reglab/housing_qa huggingface dataset:
NH Rev Stat § 420-B:8-i (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:8-i - Incontestable Provision.

    420-B:8-i Incontestable Provision. –||The validity of the contract shall not be contested except for nonpayment of premiums, after it has been in force for 2 years from its date of issue. No statement made by any person covered under the contract relating to insurability shall be used in contesting the validity of the insurance with respect to which such statement was made after such insurance has been in force prior to the contest for a period of 2 years during such person's lifetime, and not unless it is contained in a written instrument signed by the person making such statement. No such provision, however, shall preclude the assertion, at any time, of defenses based upon the person's ineligibility for coverage under the plan or upon other provisions in the plan, except for any provisions establishing, as a requirement of eligibility, the furnishing of satisfactory evidence of insurability to the health maintenance organization.|||Source. 1993, 167:4, eff. Jan. 1, 1994.|
NH Rev Stat § 420-B:8-j (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:8-j - Newborn Children.

    420-B:8-j Newborn Children. –||I. All individual and group health maintenance organization contracts shall provide that the health insurance benefits applicable for children are payable with respect to a newly born child of the insured or subscriber or a dependent child of the insured or the subscriber from the moment of birth.||II. Coverage for newly born children shall consist of coverage of injury or sickness including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities.||III. If payment of a specific premium or subscription fee is required to provide coverage for a child, the contract may require that notification of birth of a newly born child and payment of the required premium or fee must be furnished to the health maintenance organization within 31 days after the date of birth in order to have the coverage continue beyond such 31-day period. Unless the contract specifically provides that grandchildren of the insured or subscriber are eligible for coverage, coverage for newly born children of a dependent child of the insured or subscriber shall not continue beyond the initial 31-day period following birth. Nor shall such newly born children be considered dependents of the insured for any purpose addressed in this title.||IV. This section applies to all health maintenance organization contracts delivered or issued for delivery or renewed in this state on or after January 1, 1997.|||Source. 1996, 188:10, eff. Jan. 1, 1997.|
NH Rev Stat § 420-B:8-k (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:8-k - Coverage for Diabetes Services and Supplies.

    420-B:8-k Coverage for Diabetes Services and Supplies. –||Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing benefits for medical or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner, including but not limited to medical nutrition therapy for the treatment of diabetes, provided by a certified, registered, or licensed health care professional with expertise in diabetes, subject to the terms and conditions of the policy. Each health maintenance organization that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover medically appropriate or necessary insulin, oral agents, and equipment used to treat diabetes subject to the terms and conditions of the policy. Each health maintenance organization that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription. The maximum $30 copayment for each 30-day supply of each covered insulin drug prescription shall apply when an original prescription is dispensed as well as when refills of the prescription are dispensed, including early refills. Coverage for prescription insulin drugs shall not be subject to any deductible. Each health maintenance organization that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides for durable medical equipment coverage shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy.|||Source. 1997, 258:6. 2010, 188:13, eff. Aug. 20, 2010. 2020, 13:4, eff. Sept. 14, 2020.|
NH Rev Stat § 420-B:8-l (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:8-l - Medicare Risk Contracts.

    420-B:8-l Medicare Risk Contracts. –||I. The requirements of RSA 417-E, RSA 420-B:8-b, RSA 420-B:8-e, RSA 420-B:8-f, and RSA 420-B:8-ff shall not apply to a Medicare risk policy issued pursuant to a contract under section 1876 or section 1833 of the federal Social Security Act (42 U.S.C. section 1395 et seq.) as amended.||II. In the event of termination of the contract between the Centers for Medicare and Medicaid Services (CMS) and the contractor, all current enrollees of the contractor who will lose their coverage as a result of this contract termination, shall be given an opportunity to enroll, without evidence of insurability, in any Medicare Supplement policy approved for sale in this state which is then being offered by the contractor.|||Source. 1997, 282:3. 2003, 145:6, eff. Aug. 16, 2003.|
NH Rev Stat § 420-B:8-m (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:8-m - Patients' Bill of Rights.

