reglab/statecodes huggingface dataset:
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6502 - Act; purpose; applicability.

44-6502.
Act; purpose; applicability.
(1) The purpose of the Pet Insurance Act is to promote the public welfare by creating a comprehensive legal framework within which pet insurance may be sold in this state.
(2) The requirements of the Pet Insurance Act shall apply to pet insurance policies that are issued to any resident of this state and are sold, solicited, negotiated, or offered in this state and pet insurance policies or certificates that are delivered or issued for delivery in this state.
(3) All other applicable provisions of the insurance laws of this state shall continue to apply to pet insurance, except that the specific provisions of the Pet Insurance Act shall supersede any general provisions of law that would otherwise be applicable to pet insurance.
Source
Laws 2023, LB296, § 2.
Operative Date: January 1, 2024
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6503 - Pet insurer; definitions; limitations or exclusions; use.

44-6503.
Pet insurer; definitions; limitations or exclusions; use.
(1) A pet insurer that uses any of the terms defined in section 44-6504 in a policy of pet insurance shall use such terms as the terms are defined in section 44-6504. A pet insurer shall also make the specific definitions available through a clear and conspicuous link on the main page of the website of the pet insurer or pet insurer's program administrator.
(2) Nothing in the Pet Insurance Act shall prohibit or limit the types of exclusions a pet insurer may use in a pet insurance policy or require a pet insurer to use in a pet insurance policy any limitation or exclusion set forth in the Pet Insurance Act.
Source
Laws 2023, LB296, § 3.
Operative Date: January 1, 2024
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6506 - Preexisting conditions; waiting periods; renewal; benefits; eligibility; limitations.

44-6506.
Preexisting conditions; waiting periods; renewal; benefits; eligibility; limitations.
(1) A pet insurer may issue policies that exclude coverage on the basis of one or more preexisting conditions with appropriate disclosure to the consumer. The pet insurer has the burden of proving that the preexisting condition exclusion applies to the condition for which a claim is being made.
(2)(a) A pet insurer may issue policies that impose waiting periods upon effectuation of the policy that do not exceed thirty days for illness or orthopedic conditions not resulting from an accident. Waiting periods for accidents are prohibited.
(b) A pet insurer utilizing a waiting period shall include a provision in such pet insurer's policy that allows the waiting period to be waived upon completion of a medical examination. The pet insurer may require that:
(i) The examination be conducted by a veterinarian;
(ii) The examination include certain specific elements as long as such elements do not unreasonably restrict a consumer's ability to waive the waiting period; and
(iii) The examination and any required elements be documented and provided to the pet insurer.
(c) The pet insurer shall clearly and prominently disclose if the policy includes a waiting period and any requirements applicable to the waiting period to consumers prior to the policy purchase.
(3) A pet insurer shall not require a veterinary examination of the covered pet for the insured to have such insured's policy renewed.
(4) If a pet insurer includes any prescriptive, wellness, or noninsurance benefits in the policy form, then such benefits shall be considered part of the policy and the pet insurer shall follow all applicable laws, rules, and regulations related to such benefits.
(5) A consumer's eligibility to purchase a pet insurance policy shall not be based on participation, or lack of participation, in a separate wellness program.
Source
Laws 2023, LB296, § 6.
Operative Date: January 1, 2024
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6507 - Wellness program; restrictions.

44-6507.
Wellness program; restrictions.
(1) A pet insurer or insurance producer shall not market a wellness program as pet insurance.
(2) If a pet insurer or insurance producer sells a wellness program:
(a) The purchase of the wellness program shall not be a requirement to the purchase of pet insurance;
(b) The costs of the wellness program shall be separate and identifiable from any pet insurance policy sold by a pet insurer or insurance producer;
(c) The terms and conditions for the wellness program shall be separate from any pet insurance policy sold by a pet insurer or insurance producer;
(d) The products or coverage available through a wellness program shall not duplicate products or coverages available through the pet insurance policy;
(e) The advertising of the wellness program shall not be misleading; and
(f) The pet insurer or insurance producer shall provide a written disclosure to consumers in twelve-point bold font that includes:
(i) A statement that wellness programs are not insurance;
(ii) The mailing address, toll-free telephone number, and website of the Department of Insurance; and
(iii) The address and customer service telephone number of the pet insurer or insurance producer of record.
(3) Coverages included in the pet insurance policy contract described as wellness benefits are insurance.
Source
Laws 2023, LB296, § 7.
Operative Date: January 1, 2024
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6508 - License; training; required.

