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Compliance Corner

State Updates

Extension of Transitional Policies

April 27, 2021

On April 21, 2021, Director of Insurance Dunning released a notice on the extension of transitional policies, extending the ability of health insurance carriers in the individual and small group market to continue transitional health insurance plans through calendar year 2022.

On January 19, 2021, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, as long as the state allows for such an extension. Such transition policies are not required to be in compliance with certain ACA mandates including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. This bulletin applies this most recent federal extension to the state and allows the issuer to renew these non-ACA compliant plans.

Small employers that are interested in renewing their non-ACA-compliant plan should work with their advisors and insurers.

Notice »

Extended Relief for Non-ACA-Compliant Small Group and Individual Policies and Plans

March 17, 2020

On February 24, 2020, Director of Insurance Ramge released a notice extending the ability of health insurance carriers in the individual and small group market to continue transitional health insurance plans that renew for a policy year starting on or before October 1, 2021, as long as the transitional policy ends by December 31, 2021.

As background, on January 31, 2020, CMS provided guidance for a transition policy extension that allows insurers the option to renew non-grandfathered non-ACA-compliant plans, as long as the state allows for such an extension. Such transition policies are not required to be in compliance with certain ACA mandates, including community rating, coverage of essential health benefits, prohibition on pre-existing condition exclusions and the annual out-of-pocket maximum limit. This bulletin applies this most recent federal extension to Iowa and allows the issuer to renew these non-ACA compliant plans.

Small employers that are interested in renewing their non-ACA-compliant plan should work with their advisors and insurers.

Notice »

Dental Plan “Covered Services”

September 17, 2019

On July 22, 2019, the Department of Insurance released Bulletin CB-143. This bulletin clarifies a Nebraska law that prohibits prepaid dental service plans, insurance policies, self-funded employee benefit plans and prepaid limited heath organization plans from dictating the price of dental services that they do not cover. The bulletin clarifies that plans can rely on two interpretations of the term "covered services " when complying with this law. They can either define “covered services” to mean services that the insurer or plan actually paid for on behalf of a participant or it can be defined to mean any service that could be covered under the contract.

The Department intends to allow either interpretation until the legislature clarifies their intended definition. Employers sponsoring dental plans offered to Nebraska residents should be aware of this clarification.

Bulletin CB-143 »

Short-Term Duration Medical Plan Filing Requirements

October 03, 2018

On Sept. 14, 2018, Director of Insurance Ramge issued a Notice addressing short-term, limited duration medical plan filing requirements. The notice identifies Nebraska law related to short-term, limited duration policies. As background, the federal government issued final regulations on short-term, limited duration health plans on Aug. 3, 2018.

This bulletin mentions the federally-required notice that must be issued to consumers upon enrollment in a short-term, limited duration policy. NE requires additional consumer disclosures that identify the length of contract, renewability, pre-existing conditions, free look periods, benefits provided, provider networks, external review, association plans, mandatory and permissive state provisions, annual and lifetime limits, and state mandates. Additionally, the notice indicates that insurers will be required to refile these policies to comply with federal and state law and meet certain marketing requirements.

This notice reminds insurers of the state’s requirements for short-term, limited duration health policies. Employers should be aware that though these plans may be a lower cost option for individuals that just experienced a separation of employment, it doesn’t change an employer’s obligation to make an offer of COBRA (or state continuation), if otherwise required.

Notice »

Telehealth Services Can’t Be Excluded

May 31, 2017

On April 27, 2017, Gov. Ricketts signed LB 92 into law. This law prohibits insurers from excluding health-care services that are provided through telehealth and not in person. The law also purports to impose this requirement on self-funded plans (to the extent not preempted by federal law). This law does not, however, apply to any plan that provides coverage for a specified disease or other limited-benefit coverage.

LB 92 is effective on Aug. 31, 2017.

LB 92 »

Transitional Policies Extended

March 07, 2017

On Feb. 24, 2017, Director of Insurance Ramge provided a notice to companies in the individual and small group health insurance market. The notice indicated that Nebraska will allow transitional policies in the individual and small group markets to continue until Dec. 31, 2018. As background, these plans are not subject to certain provisions of the PPACA. This comes after the Center for Consumer Information and Insurance Oversight (CCIIO) issued guidance allowing states the option to extend transitional policies for individual and small group health insurance plans to policy years beginning on or before October 1, 2018 provided that all policies end by December 31, 2018.

Notice »

News Release: Process for Appealing a Health Plan Decision

March 07, 2017

On March 1, 2017, the Department of Insurance released a document that discusses Nebraskans right to appeal denied claims. The news release explains the internal appeals and external review processes. Although these steps will be undertaken by insurance companies, this is information that employers can familiarize themselves with in the event that an employee has questions about the appeals process.

News Release »

NE State Updates - 2015 Jan 22 No.01

September 22, 2015

The Nebraska Department of Insurance has posted the final 2016 premium rates for individual policies sold through the marketplace. For policies purchased from BCSBS NE and Coventry, the rates increased from 12 percent to 31 percent compared to 2015 premium rates. Policies are also available from United Healthcare of the Midlands and Medica, who did not participate in the individual marketplace in 2015. Open enrollment begins Nov. 1, 2015, and continues through Jan. 31, 2016.

While the announcement does not directly affect employers, it is important for employers to understand the marketplace options and they may compare to the employer’s offerings.

2016 Approved Rates »

NE State Updates - 2015 Jan 25 No.01

August 25, 2015

On July 29, 2015, the Nebraska Department of Insurance issued Bulletin CB-135. The bulletin is directed at insurers and details how they should calculate premiums for non-grandfathered small group policies for policy years beginning on or after Jan. 1, 2016. While much of the bulletin is technical, there are a few key points for small employers to understand about their upcoming plan year premiums.

Insurers are not required to provide small employers with composite rates. An insurer has the choice of charging a per member rate (based on age, geographic area, and tobacco usage) or a composite rate. If the insurer chooses to use composite rates, they must offer that method to all small employers. The employer will then have the choice of composite or per member rates. If composite rates are elected, the insurer must calculate the average premium at the time the policy is issued based on the number of participants enrolled at that time. The insurer must provide a four tier-rate structure: employee only, employee plus spouse, employee plus child(ren) and employee plus family. The composite rate would remain unchanged during the entire policy year regardless of enrollment changes under the policy. Lastly, tobacco surcharges are applied to the applicable participants and are not factored into composite rates.

Bulletin CB-135 »

NE State Updates - 2015 Jan 02 No.01

June 02, 2015

On April 13, 2015, Gov. Ricketts signed LB 627 into law. The new law revises the state’s fair employment practices. Effective 90 days after the state’s legislative session ends (which is expected June 5, 2015), employers with 15 or more employees will be prohibited from discriminating against employees who are pregnant, have given birth or have related medical conditions. Employers must provide a reasonable accommodation unless it would cause an undue hardship for the employer. Reasonable accommodations include time off to recover from childbirth, more frequent or longer breaks, assistance with manual labor, job restructuring, light-duty assignments, modified work schedules, break time and appropriate facilities for breast feeding or expressing breast milk, temporary transfers to less strenuous or hazardous work and acquisition of equipment for sitting.

LB 627 »


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