reglab/housing_qa huggingface dataset:
NH Rev Stat § 420-B:20 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:20 - Statutory Construction and Relationship to Other Laws.

    420-B:20 Statutory Construction and Relationship to Other Laws. –||I. A health maintenance organization shall be considered an insurance company, however, except as provided in this chapter, title XXXVII shall not be applicable to any health maintenance organization granted a certificate of authority under this chapter; provided that this provision does not apply to an insurer or hospital or medical service corporation licensed and regulated pursuant to the insurance laws or the hospital or medical service corporation laws of this state, except with respect to its health maintenance organization activities authorized and regulated pursuant to this chapter.||II. The solicitation of enrolled participants or the provision of factually accurate information regarding coverage, rates, locations and hours of service, concepts and programs for the delivery of health care services, names of affiliated institutions, and credentials of participating providers, by a health maintenance organization or its agents to potential enrolled participants and to the general public shall not be construed to be violative of any provision of the laws of this state relating to solicitation or advertising by health professionals, nor be grounds for revocation or suspension of the license of a physician or surgeon under RSA 329:17.||III. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-t, RSA 415:6-u, RSA 415:6-v, RSA 415:6-w, RSA 415:6-x, RSA 415:6-y, RSA 415:6-z, RSA 415:6-a1, RSA 415:18, VII-a, RSA 415:18, XVI and XVII, RSA 415:18-i, RSA 415:18-j, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-y, RSA 415:18-z, RSA 415:18-aa, RSA 415:18-bb, RSA 415:18-cc, RSA 415:18-dd, RSA 415:18-ee, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.|||Source. 1977, 282:1. 1989, 186:4. 1990, 114:2, 3. 1994, 166:10. 1995, 112:18. 1996, 188:11. 1997, 344:8, 16; 345:6. 1999, 323:8. 2000, 207:7. 2006, 187:4. 2007, 289:36. 2008, 389:4. 2010, 362:4. 2011, 133:4; 189:9, 11. 2012, 278:4. 2014, 299:4, eff. Sept. 30, 2014; 299:7, eff. Oct. 1, 2017. 2015, 263:10, eff. Jan. 1, 2017; 263:11, eff. Oct. 1, 2017 at 12:01 a.m.; 263:13, eff. Jan. 1, 2021. 2016, 326:6, eff. Aug. 23, 2016; 326:7, eff. Oct. 1, 2017 at 12:02 a.m.; 326:8, eff. Jan. 1, 2021 at 12:01 a.m.; 326:10, eff. Jan. 1, 2017 at 12:01 a.m. 2018, 4:15, eff. Feb. 8, 2018; 4:16, eff. Jan. 1, 2021 at 12:02 a.m.; 361:6, eff. Jan. 1, 2019; 361:7, eff. Jan. 1, 2021 at 12:02 a.m. 2019, 113:6, eff. Aug. 20, 2019; 113:7, eff. Jan. 1, 2021 at 12:03 a.m. 2020, 13:13, eff. Sept. 14, 2020; 13:14, eff. Jan. 1, 2021 at 12:04 a.m.; 30:13, eff. Sept. 21, 2020; 30:14, eff. Jan. 1, 2021 at 12:04 p.m.; 39:8, eff. Jan. 1, 2021 at 12:04 a.m.; 39:24, eff. June 30, 2021; 39:25, eff. Jan. 1, 2021 at 12:05 p.m.|
NH Rev Stat § 420-B:21 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:21 - Regulations.

    420-B:21 Regulations. –||The commissioner in accordance with RSA 541-A may promulgate reasonable rules for the implementation of the provisions of this chapter.|||Source. 1977, 282:1, eff. Aug. 21, 1977.|
NH Rev Stat § 420-B:22 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:22 - Federal Legislation.

    420-B:22 Federal Legislation. –||Nothing in this chapter shall prohibit any health maintenance organization from meeting the requirements of any federal law which would authorize such health maintenance organization to receive federal financial assistance or enroll beneficiaries assisted by federal funds, or shall be interpreted or applied to prevent qualification of an organization holding a certificate of authority under this chapter from qualifying as a "health maintenance organization" under Public Law 93-222 as defined in 42 U.S.C. section 300e(a).|||Source. 1977, 282:1, eff. Aug. 21, 1977.|
NH Rev Stat § 420-B:23 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:23 - Systems Failing to Meet Requirements of This Chapter; Operation, Licensing and Regulation.

