policies if fewer than twenty-five percent of the certificate holders or insureds reside in this state and the person is regulated to a comparable extent by another state in which a larger number of certificate holders or insureds reside.
Source
Laws 1979, LB 52, § 4.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3305 - Legal expense insurance; policy; certificate of coverage; issuance.

44-3305.
Legal expense insurance; policy; certificate of coverage; issuance.
(1) Legal expense insurance may be written as individual, group, blanket, or franchise insurance. Each contractual obligation for legal expense insurance shall be evidenced by a policy. Each person insured under a group policy shall be issued a certificate of coverage.
(2) No policy or certificate of legal expense insurance may be issued in this state unless a copy of the form has been filed with and approved by the director.
Source
Laws 1979, LB 52, § 5.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3306 - Policy or certificate form; disapproval; grounds.

44-3306.
Policy or certificate form; disapproval; grounds.
The director may disapprove a policy or certificate form of an insurer whose purpose according to its articles of incorporation is restricted to transacting legal expense insurance and business reasonably related thereto if he or she finds that it:
(1) Is unfair, unfairly discriminatory, misleading, or encourages misrepresentation or misunderstanding of the contract;
(2) Provides coverage or benefits or contains other provisions that would endanger the solidity of the insurer;
(3) Provides rates which are excessive, inadequate, or unfairly discriminatory; or
(4) Is contrary to law.
Source
Laws 1979, LB 52, § 6.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3307 - Provider contracts; director approval required; report.

44-3307.
Provider contracts; director approval required; report.
(1) Provider contracts, and changes thereto, made between an insurer, whose purpose is restricted to transacting legal expense insurance and business reasonably related thereto, and providing attorneys or other providers of services covered by the legal expense insurance policy shall be filed with the director and shall not become effective until approved by the director.
(2) Legal expense insurers shall annually report to the director, in such detail as the director reasonably requires, the number and geographical distribution of attorneys and other providers of services covered by the legal expense insurance policy with whom they maintain contractual relations and the nature of the relations. For individual insurers or groups of insurers the directors may require more frequent reports.
Source
Laws 1979, LB 52, § 7.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3310 - Insurers; contract with others; purposes; approval.

44-3310.
Insurers; contract with others; purposes; approval.
Insurers may contract with other insurers, including insurance companies organized under any of the laws of the State of Nebraska, for partial or total administrative services or for joint participation through contractual agreements or otherwise cede or accept legal expense insurance obligations from such insurers on the whole or any part of such legal expense insurance obligations. Such contract forms, documents, treaties, or agreement forms shall be filed with and approved by the director to be in accordance with the plan of operation of such insurer prior to their effectiveness. The director may adopt and promulgate rules and regulations concerning such participation contracts and agreements with insurers.
Source
Laws 1979, LB 52, § 10;
Laws 1989, LB 92, § 231.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-3311 - Legal expense insurance policy; possible violations; director; report.

44-3311.
Legal expense insurance policy; possible violations; director; report.
The director shall report to the Counsel for Discipline of the Nebraska Supreme Court any information of possible instances of overcharging for legal services, incompetence, or violations of the Nebraska Rules of Professional Conduct by lawyers who provide services in connection with a legal expense insurance policy.
Source
Laws 1979, LB 52, § 11;
Laws 2004, LB 1207, § 44;
Laws 2006, LB 1115, § 35.