reglab/statecodes huggingface dataset:
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:7-d - Continued Access to Care Subsequent to a Provider Contract Termination.

420-J:7-d Continued Access to Care Subsequent to a Provider Contract Termination. –
The commissioner may extend the period of continued access to care subsequent to a provider contract termination provided for under RSA 420-J:8, XI for up to an additional 60-day period.
Source.
2003, 284:3, eff. July 1, 2003.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:7-e - Notice of Consumer Rights.

420-J:7-e Notice of Consumer Rights. –
A health carrier shall, at least annually, in a conspicuous communication as approved by the commissioner which may be included as an insert in an annual mailing or by electronic communication, notify each covered person of his or her consumer rights under this chapter, including, but not limited to, appeal rights and the ability to access services out-of-network in the event covered services are not available in-network. A health carrier shall also notify covered persons of the right to access out-of-network services when the covered person contacts the health carrier directly requesting assistance finding clinically appropriate in-network care. A health carrier shall also provide notification to covered persons of their right to appeal whenever a covered person contacts the health carrier regarding a denial of coverage or when a health carrier verbally informs the covered person of the denial of coverage.
Source.
2017, 214:2, eff. Jan. 1, 2018.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:8-b - Retroactive Denials Prohibited; Exceptions.

420-J:8-b Retroactive Denials Prohibited;  Exceptions. –
I. In this section, "retroactive denial of a previously paid claim" means any attempt by a health carrier 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, or reducing or affecting the future claim payments to the provider in any other manner.
II. No health carrier shall impose on any health care provider any retroactive denial of a previously paid claim or any part thereof unless:
(a) The carrier 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 12 months. The retroactive denial of a previously paid claim may be permitted beyond 12 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 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 physician/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. A health carrier 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 health carrier and provider, the health carrier 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, 143:4. 2006, 104:4, eff. Aug. 7, 2006. 2018, 317:2, eff. Jan. 1, 2019.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:8-c - Reimbursement for Providers Waiting for Health Carrier Credentialing Verification.

420-J:8-c Reimbursement for Providers Waiting for Health Carrier Credentialing Verification. –
I. Pursuant to RSA 420-J:4, I, health carriers issuing health benefit plans subject to this chapter shall pay claims for covered services rendered to covered persons by a health care provider who, at the time of submission of a clean and complete credentialing application, has a valid license from the respective state licensing board and has been credentialed by the hospital, if appropriate. The claim for covered services rendered by the provider applicant shall be paid at the same contracted rate as the credentialed provider:
(a) When covering on-call for another health care provider who is credentialed by the carrier and billed using the name of the credentialed provider; or
(b) Who, at the time of application, is credentialed by the health carrier in another state or is in the health carrier's New Hampshire network based on employment with a particular health care entity.
II. For purposes of RSA 420-J:4 and this section, a health care provider having a valid license shall include all:
(a) Mental health practitioners licensed under RSA 330-A and applicants for mental health practice licensure from other states who are permitted to practice in this state pursuant to RSA 330-A:26, II.
(b) Psychologists licensed under RSA 329-B and psychologists licensed in another jurisdiction issued a temporary license to practice under RSA 329-B:20, III.
Source.
2007, 98:2, eff. Aug. 10, 2007. 2019, 228:5, eff. Sept. 10, 2019.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:8-d - Dependent Coverage.

420-J:8-d 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;
(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 of the effective date of this section.
(b) Such notice shall include information regarding the required special open enrollment period.
Source.
2007, 352:6. 2009, 235:18. 2010, 243:13, eff. Sept. 23, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:8-e - Reasonable Value of Health Care Services.

420-J:8-e Reasonable Value of Health Care Services. –
In the event of a dispute between a health care provider and an insurance carrier relative to the reasonable value of a service under RSA 329:31-b or RSA 415-J:3, the commissioner shall have exclusive jurisdiction to determine if the fee is commercially reasonable. Either the provider or the insurance carrier may petition for a hearing under RSA 400-A:17. The petition shall include the appealing party's evidence and methodology for asserting that the fee is reasonable, and shall detail the efforts made by the parties to resolve the dispute prior to petitioning the commissioner for review. The department may require the parties to engage in mediation prior to rendering a decision.
Source.
2018, 356:2, eff. July 1, 2018. 2020, 27:35, eff. July 21, 2020.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:8-f - Non-Covered Dental Services.

