§ 44-3292 Act, how cited
§ 44-3293 Definitions, where found
§ 44-3294 Basic health care services, defined
§ 44-3295 Carrier, defined
§ 44-3296 Copayment, defined
§ 44-3297 Deductible, defined
§ 44-3298 Director, defined
§ 44-3299 Enrollee, defined
§ 44-32,100 Evidence of coverage, defined
§ 44-32,101 Extension of benefits, defined
§ 44-32,102 Grievance, defined
§ 44-32,103 Group contract, defined
§ 44-32,104 Group contract holder, defined
§ 44-32,105 Health maintenance organization, defined
§ 44-32,106 Health maintenance organization producer, defined
§ 44-32,107 Individual contract, defined
§ 44-32,108 Insolvent or insolvency, defined
§ 44-32,109 Net worth, defined
§ 44-32,110 Participating provider, defined
§ 44-32,111 Provider, defined
§ 44-32,112 Replacement coverage, defined
§ 44-32,113 Subscriber, defined
§ 44-32,114 Uncovered expenditures, defined
§ 44-32,115 Establishment of health maintenanceorganization; certificate of authority required
§ 44-32,116 Existing health maintenance organization; application
§ 44-32,117 Certificate of authority; application; contents
§ 44-32,118 Modification or amendment of application; required; when
§ 44-32,119 Application; transmittal to Department of Health and Human Services; duties; applicability
§ 44-32,120 Certificate of authority; issuance; conditions
§ 44-32,121 Certificate of authority; expiration; renewal
§ 44-32,122 Health maintenance organization; powers
§ 44-32,123 Health maintenance organization; exercise of powers; approval requirements
§ 44-32,124 Health maintenance organization; deemed to transact business of insurance
§ 44-32,125 Fiduciary relationships; bond or insurance required
§ 44-32,126 Quality of care; procedures established
§ 44-32,127 Quality assurance program; requirements
§ 44-32,128 Patient record system; requirements
§ 44-32,129 Group and individual contracts; required provisions
§ 44-32,130 Group and individual contracts; additional required provisions
§ 44-32,131 Subscriber; receive evidence of coverage; contents
§ 44-32,132 Forms; readability standards; filing requirements
§ 44-32,133 Forms; filing; when; disapproval or withdrawal of approval; notice; hearing
§ 44-32,134 Filings; required
§ 44-32,135 Information to subscribers and enrollees
§ 44-32,136 Grievance procedure
§ 44-32,137 Investments
§ 44-32,138 Net worth requirements
§ 44-32,139 Deposit requirements
§ 44-32,140 Liabilities; computation
§ 44-32,141 Provider contracts; requirements
§ 44-32,142 Provider agreement; notice of termination
§ 44-32,143 Insolvency; plan required
§ 44-32,144 Uncovered expenditures insolvency deposit
§ 44-32,145 Uncovered expenditures insolvency deposit; use
§ 44-32,146 Uncovered expenditures; reports
§ 44-32,147 Insolvency; replacement coverage; duty to provide; director; duties
§ 44-32,148 Replacement coverage; requirements
§ 44-32,149 Premium rates
§ 44-32,150 Insurance Producers Licensing Act; applicability
§ 44-32,151 Powers of insurers
§ 44-32,152 Examinations; expenses
§ 44-32,153 Certificate of authority; suspension, revocation, or denial; grounds
§ 44-32,154 Deficiency in net worth; impaired condition; director; powers
§ 44-32,155 Certificate of authority; suspension, revocation, or denial; administrative penalty; procedure
§ 44-32,156 Suspension, revocation, denial, or administrative penalty; order; hearing
§ 44-32,157 Hearing; notice; decision; appeal
§ 44-32,158 Certificate of authority; suspension or revocation; effect
§ 44-32,159 Hazardous operation; violations; director; powers
§ 44-32,160 Hazardous operation; violations; uniform standards and criteria; remedies not exclusive
§ 44-32,161 Supervision, rehabilitation, liquidation, or conservation; grounds and procedure applicable
§ 44-32,162 Rules and regulations
§ 44-32,163 Fees; distribution
§ 44-32,164 Administrative penalty
§ 44-32,165 Violations; conference; requirements
§ 44-32,166 Cease and desist order; hearing; appeal; injunction
§ 44-32,167 Net worth violation; director; powers
§ 44-32,168 Insurance laws; when applicable
§ 44-32,169 Solicitation of enrollees; other law; how construed
§ 44-32,170 Practice of medicine; laws not applicable
§ 44-32,171 Applications, filings, and reports; public documents; exception
§ 44-32,172 Confidential information; disclosure prohibited; exception
§ 44-32,173 Health care review committee; health maintenance organization; exemption from liability
§ 44-32,174 Health care review committee; information and records; confidentiality
§ 44-32,175 Quality assurance; access to records and information
§ 44-32,176 Department of Health and Human Services; contracts authorized
§ 44-32,177 Health maintenance organization;acquisition, merger, and consolidation; procedure
§ 44-32,178 Coordination of benefits
§ 44-32,179 Unfair trade and claims settlement practices laws; applicability
§ 44-32,180 Taxation

Terms Used In Nebraska Statutes > Health Maintenance Organization Act

  • Acquire: when used in connection with a grant of power or property right to any person shall include the purchase, grant, gift, devise, bequest, and obtaining by eminent domain. See Nebraska Statutes 49-801
  • Action: shall include any proceeding in any court of this state. See Nebraska Statutes 49-801
  • Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
  • Attorney: shall mean attorney at law. See Nebraska Statutes 49-801
  • Basic health care services: shall include as a minimum the following medically necessary services: Preventive care. See Nebraska Statutes 44-3294
  • Basic health care services shall: include as a minimum the following medically necessary services: Preventive care. See Nebraska Statutes 44-3294
  • Carrier: shall mean a health maintenance organization, an insurer, or any other entity responsible for the payment of benefits or the provision of services under a group contract. See Nebraska Statutes 44-3295
  • Company: shall include any corporation, partnership, limited liability company, joint-stock company, joint venture, or association. See Nebraska Statutes 49-801
  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Continuance: Putting off of a hearing ot trial until a later time.
