reglab/housing_qa huggingface dataset:
NH Rev Stat § 420-G:14-b (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-G - Portability, Availability, and Renewability of Health Coverage|Section 420-G:14-b - Prohibited Transactions.

    420-G:14-b Prohibited Transactions. –||No health care provider shall submit a claim for reimbursement, or otherwise accept payment, for health care services provided to a patient covered by individual health insurance if the provider has paid the premium for such individual health insurance.|||Source. 1998, 340:16, eff. Aug. 25, 1998.|
NH Rev Stat § 420-G:14-c (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-G - Portability, Availability, and Renewability of Health Coverage|Section 420-G:14-c - Repealed by 2003, 188:17, eff. Jan. 1, 2009.

    420-G:14-c Repealed by 2003, 188:17, eff. Jan. 1, 2009. –|
NH Rev Stat § 420-G:15 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-G - Portability, Availability, and Renewability of Health Coverage|Section 420-G:15 - Severability.

    420-G:15 Severability. –||If any provision of this chapter or the application thereof to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of the chapter which can be given effect without the invalid provisions or applications, and to this end the provisions of this chapter are severable.|||Source. 1997, 344:1, eff. July 1, 1997.|
NH Rev Stat § 420-G:16 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-G - Portability, Availability, and Renewability of Health Coverage|Section 420-G:16 - Penalties for Violations.

    420-G:16 Penalties for Violations. –||Any health carrier who proposes, advertises, solicits, issues or delivers to any person or entity in this state any form which does not comply with this chapter or who shall in any way violate this chapter may:||I. Be prohibited from marketing, selling, or otherwise administering to the individual or small employer market if the commissioner finds a health carrier to be in violation of RSA 420-G.||II. Be subject to an administrative fine not to exceed $2,500 for each violation. Repeated violations of the same chapter shall constitute separate fineable offenses.||III. Have its certificate of authority indefinitely suspended or revoked at the discretion of the commissioner.|||Source. 1997, 344:1, eff. July 1, 1997.|
NH Rev Stat § 420-H:1 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-H - Explanation of Benefits|Section 420-H:1 - Purpose.

    420-H:1 Purpose. –||The legislature finds and declares that:||I. Current and prospective beneficiaries, and enrollees and subscribers of group and individual health policies and hospital service plans, nonprofit health service plans, medical service plans, and health maintenance organizations do not always understand the medical services that will and will not be covered by such third-party payors, or the payment schedule contained in such policies or plans.||II. Third-party payors should be required to provide such information regarding covered services in clear and simple terms with an easily understandable schedule of payment for services covered to current and potential beneficiaries, enrollees and subscribers.|||Source. 1994, 359:1, eff. Jan. 1, 1997.|
NH Rev Stat § 420-H:2 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-H - Explanation of Benefits|Section 420-H:2 - Definitions.

    420-H:2 Definitions. –||As used in this chapter:||I. "Certificate" means a document received by an insured, enrollee, or subscriber from an insurer in lieu of a policy or contract which evidences the coverage to which the insured, enrollee or subscriber is entitled.||II. "Commissioner" means the commissioner of the insurance department.||III. "Company" or "insurer" means any life or health insurance company, fraternal benefit society, nonprofit health service corporation, nonprofit hospital service corporation, nonprofit medical service corporation, prepaid health plan, dental care plan, vision care plan, pharmaceutical plan, health maintenance organization, and all similar type organizations.||IV. "Policy" or "policy form" means any policy, contract, certificate, plan or agreement of life or health insurance, including credit life insurance and credit health insurance, delivered or issued for delivery in this state by any company subject to this chapter; any certificate, contract or policy issued by a fraternal benefit society; and any certificate issued pursuant to a group insurance policy delivered or issued for delivery in this state.|||Source. 1994, 359:1, eff. Jan. 1, 1997.|
NH Rev Stat § 420-H:3 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-H - Explanation of Benefits|Section 420-H:3 - Scope.

    420-H:3 Scope. –||This chapter shall apply to all policies delivered or issued for delivery in this state by any company on or after the date such forms must be approved under this chapter, but nothing in this chapter, shall apply to:||I. Any policy which is a security subject to federal jurisdiction;||II. Any group policy covering a group of 1,000 or more lives at date of issue, other than a group credit life insurance policy or a group credit health insurance policy; however, this shall not exempt any certificate issued pursuant to a group policy delivered or issued for delivery in this state;||III. Any group annuity contract which serves as a funding vehicle for pension, profit sharing or deferred compensation plans;||IV. Any form used in connection with, as a conversion from, as an addition to, or in exchange pursuant to a contractual provision for, a policy delivered or issued for delivery on a form approved or permitted to be issued prior to the dates such forms must be approved under this chapter;||V. The renewal of a policy delivered or issued for delivery prior to the dates such forms must be approved under this chapter.|||Source. 1994, 359:1, eff. Jan. 1, 1997.|
NH Rev Stat § 420-H:4 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-H - Explanation of Benefits|Section 420-H:4 - Requirements.

