reglab/housing_qa huggingface dataset:
NH Rev Stat § 415:18-h (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 415 - Accident and Health Insurance|Section 415:18-h - Coverage for Dental Procedures; Dental Offices.

    415:18-h Coverage for Dental Procedures;  Dental Offices. –||I. Each dental insurer or other similar entity, including Delta under RSA 420-F, that issues or renews any policy of group insurance providing benefits for oral surgical procedures, shall provide to each certificate holder who is a resident of New Hampshire coverage for the administration of general anesthesia administered by a licensed dentist for dental procedures performed in a dentist's office on a covered person who:||(a) Is a child under the age of 13 who is determined by a licensed dentist in conjunction with a licensed physician to have a dental condition of significant complexity which requires the child to receive general anesthesia for the treatment of such condition; or||(b) Is a person who has exceptional medical circumstances or a developmental disability as determined by a licensed physician which place the person at serious risk.||II. All of the terms and conditions of the covered person's policy shall apply to these services.|||Source. 1998, 280:2. 2003, 278:2, eff. Jan. 1, 2004. 2018, 188:6, eff. Aug. 7, 2018.|
NH Rev Stat § 415:18-j (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 415 - Accident and Health Insurance|Section 415:18-j - Off-Label Prescription Drugs.

    415:18-j Off-Label Prescription Drugs. –||I. No insurer that issues or renews any policy of group accident or health insurance providing benefits for medical or hospital expenses and providing coverage for prescription drugs shall:||(a) Exclude coverage for any such drug for a particular indication on the ground that the drug has not been approved by the Food and Drug Administration (FDA) for that indication, if such drug is recognized for treatment of such indication in one of the standard reference compendia or in the medical literature; or||(b) As a condition of coverage, impose use of an alternative drug not approved by the FDA for the indication being treated, unless such alternative drug is recognized for treatment of such indication in one of the standard reference compendia or in the medical literature. An override of such condition of coverage shall be expeditiously granted consistent with RSA 420-J:7-b, II whenever the prescriber can demonstrate that the alternative drug:||(1) Has been ineffective in the treatment of the insured's medical condition in the past;||(2) Is expected to be ineffective based on the known relevant physical or mental characteristics of the insured and the known characteristics of the drug regimen;||(3) Will cause or will likely cause an adverse reaction or other physical harm to the insured; or||(4) Is not in the insured's best interest, based on medical necessity consistent with RSA 420-J:7-b, II.||II. Any coverage of a drug required by this section shall also include medically necessary services associated with the administration of the drug.||III. Nothing in this section requires:||(a) Coverage for any drug if the FDA has determined its use to be contraindicated for the treatment of the particular indication for which the drug has been prescribed;||(b) Coverage for experimental or investigational drugs not approved for any indication by the FDA; and||(c) Reimbursement or coverage for any drug not included on the drug formulary or list of covered drugs specified in a health plan, contract, or policy.|||Source. 1999, 323:6. 2010, 188:13. 2014, 226:2, eff. Sept. 12, 2014.|
NH Rev Stat § 415:18-m (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 415 - Accident and Health Insurance|Section 415:18-m - Retroactive Denials Prohibited; Exceptions.