    420-B:8-m Patients' Bill of Rights. –||All health maintenance organizations shall provide to each new subscriber who is a resident of this state a copy of the patients' bill of rights law under RSA 151:21.|||Source. 1997, 331:17, eff. Aug. 22, 1997.|
NH Rev Stat § 420-B:8-o (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:8-o - Third-Party Payment of Covered, Court-Ordered Services.

    420-B:8-o Third-Party Payment of Covered, Court-Ordered Services. –||The existence of a court order under RSA 169-B, RSA 169-C, or RSA 169-D for a service, program, or placement that is covered under any insurance for the minor shall not be considered in determining qualification for third-party payment under such insurance. Benefits for such services shall be subject to the same dollar limits, deductibles, co-payments and co-insurance factors and to the terms and conditions of the policy or certificate, including any managed care provisions. However, the claimant or claimant's representative shall have 48 hours from the commencement of a court-ordered service, placement, or program to seek any pre-authorization, pre-certification, or referral required under the terms of the policy. The determination of these preservice claims for court-ordered services for a minor shall be made as soon as possible, taking into account the medical exigencies, but in no event later than 48 hours after receipt of the request and sufficient information, unless the claimant or claimant's representative fails to provide sufficient information to determine whether, or to what extent, benefits are covered or payable. In the case of such failure, the insurer shall notify the claimant or claimant's representative within 24 hours of receipt of the request and shall advise the claimant or claimant's representative of the specific information necessary to determine to what extent benefits are covered or payable. The claimant or claimant's representative shall be afforded a reasonable amount of time, taking into account the circumstances, but not less than 48 hours, to provide the specified information. Thereafter, notification of the claim determination shall be made as soon as possible, but in no case later than 48 hours after the earlier of:||I. The insurer's receipt of the specified additional information; or||II. The end of the period afforded the claimant or claimant's representative to provide the specified additional information.|||Source. 2004, 117:3, eff. Aug. 15, 2004.|
NH Rev Stat § 420-B:8-p (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:8-p - Coverage for Certified Midwives.

    420-B:8-p Coverage for Certified Midwives. –||Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing maternity benefits shall also provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage consistent with the terms and conditions of the policy for services rendered by a midwife certified under RSA 326-D. Such coverage shall be subject to each insurer's standards and mechanisms for credentialing and contracting pursuant to RSA 420-J:4 and RSA 420-J:8 respectively, where applicable, and contingent upon services being provided in a licensed health care facility or at home and within the scope of practice of a certified midwife. Benefits provided shall not be subject to any greater co-payment, deductible, or coinsurance than any other similar benefits provided by the insurer.|||Source. 2006, 8:4. 2008, 298:4. 2010, 188:13, eff. Aug. 20, 2010.|
NH Rev Stat § 420-B:8-q (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:8-q - Coverage for Dependents.

    420-B:8-q Coverage for Dependents. –||If the coverage for dependent children includes coverage for dependent children who are full-time students, as defined by the appropriate educational institution, beyond the age of 18, such dependent coverage shall include coverage for a dependent's medically necessary leave of absence from school for a period not to exceed 12 months or the date on which coverage would otherwise end pursuant to the terms and conditions of the policy, whichever comes first. Any breaks in the school semester shall not disqualify the dependent child from coverage under this section. Documentation and certification of the medical necessity of a leave of absence shall be submitted to the insurer by the student's attending physician and shall be considered prima facie evidence of entitlement to coverage under this section. The date of the documentation and certification of the medical necessity of a leave of absence shall be the date the insurance coverage under this section commences.|||Source. 2007, 289:15, eff. Jan. 1, 2008.|
NH Rev Stat § 420-B:8-r (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:8-r - Coverage for Children's Early Intervention Services.

