Allowable Electronic Materials for Individual and Group Major Medical
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Governance of when and how insurers may provide individual and group major medical plan documents electronically to insureds and beneficiaries in Nebraska; affects insurers and group health plans offering such coverage.
No material clinical or coverage changes in this revision.
Conditions for Electronic Delivery
Electronic delivery conditions
Conditions under which insurers may provide materials electronically:
ALL of the following
ALL of the following
- Insurers may provide individual and group insurance policies, including certificates of coverage, online provided the welcome letter: instructs how to view the policy online, includes the website address, and offers a paper copy of the policy free of charge.
ALL of the following
- For all other documents the insurer's default must be to provide materials in paper format, with an option for individuals to opt into electronic delivery.
ALL of the following
- The insurer's offer and explanation of the electronic delivery option must: (1) list the types of documents that will be provided electronically, (2) notify the individual that any of these documents are available free of charge in paper form upon request, and (3) provide the procedure for withdrawing consent and updating contact information.
ALL of the following
- The insured or beneficiary must designate an email address for receipt of insurance materials or links to materials; the insurer must use a notice-of-undelivered-email feature to confirm receipt and must take reasonable additional steps to ensure delivery for any emails returned undeliverable.
ALL of the following
- Insurers must provide materials in a readily accessible format (HTML, MS Word, or PDF) that can be retained and printed.
ALL of the following
- The insurer must use reasonable privacy safeguards appropriate for the detail of personal or health information disclosed in the materials.
ALL of the following
- If state or federal law or rule expressly addresses electronic delivery of particular documents, those provisions govern instead of these guidance conditions.
ALL of the following
- Electronic delivery encompasses providing plan documents, certificates, explanations of benefits, billing invoices, summaries of benefits and coverage, coordination of benefits forms, and claim or appeal related materials via readable, retainable electronic formats or links, subject to consent and safeguards.
Insurer Posting and Notification Requirements
Electronic posting allowed for policies/certificates only if welcome letter and free paper offer provided
Insurers may post individual and group insurance policies and certificates online provided that every welcome letter instructs how to view the policy online, includes the website address, and offers a paper copy of the policy free of charge. For all other documents, the insurer’s default must be paper delivery unless the individual opts into electronic delivery.
- Welcome letter must provide website address and offer free paper copy.
- Default for other documents is paper, with opt-in available for electronic delivery.
Key Terms and Scope
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