Nebraska Administrative Code
Topic - HEALTH AND HUMAN SERVICES SYSTEM
Title 471 - NEBRASKA MEDICAL ASSISTANCE PROGRAM SERVICES
Chapter 30 - HEALTH INSURANCE PREMIUM PAYMENT PROGRAM
Section 471-30-002 - DEFINITIONS
Current through September 17, 2024
The following definitions apply:
002.01 COST EFFECTIVENESS. A determination, made by the Department, that payment for coverage under a group health plan or individual market health plan will be less than the amount of expenditures under the Nebraska Medicaid State Plan that Medicaid would have made to provide comparable coverage for the client.
002.02 GROUP HEALTH PLAN. Any plan of, or contributed to by, an employer (including a self-insured plan) to provide health care (directly or otherwise) to the employer's employees, former employees, or the families of employees or former employees. A group health plan must meet S. 5000(b)(1) of the Internal Revenue Code of 1986, and includes continuation coverage pursuant to Title XXII of the Public Health Services Act, S. 4980B of the Internal Revenue Code of 1986, or Title VI of the Employee Retirement Income Security Act of 1974.
002.03 INDIVIDUAL MARKET HEALTH PLAN. Individual market is the market for health insurance coverage offered to individuals other than in connection with a group health plan. For purposes of the Health Insurance Premium Payment (HIPP) Program, individual market policies include health plans that comply with the requirements of the Patient Protection and Affordable Care Act of 2010 (ACA) and may include policies that do not meet all Affordable Care Act (ACA) requirements but are still found to provide comprehensive health coverage as determined by the Department.
