Terms Used In Nebraska Statutes > Small Employer Health Insurance Availability Act

• Action: shall include any proceeding in any court of this state. See Nebraska Statutes 49-801
• Actuarial certification: shall mean a written statement by a member of the American Academy of Actuaries or other individual acceptable to the director that a small employer carrier is in compliance with the provisions of section Nebraska Statutes 44-5226
• Affiliate or affiliated: shall mean any entity or person who directly or indirectly, through one or more intermediaries, controls or is controlled by, or is under common control with, a specified entity or person. See Nebraska Statutes 44-5227
• Affiliation period: means a period of time that must expire before health insurance coverage provided by a carrier becomes effective and during which the carrier is not required to provide benefits. See Nebraska Statutes 44-5227.01
• Base premium rate: shall mean for each class of business as to a rating period, the lowest premium rate charged or that could have been charged under a rating system for that class of business by the small employer carrier to small employers with similar case characteristics for health benefit plans with the same or similar coverage. See Nebraska Statutes 44-5229
• Basic health benefit plan: shall mean a lower cost health benefit plan regulated by the Department of Insurance. See Nebraska Statutes 44-5230
• Case characteristics: shall mean demographic or other objective characteristics of a small employer that are considered by the small employer carrier in the determination of premium rates for the small employer. See Nebraska Statutes 44-5234
• Church plan: shall mean a plan as defined under Nebraska Statutes 44-5234.01
• Class of business: shall mean all or a separate grouping of small employers established pursuant to section Nebraska Statutes 44-5235
• Company: shall include any corporation, partnership, limited liability company, joint-stock company, joint venture, or association. See Nebraska Statutes 49-801
• Contract: A legal written agreement that becomes binding when signed.
• Conviction: A judgement of guilt against a criminal defendant.
• 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.
• Creditable coverage shall not: include any coverage that occurs before a significant break in coverage. See Nebraska Statutes 44-5237.01
• Department: shall mean the Department of Insurance. See Nebraska Statutes 44-103
• Dependent: A person dependent for support upon another.
• Dependent: shall mean a spouse, an unmarried child under the age of nineteen years, an unmarried child who is a full-time student under the age of twenty-three years and who is financially dependent upon the parent, and an unmarried child of any age who is medically certified as disabled and dependent upon the parent. See Nebraska Statutes 44-5238
• Director: shall mean the Director of Insurance. See Nebraska Statutes 44-5239
• Domestic: when applied to corporations shall mean all those created by authority of this state. See Nebraska Statutes 49-801
• Eligible employee: shall mean an employee who works on a full-time basis and has a normal workweek of thirty or more hours. See Nebraska Statutes 44-5240
• Enrollment date: means the first day of coverage in the health benefit plan or, if earlier, the first day of the waiting period. See Nebraska Statutes 44-5240.01
• Established geographic service area: shall mean a geographic area, as approved by the director and based on the carrier's certificate of authority to transact insurance business in this state, within which the carrier is authorized to provide coverage. See Nebraska Statutes 44-5241
• 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.
• Fraud: Intentional deception resulting in injury to another.
• Governmental plan: shall mean a plan as defined under Nebraska Statutes 44-5241.01
• Group health plan: shall mean an employee welfare benefit plan as defined by Nebraska Statutes 44-5241.02
• Health benefit plan: shall mean any hospital or medical policy or certificate, major medical expense insurance, or health maintenance organization subscriber contract. See Nebraska Statutes 44-5242
• Health benefit plan shall not: include one or more, or any combination, of the following:

  (a) Coverage only for accident or disability income insurance, or any combination thereof. See Nebraska Statutes 44-5242

• Health carrier or carrier: shall mean any entity that provides health insurance in this state. See Nebraska Statutes 44-5242.01
• Health maintenance organization: means a person that 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 or both. See Nebraska Statutes 44-5242.03
• Health-status-related factor: shall mean any of the following factors:

  (1) Health status. See Nebraska Statutes 44-5242.02

• 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.
• Late enrollee: shall mean an eligible employee or dependent who requests enrollment in a health benefit plan of a small employer following the initial enrollment period during which the individual is entitled to enroll under the terms of the health benefit plan if the initial enrollment period is a period of at least thirty days. See Nebraska Statutes 44-5244
• 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}
• Medical care: shall mean amounts paid for:

  (1)(a) The diagnosis, care, mitigation, treatment, or prevention of disease or (b) the purpose of affecting any structure or function of the body. See Nebraska Statutes 44-5244.01

• Month: shall mean calendar month. See Nebraska Statutes 49-801
• Network plan: shall mean health insurance coverage offered by a health carrier under which the financing and delivery of medical care including items and services paid for as medical care are provided, in whole or in part, through a defined set of providers under contract with the health carrier. See Nebraska Statutes 44-5244.02
• 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.
• 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.
• Peace officer: shall include sheriffs, coroners, jailers, marshals, police officers, state highway patrol officers, members of the National Guard on active service by direction of the Governor during periods of emergency, and all other persons with similar authority to make arrests. 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
• 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
• Preexisting condition: means a condition whether physical or mental, regardless of the cause of the condition, for which medical advice, diagnosis, care, or treatment was recommended or received within the six-month period ending on the enrollment date. See Nebraska Statutes 44-5246.02
• Premium: shall mean all money paid by a small employer and eligible employees as a condition of receiving coverage from a small employer carrier, including any fees or other contributions associated with the health benefit plan. See Nebraska Statutes 44-5247
• Rating period: shall mean the calendar period for which premium rates established by a small employer carrier are assumed to be in effect. See Nebraska Statutes 44-5250
• 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
• Restricted network provision: shall mean any provision of a health benefit plan that conditions the payment of benefits, in whole or in part, on the use of health care providers that have entered into contractual arrangement with the carrier to provide health care services to covered individuals. See Nebraska Statutes 44-5252
• Small employer: shall mean any person, political subdivision, firm, corporation, limited liability company, partnership, or association that is actively engaged in business that, on at least fifty percent of its working days during the preceding calendar quarter, employed at least two and no more than fifty eligible employees, the majority of whom were employed within this state. See Nebraska Statutes 44-5253
• Small employer carrier: shall mean a carrier that offers health benefit plans covering eligible employees of one or more small employers in this state. See Nebraska Statutes 44-5254
• Standard health benefit plan: shall mean a health benefit plan regulated by the Department of Insurance. See Nebraska Statutes 44-5255
• 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.
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• United States: shall include territories, outlying possessions, and the District of Columbia. See Nebraska Statutes 49-801
• Waiting period: means the period that must pass with respect to an individual before the individual is eligible to be covered for benefits under the terms of the health benefit plan. See Nebraska Statutes 44-5255.01
• Year: shall mean calendar year. See Nebraska Statutes 49-801