44-6508.
License; training; required.
(1) An insurance producer shall not sell, solicit, or negotiate a pet insurance product until after the insurance producer is appropriately licensed and has completed the required training as provided in subsection (3) of this section.
(2) A pet insurer shall ensure that its insurance producers are appropriately trained on the coverages and conditions of such insurer's pet insurance products and have received the training required in subsection (3) of this section.
(3) Training required for an insurance producer shall include information on:
(a) Preexisting conditions and waiting periods;
(b) The differences between pet insurance and noninsurance wellness programs;
(c) Hereditary disorders, congenital anomalies or disorders, and chronic conditions, and how pet insurance policies interact with such conditions or disorders; and
(d) Rating, underwriting, renewal, and other related administrative topics.
(4) An insurance producer that has satisfied substantially similar training requirements in another state shall be considered to have satisfied the training requirements in this state.
Source
Laws 2023, LB296, § 8.
Operative Date: January 1, 2024
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6510 - Violation; unfair trade practice.

44-6510.
Violation; unfair trade practice.
Any violation of the Pet Insurance Act or the rules and regulations adopted and promulgated under the act shall be considered an unfair trade practice under the Unfair Insurance Trade Practices Act in addition to any other remedies and penalties available under the laws of this state.
Source
Laws 2023, LB296, § 10.
Operative Date: January 1, 2024
Cross References
Unfair Insurance Trade Practices Act, see section 44-1521.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6602 - Purpose of act.

44-6602.
Purpose of act.
The purpose of the Insurance Fraud Act is to confront the problem of insurance fraud in Nebraska by facilitating the detection of insurance fraud, eliminating the occurrence of insurance fraud through the development of fraud prevention programs, authorizing imposition of civil penalties, authorizing restitution of fraudulently obtained insurance benefits, and reducing the amount of premium dollars used to pay fraudulent claims.
Source
Laws 1995, LB 385, § 2.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6603 - Terms, defined.

44-6603.
Terms, defined.
For purposes of the Insurance Fraud Act:
(1) Department means the Department of Insurance;
(2) Director means the Director of Insurance;
(3) Insurer means any person or entity transacting insurance as defined in section 44-102 with or without a certificate of authority issued by the director. Insurer also means health maintenance organizations, legal service insurance corporations, prepaid limited health service organizations, dental and other similar health service plans, discount medical plan organizations, and entities licensed pursuant to the Intergovernmental Risk Management Act and the Comprehensive Health Insurance Pool Act. Insurer also means an employer who is approved by the Nebraska Workers' Compensation Court as a self-insurer; and
(4) Statement includes, but is not limited to, any notice, statement, proof of loss, bill of lading, receipt for payment, invoice, account, estimate of property damages, bill for services, diagnosis, prescription, hospital or medical records, X-rays, test result, or other evidence of loss, injury, or expense, whether oral, written, or computer-generated.
Source
Laws 1995, LB 385, § 3;
Laws 1997, LB 272, § 2;
Laws 2002, LB 547, § 2;
Laws 2008, LB855, § 31.
Cross References
Comprehensive Health Insurance Pool Act, see section 44-4201.
Intergovernmental Risk Management Act, see section 44-4301.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6605 - Immunity from civil liability.

44-6605.
Immunity from civil liability.
(1) Any person or entity, including the department, an insurer, or a person employed by or authorized by an insurer whose activities include the investigation of or reporting of suspected insurance fraud, acting without malice, fraudulent intent, or bad faith shall be immune from civil liability for furnishing any information relating to suspected fraudulent insurance acts to:
(a) The director or his or her agents or employees;
(b) Law enforcement officials or their agents or employees;
(c) The Nebraska Workers' Compensation Court or its agents or employees;
(d) Persons or entities subject to Chapter 44 or their agents or employees; or
(e) The National Association of Insurance Commissioners or any organization established to detect and prevent fraudulent insurance acts or its agents, employees, or designees.
(2) This section does not abrogate or modify in any way any common-law or statutory privilege or immunity.
Source
Laws 1995, LB 385, § 5;
Laws 1997, LB 272, § 4.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6607 - Civil penalty; costs; section, how construed.