420-J:8-f Non-Covered Dental Services. –
I. No insurer, health care service contractor, health maintenance organization, dental insurer, or any other similar entity, including Delta Dental Plan of New Hampshire Inc., subject to regulation by the insurance department that covers dental services, and no contract or participating provider agreement with a dentist shall require, directly or indirectly, that a dentist who is a participating provider provide services to an enrolled participant at a fee set by, or at a fee subject to the approval of, the regulated entity unless the dental services are covered services.
II. No person providing third party administrator services shall make available for any customers a plan that sets dental fees for providers in its provider network for any services except covered services.
III. In this paragraph "covered services" means dental care service for which reimbursement is available under an enrollee's plan contract, or for which reimbursement would be available but for the application of contractual limitations such as deductibles, copayments, coinsurance, waiting periods, annual or lifetime maximums, frequency limitations, alternative benefit payments, or any other limitation.
IV. Fees for covered services shall be set in good faith and shall not be nominal.
Source.
2020, 39:14, eff. Jan. 1, 2021.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:9 - Quality Assessment, Quality Improvement, and Reporting.

420-J:9 Quality Assessment, Quality Improvement, and Reporting. –
I. A health carrier shall:
(a) Establish and maintain a written quality assessment program designed to collect and evaluate information regarding the quality of the health care processes used by the health carrier and the health outcomes of its covered persons.
(b) Establish and maintain a written quality improvement program structured to identify opportunities to improve care, practices that result in improved health care outcomes, problematic utilization patterns, and those providers who may be responsible for either exemplary or problematic patterns of utilization.
II. The quality improvement program shall at a minimum include: a statement of the objectives of the program; a description of how the health carrier will conduct its quality improvement program; the lines of authority and accountability including data collection responsibilities; evaluation tools; performance improvement activities; and an annual effectiveness review.
III. The chief medical officer or clinical director of the health carrier shall have primary responsibility for the quality assessment and quality improvement activities carried out by, or on behalf of, the health carrier and for ensuring that all requirements of this chapter relative to quality assessment and quality improvement are met.
IV. A health carrier shall:
(a) Assure that participating providers have an opportunity to participate in developing, implementing, and evaluating the quality assessment and quality improvement programs.
(b) Maintain at its principal office a copy of the quality assessment program and the quality improvement program which shall be available for inspection by the commissioner or designee at any time during the health carrier's regular business hours.
(c) Certify to the commissioner on or before March 1 of each year that its quality assessment program and its quality improvement program meet the requirements of this chapter and any applicable rules.
(d) Notify the commissioner on or before March 1 of each year of its accreditation by any external accrediting agencies and shall provide a contact person and a phone number for consumer phone calls.
Source.
1997, 345:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:10 - Confidentiality of Insurer Records.

420-J:10 Confidentiality of Insurer Records. –
I. Data or information pertaining to the diagnosis, treatment, or health of a covered person obtained from the person or from a provider by a health carrier is confidential and shall not be disclosed to any person except to the extent that it may be necessary to carry out the purposes of this chapter and as allowed by any applicable state or federal law; or upon the express consent of the covered person; or pursuant to statute or court order for the production of evidence or the discovery thereof; or in the event of a claim or litigation between the covered person and the health carrier where the data or information is pertinent, regardless of whether the information is in the form of paper, is preserved on microfilm, or is stored in a computer retrievable form.
II. If any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant is disclosed pursuant to paragraph I, the health carrier making this required disclosure shall not be liable for the disclosure or any subsequent use or misuse of the data.
III. A health carrier shall be entitled to claim any statutory privileges against disclosure that the provider who furnished the information to the health carrier is entitled to claim.
IV. The records of the quality assessment program, and the information considered by any quality committee and the records of its actions and proceedings shall be confidential and not subject to subpoena or order to produce except in proceedings before the department or other appropriate state licensing or certifying agency, or in an appeal, if permitted, from the quality committee's findings or recommendations. This section shall not be construed to affect the confidentiality of any other proprietary record of a health carrier.
Source.
1997, 345:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:11 - Confidentiality of Insurance Department Records.

