Nebraska § 44-1402 Terms, defined

Nebraska Statutes

§ 44-1402 — Terms, defined

Nebraska·Ch. 44 Insurance

For purposes of the Nebraska Right to Shop Act:

(1)Allowed amount means the contractually agreed-upon amount paid by an insurance carrier to a health care entity participating in the insurance carrier’s network or the amount the health plan is required to pay under the health plan policy or certificate of insurance for out-of-network covered benefits provided to the patient;

(2)Department means the Department of Insurance;

(3)Director means the Director of Insurance;

(4)Enrollee means an individual receiving health insurance coverage from an insurance carrier;

(5)Health care entity means:

(a)A facility licensed under the Health Care Facility Licensure Act;

(b)A health care professional licensed under the Uniform Credentialing Act; and

(c)An organization or association of health car

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For purposes of the Nebraska Right to Shop Act:
(1) Allowed amount means the contractually agreed-upon amount paid by an insurance carrier to a health care entity participating in the insurance carrier’s network or the amount the health plan is required to pay under the health plan policy or certificate of insurance for out-of-network covered benefits provided to the patient;
(2) Department means the Department of Insurance;
(3) Director means the Director of Insurance;
(4) Enrollee means an individual receiving health insurance coverage from an insurance carrier;
(5) Health care entity means:
(a) A facility licensed under the Health Care Facility Licensure Act;
(b) A health care professional licensed under the Uniform Credentialing Act; and
(c) An organization or association of health care professionals licensed under the Uniform Credentialing Act;
(6) Incentive payment means a payment described in section 44-1407 that is made by an insurance carrier to an enrollee;
(7) Insurance carrier means any entity that provides health insurance in this state. Insurance carrier includes (a) an insurance company, (b) a fraternal benefit society, (c) a health maintenance organization, and (d) any other entity providing a plan of health insurance or health benefits subject to state insurance regulation;
(8) Shared savings incentive payment program means a program established by an insurance carrier pursuant to section 44-1407 to provide incentive payments to enrollees; and
(9) Shoppable health care service means a health care service for which an insurance carrier offers incentive payments under a shared savings incentive payment program established by the insurance carrier. Shoppable health care service includes, at a minimum, health care services in the following categories:
(a) Physical and occupational therapy services;
(b) Obstetrical and gynecological services;
(c) Radiology and imaging services;
(d) Laboratory services;
(e) Infusion therapy;
(f) Inpatient or outpatient surgical procedures; and
(g) Outpatient nonsurgical diagnostic tests or procedures.

Nebraska § 44-1402 (Terms, defined) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

Legislative History

Source: Laws 2018, LB1119, § 12. Cross References: Health Care Facility Licensure Act, see section 71-401. Uniform Credentialing Act, see section 38-101.