Nebraska Health Insurance Policy Requirements

Nebraska has health insurance regulations that work alongside federal requirements under Chapter 44 of the Nebraska Revised Statutes.

Regulatory Structure

Nebraska health coverage is regulated by the Nebraska Department of Insurance (NDOI):

Health Insurance Marketplace

Nebraska uses the federal HealthCare.gov marketplace:

• Federally facilitated marketplace
• Provides access to qualified health plans (QHPs)
• Premium tax credits available for eligible residents
• Open enrollment and special enrollment periods apply

Metal Tier Plans

Small Group Definition

Nebraska defines small employer groups as:

• 1 to 50 employees (can include sole proprietors)
• Must include at least one eligible employee
• Self-employed individuals may qualify

Pre-Existing Condition Protections

Nebraska prohibits pre-existing condition exclusions in ACA-compliant plans:

Guaranteed Issue and Renewal

Nebraska requires:

Guaranteed Issue

• Insurers must accept all applicants for ACA-compliant plans
• Cannot deny coverage based on health status
• Applies to individual and small group markets

Guaranteed Renewal

• Insurers cannot cancel coverage except for:
  • Non-payment of premium
  • Fraud or misrepresentation
  • Plan discontinuation (with proper notice)

Mental Health Parity

Nebraska requires mental health parity:

Federal MHPAEA Compliance

Nebraska requires insurers to comply with the federal Mental Health Parity and Addiction Equity Act (MHPAEA):

• Financial requirements must be comparable to medical/surgical
• Treatment limitations must be comparable
• Prior authorization requirements must be comparable
• Out-of-pocket costs must be comparable

Coverage Requirements

Health plans must provide:

• Mental health coverage
• Substance use disorder treatment
• No annual or lifetime dollar limits specific to mental health

Exam Tip: Nebraska requires mental health benefits to be provided at parity with medical/surgical benefits under federal MHPAEA requirements.

Essential Health Benefits

All individual and small group plans must cover:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorders
6. Prescription drugs
7. Rehabilitative services
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services (including dental and vision)

Claims Handling Requirements

Nebraska has specific claims handling timeframes:

External Review

Nebraska provides external review rights:

• Consumers can appeal denied claims
• Independent external review available
• Binding decision on insurer