    420-H:4 Requirements. –||Enrollees, subscribers, certificate holders, and individual insureds shall receive in simple and concise written language at least the following information:||I. An explanation of benefits provided.||II. Any benefit limitations, reductions, exclusions or exceptions to covered services, including an explanation of any restrictions on a subscriber's access to network practitioners based upon the subscriber's choice of primary care physician. The explanation of restrictions shall include a section regarding "referrals to other providers or other medical specialists" that shall urge enrollees, subscribers, certificate holders, and individual insureds to inquire about their primary care provider's referral group within the insurer's network. Such explanation shall include a general statement regarding the existence of physician hospital organizations within the insurer's network, to which primary care providers may be associated.||III. The nature of any payments required of the beneficiary, enrollee or subscriber such as copayments or deductibles.||IV. The nature of any limitations on payment by the insurer, including limitations based on the use of network or out-of-network health care providers.||V. The credentials of any health care provider the health care plan holds out as a specialist denoting board eligibility or board certification for such specialty.||VI. For companies or insurers providing health insurance through a managed care system of health care delivery or reimbursement, a description of the grievance procedures as required pursuant to RSA 420-J:5.||VII. For enrollees, subscribers, certificate holders, or individual insureds whose health insurance is provided through a managed care system of health care delivery and reimbursement, an explanation of a covered person's option to receive direct access to certain obstetrical-gynecological care, pursuant to RSA 420-J:6-a.|||Source. 1994, 359:1. 1998, 216:1; 319:2. 2001, 207:16. 2002, 59:1, eff. June 25, 2002.|
NH Rev Stat § 420-H:6 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-H - Explanation of Benefits|Section 420-H:6 - Powers of the Commissioner.

    420-H:6 Powers of the Commissioner. –||The commissioner may authorize a lower score than the Flesch reading ease score required in RSA 420-H:5, I(a) whenever he finds that a lower score:||I. Will provide a more accurate reflection of the readability of a policy form;||II. Is warranted by the nature of a particular policy form or type or class of policy forms; or||III. Is caused by certain policy language which is drafted to conform to the requirements of any state law, rule or agency interpretation.|||Source. 1994, 359:1, eff. Jan. 1, 1997.|
NH Rev Stat § 420-H:7 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-H - Explanation of Benefits|Section 420-H:7 - Approval of Forms.

    420-H:7 Approval of Forms. –||A policy form meeting the requirements of RSA 420-H:5, I shall be approved notwithstanding the provisions of any other laws which specify the content of policies, if the policy form provides the policyholders and claimants protection not less favorable than they would be entitled to under such laws.|||Source. 1994, 359:1, eff. Jan. 1, 1997.|
NH Rev Stat § 420-I:1 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-I - Prohibition of Exclusive Arrangements With Managed Care Insurers|Section 420-I:1 - Definitions.

    420-I:1 Definitions. –||In this chapter:||I. An "affiliate" of a specific person means any person directly or indirectly controlling, controlled by or under common control with such specific person.||II. "Exclusive arrangement" means any agreement, contract, combination or conspiracy, including, without limitation, acquisition, purchase, affiliation or consulting agreements with medical practitioners or group practices and contracts of employment, between a managed care insurer and any person or persons which has the purposes or effect of:||(a) Committing any person providing physician services to accept and treat as patients the subscribers to or participants in a managed care plan to the exclusion of persons who have coverage from any or all other managed care insurers;||(b) Providing reimbursement on sliding scales, capitation rates, payment schedules or other payment arrangements as a financial incentive for persons providing physician services to restrict treatment of persons who have coverage from some or all other managed care insurers; or||(c) Providing reimbursement on sliding scales, capitation rates, payment schedules or other payment arrangements which contain a financial disincentive for failing to restrict treatment of persons who have coverage through any or all other managed care insurers.||III. "Managed care" means any arrangement for the provision of physician services which is characterized by some measure of risk-sharing through capitated or other shared-risk compensation formulae, and which are characterized by the establishment and maintenance of a provider network available to subscribers or participants, and which provides incentives for subscribers or participants to use that network for covered services, and which ordinarily limit coverage or the extent of such coverage to physician services provided by that network. "Managed care" shall include any managed care products or services or similar products including but not limited to those governed by RSA 415, RSA 419, RSA 420, RSA 420-A, RSA 420-B, and RSA 420-C. "Managed care" shall not include direct primary care services which meet the requirements of RSA 329:1-e.||IV. "Managed care insurer" means a person offering or underwriting managed care and any affiliate thereof.||V. "Managed care plan" means any medical insurance plan offering or underwriting managed care.||VI. "Person" includes natural persons, trusts, corporations, limited liability companies, partnerships, limited partnerships, proprietorships, incorporated or unincorporated associations, and any other legal entity, and any and all of their affiliates.|||Source. 1996, 134:2, eff. May 21, 1996. 2019, 330:4, eff. Oct. 15, 2019.|
NH Rev Stat § 420-I:2 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-I - Prohibition of Exclusive Arrangements With Managed Care Insurers|Section 420-I:2 - Prohibition of Exclusive Arrangements.

