68-927. Terms, defined.

266 words·~1 min read·/ne/chapter-68/68-927

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

For purposes of sections 68-926 to 68-933 :

(1)Coordinate benefits means:

(a)Provide to the department information regarding the licensed insurer's or self-funded insurer's existing coverage for an individual who is eligible for a state benefit program; and

(b)Meet payment obligations;

(2)Coverage information means health information possessed by a licensed insurer or self-funded insurer that is limited to the following information about an individual:

(a)Eligibility for coverage under a health plan;

(b)Coverage of health care under the health plan; or

(c)Benefits and payments associated with the health plan;

(3)Health plan means any policy of insurance issued by a licensed insurer or any employee benefit plan offered by a self-funded insurer that provides for payment to, or on behalf of, an individual as a result of an illness, disability, or injury or change in a health condition and includes a service benefit plan, managed care organization, pharmacy benefit manager, or another party that is legally responsible by law, contract, or agreement for payment of a claim for a health care item or service;

(4)Individual means a person covered by a state benefit program, including the medical assistance program, or a person applying for such coverage;

(5)Licensed insurer means any insurer, except a self-funded insurer, including a fraternal benefit society, producer, or other person licensed or required to be licensed, authorized or required to be authorized, or registered or required to be registered pursuant to the insurance laws of the state; and

(6)Self-funded insurer means any employer or union who or which provides a self-funded employee benefit plan.