    420-B:23 Systems Failing to Meet Requirements of This Chapter;  Operation, Licensing and Regulation. –||Notwithstanding the provisions of this chapter, a person proposing to operate a system of health care delivery and financing which is to be offered to individuals, whether or not as members of groups, in exchange for a fixed payment and organized so that providers and the organization are in some part at risk for the cost of services in a manner similar to a health maintenance organization, but who fails to meet the requirements set forth in this chapter, may operate such a system if the commissioner finds that the proposed operation will benefit persons who will be served by it. The operation shall be licensed and regulated in the same manner as a health maintenance organization under this chapter, except to the extent that the commissioner determines that the regulation is inappropriate to the system of health care delivery and financing. A person operating a system of health care delivery and financing pursuant to this section shall not advertise or solicit or in any way identify itself in a manner implying to the public that it is a health maintenance organization licensed under this chapter.|||Source. 1986, 56:1, eff. July 4, 1986.|
NH Rev Stat § 420-B:24 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:24 - Notification of Option to Enroll in Health Maintenance Organization.

    420-B:24 Notification of Option to Enroll in Health Maintenance Organization. –||I. Each employer, public or private, in this state which offers its employees a health benefit plan and employs at least 25 employees, and each employee benefit fund in this state which offers its members any form of health benefit, shall make available to and inform its employees or members of the option to enroll in at least one health maintenance organization holding a valid certificate of authority which provides health care services in the geographic areas in which a substantial number of such employees or members reside; provided, however, that such employer or employee benefit fund shall not be required to make available or inform its employees or members about such option if no health maintenance organization is available to such employer or employee benefit plan. Where there is a prevailing collective bargaining agreement, the selection of the available health maintenance organizations shall be made pursuant to the agreement.||II. No employer in this state shall be required to pay more for health benefits as a result of the application of this section than would otherwise be required by any prevailing collective bargaining agreement or other contract for the provision of health benefits to its employees, provided that the employer or benefits fund shall pay to the health maintenance organization chosen by each employee or member an amount equal to the lesser of:||(a) The amount paid on behalf of its other employees or members for health benefits; or||(b) The health maintenance organization's charge for coverage approved by the commissioner.||III. Should federal legislation requiring employers to offer to employees the option to enroll in a health maintenance organization be repealed or expire, the provisions of RSA 420-B:24, I and II shall no longer apply.|||Source. 1989, 186:5, eff. July 1, 1989.|
NH Rev Stat § 420-B:25 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:25 - Capital Requirements.

    420-B:25 Capital Requirements. –||I. Before issuing a certificate of authority under this chapter, the commissioner shall require that the health maintenance organization have an initial net worth of $6,000,000 and that the minimum net worth required under paragraph II is maintained.||II. Every health maintenance organization shall maintain a minimum net worth equal to the greater of:||(a) $6,000,000; or||(b) Seven and one-half percent of annual premium revenues as reported on the most recent annual financial statement filed with the commissioner. The minimum net worth shall be met by the health maintenance organization upon expiration of the certificate of authority.||III. In addition to paragraphs I and II, if at any time uncovered expenditures exceed 15 percent of the total health care expenditures, a health maintenance organization shall increase the required minimum net worth by 120 percent of the health maintenance organization's outstanding liability for uncovered expenditures for enrollees including incurred but not reported claims which shall be calculated as of the first date of the month and retained for the remainder of the month. The increase to minimum net worth required by this paragraph shall not exceed $5,000,000. Health maintenance organizations shall file a report within 45 days after the end of the calendar quarter with information sufficient to demonstrate compliance with this section.||IV. In addition to paragraphs I, II and III, the commissioner shall require additional capital if he finds that the health maintenance organization does not have reasonable and adequate specific stop-loss reinsurance for its individual members.||V. Every health maintenance organization shall, when determining liabilities, include an amount estimated in the aggregate to provide for any unearned premium and for the payment of all claims for health care expenditures which have been incurred, whether reported or unreported, which are unpaid and for which such organization is or may be liable, and to provide for the expense of adjustment of settlement of such claims.||VI. Such liabilities shall be computed in accordance with rules adopted by the commissioner upon reasonable consideration of the ascertained experience and character of the health maintenance organization.|||Source. 1989, 186:5. 1990, 114:4, eff. July 1, 1990.|
NH Rev Stat § 420-B:26 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-B - Health Maintenance Organizations|Section 420-B:26 - Repealed by 1997, 345:8, II, eff. Jan. 1, 1998.

    420-B:26 Repealed by 1997, 345:8, II, eff. Jan. 1, 1998. –|
NH Rev Stat § 420-C:1 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-C - Preferred Provider Agreements|Section 420-C:1 - Purpose.

