Nebraska Administrative Code
Topic - INSURANCE, DEPARTMENT OF
Title 210 - NEBRASKA DEPARTMENT OF INSURANCE
Chapter 44 - SCOPE OF COVERAGE TO BE OFFERED BY THE NEBRASKA COMPREHENSIVE HEALTH INSURANCE POOL
Section 210-44-006 - Exceptions and limitations

006.01A Expense incurred while the policy is not in force.

006.01B Charges made by a physician for the treatment or movement of the teeth or tissues next to the teeth, except due to injury.

006.01C Injuries or sickness for which any benefits are provided for by workers' compensation or employer's liability laws whether or not you assert rights to such coverage.

006.01D Care of treatment in a hospital owned or operated by the United States Government or any of its agencies unless you are obligated to pay such charges.

006.01E Eye refractions, eyeglasses, contact lenses, hearing aids or their fitting.

006.01F Refractive corneal surgery, except for corneal grafts.

006.01G Private duty nursing.

006.01H Loss that results from an act of declared or undeclared war.

006.01I Loss sustained while in an armed service (Upon notice to the Pool of entry into a service, the pro rata premium will be refunded).

006.01J Normal childbirth, normal pregnancy, (unless insured purchases the optional Maternity Benefit Rider); or voluntarily induced abortion, or care of a newborn infant, except as provided by 008.01K.

006.01K Complications of pregnancy when the pregnancy had its inception before the policy date. For a person eligible for CHIP benefits pursuant to Neb. Rev. Stat. § 44-4221(1)(b)(i) through § 44-4221(1)(b)(iii), the policy will pay for complications of pregnancy regardless of whether the pregnancy began prior to the inception of eligibility for benefits under the CHIP policy.

006.01L Gender transformations or changes or the promotion of fertility including (but not limited to):

006.01M Routine physical exams or tests, except as provided in 008.01I and 008.01J.

006.01N Expenses incurred for the transplant of a part of the insured person's body to the body of another.

006.01O Treatment of a pre-existing condition or any complications of or resulting from such pre-existing condition, with the exception of prescription medication until the policy has been in force at least six months. This exclusion does not apply to an individual eligible for pool benefits pursuant to Neb. Rev. Stat. § 44-4221(1)(b)(i) through § 44-4221(1)(b)(iii).

006.01P Expenses incurred for services or treatment not medically necessary, or not administered or not provided under supervision of a physician.

006.01Q Investigative or experimental services and supplies.

006.01R Any expenses incurred that are covered by any local, state or federal programs;

006.01S Loss that is covered by any other insurance plan.

006.01T Services or supplies for any person other than the insured.

006.01U Services performed by a member of the insured's immediate family.

006.01V Education or training of any type, including biofeedback, treatment of learning disabilities and attention deficit disorders, IQ testing unless expressly provided for in the policy.

006.01W Weight modification or for surgical treatment of obesity, including wiring of the teeth and all forms of intestinal bypass surgery, or breast reduction or augmentation.

006.01X Transplant surgery which is not precertified; and

006.01Y Custodial care.