210 Neb. Admin. Code, ch. 32, § 004

Current through September 17, 2024

Section 210-32-004 - Qualification

In order to qualify under the Act, a health care provider must file with the Director proof of financial responsibility pursuant to Neb.Rev.Stat. §44-2827 and pay the surcharge and any special surcharge levied on all health care providers pursuant to Neb.Rev.Stat. §§44-2829 through44-2831 and shall post notice of qualification under the Act in accordance with Section 009.

004.01 Proof of Financial Responsibility

Financial Responsibility of a health care provider may be established only by filing with the Director proof that the health care provider is currently insured pursuant to Neb.Rev.Stat. §§44-2837 through44-2839 or by a policy of professional liability insurance in a company authorized to do business in Nebraska.

The use of deductibles on a policy of professional liability insurance utilized to establish proof of financial responsibility is acceptable with the provision that the insurer must pay any settlement or judgment and then may be reimbursed by the insured for the deductible set out in the policy. The full premium, without credit for the deductible, must be reported on the proof of financial responsibility and the applicable surcharge will be based upon that full premium.

004.01A The following constitutes acceptable proof of financial responsibility:

004.01A(1) certificate of professional liability insurance;

004.01A(2) copy of professional liability insurance policy or declarations page

004.01A(3) written statement or binder from insurance company representative or agent

004.01B Proof of financial responsibility shall provide the following information:

004.01B(1) name of each qualified health care provider and insurer;

004.01B(2) limits of coverage;

004.01B(3) policy inception and expiration date;

004.01B(4) premium for insurance coverage for limits required to qualify under the act without credit for deductibles, if applicable;

004.01B(5) any retroactive dates, if applicable;

004.01B(6) whether qualification is on an occurrence or a claims-made basis; and

004.01B(7) deductible amount, if any.

004.02 Qualification Effective Date

004.02A Initial Qualification. An initial qualification is effective upon the date the health care provider's proof of financial responsibility is received by the Director on the condition that the Director also receives the required surcharge not later than 30 days thereafter. In no event shall a health care provider's qualification become effective prior to the effective date of the professional liability insurance coverage filed by the health care provider. If the Director does not receive the surcharge for an initial qualification within such 30 day period, the qualification shall not become effective until the surcharge is received by the Director along with current proof of financial responsibility.

004.02B Renewed Qualification. A health care provider's qualification expires on the date his or her proof of financial responsibility expires unless the Director receives proof of renewed financial responsibility on or before that date. The health care provider will be given a grace period of 30 days following the expiration of his or her proof of financial responsibility to submit proof of renewed financial responsibility. Qualification does not continue past the expiration date of the health care provider's proof of financial responsibility if the Director does not receive the proof of renewed financial responsibility within the 30 day grace period.

004.03 Cancellation of Qualification

In the event the professional liability insurance policy filed by the health care provider to qualify under the Act is terminated by cancellation pursuant to Neb.Rev.Stat. §44-2836, the health care provider's qualification under the Act also terminates automatically on the effective date of the cancellation without notice from the Excess Liability Fund unless the Director receives a replacement proof of financial responsibility on or before the cancellation date. The Director shall endeavor to notify the health care provider of the effect of the cancellation of primary coverage on his or her qualification under the Act within five (5) business days of receipt by the Director of notice of such cancellation.

004.04 Suspension of Qualification

If the annual premium surcharge is not paid in accordance with the Subsection 005.01 time period, the qualification of the health care provider shall be suspended until the annual surcharge premium is paid. Such suspension shall not be effective as to patients claiming against the health care provider unless, at least 30 days before the effective date of the suspension, a written notice giving the date upon which suspension becomes effective has been provided by the Director to the health care provider. During the period that the suspension is effective, the health care provider is not qualified under the Act and is not provided coverage by the Excess Liability Fund. Notification of suspension to the health care provider must be given in accordance with Subsection 006.02.

210 Neb. Admin. Code, ch. 32, § 004