(1) Except as specified in section 44-7311, a health carrier shall use written procedures for receiving and resolving grievances from covered persons.

Terms Used In Nebraska Statutes 44-7307

  • Director: shall mean the Director of Insurance. See Nebraska Statutes 44-103
  • Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
  • Person: shall include bodies politic and corporate, societies, communities, the public generally, individuals, partnerships, limited liability companies, joint-stock companies, and associations. See Nebraska Statutes 49-801
  • Process: shall mean a summons, subpoena, or notice to appear issued out of a court in the course of judicial proceedings. See Nebraska Statutes 49-801

(2)(a) A copy of the grievance procedures, including all forms used to process a grievance, shall be made available to the director upon request. A health carrier shall file annually with the director a certificate of compliance stating that the health carrier has established and maintains grievance procedures that fully comply with the provisions of the Health Carrier Grievance Procedure Act.

(b) A description of the grievance procedure shall be set forth in or attached to the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage provided to covered persons.

(c) The grievance procedure documents shall include a statement of a covered person‘s right to contact the director’s office for assistance at any time. The statement shall include the telephone number and address of the director.