420-J:11 Confidentiality of Insurance Department Records. –
All information, documents and copies thereof obtained by or disclosed to the commissioner or any other person in the course of an examination or investigation made pursuant to RSA 400-A:37, and, unless otherwise provided in this chapter, all information reported and maintained pursuant to this chapter shall be given confidential treatment and shall not be made public by the commissioner or any other person, except to insurance departments of other states, unless the commissioner after consultation with the affected parties, determines that the interest of policyholders, shareholders, or the public will be served by the publication thereof, in which event the commissioner may disclose all or any part thereof in such manner as the commissioner may deem appropriate.
Source.
1997, 345:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:12 - Rulemaking Authority.

420-J:12 Rulemaking Authority. –
The commissioner may adopt such rules, under RSA 541-A, and issue such orders as may be necessary to carry out the purposes and provisions of this chapter.
Source.
1997, 345:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:13 - Severability.

420-J:13 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, 345:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:14 - Penalties.

420-J:14 Penalties. –
Any health carrier or other organization violating any of the provisions of this chapter may be subject to an administrative fine not to exceed $2,500 per violation. The commissioner may also suspend or revoke the certificate of authority or license of a health carrier or other organization for any violation of this chapter or the failure to comply with an order of the commissioner issued under this chapter.
Source.
1997, 345:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:15 - Definitions.

420-J:15 Definitions. –
In this subdivision:
I. "ASAM criteria" means the latest edition of the Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions, developed by the American Society of Addiction Medicine.
II. "Clinical stabilization services" means 24-hour clinically-managed post-withdrawal management treatment for adults or adolescents which may include intensive education and counseling regarding the nature of addiction and its consequences, relapse prevention, outreach to families and significant others, and after-care planning, for individuals beginning to engage in recovery from addiction.
III. "Short-term inpatient withdrawal management" means 24-hour medically-supervised addiction treatment for adults or adolescents provided in medically-managed or medically-monitored inpatient facilities that provide evaluation and withdrawal management and which may include biopsychosocial assessment, individual and group counseling, psychological educational groups, and discharge planning.
IV. "Substance use disorder services" means health care services that are provided to a covered person as treatment for an addictive substance-related condition, not including treatment for any condition related to tobacco use.
Source.
2016, 2:11, eff. Jan. 1, 2017; 275:1, eff. Jan. 1, 2017 at 12:01 a.m.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:16 - Levels of Care Criteria; Attestation.

420-J:16 Levels of Care Criteria;  Attestation. –
I. Whenever substance use disorder services are a covered benefit under a health benefit plan subject to this chapter, the health carrier providing such benefits shall rely upon ASAM criteria when determining medical necessity and developing utilization review standards for levels of care for substance use disorder services.
II. On January 1 of each year, each health carrier that provides coverage for substance use disorder services shall file with the commissioner an annual attestation of compliance with this subdivision.
Source.
2016, 2:11, eff. Jan. 1, 2017.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:17 - Prior Authorization.

420-J:17 Prior Authorization. –
I. Whenever substance use disorder services are a covered benefit under a health benefit plan subject to this chapter, no prior authorization shall be required for the first 2 routine outpatient visits of an episode of care by an individual for assessment and care with respect to a substance use disorder.
II. Whenever substance use disorder services are a covered benefit under a health benefit plan subject to this chapter, no prior authorization shall be required for short-term inpatient withdrawal management and clinical stabilization services for up to 24 hours, when prescribed by a clinician trained in the use and application of the ASAM criteria; provided, that the facility notifies the patient's health carrier as soon as practicable after admission of the patient. If the facility fails to notify the patient's health carrier as soon as practicable after admission of the patient, the facility shall be financially responsible for the costs of any services provided by the facility to the patient.
III. Alternatively, a carrier may require prior authorization for the services described in paragraph II, but only if the carrier has a medical clinician or licensed alcohol and drug counselor available on a 24-hour hotline to make the medical necessity determination and assist with placement at the appropriate level of care, and the carrier provides a prior authorization decision as soon as practicable after receipt from the treating clinician of the clinical rationale consistent with the ASAM criteria, but in no event more than 6 hours of receiving such information; provided that until such hotline determination is made, coverage for substance use disorder services shall be provided at an appropriate level of care consistent with the ASAM criteria, as defined in RSA 420-J:15, I.
IV. If an insurance policy does not require prior authorization for short-term inpatient withdrawal management services or clinical stabilization services, paragraphs II and III shall not apply.
V. Nothing in this section shall be construed to require coverage for services provided by a non-participating provider.
Source.
2016, 2:11, eff. Jan. 1, 2017; 275:2, eff. Jan. 1, 2017 at 12:01 a.m.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:18 - Authorization for Medication-Assisted Treatment.

