Medicare, the standardized Medigap plans, Medicaid and long-term care design are covered in the national Senior and Special Needs guide. This guide covers Nebraska's Medicare supplement law (Neb. Rev. Stat. 44-3601 and following; 210 NAC 36) and its Long-Term Care Insurance Act (44-4501 and following; 210 NAC 46).

Medicare supplement

• Outline of coverage. It must be delivered at the time the application is made (44-3607).
• Free look. The buyer may return the policy within 30 days of delivery for a premium refund (44-3608). Other individual A&H policies have a 10-day free look.
• Open enrollment (210 NAC 36, sec. 013). For six months, starting the first month the person is both 65 or older and enrolled in Part B, an issuer can't deny coverage, set conditions, or charge more because of health status or claims history.
• Guaranteed issue (sec. 014). In guaranteed issue situations, such as losing certain coverage, the right generally ends 63 days after the earlier coverage ends.
• Preexisting conditions. A policy can't exclude losses incurred more than six months after the effective date because of a preexisting condition.

Long-term care insurance

Selling the policy

• Shopper's guide. Prospective applicants get a long-term care shopper's guide in the NAIC format, or one the Director approves (210 NAC 46, sec. 027).
• Outline of coverage. It goes to the applicant before an application or enrollment form is presented (44-4516).
• Free look. The buyer may return the policy within 30 days of delivery for a refund (44-4515).
• Training. 8 hours once, then 4 hours every 24 months.

Policy standards (44-4513)

• Renewal. A policy can't be canceled or nonrenewed because of the insured's age or declining health.
• Levels of care. A policy can't cover only skilled nursing care, or give significantly more coverage for skilled care than for lower levels.
• Preexisting conditions. Defined by a look-back of no more than six months. Losses may be excluded only if they begin within six months after coverage starts.
• No prior hospitalization may be required for any benefit.
• Prior institutional stays may not be required for longer than 30 days.

Lapse protections (210 NAC 46, sec. 007)

• The applicant may name at least one person, besides the insured, to receive notice of lapse for nonpayment.
• The lapse notice goes out at least 30 days before the lapse takes effect.
• Reinstatement is required if the insured shows cognitive impairment or loss of functional capacity that existed before the grace period ended, and asks within five months after termination.

Life policies with LTC benefits. When a life policy pays long-term care benefits, the insurer sends a monthly report. It shows LTC benefits paid, changes in the death benefit or cash value, and remaining benefits (44-4516(5)).

Related protections

• Sex or marital status. Refusing or limiting coverage solely because of sex or marital status is unfair discrimination (44-1525(7)(e)).
• Blindness. Refusing, limiting or surcharging coverage solely because of blindness is unfair discrimination (210 NAC 35).
• Creditors. Accident and health benefits are exempt from creditors' claims (44-371).

Common exam traps

• The free look for Medigap and LTC in Nebraska is 30 days. Individual A&H is 10 days.
• Medigap open enrollment begins when the person is both 65 and in Part B, and it lasts six months.
• LTC: no prior hospitalization, a 30-day cap on prior institutional stays, and a six-month preexisting limit.
• The LTC outline of coverage comes before the application. The Medigap outline comes at application.