    415:18-m Retroactive Denials Prohibited;  Exceptions. –||I. In this section, "retroactive denial of a previously paid claim" means any attempt by an insurer to retroactively collect payments already made to a health care provider with respect to a claim by requiring repayment of such payments, reducing other payments currently owed to the provider, withholding or setting off against future payments, reducing or affecting the future claim payments to the provider in any other manner.||II. No insurer shall impose on any health care provider any retroactive denial of a previously paid claim or any part thereof unless:||(a) The insurer has provided the reason for the retroactive denial in writing to the health care provider; and||(b) The time which has elapsed since the date of payment of the challenged claim does not exceed 18 months. The retroactive denial of a previously paid claim may be permitted beyond 18 months from the date of payment only for the following reasons:||(1) The claim was submitted fraudulently;||(2) The claim payment was incorrect because the health care provider or the insured was already paid for the health care services identified in the claim;||(3) The health care services identified in the claim were not delivered by the health care provider;||(4) The claim payment was for services covered by Title XVIII, Title XIX, or Title XXI of the Social Security Act;||(5) The claim payment is the subject of an adjustment with a different insurer, administrator, or payor and such adjustment is not affected by a contractual relationship, association, or affiliation involving claims payment, processing, or pricing; or||(6) The claim payment is the subject of legal action.||III. An insurer shall notify a health care provider at least 15 days in advance of the imposition of any retroactive denials of previously paid claims. The health care provider shall have 6 months from the date of notification under this paragraph to determine whether the insured has other appropriate insurance, which was in effect on the date of service. Notwithstanding the contractual terms between the insurer and provider, the insurer shall allow for the submission of a claim that was previously denied by another insurer due to the insured's transfer or termination of coverage.|||Source. 2002, 143:2. 2006, 104:2, eff. Aug. 7, 2006.|
NH Rev Stat § 415:18-n (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 415 - Accident and Health Insurance|Section 415:18-n - Coverage for Certain Prosthetic Devices.

    415:18-n Coverage for Certain Prosthetic Devices. –||I. Each insurer that issues or renews any policy of group accident or health insurance providing benefits for medical or hospital expenses, except for supplemental policies covering a specified disease or other limited benefit, shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state and whose principal place of employment is in this state, coverage for benefits for prosthetic devices under the same terms and conditions that apply to other durable medical equipment covered under the policy, except as otherwise provided in this section.||II. In this section, "prosthetic device" means an artificial limb device to replace, in whole or in part, an arm or leg.||III. An insurer shall not impose any annual or lifetime dollar maximum on coverage for prosthetic devices other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy.||IV. An insurer shall not apply amounts paid for prosthetic devices to any annual or lifetime dollar maximum applicable to other durable medical equipment covered under the policy other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy.||V. The provisions of this section shall apply to group health service plan contracts issued pursuant to RSA 420-A, and to health maintenance organization policies and plans issued pursuant to RSA 420-B.|||Source. 2003, 216:1. 2010, 188:13, eff. Aug. 20, 2010.|
NH Rev Stat § 415:18-o (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 415 - Accident and Health Insurance|Section 415:18-o - Group or Blanket Plan Prescription Drug Information Cards.

    415:18-o Group or Blanket Plan Prescription Drug Information Cards. –||I. Each insurer that issues or renews any policy of group accident or health insurance which provides coverage for prescription drugs or devices, or which contracts with an entity providing such prescription drug coverage, including but not limited to pharmacy benefit manager companies, shall issue to certificate holders a card or other technology containing uniform prescription drug information. The uniform prescription drug information card or technology shall include all of the fields required by the health insurance provider for claims processing in a clear, readable, and understandable manner on the card or other technology issued, shall include the information required under RSA 400-A:15-c, and shall include, at a minimum, the following information:||(a) The name or trademark logo of the insurer and, if another company administers the prescription benefit, the name or trademark logo of the benefit administrator.||(b) The certificate holder's name and identification number.||(c) All of the electronic transaction routing information required by the insurer or its benefit administrator in order for the pharmacy to electronically process a prescription claim, including but not limited to the BIN number labeled as such or the Processor Control Number labeled as such, or both.||II. All subscriber health insurance cards issued after January 1, 2004 shall contain the information required under paragraph I.||III. A new uniform prescription drug information card, as required under this section, shall be issued by an insurer upon enrollment of new members and when reissuing a new card to current members when there is a change in the certificate holder's pharmacy coverage that affects data contained on the card.|||Source. 2003, 286:3. 2010, 188:13, eff. Aug. 20, 2010. 2016, 111:3, eff. Jan. 1, 2017.|
NH Rev Stat § 415:18-p (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 415 - Accident and Health Insurance|Section 415:18-p - Third-Party Payment of Covered, Court-Ordered Services.