420-J:18 Authorization for Medication-Assisted Treatment. –
Whenever substance use disorder services are a covered benefit under a health benefit plan subject to this chapter, a health carrier shall:
I. Be required to offer at least one medication-assisted treatment therapy option approved by the federal Food and Drug Administration for treatment of substance use disorders without a requirement for prior authorization.
II. Not require a renewal of a prior authorization for a medication-assisted treatment therapy for treatment of substance use disorders more frequently than once every 12 months.
Source.
2017, 185:1, eff. Aug. 28, 2017. 2020, 39:52, eff. Sept. 27, 2020.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:19 - Medication Synchronization.

420-J:19 Medication Synchronization. –
I. An individual or group health insurance plan or policy providing prescription drug coverage in New Hampshire, shall permit and apply a prorated, daily cost-sharing rate to covered prescriptions for a chronic condition that are dispensed by an in-network pharmacy for less than a 30-day supply if the prescriber and pharmacist determine the fill or refill to be in the best interest of the patient for the management or treatment of a chronic, long-term care condition and the patient requests or agrees to less than a 30-day supply for the purpose of synchronizing the patient's medications. For the purposes of this paragraph, the insured's or enrollee's maintenance prescription drugs to be synchronized shall meet all of the following requirements:
(a) They are covered by the policy, certificate, or contract described in this chapter.
(b) They are used for the management and treatment of a chronic, long-term care condition and have authorized refills that remain available to the insured or enrollee.
(c) Except as otherwise provided in this paragraph, they are not a controlled substance included in schedules II-V.
(d) They meet all utilization management requirements specific to the maintenance-prescription drugs at the time of the request to synchronize the insured's or enrollee's multiple, maintenance-prescription drugs.
(e) They are of a formulation that can be effectively split over required short-fill periods to achieve synchronization.
(f) They do not have quantity limits or dose-optimization criteria or requirements that will be violated when synchronizing the insured's or enrollee's multiple, maintenance-prescription drugs.
II. The plan or policy described in paragraph I shall apply a prorated, daily cost-sharing rate for maintenance-prescription drugs that are dispensed by an in-network pharmacy for the purpose of synchronizing the insured's or enrollee's multiple, maintenance-prescription drugs.
III. The plan or policy described in paragraph I shall not reimburse or pay any dispensing fee that is prorated. The insurer shall only pay or reimburse a dispensing fee that is based on each maintenance-prescription drug dispensed.
IV. A synchronization shall only occur once per year per maintenance-prescription drug.
Source.
2018, 103:2, eff. Jan. 1, 2019.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-K - Small Employer Health Reinsurance Pool › Section 420-K:1 - Definitions.

420-K:1 Definitions. –
In this chapter:
I. "Assessment" means the liability of the member insurer to the reinsurance pool.
II. "Board" means the board of directors of the small employer health reinsurance pool.
III. "Commissioner" means the insurance commissioner.
IV. "Covered lives" shall include all persons who are:
(a) Covered under an individual health insurance policy issued or delivered in New Hampshire.
(b) Covered under a group health insurance policy that is issued or delivered in New Hampshire.
(c) Covered under a group health insurance policy evidenced by a certificate of insurance that is issued or delivered in New Hampshire.
(d) Protected, in part, by a group excess loss insurance policy where the policy or certificate of coverage has been issued or delivered in New Hampshire, and where coverage has been purchased by a group health insurance plan subject to the Employee Retirement Income Security Act of 1974, Public Law No. 93-406 (ERISA).
V. "Health carrier" means any entity licensed pursuant to RSA 402, RSA 420-A, or RSA 420-B that delivers, issues for delivery or maintains in force policies of health insurance in New Hampshire.
VI. "Health insurance" means "health insurance" as defined in RSA 404-G:2, VII.
VII. "Plan of operation" means the plan of operation of the small employer health reinsurance pool, including articles, bylaws and operating rules, procedures and policies approved by the commissioner and adopted by the pool.
VIII. "Pool" means the small employer health reinsurance pool.
IX. "Small employer" means "small employer" as defined in RSA 420-G: 2, XVI.
X. "Standard health benefit plan" means a health benefit plan developed pursuant to RSA 420-K:4, I.
Source.
2005, 225:12. 2008, 375:7, eff. July 1, 2008.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-K - Small Employer Health Reinsurance Pool › Section 420-K:3 - Powers of the Pool.

