44-1402. Terms, defined.

305 words·~1 min read·/ne/chapter-44/44-1402

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

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.