Nebraska § 68-928 - Licensed insurer or self-funded insurer; provide coverage information; health plan; requirements regarding claims.

§ 68-928. Licensed insurer or self-funded insurer; provide coverage information; health plan; requirements regarding claims.

(1) Except as provided in subsection (2) of this section, at the request of the department, a licensed insurer or a self-funded insurer shall provide coverage information to the department without an individual's authorization for purposes of:

(a) Determining an individual's eligibility for state benefit programs, including the medical assistance program; or

(b) Coordinating benefits with state benefit programs.

Such information shall be provided within thirty days after the date of request unless good cause is shown. Requests for coverage information shall specify individual recipients for whom information is being requested.

(2)(a) Coverage information requested pursuant to subsection (1) of this section regarding a limited benefit policy shall be limited to whether a specified individual has coverage and, if so, a description of that coverage, and such information shall be used solely for the purposes of subdivision (1)(a) of this section.

(b) For purposes of this section, limited benefit policy means a policy of insurance issued by a licensed insurer that consists only of one or more, or any combination of the following:

(i) Coverage only for accident or disability income insurance, or any combination thereof;

(ii) Coverage for specified disease or illness; or

(iii) Hospital indemnity or other fixed indemnity insurance.

(3) An entity that issues a health plan shall:

(a) Respond to a request by the department regarding a claim for payment for a health care item or service submitted not later than three years after the date of the provision of such health care item or service; and

(b) Not deny a claim submitted by the department solely on the basis of the date of submission, the type or format of the claim form, or a failure to present proper documentation at the point-of-sale, if (i) the claim is submitted by the department within the three-year period beginning on the date that the health care item or service was provided and (ii) an action by the department to enforce its rights with respect to such claim is commenced within six years after the date of the claim's submission. Such information shall be provided to the department within thirty days after the date of its request unless good cause is shown. A request for coverage information shall specify the individual for whom information is being requested.