44-6607.
Civil penalty; costs; section, how construed.
(1) A person or entity who is found by a court of competent jurisdiction, pursuant to an action initiated by the Director of Insurance, to have committed a fraudulent insurance act set forth in section 44-6604 is subject to a civil penalty not to exceed five thousand dollars for the first violation, ten thousand dollars for the second violation, and fifteen thousand dollars for each subsequent violation. An action under this section shall be in lieu of a prosecution under section 28-631.
(2) Costs and expenses incurred in any investigation or other action arising out of a violation under the Insurance Fraud Act may be sought in any judgment, court decree, or other final result. Any recovered costs, except civil or criminal penalties, shall be deposited by the director in the fund from which the costs were expended. The court may make such additional orders or judgments as may be necessary to restore to any person in interest any compensation which may have been acquired by means of any act prohibited in section 44-6604.
(3) This section shall not be construed to prohibit the director and the alleged violator from entering into a written agreement upon commencement of a civil action in which the alleged violator does not admit or deny the charges but consents to payment of the civil penalty. A consent agreement may not be used in a subsequent civil or criminal proceeding relating to any violation of the act.
Source
Laws 1995, LB 385, § 7.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6608 - Act, how construed.

44-6608.
Act, how construed.
The Insurance Fraud Act does not:
(1) Preempt the authority or relieve the duty of any other law enforcement agency to investigate, examine, and prosecute suspected violations of law;
(2) Prevent or prohibit a person from voluntarily disclosing any information concerning insurance fraud to any law enforcement agency;
(3) Limit any of the powers granted elsewhere by the laws of this state to the Director of Insurance or the Department of Insurance to investigate and examine possible violations of law and to take appropriate action; or
(4) Limit any of the powers granted elsewhere by the laws of this state to the Nebraska Workers' Compensation Court to investigate and examine possible violations of law and to take appropriate action.
Source
Laws 1995, LB 385, § 8.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6701 - Act, how cited.

44-6701.
Act, how cited.
Sections 44-6701 and 44-6702 shall be known and may be cited as the Health Care Purchasing Pool Act.
Source
Laws 1995, LB 837, § 5;
Laws 1996, LB 1044, § 259.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6702 - Legislative intent.

44-6702.
Legislative intent.
The Legislature recognizes that a pooling mechanism offers the potential to purchase health care at more affordable prices. The Legislature further recognizes that health care purchasing pools do not require that all groups have the same type of health care coverage or benefits and that many options are available.
It is the intent of the Legislature to establish a process to determine whether there should be a coordinated purchasing process for some or all publicly sponsored health care coverage in order to reduce costs and to promote the most efficient methods of financing and coordinating health care services. It is also the intent of the Legislature that the process established also determine whether a health care purchasing pool if established should be made available to individuals, small employer groups, and other associations.
Source
Laws 1995, LB 837, § 6.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6825 - Act, how cited.

44-6825.
Act, how cited.
Sections 44-6825 to 44-6833 shall be known and may be cited as the Managed Care Emergency Services Act.
Source
Laws 1997, LB 279, § 1;
R.S.Supp.,1997, § 44-6801;
Laws 1998, LB 1162, § 17.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6826 - Purpose of act.

44-6826.
Purpose of act.
The purpose of the Managed Care Emergency Services Act is to establish standards for health carriers that offer managed care plans to provide for access by covered persons to and delivery of emergency services.
Source
Laws 1997, LB 279, § 2;
R.S.Supp.,1997, § 44-6802;
Laws 1998, LB 1162, § 18.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6828 - Applicability of act.

44-6828.
Applicability of act.
The Managed Care Emergency Services Act applies to all health carriers that offer managed care plans.
Source
Laws 1997, LB 279, § 20;
R.S.Supp.,1997, § 44-6820;
Laws 1998, LB 1162, § 20.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6829 - Health carrier; emergency services; how treated.

44-6829.
Health carrier; emergency services; how treated.
(1) A health carrier which provides a covered benefit for emergency services is, subject to the terms and conditions of the health benefit plan, responsible for charges for medically necessary emergency services provided to a covered person, including services furnished outside the network and services deemed approved under subsection (2) of this section.
(2) If a treating physician or other emergency department personnel who have provided emergency services to a covered person determine that additional medically necessary services are promptly needed by the covered person and they have requested health carrier approval for such services, the health carrier is deemed to have approved the request if the treating physician or other emergency department personnel involved:
(a) Has made a reasonable effort to contact the individual at the health carrier authorized to approve such requests and the health carrier has not provided access to that individual; or
(b) Has requested authorization from the individual at the health carrier authorized to approve such requests and the individual has not denied authorization within thirty minutes after the time the request was made, unless the health carrier can document that it had made a good faith effort but was unable to reach the emergency physician within thirty minutes after receiving a request for authorization.
A request which is deemed approved under this subsection shall be treated as approval for any medically necessary covered benefits that are required to treat the medical condition identified by the treating physician or other emergency department personnel.
(3) A health carrier may impose a reasonable copayment for emergency services to deter inappropriate use of services of hospital emergency departments if the copayment is the same without regard to whether the health care provider has a contractual or other arrangement with the health carrier.
Source
Laws 1997, LB 279, § 23;
R.S.Supp.,1997, § 44-6823;
Laws 1998, LB 1162, § 21.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6830 - Health carrier violation; notice; hearing.