    420-B:8-r Coverage for Children's Early Intervention Services. –||Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing benefits for medical, rehabilitation, or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for expenses arising from the services of licensed and credentialed occupational therapists, physical therapists, speech-language pathologists, and clinical social workers working with children from birth to 36 months of age with an identified developmental disability and/or delay as specified in rules adopted pursuant to RSA 171-A:18, IV as long as the providing therapist receives a referral from the child's primary care provider if applicable. The benefits in this section shall not be subject to deductibles, copayments, or coinsurance; provided that the benefits included in this section may have a cap of $3,200 per child per year not to exceed $9,600 by the child's third birthday. For a health care contract that meets the definition of a "high deductible plan" set forth in 26 U.S.C. section 223(c)(2) or a catastrophic health plan, as defined under the Patient Protection and Affordable Care Act of 2009, a carrier shall be exempt from the deductible provisions of this section and may apply a deductible to children's early intervention therapy services until an enrollee's deductible has been satisfied for the year. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall apply to the medical assistance program, pursuant to RSA 161 and RSA 167.|||Source. 2007, 338:4. 2010, 188:13, eff. Aug. 20, 2010. 2020, 26:42, eff. Sept. 18, 2020. 2021, 56:11, eff. July 24, 2021.|
NH Rev Stat § 420-B:9 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:9 - Reports to the Commissioner.

    420-B:9 Reports to the Commissioner. –||I. Every organization subject to this chapter annually, on March 1, shall file a report with the commissioner and with the commissioner of health and human services, said report verified by an appropriate official of the organization, showing its financial condition on the last day of the preceding fiscal year.||II. Such report shall be filed on forms prescribed by the commissioner and shall include:||(a) A financial statement of the organization, including its balance sheet and statement of income, and expenditures for the preceding year, certified by an independent public accountant;||(b) Any changes in the information submitted pursuant to RSA 420-B:4; and||(c) Such other information relating to the performance of the health maintenance organization as the commissioner or the commissioner of health and human services may require.|||Source. 1977, 282:1. 2001, 224:8, eff. Jan. 1, 2002.|
NH Rev Stat § 420-B:10 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:10 - Examinations.

    420-B:10 Examinations. –||I. The commissioner shall make an examination of the affairs of any health maintenance organization and providers with whom such organization has contracts, agreements, or other arrangements as often as he or she deems it necessary, but not less frequently than once in every 5 years. All examinations shall be conducted at the expense of the health maintenance organizations.||II. Every health maintenance organization and provider shall submit its books and records relating its operation to such examinations and in every way facilitate them. For the purpose of examinations, the commissioner may issue subpoenas, administer oaths to, and examine the officers and agents of the health maintenance organization.|||Source. 1977, 282:1, eff. Aug. 21, 1977. 2018, 36:2, eff. May 15, 2018.|
NH Rev Stat § 420-B:11 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:11 - Complaint System.

    420-B:11 Complaint System. –||I. Every health maintenance organization shall establish and maintain a complaint system which has been approved by the commissioner to provide reasonable procedures for the resolution of written complaints initiated by enrolled participants concerning health care services.||II. Every health maintenance organization shall establish and maintain a full log of all written complaints initiated by enrolled participants which shall include a full description of all procedures taken under said complaints and their resolution.|||Source. 1977, 282:1, eff. Aug. 21, 1977.|
NH Rev Stat § 420-B:13 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:13 - Sanctions.

    420-B:13 Sanctions. –||Upon satisfactory evidence that any health maintenance organization has violated any law or regulation or in any way has failed in meeting its obligations, the commissioner may, in his discretion, pursue any one or more of the following courses of action:||I. Suspend the certificate of authority to operate as a health maintenance organization under this chapter. When the certificate of authority is suspended, the organization shall not during the period of such suspension enroll any additional enrolled participants except newborn children or other newly acquired dependents of existing enrolled participants, and shall not engage in any advertising or solicitation whatever;||II. Revoke the certificate of authority to operate as a health maintenance organization under this chapter. When the certificate of authority is revoked, such organization shall proceed under the supervision of the commissioner, immediately following the effective date of the order of revocation, to wind up its affairs, and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of such organization. It shall engage in no further advertising or solicitation whatsoever. The commissioner may, by written order, permit such further operation of the organization as he may find to be in the best interest of enrolled participants, to the end that enrolled participants will be afforded the greatest practical opportunity to obtain continuing health care coverage;||III. Impose a penalty of not more than $2,500 for each and every unlawful act committed; each violation shall constitute a separate fineable offense;||IV. Issue an administrative order requiring the health maintenance organization: to cease or modify inappropriate conduct or practices by it or any of the personnel employed or associated with it; to fulfill its contractual obligations; to provide a service which has been improperly denied; or to take appropriate steps to restore the ability of the organization to provide a contracted-for service; and||V. Apply to any court for such legal or equitable relief as the commissioner deems appropriate.|||Source. 1977, 282:1, eff. Aug. 21, 1977.|
NH Rev Stat § 420-B:14 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:14 - Procedure and Appeals.