    420-I:2 Prohibition of Exclusive Arrangements. –||I. No managed care insurer may enter into any new exclusive arrangement or renew any exclusive arrangement with any person on or after the effective date of this act.||II. No managed care insurer shall maintain exclusive arrangements or engage in any act or practice that would result in exclusive arrangements with any person, except in accordance with paragraph III of this section, on or after June 30, 1997.||III. The provisions of paragraph II of this section shall not apply to physicians employed by a managed care insurer until June 30, 1999.|||Source. 1996, 134:2, eff. May 21, 1996.|
NH Rev Stat § 420-I:3 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-I - Prohibition of Exclusive Arrangements With Managed Care Insurers|Section 420-I:3 - Penalties.

    420-I:3 Penalties. –||In addition to those actions authorized under RSA 420-B:13, the commissioner may impose a penalty on any managed care insurer of not more than $2,500 for each day such managed care insurer shall be a party to a contract, arrangement, conspiracy, act or practice declared unlawful under RSA 420-I:2.|||Source. 1996, 134:2, eff. May 21, 1996.|
NH Rev Stat § 420-I:4 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-I - Prohibition of Exclusive Arrangements With Managed Care Insurers|Section 420-I:4 - Reports to Insurance Commissioner.

    420-I:4 Reports to Insurance Commissioner. –||Each managed care insurer shall file a report in form and containing such information as the insurance commissioner prescribes when requested by the commissioner. Such report shall include the name of the managed care insurer, its affiliates, a description of each exclusive arrangement to which it is a party and, as applicable, the date on which exclusive arrangement has been or will be terminated.|||Source. 1996, 134:2. 2000, 166:4, eff. July 22, 2000.|
NH Rev Stat § 420-I:5 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-I - Prohibition of Exclusive Arrangements With Managed Care Insurers|Section 420-I:5 - Effect on Current Contracts.

    420-I:5 Effect on Current Contracts. –||No person who is party to an exclusive arrangement on the effective date of this chapter shall renew or extend any such exclusive arrangement after the effective date of this act. No provision of any contract or agreement establishing an exclusive arrangement shall be effective after the earliest date on which any party to the arrangement may terminate the exclusive nature of the arrangement. All exclusive arrangements shall be unlawful on and after the date set out at RSA 420-I:2, II. Any exclusive arrangement entered into, extended or maintained in violation of this chapter shall be void and unenforceable.|||Source. 1996, 134:2, eff. May 21, 1996.|
NH Rev Stat § 420-I:6 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-I - Prohibition of Exclusive Arrangements With Managed Care Insurers|Section 420-I:6 - Limitation on Termination of Patient Relations.

    420-I:6 Limitation on Termination of Patient Relations. –||No exclusive arrangement between a managed care insurer and any person shall require a primary care physician to terminate any existing patient relationship with an individual who is covered by another managed care insurer. The physician shall continue to offer to provide services to existing patients for at least 5 years from the commencement date of this exclusive relationship or the effective date of the change of coverage, whichever is later. During such period, the physician will be reimbursed by the managed care insurer covering the patient at a rate which is not more than the highest rate paid by the insurer for similar services in the same service area.|||Source. 1996, 134:2, eff. May 21, 1996.|
NH Rev Stat § 420-I:7 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-I - Prohibition of Exclusive Arrangements With Managed Care Insurers|Section 420-I:7 - Provisions Severable.

    420-I:7 Provisions Severable. –||If any provision of this chapter or the application thereof to any person or circumstances is held to be invalid for any reason, such invalidity shall not affect any other provision or application of this chapter which may be effected without the invalid provision or application.|||Source. 1996, 134:2, eff. May 21, 1996.|
NH Rev Stat § 420-J:1 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:1 - Purpose and Intent.