44-6830.
Health carrier violation; notice; hearing.
If the director finds that any health carrier doing business in this state is engaging in any violation of the Managed Care Emergency Services Act and that a proceeding in respect thereto would be in the public interest, the director shall issue and serve upon such health carrier a statement of the charges in that respect and a notice of hearing thereon, which notice shall set a hearing date not less than ten days after the date of the notice.
Source
Laws 1998, LB 1162, § 22.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6831 - Violation; penalty.

44-6831.
Violation; penalty.
If, after the hearing, the director finds a health carrier has violated the Managed Care Emergency Services Act, the director shall reduce his or her findings to writing and shall issue and cause to be served upon the health carrier charged with the violation a copy of the findings and an order requiring the health carrier to cease and desist from engaging in the violation and the director may order any one or more of the following:
(1) Payment of a monetary penalty of not more than one thousand dollars for each violation, not to exceed an aggregate penalty of thirty thousand dollars, unless the violation was committed flagrantly and in conscious disregard of the Managed Care Emergency Services Act, in which case the penalty shall not be more than fifteen thousand dollars for each violation, not to exceed an aggregate penalty of one hundred fifty thousand dollars; and
(2) Suspension or revocation of the health carrier's certificate of authority if the health carrier knew or reasonably should have known it was in violation of the act.
Source
Laws 1998, LB 1162, § 23.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6832 - Violation of cease and desist order; penalty.

44-6832.
Violation of cease and desist order; penalty.
Any health carrier who violates a cease and desist order of the director under section 44-6831 may after notice and hearing and upon order of the director be subject to:
(1) A monetary penalty of not more than thirty thousand dollars for each violation, not to exceed an aggregate penalty of one hundred fifty thousand dollars; and
(2) Suspension or revocation of the health carrier's certificate of authority.
Source
Laws 1998, LB 1162, § 24.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6837 - Emergency medical condition, defined.

44-6837.
Emergency medical condition, defined.
Emergency medical condition means a medical or behavioral condition, the onset of which is sudden, that manifests itself by symptoms of sufficient severity, including, but not limited to, severe pain, that a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in (1) placing the health of the person afflicted with such condition in serious jeopardy or, in the case of a behavioral condition, placing the health of such persons or others in serious jeopardy, (2) serious impairment to such person's bodily functions, (3) serious impairment of any bodily organ or part of such person, or (4) serious disfigurement of such person.
Source
Laws 2020, LB997, § 4.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6839 - Health benefits plan, defined.

44-6839.
Health benefits plan, defined.
(1) Health benefits plan means a benefits plan which pays or provides hospital and medical expense benefits for covered services and is delivered or issued for delivery in this state by or through an insurer.
(2) Health benefits plan does not include the medical assistance program, medicare, medicare advantage, accident-only, credit, disability, or long-term care coverage, TRICARE supplement coverage, coverage arising out of a workers' compensation or similar law, automobile medical payment insurance, personal injury protection insurance, and hospital confinement indemnity coverage.
Source
Laws 2020, LB997, § 6.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6840 - Health care facility, defined.

44-6840.
Health care facility, defined.
Health care facility means a general acute hospital, satellite emergency department, or ambulatory surgical center licensed pursuant to the Health Care Facility Licensure Act.
Source
Laws 2020, LB997, § 7.
Cross References
Health Care Facility Licensure Act, see section 71-401.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6841 - Health care professional, defined.

44-6841.
Health care professional, defined.
Health care professional means an individual who is credentialed pursuant to the Uniform Credentialing Act, who is acting within the scope of his or her credential, and who provides a covered service defined by the health benefits plan.
Source
Laws 2020, LB997, § 8.
Cross References
Uniform Credentialing Act, see section 38-101.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6843 - Insurer, defined.