    415:18-p 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, 117:1, eff. Aug. 15, 2004.|
NH Rev Stat § 415:18-q (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 415 - Accident and Health Insurance|Section 415:18-q - Coverage for Certified Midwives.

    415:18-q Coverage for Certified Midwives. –||Each insurer that issues or renews any policy of group accident or 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, 8:2. 2008, 298:2. 2010, 188:13, eff. Aug. 20, 2010.|
NH Rev Stat § 415:18-r (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 415 - Accident and Health Insurance|Section 415:18-r - Coverage for the Cost of Testing for Bone Marrow Donation.

    415:18-r Coverage for the Cost of Testing for Bone Marrow Donation. –||I. Each insurer that issues or renews any policy of group accident or health insurance providing benefits for medical or hospital expenses, shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state and who meet the criteria for testing as established by the Match Registry (the National Marrow Donor Program), coverage for laboratory fee expenses up to $150 arising from human leukocyte antigen testing, also referred to as histocompatibility locus antigen testing, for utilization in bone marrow transplantation. The testing shall be performed in a facility that is accredited by the American Association of Blood Banks or its successors, or the College of American Pathologists, or its successors, or any other national accrediting body with requirements that are substantially equivalent to or more stringent than those of the College of American Pathologists, and is licensed under the Clinical Laboratory Improvement Act of 1967, 42 U.S.C. section 263a, as amended. At the time of the new testing, the person tested shall complete and sign an informed consent form that also authorizes the results of the test to be used for participation in the National Marrow Donor Program and shall acknowledge a willingness to be a bone marrow donor if a suitable match is found.||II. In addition to paragraph I, the testing facility shall not bill, charge, collect a deposit from, seek payment or reimbursement from, or have recourse against a covered person or a person acting on behalf of the covered person for any portion of the laboratory fee expenses.|||Source. 2006, 187:2. 2010, 188:13. 2011, 133:6, eff. Jan. 1, 2012.|
NH Rev Stat § 415:18-s (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 415 - Accident and Health Insurance|Section 415:18-s - Coverage for Children's Early Intervention Services.

    415:18-s Coverage for Children's Early Intervention Services. –||Each insurer that issues or renews any policy of group accident or health insurance providing benefits for medical, rehabilitation, or hospital expenses, shall 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 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, 338:2. 2010, 188:13, eff. Aug. 20, 2010. 2020, 26:40, eff. Sept. 18, 2020. 2021, 56:9, eff. July 24, 2021.|
NH Rev Stat § 415:18-t (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 415 - Accident and Health Insurance|Section 415:18-t - Coverage for Obesity and Morbid Obesity; Group.

    415:18-t Coverage for Obesity and Morbid Obesity;  Group. –||Each insurer that issues or renews any policy of group accident or health insurance providing benefits for medical or hospital expenses, shall 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 for the diseases and ailments caused by obesity and morbid obesity and treatment for such, including bariatric surgery, when the prescribing physician has issued a written order stating that treatment is medically necessary and in accordance with the patient qualifications and treatment standards set forth by the American Society for Metabolic and Bariatric Surgery or the American College of Surgeons. Such treatment standards may include, but not be limited to, pre-operative psychological screening and counseling, behavior modification, weight loss, exercise regimens, nutritional counseling, and post-operative follow-up, overview, and counseling of dietary, exercise, and lifestyle changes. The covered insured shall be at least 18 years of age. The benefits included in this section shall be subject to the terms and conditions of the policy and shall be no less extensive than coverage provided for similar conditions or illnesses.|||Source. 2008, 389:2. 2010, 188:13, eff. Aug. 20, 2010.|
NH Rev Stat § 415:18-u (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 415 - Accident and Health Insurance|Section 415:18-u - Coverage for Hearing Aids.

