NH Rev Stat § 415-E:3-c (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 415-E - Multiple-Employer Welfare Arrangements|Section 415-E:3-c - Bona Fide Pathway II Association Coverage; Benefit Requirements.

[RSA 415-E:3-c effective 60 days after certification by the insurance commissioner that 29 C.F.R. section 2510.3-5(b) is valid and that issues raised in State of New York v. United States Department of Labor have been resolved, but not later than December 1, 2021.]|    415-E:3-c Bona Fide Pathway II Association Coverage;  Benefit Requirements. –||I. Each health benefit plan offered to or by a bona fide pathway II association, whether on a fully insured or self-funded basis, shall, at a minimum, provide the following benefits:||(a) Coverage for each of the 10 essential health benefits as defined in 42 U.S.C. section 18022(b)(1), subject to approval of the commissioner based on the New Hampshire benchmark plan;||(b) Cost sharing requirements of 42 U.S.C. section 18022(c)(1)-(c)(3);||(c) Lifetime and annual limits as prescribed in 29 C.F.R. section 2590.715-2711;||(d) A level of coverage equal to or greater than that designed to provide benefits that are actuarially equivalent to 60 percent of the full actuarial value of the benefits provided under the plan; and||(e) All other benefits required to comply with applicable federal laws and regulations and with any provision of title XXXVII that applies to large group health insurance coverage.||II. Every health benefit plan offered by any bona fide pathway II association, whether offering coverage on a self-funded basis or fully insured basis, and any insurer contracting with an offering association, shall comply with the following:||(a) Except as otherwise specifically provided herein, all requirements of RSA 420-G, including claims data and other reporting requirements;||(b) Requirements contained in RSA 420-J, and any rules adopted thereunder by the commissioner including, but not limited to, network adequacy, balance billing protections, and appeal and grievance processes;||(c) Payment of premium tax as provided in RSA 400-A:31-35 and administrative assessment under RSA 400-A:39;||(d) Requirements pertaining to examinations under RSA 400-A:37;||(e) Requirements pertaining to unfair insurance trade practices under RSA 417;||(f) Vaccine association assessment under RSA 126-Q; and||(g) Individual market assessment under RSA 404-G.||III. No health benefit plan or related policy, contract, certificate, or agreement offered or issued in this state to a bona fide pathway II association, whether offering coverage on a self-funded basis or fully insured basis, shall reserve discretion to the insurer or sponsoring association to interpret the terms of the contract or to provide standards of interpretation or review that are inconsistent with the laws of this state. Any such policy, contract, certificate, or agreement shall be void and unenforceable to the extent it conflicts with this section.||IV. A bona fide pathway II association, whether offering coverage on a self-funded basis or fully insured basis, shall not offer, and an insurer shall not deliver or issue for delivery to such association, a health benefit plan covering lives located in this state that contains an exclusion or limitation for pre-existing conditions or a waiting period on the coverage of pre-existing conditions.||V. For any bona fide pathway II association, whether offering coverage on a self-funded basis or fully insured basis, if coverage is issued to a sole proprietor, the association sponsoring the coverage shall be responsible for monitoring and ensuring that the sole proprietor meets the requirements to qualify as an employer under 29 C.F.R. section 2510.3-5(b) and meets the per month hourly work requirement contained in RSA 126-AA:2, III. Failure to ensure compliance with this provision shall be a violation of this chapter.|||Source. 2019, 346:402.|