44-6843.
Insurer, defined.
Insurer means an entity that contracts to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services under a health benefits plan, including (1) any individual or group sickness and accident insurance policy or subscriber contract delivered, issued for delivery, or renewed in this state and any hospital, medical, or surgical expense-incurred policy, except for a policy that provides coverage for a specified disease or other limited-benefit coverage, and (2) any self-funded employee benefit plan to the extent not preempted by federal law.
Source
Laws 2020, LB997, § 10.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6845 - Medically necessary, defined.

44-6845.
Medically necessary, defined.
Medically necessary means a health care service that a health care provider, exercising his or her prudent clinical judgment, would provide to a covered person for the purpose of evaluating, diagnosing, or treating an illness, an injury, or a disease, or its symptoms, and that is in accordance with the generally accepted standards of medical practice; that is clinically appropriate, in terms of type, frequency, extent, site, and duration, and considered effective for the covered person's illness, injury, or disease; that is not primarily for the convenience of the covered person or the health care provider; and that is not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that covered person's illness, injury, or disease.
Source
Laws 2020, LB997, § 12.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6847 - Emergency services; facility, bill; limitation.

44-6847.
Emergency services; facility, bill; limitation.
If a covered person receives emergency services at any health care facility, the facility shall not bill the covered person in excess of any deductible, copayment, or coinsurance amount applicable to in-network services pursuant to the covered person's health benefits plan.
Source
Laws 2020, LB997, § 14.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6848 - Emergency services; health care provider, bill; limitation.

44-6848.
Emergency services; health care provider, bill; limitation.
If a covered person receives emergency services at an in-network or out-of-network health care facility, the health care provider performing those services shall not bill the covered person in excess of any deductible, copayment, or coinsurance amount applicable to in-network services pursuant to the covered person's health benefits plan.
Source
Laws 2020, LB997, § 15.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6849 - Emergency services; insurer; duties; payment; presumed reasonable; dispute resolution procedure.

44-6849.
Emergency services; insurer; duties; payment; presumed reasonable; dispute resolution procedure.
(1) If a covered person receives emergency services at an in-network or out-of-network health care facility, the insurer shall ensure that the covered person incurs no greater out-of-pocket costs than the covered person would have incurred with an in-network health care provider for covered services.
(2) With respect to emergency services at an in-network or out-of-network health care facility, if the out-of-network health care provider bills an insurer directly, any reimbursement paid by the insurer shall be paid directly to the out-of-network health care provider. The insurer shall provide the out-of-network health care provider with a written remittance of payment that specifies the proposed reimbursement and the applicable deductible, copayment, or coinsurance amounts owed by the covered person.
(3) If emergency services provided at an in-network or out-of-network health care facility are performed, the out-of-network health care provider may bill the insurer for the services rendered. The insurer may pay the billed amount. A claim or a payment shall be presumed reasonable if it is based on the higher of (a) the contracted rate under any then-existing in-network contractual relationship between the insurer and the out-of-network health care provider for the same or similar services or (b) one hundred seventy-five percent of the payment rate for medicare services received from the federal Centers for Medicare and Medicaid Services for the same or similar services in the same geographic area. If the out-of-network health care provider deems the payment made by the insurer unreasonable, the out-of-network health care provider shall return payment to the insurer and utilize the dispute resolution procedure under section 44-6850.
Source
Laws 2020, LB997, § 16.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6850 - Settlement, negotiation; mediation, when.

44-6850.
Settlement, negotiation; mediation, when.
(1) If an insurer or an out-of-network health care provider provides notification that it considers a claim or payment to be not reasonable, the insurer and the health care provider shall have thirty days after the date of such notification to negotiate a settlement. If a settlement has not been reached after such thirty-day period, the insurer and the health care provider shall engage in mediation in accordance with the Uniform Mediation Act. The insurer may attempt to negotiate a final reimbursement amount with the out-of-network health care provider which differs from the amount paid by the insurer pursuant to this section.
(2) Following completion of the mediation process, the cost of mediation shall be split evenly and paid by the insurer and the health care provider.
(3) Mediation shall not be used when the insurer and the health care provider agree to a separate payment arrangement.
Source
Laws 2020, LB997, § 17.
Cross References
Uniform Mediation Act, see section 25-2930.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6901 - Definitions, where found.

44-6901.
Definitions, where found.
For purposes of sections 44-6901 to 44-6918, the definitions found in sections 44-6902 to 44-6915.01 shall be used.
Source
Laws 1997, LB 862, § 1;
Laws 2000, LB 1253, § 38;
Laws 2002, LB 1139, § 44.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6904 - Creditable coverage, defined.