420-K:3 Powers of the Pool. –
I. The pool shall have the general powers and authority granted under the laws of New Hampshire to insurance companies licensed to transact health insurance.
II. In addition, the pool shall have the specific authority to:
(a) Enter into contracts as are necessary or proper to carry out the provisions and purposes of this chapter, including the authority, with the approval of the commissioner, to enter into contracts with programs of other states for the joint performance of common functions, or with persons or other organizations for the performance of administrative functions.
(b) Sue or be sued, including taking any legal actions necessary or proper for recovery of any assessments for, on behalf of, or against members.
(c) Take such legal action as necessary to avoid the payment of improper claims against the pool.
(d) Define the array of health coverage products for which reinsurance will be provided, and to issue reinsurance policies, in accordance with the requirements of this chapter.
(e) Establish rules, conditions, and procedures pertaining to the reinsurance of members' risks by the pool.
(f) Establish appropriate rates, rate schedules, rate adjustments, rate classifications, and any other actuarial functions appropriate to the operation of the pool.
(g) Assess members in accordance with the provisions of this chapter, and to make advance interim assessments as may be reasonable and necessary for organizational and interim operating expenses and to pay claims reinsured by the pool. Any such interim assessments shall be credited as offsets against any regular assessments due following the close of the fiscal year.
(h) Appoint from among the members appropriate legal, actuarial, and other committees as necessary to provide technical assistance in the operation of the pool, policy, and other contract design, and any other function within the authority of the pool.
(i) Borrow money to effectuate the purposes of the pool. Any notes or other evidence of indebtedness of the pool not in default shall be legal investments for insurers and may be carried as admitted assets.
(j) Develop a standard health benefit plan.
Source.
2005, 225:12. 2007, 289:30, eff. Sept. 1, 2007.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-K - Small Employer Health Reinsurance Pool › Section 420-K:4 - Standard Health Benefit Plan.

420-K:4 Standard Health Benefit Plan. –
I. The board shall:
(a) Develop a standard health benefit plan which shall contain benefit and cost sharing levels that reflect the health coverages most commonly sold by small employer carriers in the state.
(b) Develop base reinsurance premium rates for the standard health benefit plan. The base reinsurance premium rates shall be set at levels which reasonably approximate gross premiums charged to small employers by small employer carriers for health benefit plans with benefits similar to the standard health benefit plan. The base premium rates shall be subject to approval of the commissioner.
(c) Establish a methodology for determining premium rates to be charged by the pool to reinsure small employer groups and individuals. The methodology shall include a system for classification of small employers that reflects the types of case characteristics commonly used by small employer carriers in establishing premium rates.
II. The standard health benefit plan, base reinsurance premium rates, and the rating methodology shall be submitted to the commissioner for approval within 45 days after the appointment of the board and shall subsequently be revised as necessary and appropriate.
Source.
2005, 225:12, eff. July 1, 2005.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-K - Small Employer Health Reinsurance Pool › Section 420-K:7 - Immunity and Indemnification.

