Nebraska Department of Insurance

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In 1985, the Nebraska Legislature enacted LB 931, the Comprehensive Health Insurance Pool Act, which is codified at Neb.Rev.Stat. §44-4201 through §44-4235. This Act established the Nebraska Comprehensive Health Insurance Pool which became operational on November 1, 1986. The purpose of the Act is to provide a mechanism to ensure the availability of health insurance to persons unable to purchase such insurance coverage for a pre-existing medical condition and to provide that adequate levels of health insurance coverage may be made available and affordable to the residents of Nebraska who are otherwise considered uninsurable or who are underinsured due to a medical condition creating a high risk. Under the Act, all insurers authorized to issue or provide health insurance in Nebraska on or after September 6, 1985, are members of the Pool. Insurer means any insurance company as defined by Neb.Rev.Stat. §44-103, or a health maintenance organization as defined by §44-32,105, authorized to transact health insurance business in Nebraska.

The Pool is granted authority to make assessments upon member insurers for the Pool as may be reasonable and necessary to provide for losses resulting from claims incurred and operating expenses to assure the financial stability of the Pool. Each member insurer's assessment is determined by multiplying the total net loss from operation of the Pool by a fraction, the numerator of which equals the insurer's premium and subscriber contract charges for health insurance written and renewed in Nebraska during the preceding calendar year and the denominator of which equals the total of all premiums and subscriber contract charges of insurers for health insurance written or renewed in Nebraska during the preceding calendar year. Under the Act, "health insurance" is defined as any hospital, surgical, or medical expense incurred policy or health maintenance contract. Health insurance does not include: (1) accident only, disability income, hospital confinement indemnity, dental, or credit insurance; (2) coverage issued as a supplement to liability insurance; (3) Medicare or insurance provided as a supplement to Medicare; (4) insurance arising from workers' compensation provisions; (5) automobile medical payment insurance; (6) any other specific limited coverage; or (7) insurance under which benefits are payable with or without regard to fault and which is statutorily required to be contained in any liability insurance policy.

The assessments are due and payable within thirty days of receipt of the assessment notice. Any insurer subject to premium and related retaliatory tax liability imposed by §§44-1213, 44-150 and 77-908 may offset assessments paid to the Pool by such insurer against its tax liability in the year of payment of subsequent years.

Finally, the Act expressly provides that every insurer licensed in Nebraska shall include a notice of the existence of the Comprehensive Health Insurance Pool in: (1) any rejection of an application for health insurance coverage for reasons of the health of the applicant; and (2) any restrictive health insurance rider issued after January 1, 1999. Attached hereto as Exhibit A is suggested language for this notice. Currently, the administering insurer for the Pool can be contacted at 7261 Mercy Road, Omaha, NE 68180, phone 390-1814 in Omaha, 1-800-356-3485 toll free in Nebraska.

TIMOTHY J. HALL

Director of Insurance

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NOTICE

Your application for health insurance has been carefully reviewed. Unfortunately, based upon your answers to the health questions necessary to complete the application, we are unable to provide you with coverage or you are being offered coverage with a restrictive rider which will result in the health insurance policy excluding coverage for a health condition.

However, you may be eligible to receive health insurance coverage through the Nebraska Comprehensive Health Insurance Pool, which provides coverage to Nebraska residents who are uninsurable for medical reasons. The State Legislature created this program in 1985.

If you are interested in learning more about the coverage, you or your agent or broker may contact the Nebraska Comprehensive Health Insurance Pool or the Nebraska Department of Insurance and ask about the Comprehensive Health Insurance Pool.

Call or write to either:

• Nebraska Comprehensive Health Insurance Pool
  7261 Mercy Road
  Omaha, Nebraska 68180
  390-1814 in Omaha
  1-800-356-3485
  Toll-free in Greater Nebraska

  or

  Nebraska Department of Insurance
  941 "O" Street
  Lincoln, Nebraska 68508
  (402) 471-2201