44-6904.
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) Part A or Part B of Title XVIII of the Social Security Act;
(d) Title XIX of the Social Security Act, 42 U.S.C. 1396 et seq., other than coverage consisting solely of benefits under section 1928 of the act, 42 U.S.C. 1396s;
(e) 10 U.S.C. chapter 55, as such chapter existed on January 1, 2003;
(f) A medical care program of the Indian Health Service or of a tribal organization;
(g) A state health benefits risk pool;
(h) A health plan offered under 5 U.S.C. 8901 et seq.;
(i) A public health plan as defined under regulations promulgated by the federal Secretary of Health and Human Services; and
(j) A health benefit plan under 22 U.S.C. 2504.
(2) Creditable coverage shall not include any coverage that occurs before a significant break in coverage. For purposes of this section, a significant break in coverage shall mean any period of sixty-three consecutive days during all of which the individual does not have any creditable coverage, except that neither a waiting period nor an affiliation period shall be taken into account in determining a significant break in coverage.
(3) Creditable coverage shall not include coverage consisting solely of coverage of excepted benefits as that term is defined in the federal Health Insurance Portability and Accountability Act of 1996, 29 U.S.C. 1191b, and regulations adopted pursuant to the act and in effect on April 19, 1998.
Source
Laws 1997, LB 862, § 4;
Laws 1998, LB 1035, § 13;
Laws 2003, LB 6, § 4.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6906 - Governmental plan, defined.

44-6906.
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, § 6.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6907 - Group health plan, defined.

44-6907.
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, § 7.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6908 - Health benefit plan, defined.

44-6908.
Health benefit plan, defined.
(1) Health benefit plan means any employer group hospital or medical policy or certificate or employer group health maintenance organization subscriber contract.
(2) Health benefit plan does not include one or more, or any combination, of the following:
(a) Coverage only for accident or disability income insurance, or any combination thereof;
(b) Coverage issued as a supplement to liability insurance;
(c) Liability insurance, including general liability insurance and automobile liability insurance;
(d) Workers' compensation or similar insurance;
(e) Automobile medical payment insurance;
(f) Credit-only insurance;
(g) Coverage for onsite medical clinics; and
(h) Other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.
(3) Health benefit plan does not include the following benefits if they are provided under a separate policy, certificate, or contract of insurance or are otherwise not an integral part of the plan:
(a) Limited-scope dental or vision benefits;
(b) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof; and
(c) Such other similar, limited benefits as are specified in federal regulations.
(4) Health benefit plan does not include the following benefits if the benefits are provided under a separate policy, certificate, or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group health benefit plan maintained by the same plan sponsor, and such benefits are paid with respect to an event without regard to whether benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor:
(a) Coverage only for a specified disease or illness; and
(b) Hospital indemnity or other fixed indemnity insurance.
(5) Health benefit plan does not include the following if it is offered as a separate policy, certificate, or contract of insurance:
(a) Medicare supplemental health insurance as defined under section 1882(g)(1) of the Social Security Act;
(b) Coverage supplemental to the coverage provided under 10 U.S.C. chapter 55, as such chapter existed on January 1, 2003; and
(c) Similar supplemental coverage provided to coverage under a group health plan.
Source
Laws 1997, LB 862, § 8;
Laws 2003, LB 6, § 5.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6909 - Health carrier, defined.

44-6909.
Health carrier, defined.
Health carrier means any entity that provides a health benefit plan including an insurance company, a fraternal benefit society, a health maintenance organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation.
Source
Laws 1997, LB 862, § 9.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6909.01 - Health maintenance organization, defined.

44-6909.01.
Health maintenance organization, defined.
Health maintenance organization means a person that undertakes to provide or arrange for the delivery of basic health care services to enrollees on a prepaid basis, except for enrollee responsibility for copayments or deductibles or both.
Source
Laws 2002, LB 1139, § 45.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6910 - Health-status-related factor, defined.

44-6910.
Health-status-related factor, defined.
Health-status-related factor means any of the following factors:
(1) Health status;
(2) Medical condition, including both physical and mental illnesses;
(3) Claims experience;
(4) Receipt of health care;
(5) Medical history;
(6) Genetic information;
(7) Evidence of insurability, including conditions arising out of acts of domestic violence; and
(8) Disability.
Source
Laws 1997, LB 862, § 10.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6911 - Late enrollee, defined.