420-K:7 Immunity and Indemnification. –
I. Neither the participation in the pool as members, the establishment of rates, forms, or procedures, nor any other joint or collective action required by this chapter shall be the basis of any legal action against the pool or any of its members.
II. Any person or member made a party to any action, suit, or proceeding because the person or member served on the board or on a committee or was an officer or employee of the pool shall be held harmless and be indemnified by the pool against all liability and costs, including the amounts of judgments, settlements, fines or penalties, and expenses and reasonable attorney's fees incurred in connection with the action, suit, or proceeding. The indemnification shall not be provided on any matter in which the person or member is finally adjudged in the action, suit, or proceeding to have committed a breach of duty involving gross negligence, dishonesty, willful misfeasance, or reckless disregard of the responsibilities of office. Costs and expenses of the indemnification shall be prorated and paid for by all members. The right of indemnification shall not be exclusive of other rights or defenses to which such person or the legal representative or successors of such person, may be entitled to as a matter of law. The commissioner may retain actuarial consultants necessary to carry out his or her responsibilities pursuant to this chapter and such expenses shall be paid by the pool established in this chapter.
Source.
2005, 225:12. 2007, 289:33, eff. Sept. 1, 2007.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-M - Purchasing Alliances › Section 420-M:1 - Purpose.

420-M:1 Purpose. –
The purpose of this chapter is to:
I. Increase the affordability, efficiency, and fairness of health insurance coverage for employers by setting standards for the licensure and oversight of purchasing alliances through which employers and their employees may purchase health coverage.
II. Allow employers and their employees to obtain better value in purchasing health insurance by consolidating purchasing responsibilities and resources, thereby increasing purchasing expertise and reducing the administrative cost of health plan contracting, enrollment, premium collection, and payment for multiple employers.
III. Foster competition based on value.
Source.
2010, 346:1, eff. July 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-M - Purchasing Alliances › Section 420-M:2 - Definitions.

420-M:2 Definitions. –
In this chapter:
I. "Commissioner" means the insurance commissioner.
II. "Eligible dependents" means "eligible dependents" as defined in RSA 420-G:2, V.
III. "Eligible employee" means "eligible employee" as defined in RSA 420-G:2, VI.
IV. "Employee enrollee" means an eligible employee, self-employed individual, or an eligible dependent of an eligible employee who is enrolled in a health benefit plan offered through an alliance by a participating carrier.
V. "Health benefit plan" means "health coverage" as defined in RSA 420-G:2, IX.
VI. "Health carrier" or "carrier" means "health carrier" as defined in RSA 420-G:2, VIII.
VII. "Member employer" means an employer who enrolls in an alliance.
VIII. "Participating carrier" means a carrier that contracts with the alliance.
IX. "Purchasing alliance" or "alliance" means a non-risk bearing corporation or other entity licensed pursuant to RSA 420-G:10-a that provides health insurance coverage to member employers and their employees.
X. "Qualified purchasing alliance" means a purchasing alliance that has obtained certification from the commissioner under RSA 420-M:13 as a qualified purchasing alliance with authority to operate in the same manner as a qualified association trust pursuant to RSA 420-G:10.
XI. "Small employer" means "small employer" as defined in RSA 420-G:2, XVI.
Source.
2010, 346:1, eff. July 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-M - Purchasing Alliances › Section 420-M:3 - Jurisdiction of the Commissioner; Penalties.

420-M:3 Jurisdiction of the Commissioner;  Penalties. –
I. The commissioner shall regulate the establishment and conduct of purchasing alliances.
II. No person or entity, other than a qualified association trust, shall market, sell, offer, or arrange the sale of one or more health benefit plans to 2 or more employers or their eligible employees without first being licensed by the commissioner pursuant to this chapter.
III. A person or entity, not licensed by the commissioner as a purchasing alliance and engaged in the purchase, sale, marketing, or distribution of health insurance or health care benefit plans shall not hold itself out as a health insurance purchasing alliance, health insurance purchasing cooperative, or a health insurance purchasing association.
Source.
2010, 346:1, eff. July 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-M - Purchasing Alliances › Section 420-M:4 - Purchasing Alliance Application and Licensing.

420-M:4 Purchasing Alliance Application and Licensing. –
To obtain authority to operate as a purchasing alliance, an application shall be completed and filed with the commissioner by an authorized representative of the corporation or other entity established to operate as a purchasing alliance. An application shall not be deemed filed until all information necessary to properly process the application has been received by the commissioner. Upon filing, the commissioner shall make a determination concerning the application and shall provide notice of the determination to the applicant. If approved, a copy of a license shall be provided to the purchasing alliance. The license shall serve as authorization to operate pursuant to this chapter.
Source.
2010, 346:1, eff. July 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-M - Purchasing Alliances › Section 420-M:5 - Preparation of a Business Plan and Other Required Documents.

