Nebraska Statutes 44-32,144. Uncovered expenditures insolvency deposit
(1) If uncovered expenditures exceed ten percent of the total health care expenditures of a health maintenance organization for the previous calendar quarter, the health maintenance organization shall place an uncovered expenditures insolvency deposit of cash or securities that are acceptable to the director with the director or with any organization or trustee acceptable to the director through which a custodial or controlled account is maintained. Such deposit shall at all times have a fair market value in an amount of one hundred twenty percent of the health maintenance organization’s outstanding liability for uncovered expenditures for enrollees in this state, including incurred but not reported claims. The fair market value of the deposit shall be calculated as of the first day of the month and maintained for the remainder of the month. If a health maintenance organization is not otherwise required to file a quarterly report, it shall file a report within forty-five days of the end of the calendar quarter with information sufficient to demonstrate compliance with this section.
Terms Used In Nebraska Statutes 44-32,144
- Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
- Director: shall mean the Director of Insurance. See Nebraska Statutes 44-3298
- Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
- Health maintenance organization: shall mean any person who 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. See Nebraska Statutes 44-32,105
- Month: shall mean calendar month. See Nebraska Statutes 49-801
- Net worth: shall mean the excess of total admitted assets over total liabilities. See Nebraska Statutes 44-32,109
- Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
- State: when applied to different states of the United States shall be construed to extend to and include the District of Columbia and the several territories organized by Congress. See Nebraska Statutes 49-801
- Trustee: A person or institution holding and administering property in trust.
- Uncovered expenditures: shall mean the costs to the health maintenance organization for health care services that are the obligation of the health maintenance organization for which an enrollee may also be liable in the event of the health maintenance organization's insolvency and for which no alternative arrangements have been made that are acceptable to the director. See Nebraska Statutes 44-32,114
(2) The deposit required under this section shall be in addition to the deposit required under section 44-32,139 and shall be an admitted asset of the health maintenance organization in the determination of net worth. All income from such deposits or trust accounts shall be assets of the health maintenance organization and may be withdrawn quarterly with the approval of the director.
(3) A health maintenance organization that has made a deposit may withdraw that deposit or any part of the deposit if (a) a substitute deposit of cash or securities of equal amount and value is made, (b) the fair market value of the deposit exceeds the amount of the required deposit, or (c) the required deposit is reduced or eliminated. Deposits, substitutions, or withdrawals may be made only with the prior written approval of the director.