44-6911.
Late enrollee, defined.
Late enrollee means an eligible employee or dependent who requests enrollment in a health benefit plan following the initial enrollment period during which the individual is entitled to enroll under the terms of the health benefit plan if the initial enrollment period is a period of at least thirty days. An eligible employee or dependent shall not be considered a late enrollee if:
(1) The individual meets each of the following:
(a) The individual was covered under creditable coverage at the time of the initial enrollment;
(b) The individual lost coverage under creditable coverage as a result of termination of employment or eligibility, reduction in the number of hours of employment, the involuntary termination of the creditable coverage, death of a spouse, divorce, or legal separation; and
(c) The individual requests enrollment within thirty days after termination of the creditable coverage;
(2) The individual is employed by an employer which offers multiple health benefit plans and the individual elects a different plan during an open enrollment period;
(3) A court has ordered coverage be provided for a spouse or minor or dependent child under a covered employee's health benefit plan and request for enrollment is made within thirty days after issuance of the court order; or
(4) The individual had coverage under a COBRA continuation provision and the coverage under that provision was exhausted.
Source
Laws 1997, LB 862, § 11.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6912 - Medical care, defined.

44-6912.
Medical care, defined.
Medical care means amounts paid for:
(1)(a) The diagnosis, care, mitigation, treatment, or prevention of disease or (b) the purpose of affecting any structure or function of the body;
(2) Transportation primarily for and essential to medical care referred to in subdivision (1) of this section; and
(3) Insurance covering medical care referred to in subdivisions (1) and (2) of this section.
Source
Laws 1997, LB 862, § 12.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6913 - Network plan, defined.

44-6913.
Network plan, defined.
Network plan means health insurance coverage offered by a health carrier under which the financing and delivery of medical care including items and services paid for as medical care are provided, in whole or in part, through a defined set of providers under contract with the health carrier.
Source
Laws 1997, LB 862, § 13.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6915 - Preexisting condition, defined.

44-6915.
Preexisting condition, defined.
Preexisting condition means a condition whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the six-month period ending on the enrollment date. Genetic information shall not be treated as a condition for which a preexisting condition exclusion may be imposed in the absence of a diagnosis of the condition related to such information.
Source
Laws 1997, LB 862, § 15;
Laws 2000, LB 1253, § 40.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6915.01 - Waiting period, defined.

44-6915.01.
Waiting period, defined.
Waiting period means the period that must pass with respect to an individual before the individual is eligible to be covered for benefits under the terms of the health benefit plan. If an individual enrolls as a late enrollee or on a special enrollment date, any period before such late or special enrollment is not a waiting period.
Source
Laws 2000, LB 1253, § 41.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6917.01 - Certification of creditable coverage.

44-6917.01.
Certification of creditable coverage.
(1) Health carriers shall provide written certification of creditable coverage to individuals in accordance with subsection (2) of this section.
(2) The certification of creditable coverage shall be provided:
(a) At the time an individual ceases to be covered under the health benefit plan or otherwise becomes covered under a COBRA continuation provision;
(b) In the case of an individual who becomes covered under a COBRA continuation provision, at the time the individual ceases to be covered under that provision; and
(c) At the time a request is made on behalf of an individual if the request is made not later than twenty-four months after the date of cessation of coverage described in subdivision (2)(a) or (b) of this section, whichever is later.
(3) Health carriers may provide the certification of creditable coverage required under subdivision (2)(a) of this section at a time consistent with notices required under any applicable COBRA continuation provision.
(4) The certificate of creditable coverage required to be provided pursuant to subsection (1) of this section shall contain:
(a) Written certification of the period of creditable coverage of the individual under the health benefit plan and the coverage, if any, under the applicable COBRA continuation provision; and
(b) The waiting period, if any, and, if applicable, affiliation period imposed with respect to the individual for any coverage under the health benefit plan.
(5) To the extent medical care under a group health plan consists of group health insurance coverage, the plan is deemed to have satisfied the certification requirement under subsection (1) of this section if the health carrier offering the coverage provides for certification in accordance with subsection (2) of this section.
(6)(a) If an individual enrolls in a group health plan that uses the alternative method of counting creditable coverage pursuant to subdivision (6)(c) of section 44-6916 and the individual provides a certificate of coverage that was provided to the individual pursuant to subsection (3) of this section, on request of the group health plan, the entity that issued the certification to the individual promptly shall disclose to the group health plan information on the classes and categories of health benefits available under the entity's health benefit plan.
(b) The entity providing the information pursuant to subdivision (6)(a) of this section may charge the requesting group health plan the reasonable cost of disclosing the information.
Source
Laws 2002, LB 1139, § 47.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-6918 - Rules and regulations.