  • Contract: A legal written agreement that becomes binding when signed.
  • Conviction: A judgement of guilt against a criminal defendant.
  • Copayment: shall mean an amount an enrollee must pay in order to receive a specific service which is not fully prepaid. See Nebraska Statutes 44-3296
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
  • Deductible: shall mean the amount an enrollee is responsible to pay out of pocket before the health maintenance organization begins to pay the costs associated with treatment. See Nebraska Statutes 44-3297
  • Department: shall mean the Department of Insurance. See Nebraska Statutes 44-103
  • Director: shall mean the Director of Insurance. See Nebraska Statutes 44-3298
  • Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
  • Domestic: when applied to corporations shall mean all those created by authority of this state. See Nebraska Statutes 49-801
  • Enrollee: shall mean an individual who is covered by a health maintenance organization and shall include both subscribers and dependents of subscribers. See Nebraska Statutes 44-3299
  • Enrollee shall mean an individual who is covered by a health maintenance organization and shall: include both subscribers and dependents of subscribers. See Nebraska Statutes 44-3299
  • Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
  • 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.
  • Evidence of coverage: shall mean a statement of the essential features and services of the health maintenance organization coverage which is given to the subscriber by the health maintenance organization or by the group contract holder. See Nebraska Statutes 44-32,100
  • Ex officio: Literally, by virtue of one's office.
  • Executor: A male person named in a will to carry out the decedent
  • Extension of benefits: shall mean the continuation of coverage under a particular benefit provided under a contract following termination with respect to an enrollee who is totally disabled on the date of termination. See Nebraska Statutes 44-32,101
  • 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.
  • Fiduciary: A trustee, executor, or administrator.
  • Foreclosure: A legal process in which property that is collateral or security for a loan may be sold to help repay the loan when the loan is in default. Source: OCC
  • Foreign: when applied to corporations shall include all those created by authority other than that of this state. See Nebraska Statutes 49-801
  • Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. Source: Federal Reserve
  • Grievance: shall mean a written complaint submitted in accordance with the health maintenance organization's formal grievance procedure by or on behalf of the enrollee regarding any aspect of the health maintenance organization relative to the enrollee. See Nebraska Statutes 44-32,102
  • Group contract: shall mean a contract for health care services which by its terms limits eligibility to members of a specified group. See Nebraska Statutes 44-32,103
  • Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
  • 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
  • Individual contract: shall mean a contract for health care services issued to and covering an individual. See Nebraska Statutes 44-32,107
  • Insolvent or insolvency: shall mean that the health maintenance organization has been declared insolvent and placed under an order of liquidation by a court of competent jurisdiction. See Nebraska Statutes 44-32,108
  • Insurer: shall include all companies, exchanges, societies, or associations whether organized on the stock, mutual, assessment, or fraternal plan of insurance and reciprocal insurance exchanges. See Nebraska Statutes 44-103
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • Lien: A claim against real or personal property in satisfaction of a debt.
  • Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
  • 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
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • Participating provider: shall mean a provider who, under an express or implied contract with the health maintenance organization or with its contractor or subcontractor, has agreed to provide health care services to enrollees with an expectation of receiving payment, other than copayment or deductible, directly or indirectly from the health maintenance organization. See Nebraska Statutes 44-32,110
  • Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
  • 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
  • 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
  • Personal property: All property that is not real property.
  • Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. Source: OCC
  • 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
  • Provider: shall mean any physician, hospital, or other person licensed or otherwise authorized to furnish health care services. See Nebraska Statutes 44-32,111
  • Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
  • Reinsurance: shall mean a contract by which an insurer procures a third party to insure it against loss or liability by reason of such original insurance. See Nebraska Statutes 44-103
  • 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.
  • Replacement coverage: shall mean the benefits provided by a succeeding carrier. See Nebraska Statutes 44-32,112
  • Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
  • 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
  • Statute: A law passed by a legislature.
  • Subpoena: A command to a witness to appear and give testimony.
  • Subscriber: shall mean an individual whose employment or other status, except family dependency, is the basis for eligibility for enrollment in the health maintenance organization or, in the case of an individual contract, the individual in whose name the contract is issued. See Nebraska Statutes 44-32,113
  • Testify: Answer questions in court.
  • Transcript: A written, word-for-word record of what was said, either in a proceeding such as a trial or during some other conversation, as in a transcript of a hearing or oral deposition.
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • 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
  • United States: shall include territories, outlying possessions, and the District of Columbia. See Nebraska Statutes 49-801
  • Violate: shall include failure to comply with. See Nebraska Statutes 49-801
  • Year: shall mean calendar year. See Nebraska Statutes 49-801