Every health maintenance organization shall, when determining liabilities, include an amount estimated in the aggregate to provide (1) for any unearned premium, (2) for the payment of all claims for health care expenditures which have been incurred, whether reported or unreported, which are unpaid, and for which such organization is or may be liable, and (3) for the expense of adjustment or settlement of such claims. Such liabilities shall be computed in accordance with rules and regulations adopted and promulgated by the director upon reasonable consideration of the ascertained experience and character of the health maintenance organization.

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Terms Used In Nebraska Statutes 44-32,140

  • Director: shall mean the Director of Insurance. See Nebraska Statutes 44-3298
  • 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
  • Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
  • 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.