44-6918.
Rules and regulations.
The director may adopt and promulgate rules and regulations to carry out sections 44-6901 to 44-6918.
Source
Laws 1997, LB 862, § 18;
Laws 2000, LB 1253, § 42;
Laws 2002, LB 1139, § 48.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-7002 - Purpose and intent.

44-7002.
Purpose and intent.
The Health Care Professional Credentialing Verification Act requires a health carrier to establish a comprehensive health care professional credentialing verification program to ensure that its participating health care professionals meet specific minimum standards of professional qualification. The standards set out in the act address the initial credentialing verification and subsequent recredentialing process.
Source
Laws 1998, LB 1162, § 27.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-7005 - Use of nationally recognized private accrediting entities; authorized.

44-7005.
Use of nationally recognized private accrediting entities; authorized.
The director may recognize accreditation by one or more nationally recognized private accrediting entities, with established and maintained standards, as evidence of meeting some or all of the requirements of the Health Care Professional Credentialing Verification Act. A recognized accrediting entity shall make available to the director its current standards to demonstrate that the entity's standards meet or exceed this state's requirements. The health carrier may provide the director with documentation that a managed care plan has been accredited by the entity.
Source
Laws 1998, LB 1162, § 30.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-7006 - Health carrier; credentialing verification duties.

44-7006.
Health carrier; credentialing verification duties.
(1) A health carrier shall:
(a) Establish written policies and procedures for credentialing verification of all health care professionals with whom the health carrier contracts and apply these standards consistently;
(b) Verify the credentials of a health care professional before entering into a contract with that health care professional. The medical director of the health carrier or other designated health care professional shall have responsibility for, and shall participate in, credentialing verification;
(c) Establish a credentialing verification committee consisting of licensed physicians and other health care professionals to review credentialing verification information and supporting documents and make decisions regarding credentialing verification;
(d) Make available for review by the applying health care professional upon written request all application and credentialing verification policies and procedures;
(e) Retain all records and documents relating to a health care professional's credentialing verification process for at least five years; and
(f) Keep confidential all information obtained in the credentialing verification process except as otherwise provided by law.
(2) Nothing in the Health Care Professional Credentialing Verification Act shall be construed to require a health carrier to select a provider as a participating provider solely because the provider meets the health carrier's credentialing verification standards or to prevent a health carrier from utilizing separate or additional criteria in selecting the health care professionals with whom it contracts.
(3) The policies and procedures for credentialing verification shall be available for review by the director, and, in the case of a health maintenance organization, shall also be available for review by the chief medical officer, if one is appointed pursuant to section 81-3115, and if not, then the Director of Public Health.
Source
Laws 1998, LB 1162, § 31;
Laws 2007, LB296, § 198.
2023 Nebraska Revised Statutes › Chapter 44 - Insurance › 44-7007 - Health carrier; primary verification; secondary verification; duties.

44-7007.
Health carrier; primary verification; secondary verification; duties.
A health carrier shall:
(1) Obtain primary verification of at least the following information about the applicant:
(a) Current license, certificate, or registration to practice a health care profession in this state and history of licensure, certification, or registration;
(b) Current level of professional liability coverage, if applicable;
(c) Status of hospital privileges, if applicable;
(d) Specialty board certification status, if applicable;
(e) Current federal Drug Enforcement Agency registration certificate, if applicable;
(f) Graduation from a health care professional school; and
(g) Completion of postgraduate training, if applicable;
(2) Obtain, subject to either primary or secondary verification at the health carrier's discretion:
(a) The health care professional's licensure, certification, or registration history in this and all other states;
(b) The health care professional's malpractice history; and
(c) The health care professional's practice history;
(3) At least every three years obtain primary verification of a participating health care professional's:
(a) Current license, certificate, or registration to practice a health care profession in this state;
(b) Current level of professional liability coverage, if applicable;
(c) Status of hospital privileges, if applicable;
(d) Current federal Drug Enforcement Agency registration certificate, if applicable; and
(e) Specialty board certification status, if applicable; and
(4) Require all participating providers to notify the health carrier of changes in the status of any of the items listed in this section at any time and identify for participating providers the individual to whom they should report changes in the status of an item listed in this section.
Source
Laws 1998, LB 1162, § 32.