    420-B:14 Procedure and Appeals. –||All procedures under this chapter shall be governed by the provisions of RSA 400-A and any person aggrieved by any order or decision of the commissioner pursuant to this chapter shall be entitled to an appeal in accordance with RSA 541.|||Source. 1977, 282:1, eff. Aug. 21, 1977.|
NH Rev Stat § 420-B:15 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:15 - Investments.

    420-B:15 Investments. –||With the exception of investments made in accordance with RSA 420-B:7, the funds of a health maintenance organization shall be invested only in securities or other investments permitted by the laws of this state for the investment of assets constituting the legal reserves of life insurance companies, or such other securities or investments as the commissioner may permit.|||Source. 1977, 282:1, eff. Aug. 21, 1977.|
NH Rev Stat § 420-B:16 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:16 - Fees.

    420-B:16 Fees. –||Every organization subject to this chapter shall pay to the commissioner those fees required for payment by hospital and medical service corporations under RSA 400-A:29.|||Source. 1977, 282:1, eff. Aug. 21, 1977.|
NH Rev Stat § 420-B:17 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:17 - Taxation.

    420-B:17 Taxation. –||Every organization doing business pursuant to this chapter shall be subject to the premium tax requirements of RSA 400-A:31 and 32. Except for payments made by the state of New Hampshire, no tax shall be levied on any premiums, fees-for-service and other payments for health, dental, and employee benefit coverages from political subdivisions of the state of New Hampshire or from employees or retirees of such political subdivisions, either directly or indirectly. Nor shall any tax be levied on any revenues of such an organization that are derived from any business of the organization where the organization has assumed no insurance risk and is providing administrative services, only.|||Source. 1977, 282:1. 1995, 256:3, eff. July 1, 1995.|
NH Rev Stat § 420-B:18 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:18 - Regulation of Agents.

    420-B:18 Regulation of Agents. –||All persons engaged in the solicitation or enrollment of enrolled participants shall be duly licensed agents for the sale of health insurance in the state pursuant to the provisions of RSA 402-J.|||Source. 1977, 282:1. 2000, 315:23, eff. Jan. 1, 2001.|
NH Rev Stat § 420-B:19 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:19 - Powers of Insurers and Hospital and Medical Service Corporations.

    420-B:19 Powers of Insurers and Hospital and Medical Service Corporations. –||I. An insurance company licensed in this state, or a hospital, medical or health service corporation authorized to do business in this state, either directly or through a subsidiary or affiliate, may organize and operate a health maintenance organization under the provisions of this chapter. An insurance company licensed in this state, or a hospital, medical or health services corporation shall obtain a certificate of authority pursuant to RSA 420-B:2 and shall comply with all of the provisions of this chapter with respect to its health maintenance organization activities. Notwithstanding any other law which may be inconsistent herewith, any 2 or more such insurance companies, hospitals or medical service corporations, or subsidiaries or affiliates thereof, may jointly organize and operate a health maintenance organization. The business of insurance is deemed to include the providing of health care services by a health maintenance organization owned or operated by an insurer or a subsidiary thereof.||II. Notwithstanding any provisions of the laws of this state relating to insurance corporations engaged in the business of insurance, or any provisions of RSA 420-A relating to health service corporations, an insurer or health service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of failure of the health maintenance organization to meet its obligations. The enrolled participants of a health maintenance organization constitute a permissible group under such laws. Under the contracts set forth in this paragraph, the insurer or health service corporation may make benefit payments to health maintenance organizations for health care services rendered by providers pursuant to the health care plan.|||Source. 1977, 282:1. 1997, 190:15. 2011, 39:1, eff. July 8, 2011.|