    420-C:1 Purpose. –||The purpose of this chapter is to assure that health benefit plans encourage covered persons to seek health care services from preferred providers and that contracts or agreements between preferred providers and health care insurers are fair and in the public interest. Further, this chapter establishes reasonable regulatory requirements for health care insurers in a manner to contain health care costs while preserving the quality of care.|||Source. 1987, 112:1, eff. July 5, 1987.|
NH Rev Stat § 420-C:2 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-C - Preferred Provider Agreements|Section 420-C:2 - Definitions.

    420-C:2 Definitions. –||In this chapter:||I. "Commissioner" means the insurance commissioner.||II. "Covered person" means an individual entitled to reimbursement for expenses of health care services under a policy issued or administered by a health care insurer.||II-a. "Date of enrollment" means the first day of coverage under the plan, or, if there is a waiting period, the first day of the waiting period, which is typically the first day of work.||III. "Health benefit plan" means the contract between the covered person or policyholder and the health care insurer which defines the services covered.||IV. "Health care insurer" means an insurance company, including nonprofit (tax exempt) health service corporations as defined in RSA 420-A, authorized in this state to issue policies that provide reimbursement for expenses of health care services.||V. "Health care services" means services or products rendered by a preferred provider which may include physician, hospitalization, laboratory, and x-ray services, and medical equipment and supplies, and which further may include, but are not limited to: medical, surgical, and dental care; psychological, obstetrical, osteopathic, optometric, optic, podiatric, chiropractic, nursing, physical therapy, and pharmaceutical services; health education; preventive medical, rehabilitative, and home health services; inpatient and outpatient hospital services, extended care, nursing home care, convalescent institutional care, laboratory and ambulance services, appliances, drugs, medicines, and supplies; and any other care, service, or treatment of disease, correction of defects, or the maintenance of the physical and mental well-being of the insured.||VI. "Preferred provider" means a licensed provider or group of providers who have contracted with or been designated by the health care insurer to provide health care services to covered persons under a health benefit plan.||VII. "Provider" means any physician, hospital or other institution, organization, or other person who furnishes health care services.|||Source. 1987, 112:1. 2007, 289:17, eff. Jan. 1, 2008.|
NH Rev Stat § 420-C:3 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-C - Preferred Provider Agreements|Section 420-C:3 - Reimbursement Agreements.

    420-C:3 Reimbursement Agreements. –||Notwithstanding any other law to the contrary, a health care insurer may:||I. Enter into contracts or other agreements with preferred providers for the delivery of health care services to covered persons. Such contracts or agreements may:||(a) Establish the amount and method of payment to the preferred provider;||(b) Establish a procedure for the review and control of utilization of health care services; and||(c) Establish a mechanism for determining whether the health care services rendered are medically necessary.||II. Issue or administer policies or contracts which provide incentives for the covered person to use the health care services of preferred providers.||III. Issue or administer policies or contracts which provide benefits for health care services only if the services have been rendered by a preferred provider.|||Source. 1987, 112:1, eff. July 5, 1987.|
NH Rev Stat § 420-C:4-a (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-C - Preferred Provider Agreements|Section 420-C:4-a - Dependent Coverage.

    420-C:4-a Dependent Coverage. –||I. A policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any other person dependent upon the policyholder. In the event a carrier elects to provide coverage for dependent children, the term "dependent child" shall include a subscriber's child by blood or by law, who is under age 26.||I-a. The coverage of any family member insured by such policy, pursuant to paragraph I, who is mentally or physically incapable of earning his or her own living as of the date on which such dependent's status as a covered family member would otherwise expire because of age, shall continue under such policy while such policy remains in force or is replaced by another policy as long as such incapacity continues and as long as such dependent remains chiefly financially dependent on the policyholder or the employee or his or her estate is chargeable for the care of such dependent; provided, that due proof of such incapacity is received by the insurer within 31 days of such expiration date. If such coverage is continued in accordance with this paragraph, such dependent shall be entitled upon the termination of such incapacity to coverage offered by the New Hampshire high risk pool under RSA 404-G.||II. Nothing in this section shall be construed to require:||(a) Coverage for services provided to a dependent before the effective date of this section; or||(b) That an employer pay all or part of the cost of family coverage that includes a dependent as provided pursuant to this section.||III. A subscriber that elects family coverage during any applicable open enrollment period may enroll any dependent eligible pursuant to this section.||IV. Coverage for a dependent provided pursuant to this section shall be provided until the earlier of the following:||(a) The dependent is disqualified for dependent status as set forth in paragraph I of this section; or||(b) The date upon which the employer under whose contract coverage is provided to a dependent ceases to provide coverage to the subscriber.||V. Nothing in this section shall be construed to permit a health insurance carrier to refuse an election for coverage by a dependent pursuant to paragraph III, based upon the dependent's prior disqualification pursuant to subparagraph IV(a).||VI. (a) Notice regarding coverage for a dependent as provided pursuant to this section shall be provided to a subscriber:||(1) In the certificate of coverage prepared for subscribers on or about the date of commencement of coverage; and||(2) Within 30 days following the effective date of the passage of this law.||(b) Such notice shall also include information regarding the required special open enrollment period.|||Source. 2007, 352:4. 2009, 235:13. 2010, 243:11, eff. Sept. 23, 2010.|
NH Rev Stat § 420-C:4-b (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-C - Preferred Provider Agreements|Section 420-C:4-b - Coverage for Dependents.

