Nebraska Department of Insurance
Certification of Creditable Coverage
State insurance law was amended by Legislative Bill 1139 to require insurance companies and HMOs to provide certificates of creditable coverage to persons covered under both small and large group employer health insurance plans (1) when an individual ceases to be covered by the health insurance policy or becomes covered under COBRA; (2) when COBRA ends; or (3) when the individual requests the certificate within 24 months after coverage ceased under either of the previous situations. Also, certificates of creditable coverage must be provided to policyholders of individual health insurance at the time the individual is no longer covered or when the individual requests a certificate within 24 months after coverage ceased. A certificate of creditable coverage is a document that certifies that the person was covered by the health insurance plan. Certain carriers may use an affiliation period if they don't use a preexisting condition exclusion period. These changes to state law are based on HIPAA law and regulation.List billed health insurance policies
Legislative Bill 719 amends the Small Employer Health Insurance Availability Act, Neb. Rev. Stat. §44-5256, to provide that individual health insurance policies sold through an employer will not be considered a small employer health insurance plan if the employer does not contribute toward the cost of the insurance. Major medical health insurance, hospital or medical policies and HMO coverage are considered small employer health insurance policies under this law if the employer pays for or reimburses any portion of the premium, or if the health benefit plan is a plan pursuant to section 106, 125, or 162 of the Internal Revenue Code. Because of the rising cost of health insurance coverage some employers have stopped paying for or reimbursing employee health insurance cost. Instead the employer allows individual health or HMO policies to be marketed through the employer and often facilitates premium payment through payroll deduction.Insurance producers that advise employers to allow marketing of individual health insurance through an employer should be aware that these policies might still be considered a group plan. A group plan has to comply with the requirements of HIPAA which means that, among other limitations, every eligible individual would have to be offered coverage and preexisting condition exclusions would be waived. The Department of Health and Human Services has stated that insurance policies that are considered individual policies under state law could still be treated as group policies subject to HIPAA. These policies will be treated as a group policy if (1) the employer makes any contributions; (2) the program is mandatory; (3) the employer does more than just permit the insurer to publicize the program and collect premiums through payroll deduction, such as endorse the plan; and (4) the employer receives any consideration in connection with the plan other than administrative costs. The HHS/Centers for Medicare and Medicaid Services (formerly HCFA) Memorandum that describes this issue is available through their website at http://www.hcfa.gov/medicaid/hipaa/content/HIP00-6.asp. One of the Department of Labor/Pension and Welfare Benefits Administration Advisory Opinions cited in the CMS Memorandum is available through the PWBA website at www.dol.gov/dol/pwba/public/programs/ori/advisory94/94-22a.htm.