    415:18-u Coverage for Hearing Aids. –||Each insurer that issues or renews any policy or certificate for delivery in this state of group or blanket accident or health insurance providing benefits for medical or hospital expenses, shall provide coverage for the professional services associated with the practice of fitting, dispensing, servicing, or sale of hearing instruments or hearing aids by a hearing instrument dispenser or other hearing care professional. The benefits included in this section shall not be subject to any greater deductible or coinsurance or copay than any other benefits provided by the insurer. Insurers are required to cover the cost of a hearing aid for each ear, as needed, as well as related services necessary to assess, select, and fit the hearing aid with a maximum for the hearing aid and related services of no less than $1,500 per hearing aid every 60 months. The insured may choose a higher price hearing aid and pay the difference in cost. The hearing aid shall be prescribed and dispensed by a licensed audiologist or hearing instrument specialist. Notwithstanding any provision of law or rule to the contrary, the coverage under this section shall not apply to the medical assistance program, pursuant to RSA 161 and RSA 167. In this section:||I. "Hearing care professional" means a person who is a licensed audiologist, a licensed hearing instrument dispenser, or a licensed physician.||II. "Hearing instrument" or "hearing aid" means any instrument or device designed, intended, or offered for the purpose of improving a person's hearing and any parts, attachments, or accessories, including earmolds. Batteries, cords, and individual or group auditory training devices and any instrument or device used by a public utility in providing telephone or other communication services are excluded.||III. "Hearing instrument dispenser" means a person who is a hearing care professional that engages in the selling, practice of fitting, selecting, recommending, dispensing, or servicing of hearing instruments or the testing for means of hearing instrument selection or who advertises or displays a sign or represents himself or herself as a person who practices the testing, fitting, selecting, servicing, dispensing, or selling of hearing instruments.||IV. "Practice of fitting, dispensing, servicing, or sale of hearing instruments" means the measurement of human hearing with an audiometer, calibrated to the current American National Standard Institute standards, for the purpose of making selections, recommendations, adoptions, services, or sales of hearing instruments including the making of earmolds as a part of the hearing instrument.|||Source. 2010, 362:2, eff. Jan. 1, 2011.|
NH Rev Stat § 415:18-v (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 415 - Accident and Health Insurance|Section 415:18-v - Reimbursement for Ambulance Service Providers.

    415:18-v Reimbursement for Ambulance Service Providers. –||Each insurer that issues or renews any policy of group or blanket accident or health insurance that constitutes health coverage under RSA 420-G:2, IX, and that provides benefits for medically necessary ambulance services shall reimburse the ambulance service provider directly or by a check payable to the insured and the ambulance service provider subject to the terms and conditions of the policy, plan, or contract. Nothing in this section shall preclude an insurer from negotiating with and subsequently entering into a contract with a non-participating ambulance provider that establishes rates of reimbursement for emergency medical services.|||Source. 2011, 133:2, eff. Jan. 1, 2012.|
NH Rev Stat § 415:18-w (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 415 - Accident and Health Insurance|Section 415:18-w - Naturopathy Providers; Payment for Equivalent Types of Services; Group.

    415:18-w Naturopathy Providers;  Payment for Equivalent Types of Services;  Group. –||Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses may 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 for expenses arising from a health service performed by a doctor of naturopathic medicine licensed under RSA 328-E if that particular type of service is within the scope of practice of such doctor and if the insurer would reimburse for that type of service when performed by any other type of health care provider. Such coverage, if provided, shall be subject to each insurer's standards and mechanisms for determining medical necessity, for credentialing pursuant to RSA 420-J:4, and for contracting pursuant to RSA 420-J:8. Any such benefits provided shall not be subject to any greater co-payment, deductible, or coinsurance than any other similar benefits provided by the insurer.|||Source. 2012, 278:2, eff. Jan. 1, 2013.|