Neb. Admin. Code INSURANCE, DEPARTMENT OF, tit. 210, ch. 46, app E
For the State of _______________________
For the Reporting Year of_______________
Company Name: __________________________________Due: June 30 annually
Company Address: _____________________________________________ _____________________________________________
Company NAIC #: _____________________________________________
Contact Person: _______________________Phone #:_____________________
Line of Business:Individual Group
Instructions
The purpose of this form is to report all long-term care claim denials under in force long-term care insurance policies. "Denied" means a claim that is not paid for any reason other than for claims not paid for failure to meet the waiting period or because of an applicable preexisting condition. .
1. The nationwide data may be viewed as a more representative and credible indicator where the data for claims reported and denied for your state are small in number.
2. Example - home health care claim filed under a nursing home only policy.
3. Example - a facility that does not meet the minimum level of care requirements or the licensing requirements as outlined in the policy.
4. Examples - a benefit trigger not met, certification by a licensed health care practitioner not provided, no plan of care.
Neb. Admin. Code INSURANCE, DEPARTMENT OF, tit. 210, ch. 46, app E