Health Insurance in Nebraska
Having a suitable health insurance is the key to all your financial worries. An illness or an injury can easily wreck the financial stability of your family. Therefore, a good evaluation of all future risks and its impact on your finances is requisite. In the U.S., approximately 47 million people are uninsured, among whom a majority of families are threatened by the unexpected medical expenses due to the lack of proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to the medically-uninsurable individuals.
In 2008, Nebraska was ranked 13th healthiest state to live in according to the United Health Foundation’s Health Rankings. The state was on the 10th and 12th position in 2007 and 2006 respectively. Nebraska has a strong healthcare system despite the high prevalence of binge drinking in the state. The state of Nebraska, with more than one million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-cost coverage to the uninsurable citizens of Nebraska who meet specific eligibility requirements of age and income.
The Nebraska Department of Insurance manages and administers all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, in spite of the state’s robust health system, approximately 12.8% of the state population is still uninsured. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 38.7% of Nebraska’s uninsured citizens come under the above 200% FPL category.
Buying health coverage can sometimes be demanding and confusing. However, with the guidance of a licensed health insurance agent/broker, you can select a proper health insurance plan with benefits befitting your family.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of Nebraska. These regulations apply to all insurance companies offering individual or family health insurance in Nebraska.
Medical Underwriting
Yes
Pre-Existing Condition Exclusion Period
No Limit
Look Back Period
No Limit
Look Back Standard
Prudent person
Mandatory Benefits
Cancer screening for women including breast cancer screening, reconstructive surgery after mastectomy, OB/GYNs as Primary Care Providers, eating disorder parity
Market Rate Restrictions
None
Guaranteed Issue Options
None
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of Nebraska. These regulations apply to all insurance companies offering small group health insurance in Nebraska:
Small Group Size
2-50
Employee Qualifications
Two employees must be present for half of the preceding calendar quarter and
work 20 hrs/week
Guaranteed Issue
Yes
Premium Rating Factors
Rate Bands
Rate Adjustment Factors
25%
Look-Back Period
6 months
Pre-existing condition exclusionary period
12 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of Nebraska. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
Mini-Cobra Option
Yes
Eligible Group Sizes
2-19
Extension of Benefits Period – Standard
9 months
Extension of Benefits Period – Disabled
12 months
Maximum Premium Increase
102%
State Legislation Reference
Revised Statute 44-5260
Additional Notes
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of Nebraska to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Nebraska is summarized in the chart below:
Plan Name
Nebraska Comprehensive Health Insurance Pool (5NECHIP)
Website: ://www.nechip.com/
Phone Number: 877-348-4304
HIPPA Eligibility Required? Yes
Available Carriers
Blue Cross and Blue Shield of Nebraska
Pre-Existing Condition Waiting Period
6 months
Enrollment Periods
Open to New Members
Premium Limits
No more than 135% of standard rate
Lifetime Maximum Benefit
$1 million
Special Notes
Individuals qualify for the risk pool:
Whose previous coverage terminated for reasons other than nonpayment of premium or fraud or rejected for coverage within previous 6 months
Who cannot be eligible for COBRA, or government programs
If an individual’s prior coverage was through a continuation of coverage policy or contract available under state or federal law (5COBRA), a waiver may be available.
Children’s Health Insurance Program
Through shared funding from the federal government, the State of Nebraska provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
Program Name
Kids Connection
Website
://www.hhs.state.ne.us/med/Kidsconx.htm
Phone Number
877-632-5437 or 402-471-8845
Apply Online
Yes
Age Limits
Under 19
Insurance Carrier
Length of Coverage
6 months
Residency Requirements
Nebraska resident, qualified immigrant
Other Eligibility Requirements
The children must not be eligible for Medicaid
Household income should be at or below 185% FPL
Some children may have certain types of health insurance and still qualify for Kids Connection
Pre-Existing Condition Exclusions
None
Cost
There are no premiums or co-payments required.
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Nebraska:
Governing Agency
Nebraska Department of Health and Human Services
Website
://www.hhs.state.ne.us/med/medindex.htm
Phone Number
402-471-3121
Residency Requirements
Nebraska resident
Federal Poverty Line Income Limits
Pregnant Mother & Child- 185% of FPL
Infants up to age 1 (5no parents)-150% of FPL
Children 1-5-133% of FPL
Children 6-19-100% of FPL
Aged, Blind and Disabled: 100% FPL
SSI Recipients: 74% FPL
Working Parents: 56%
Non-Working Parents: 48% FPL
Medically Needy Individual: 55% FPL
Medically Needy Couple: 41% FPL
Additional Resources
Nebraska Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Nebraska’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Nebraska: At-A-Glance
Provides exclusive health data of Nebraska. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.