    420-J:1 Purpose and Intent. –||The purpose and intent of this chapter is to provide standards for certain fundamental operations of licensed entities providing health insurance through a managed care system of health care delivery and reimbursement. The establishment of these standards will ensure regulatory and quality consistency among the several and various licensees offering managed care type benefit plans and will enable consumers to make informed decisions in their relationships with managed care insurers. This chapter is intended to apply only to those insurers offering managed care plans. It is not intended to apply to traditional indemnity systems of reimbursement and fee-for-service forms of health care expense coverage. Health insurers which do not significantly limit covered persons' choices of providers shall not be subject to this chapter.|||Source. 1997, 345:1, eff. Jan. 1, 1998.|
NH Rev Stat § 420-J:2 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:2 - Applicability and Scope.

    420-J:2 Applicability and Scope. –||This chapter shall apply to all health carriers offering a managed care plan in this state.|||Source. 1997, 345:1, eff. Jan. 1, 1998.|
NH Rev Stat § 420-J:3-a (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:3-a - Access to Enhanced 911 System.

    420-J:3-a Access to Enhanced 911 System. –||I. No health benefit plan issued or renewed after July 7, 2000 shall contain any provision which establishes or promotes an emergency medical response or transportation system that encourages or directs access by a covered person in competition with or in substitution of the state enhanced 911 system or other state, county, or local government emergency medical services system.||II. Notwithstanding paragraph I, a health carrier subject to this chapter may use transportation outside the enhanced 911 or other government emergency medical services system for services that are not in response to an emergency medical condition, as defined in RSA 420-J:3, XV.||III. No health benefit plan issued or renewed after July 7, 2000 shall contain any provision requiring a covered person to obtain prior authorization before accessing the enhanced 911 system or other state, county, or local government emergency medical services system for response and/or transportation for emergency services, as defined in RSA 420-J:3, XVI.||IV. No person who issues a health benefit plan subject to this chapter shall use false or misleading language in its enrollment sales materials or in any other materials provided to covered persons to discourage or prohibit covered persons from accessing the enhanced 911 system for response and/or transportation for emergency services.|||Source. 2000, 104:2, eff. July 7, 2000.|
NH Rev Stat § 420-J:3-b (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:3-b - Pre-certification Requirement.

    420-J:3-b Pre-certification Requirement. –||In the event that a person is covered by more than one plan that requires pre-certification, the member shall obtain pre-certification from the primary plan. Although the member shall not be required to obtain pre-certification from the secondary plan, the secondary plan shall not be required to treat such services as covered services if the services do not meet its certification criteria. The secondary plan shall not refuse payment for such services solely on the basis that the services were not pre-certified by the secondary plan.|||Source. 2007, 289:26, eff. Jan. 1, 2008.|
NH Rev Stat § 420-J:4-a (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:4-a - Facility Credentialing.

    420-J:4-a Facility Credentialing. –||I. Health carriers shall credential qualified entities administering community mental health programs as defined under RSA 135-C:7, entities administering community substance use disorder treatment programs as defined under RSA 172:2-c, and community health centers as facilities when paneling and enrolling participating providers, consistent with health carriers' facility credentialing standards and practices, unless the entity requests professional level credentialing. Health carriers shall not be required to credential entities who do not meet the health carriers' facility credentialing eligibility standards. If an entity disagrees with the outcome of a health carrier's application of its facility credentialing standards and practices, the entity may request a formal hearing and review of the carrier's decision by the New Hampshire insurance department pursuant to RSA 400-A:17 and/or file a complaint with the New Hampshire insurance department's health care provider complaint process.||II. Nothing in this section shall be construed to require a health carrier to select or enroll a specific facility as a participating provider.|||Source. 2021, 183:9, eff. Sept. 9, 2021.|
NH Rev Stat § 420-J:6-a (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-J - Managed Care Law|Section 420-J:6-a - Obstetrical-Gynecological Coverage.

    420-J:6-a Obstetrical-Gynecological Coverage. –||I. Health plans shall not require prior authorization by a covered person's primary care provider for coverage of the following services provided by participating providers who specialize in obstetrics and gynecology:||(a) Maternity care;||(b) An annual gynecological visit; and||(c) Follow-up care for obstetrical or gynecological conditions identified during such maternity care or annual gynecological visit.||II. Health plans may establish reasonable requirements for participating obstetricians and gynecologists to communicate with the covered person's primary care provider regarding the covered person's condition, treatment, and any need for follow-up care.|||Source. 1998, 319:1, eff. Jan. 1, 1999.|