Nebraska Statutes 44-4221. Purchase pool coverage; eligibility
(1) To be eligible to purchase pool coverage, an individual shall:
Terms Used In Nebraska Statutes 44-4221
- Board: means the Board of Directors of the pool. See Nebraska Statutes 44-4206
- Church plan: means a plan as defined under 29 U. See Nebraska Statutes 44-4206.01
- Fraud: Intentional deception resulting in injury to another.
- Governmental plan: means a plan as defined under 29 U. See Nebraska Statutes 44-4208.01
- Group health plan: means an employee welfare benefit plan as defined by 29 U. See Nebraska Statutes 44-4208.02
- Health insurance: means any hospital, surgical, or medical expense-incurred policy or health maintenance organization contract. See Nebraska Statutes 44-4209
- Insurer: means any insurance company as defined in section 44-103 or health maintenance organization as defined in section 44-32,105 authorized to transact health insurance business in the State of Nebraska. See Nebraska Statutes 44-4210
- Medicare: means coverage under parts A and B of Title XVIII of the Social Security Act, 42 U. See Nebraska Statutes 44-4211
- Pool: means the Comprehensive Health Insurance Pool. See Nebraska Statutes 44-4215
- Qualified trade adjustment assistance eligible individual: shall mean an individual who is eligible for the credit for health insurance costs under section 35 of the Internal Revenue Code. See Nebraska Statutes 44-4215.02
- Resident: means an individual who is legally domiciled in this state. See Nebraska Statutes 44-4215.01
- 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
(a) Be a resident of the state for a period of at least six months and shall be an individual:
(i) Who is not eligible for coverage under a group health plan comparable to pool coverage, medicare by reason of age, or medical assistance pursuant to the Medical Assistance Act or section 43-522, or any successor program, and who does not have any other health insurance coverage comparable to pool coverage;
(ii) Who, if such individual was offered the option of continuation coverage under COBRA or under a similar program, both elected such continuation coverage and exhausted such continuation coverage; and
(iii)(A) Who has received, within six months prior to application to the pool, a rejection in writing, for reasons of health, from an insurer for health insurance coverage comparable to pool coverage;
(B) Who currently has, or has been offered within six months prior to application to the pool, health insurance coverage comparable to pool coverage by an insurer which includes a restrictive rider which limits health insurance coverage for a preexisting medical condition; or
(C) Who has been refused health insurance coverage comparable to pool coverage, or has been offered health insurance coverage at a rate exceeding the premium rate for pool coverage, within six months prior to application to the pool;
(b) Be a resident of the state for any length of time and be an individual:
(i) For whom, as of the date the individual seeks pool coverage under this section, the aggregate of the periods of creditable coverage is eighteen or more months and whose most recent prior creditable coverage was under a group health plan, governmental plan, or church plan;
(ii) Who is not eligible for coverage under a group health plan, medicare, or medical assistance pursuant to the Medical Assistance Act or section 43-522, or any successor program, and who does not have any other health insurance coverage;
(iii) With respect to whom the most recent prior creditable coverage was not terminated for factors relating to nonpayment of premiums or fraud; and
(iv) Who, if such individual was offered the option of continuation coverage under COBRA or under a similar program, both elected such continuation coverage and exhausted such continuation coverage; or
(c) Be a resident of the state for any length of time and be a qualified trade adjustment assistance eligible individual.
(2) The board may adopt and promulgate a list of medical or health conditions for which an individual would be eligible for pool coverage without applying for health insurance coverage pursuant to subdivision (1)(a) of this section. Individuals who can demonstrate the existence or history of any medical or health conditions on the list adopted and promulgated by the board shall be eligible to apply directly to the pool for pool coverage.