    420-C:4-b 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, 289:18, eff. Jan. 1, 2008.|
NH Rev Stat § 420-C:4-c (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-C - Preferred Provider Agreements|Section 420-C:4-c - Pre-certification Requirement.

    420-C:4-c 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, 289:18, eff. Jan. 1, 2008.|
NH Rev Stat § 420-C:5 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-C - Preferred Provider Agreements|Section 420-C:5 - Discrimination Prohibited.

    420-C:5 Discrimination Prohibited. –||No health care insurer shall discriminate against any provider on the basis of religion, race, color, national origin, age, sex, gender identity, sexual orientation, or marital status. Reasonable terms and conditions including, but not limited to, those based on economic or geographic considerations, certain affiliations, or professional privileges shall not be prohibited under this section.|||Source. 1987, 112:1, eff. July 5, 1987. 2019, 332:18, eff. Oct. 15, 2019.|
NH Rev Stat § 420-C:5-a (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-C - Preferred Provider Agreements|Section 420-C:5-a - Prohibiting Limitations on Liability; Disclosure of Information.

    420-C:5-a Prohibiting Limitations on Liability;  Disclosure of Information. –||I. No contract between a health care insurer and a physician, for the purpose of delineating the rights and obligations of the parties within the provider network, shall limit the liability of the health care insurer for any actions of the physician for which the health care insurer might otherwise be liable.||II. No contract between a health care insurer and a health care provider shall limit what information such health care provider may disclose to patients or to prospective patients regarding the provisions, terms, or requirements of the health care insurer's products as they relate to the needs of such provider's patients except for trade secrets of significant competitive value.||III. No contract shall use the term physician for the purpose of allowing a health care insurer to avoid contracting with other health care professionals for health care services. A physician shall mean a person licensed to practice medicine under RSA 329. Nothing in this section shall be construed to require a health care insurer to contract with a health care provider.||IV. No contract between a health care insurer and a health care provider shall limit coverage for preexisting conditions beyond 9 consecutive months from the date of enrollment.|||Source. 1995, 126:5. 1996, 149:5. 1998, 377:2. 2007, 289:19, eff. Jan. 1, 2008.|
NH Rev Stat § 420-C:6 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-C - Preferred Provider Agreements|Section 420-C:6 - Rulemaking.

    420-C:6 Rulemaking. –||I. The commissioner may adopt rules under RSA 541-A necessary for the implementation and administration of this chapter, relative to:||(a) The length of time necessary for health care insurers to comply with this chapter; and||(b) The information he shall require health care insurers to provide to demonstrate compliance with this chapter.||II. The commissioner may adopt rules under RSA 541-A relative to the administration of this chapter.|||Source. 1987, 112:1. 2002, 207:30, eff. July 15, 2002.|
NH Rev Stat § 420-C:7 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-C - Preferred Provider Agreements|Section 420-C:7 - Notice.

    420-C:7 Notice. –||Any health care insurer commencing a preferred provider agreement shall notify the commissioner within 30 days.|||Source. 1987, 112:1, eff. July 5, 1987.|
NH Rev Stat § 420-C:8 (2021)
2021 New Hampshire Revised Statutes|Title XXXVII - Insurance|Title 420-C - Preferred Provider Agreements|Section 420-C:8 - Other Applicable Statutes.

    420-C:8 Other Applicable Statutes. –||Preferred provider agreements and health benefit plans subject to this chapter shall also be governed by the provisions of RSA 420-G and RSA 420-J.|||Source. 1997, 344:9, eff. July 1, 1997; 344:17, eff. Jan. 1, 1998.|