2006 Nebraska Revised Statutes - § 44-5262 — Health Benefit Plan Committee; appointment; duties.

Section 44-5262
Health Benefit Plan Committee; appointment; duties.

(1) The director shall appoint a Health Benefit Plan Committee. The committee shall be composed of representatives of carriers, small employers, employees, health care providers, agents, and brokers.

(2) The committee shall recommend the form and level of coverages to be made available by small employer carriers pursuant to section 44-5260.

(3)(a) The committee shall recommend benefit levels, cost-sharing levels, exclusions, and limitations for the basic health benefit plan and the standard health benefit plan. The committee shall also design a basic health benefit plan and a standard health benefit plan which contain benefit and cost-sharing levels that are consistent with the basic method of operation and the benefit plans of health maintenance organizations, including any restrictions imposed by federal law.

(b) The plans recommended by the committee may include cost-containment features such as:

(i) Utilization review of health care services, including review of medical necessity of hospital and physician services;

(ii) Case management;

(iii) Selective contracting with hospitals, physicians and other health care providers;

(iv) Reasonable benefit differentials applicable to providers that participate or do not participate in arrangements using restricted network provisions; and

(v) Other managed care provisions.

(c) The committee shall submit the health benefit plans to the director for approval within one hundred eighty days after the appointment of the committee.

Source:

Laws 1994, LB 1222, § 40

~Reissue Revised Statutes of Nebraska