420-M:5 Preparation of a Business Plan and Other Required Documents. –
I. The application for a purchasing alliance shall include a business plan containing the following information:
(a) A detailed, written plan of operations explaining how the applicant intends to fulfill the purposes and requirements of this chapter;
(b) The specific steps that the alliance will use to increase affordability, efficiency, and fairness of health insurance coverage;
(c) The specific steps that the alliance will use to allow employers and their employees to obtain better value in purchasing health insurance;
(d) The scope of services to be offered and the resources and expertise to be used to implement and administer those services;
(e) A provision requiring that any coverage procured by the alliance shall require that the members of the alliance be notified directly by the insurer of cancellation due to nonpayment of premium;
(f) The personal biographical information and descriptions of the officers of the alliance;
(g) A written statement demonstrating that those involved in the operation of the alliance have the expertise and experience to effectively and professionally represent employers and their eligible employees; and
(h) An affirmative demonstration that financial controls are in place as a condition of licensure.
II. In addition to the business plan, each applicant shall file with the commissioner the following information or documents:
(a) A plan that affirmatively demonstrates that the alliance has the technical expertise and capacity to serve a significant group of employers and their eligible employees;
(b) A plan that demonstrates that the alliance has the technical capacity to provide service quality;
(c) The applicant's articles of incorporation, bylaws, or other formation and business operation documents;
(d) A list of officers and directors of the applicant and the contract administrator, if one is employed, and personal biographical information or firm descriptions for each;
(e) Evidence of security and prudence in the accounting, deposit, collection, handling, and transfer of moneys; and
(f) A description of the service area in which the alliance will be marketing and offering services.
III. Material changes in the operations or the business plan shall not take effect without approval from the commissioner.
IV. The commissioner shall conduct financial and performance audits or examinations of an alliance on a regular basis. The commissioner shall require audited financial statements from an alliance. The costs of examinations or audits shall be paid by the alliance.
V. A purchasing alliance shall submit an annual report no later than April 1 of each year that includes quarterly financial statements that show:
(a) The alliance is operating in a sound financial fashion;
(b) The alliance is not a risk-bearing entity; and
(c) The alliance is utilizing sound financial controls and money management.
Source.
2010, 346:1, eff. July 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-M - Purchasing Alliances › Section 420-M:6 - Revocation of License and Insolvency.

420-M:6 Revocation of License and Insolvency. –
I. The following intentional acts shall constitute grounds for denial, non-renewal, suspension, or revocation of an application or existing license, following notice and an opportunity for hearing:
(a) Failure to comply with the provisions of RSA 420-G;
(b) Failure to comply with the business plan filed and approved by the commissioner;
(c) Failure to maintain adequate financial controls;
(d) Failure to extend alliance health benefit plan coverage to eligible employees;
(e) Failure to comply with a lawful order of the commissioner;
(f) Engaging in an unfair or deceptive act or practice;
(g) Filing any necessary form, including the application form, with the commissioner that contains false or materially incorrect information or omissions; or
(h) Misappropriation, conversion, illegal withholding, or refusal to pay over upon proper demand any moneys that belong to a person or participating carrier and that have been entrusted to the alliance in its fiduciary capacity.
II. The commissioner shall require the removal and replacement of managerial or marketing staff or third party contractors if necessary to remedy compliance or performance problems.
III. In the event the alliance becomes insolvent, the commissioner shall place the alliance in receivership if necessary to protect the interests of alliance enrollees.
Source.
2010, 346:1, eff. July 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-M - Purchasing Alliances › Section 420-M:8 - Contracts With Participating Carriers.

420-M:8 Contracts With Participating Carriers. –
The contracts entered into by the alliance shall:
I. Establish performance standards for specific contractual elements;
II. Set liquidated damages for breach of the contract;
III. Require the insurer to notify the member employers of cancellation of the policy;
IV. Require the member employers in the event of cancellation to arrange for continuation coverage for their employees to the extent provided under federal and state law; and
V. Contain a provision stating that if after timely receipt of the premium payment from the employer, the alliance fails to make the premium payment to the insurer, with the result that coverage is terminated, that the alliance shall be liable for benefits to the same extent as the insurer or carrier would have been liable if coverage had not been terminated.
Source.
2010, 346:1, eff. July 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-M - Purchasing Alliances › Section 420-M:9 - Requirements for Participating Carriers.

420-M:9 Requirements for Participating Carriers. –
I. To qualify as a participating carrier, a carrier shall demonstrate the following characteristics:
(a) That it is licensed and in good standing with the insurance department;
(b) That it has the ability to administer health coverage, to provide adequate service, and to comply with all contractual requirements of the alliance;
(c) That it has the ability to provide enrollees with access to covered services;
(d) That it has the ability to provide coverage for enrollees in any service area in which the carrier plans to participate through the alliance;
(e) That it has the ability to arrange and pay for quality health care services;
(f) That it has the ability to provide standard data required by the alliance, in a manner prescribed by the alliance, including information on:
(1) Plan performance;
(2) Enrollee satisfaction;
(3) Provider payment and incentive structures; and
(4) Such other data requirements prescribed by the alliance;
(g) That it has the ability to meet quality of care standards established by government and industry authorities; and
(h) That it is financially strong and has competent management.
II. Participating carriers that contract with or employ health care providers shall have the ability to accomplish the following in a manner satisfactory to the alliance:
(a) Review and report on the cost and quality of care covered;
(b) Review and report on the appropriateness of care covered; and
(c) Provide accessible health care services.
III. Each participating carrier shall:
(a) Meet the standards established by the alliance pursuant to this chapter;
(b) Provide data and information as required by the alliance;
(c) Comply with all laws and rules regarding underwriting, rating, claims handling, sales, solicitation, licensing, fair marketing, unfair trade practices, the provisions of this chapter, and other applicable state statutes;
(d) Enroll and terminate individuals in the manner specified by the alliance; and
(e) Comply with other requirements established by the alliance pursuant to this chapter.
IV. Nothing in this chapter shall prohibit participating carriers from contracting with particular health care providers or types, classes, or categories of health care providers, or setting reimbursement methodology.
V. In the event that the participating carrier elects to terminate its contract with the alliance, the participating carrier shall:
(a) Provide advance notice of its decision to the alliance; and
(b) Provide notice of the decision at least 180 days prior to the non-renewal of health coverage to the member employers and employee enrollees.
Source.
2010, 346:1, eff. July 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-M - Purchasing Alliances › Section 420-M:10 - Marketing Health Benefit Plans.

420-M:10 Marketing Health Benefit Plans. –
I. The alliance shall establish marketing standards for use by participating carriers.
II. Any marketing, advertisement, or educational material for health coverage sold through the alliance shall be approved by the alliance prior to its use.
III. The alliance shall make approved marketing materials available to member employers in an efficient and standardized manner. These materials shall include, but not be limited to, an accurate summary of benefit plans, rates, cost, and accreditation information relating to the offerings of the participating carrier.
IV. This section shall not be construed to prohibit or to compel the alliance or a participating carrier from using the services of an agent or broker.
Source.
2010, 346:1, eff. July 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-M - Purchasing Alliances › Section 420-M:11 - Conflict of Interest.

420-M:11 Conflict of Interest. –
No officer or board member or director or contract administrator of a purchasing alliance or members of their households may be employed by, be a consultant for, be a member of the board of directors of, or be affiliated with, or otherwise be a representative of a carrier or other insurer. This section shall not preclude an officer or board member or director or contract administrator of a purchasing alliance from purchasing health coverage through the alliance.
Source.
2010, 346:1, eff. July 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-M - Purchasing Alliances › Section 420-M:12 - Purchasing Alliance Distinguished From Multiple Employer Welfare Arrangement.

420-M:12 Purchasing Alliance Distinguished From Multiple Employer Welfare Arrangement. –
Purchasing alliances shall not be risk bearing entities, and shall not enter into a self-insured arrangement.
Source.
2010, 346:1, eff. July 20, 2010.