reglab/statecodes huggingface dataset:
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:17-b - Coverage for Dental Procedures.

420-A:17-b Coverage for Dental Procedures. –
I. Every health service corporation and every similar corporation licensed under the laws of another state that issues or renews any group policy of accident or health insurance providing benefits for medical or hospital expenses, shall provide to each covered individual or certificate holder who is a resident of New Hampshire coverage for the medically necessary hospital or surgical day care facility charges and administration of general anesthesia administered by a licensed anesthesiologist or anesthetist for dental procedures performed 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 primary care physician to have a dental condition of significant dental complexity which requires certain dental procedures to be performed in a surgical day care facility or hospital setting; or
(b) Is a person who has exceptional medical circumstances or a developmental disability as determined by a licensed primary care 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, 280:3. 2003, 278:4. 2010, 188:8, eff. Aug. 20, 2010. 2018, 188:7, eff. Aug. 7, 2018.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:17-e - Retroactive Denials Prohibited; Exceptions.

420-A:17-e Retroactive Denials Prohibited;  Exceptions. –
I. In this section "retroactive denial of a previously paid claim" means any attempt by a health service corporation 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 health service corporation shall impose on any health care provider any retroactive denial of a previously paid claim or any part thereof unless:
(a) The corporation has provided the reason for the retroactive denial in writing to the health care provider; and
(b) The time which has lapsed 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 physician/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 service corporation 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 service corporation and provider, the health service corporation 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, 143:3. 2006, 104:3, eff. Aug. 7, 2006.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:17-f - Coverage for Certified Midwives.

420-A:17-f Coverage for Certified Midwives. –
Every health service corporation and every other similar corporation licensed under the laws of another state 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, 8:3. 2008, 298:3. 2010, 188:13, eff. Aug. 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:17-g - Coverage for Children's Early Intervention Services.

420-A:17-g Coverage for Children's Early Intervention Services. –
Every health service corporation and every other similar corporation licensed under the laws of another state that issues or renews any policy of group accident or health insurance providing benefits for medical, rehabilitation, or hospital expenses, which provides coverage for outpatient services 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, 338:3. 2010, 188:13, eff. Aug. 20, 2010. 2020, 26:41, eff. Sept. 18, 2020. 2021, 56:10, eff. July 24, 2021.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:18 - Investments.

420-A:18 Investments. –
No health service corporation shall invest its funds otherwise than as provided in RSA 411-A relating to the investments and holding of real estate by domestic life insurance companies; provided that not exceeding 10 percent of a health service corporation's total admitted assets may be invested in such investments as are prudent for a domestic life insurance company to make, and provided further that, notwithstanding RSA 411-A:12, no such health service corporation may acquire and hold directly or indirectly through its subsidiaries or affiliates more than 10 percent of the outstanding voting stock of any life insurance company formed under the laws of this or another state or any corporation owning or holding the stock of such life insurance company.
Source.
1997, 190:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:19 - Prohibiting Limitations on Liability; Disclosure of Information.

420-A:19 Prohibiting Limitations on Liability;  Disclosure of Information. –
I. No contract between a health service corporation 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 service corporation for any actions of the physician for which the health service corporation might otherwise be liable.
II. No contract between a health service corporation 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 service corporation's products as they relate to the needs of such provider's patients except for trade secrets of significant competitive value.
Source.
1997, 190:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:20 - Reports and Examinations.

420-A:20 Reports and Examinations. –
Every health service corporation shall annually, on or before March 1, file in the office of the commissioner a statement, verified by at least 2 of its principal officers, showing its condition on the preceding December 31, which shall be in such form and contain such matters as the commissioner may prescribe. Examination of the financial condition of each health service corporation by the commissioner shall be made as often as the commissioner deems necessary. The commissioner or designee shall have the power of visitation and examination into the affairs of any health service corporation and free access to all of the books, papers, and documents that relate to the business of the corporation, and may summon and qualify witnesses under oath and examine its officers, agents, or employees or other persons in relation to the affairs, transactions, and condition of the corporation. All costs of such examination shall be paid by the health service corporation.
Source.
1997, 190:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:21 - Reserves.

420-A:21 Reserves. –
Every health service corporation shall collect reasonable rates as described in RSA 420-A:22, designed to permit it to accumulate and maintain a contingency reserve fund.
Source.
1997, 190:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:22 - Annual Review.

420-A:22 Annual Review. –
Annually, in the month of April, the commissioner may review the rates of every health service corporation, and shall, not later than 60 days after April 1 of each year, provided that the corporation has filed all pertinent data, make adjustments thereto, if any, as are just and reasonable. Whenever the contingency reserve fund of a health service corporation shall be less than 8 percent of its annual premium income, the commissioner shall permit the corporation to charge rates designed to enable it to increase its contingency reserve fund by an amount equal to at least 2 percent of the annual premium income of the corporation. If the liabilities of a health service corporation exceed its assets, however, the commissioner shall permit the corporation to charge rates designed to enable the corporation to accumulate such a reserve fund by an amount equal to at least 5 percent of the annual premium income of the corporation until such time as the assets of the corporation equal its liabilities. In no event shall the commissioner permit a health service corporation to charge rates which would result in a reserve fund in excess of 20 percent of the annual premium volume of the corporation. This section shall not preclude the granting of appropriate rate changes at any other times. In connection with a rate decision, the commissioner may also make reasonable supplemental orders to the health service corporation and may attach reasonable conditions and limitations to such orders as the commissioner finds, on the basis of competent and substantial evidence, necessary to insure that benefits and services are provided at minimum cost under efficient and economical management of the corporation.
Source.
1997, 190:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:23 - Appeals.

420-A:23 Appeals. –
All orders and decisions of the commissioner concerning matters within the commissioner's jurisdiction under this chapter shall be subject to rehearing and appeal as provided in RSA 541. RSA 541:18 and RSA 541:19 shall apply to orders and decisions of the insurance commissioner affecting the rates of health service corporations.
Source.
1997, 190:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:24 - Agreements With Providers.

420-A:24 Agreements With Providers. –
Any health service corporation may enter into agreements with eligible persons whereby such persons become providers of a plan operated by the corporation. Any health service corporation may enter into contracts for the payment of health services to the subscribers or members of similar nonprofit health service corporations of other states subject to the supervision of such other states, or of counties of this state in which the corporation does not transact business. The corporation shall maintain in its office complete records of all health services rendered to subscribers and covered dependents in such form as will include the kind of services rendered, the amounts claimed for such services by the providers and the amount paid by the corporation.
Source.
1997, 190:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:25 - Administrative Services.

420-A:25 Administrative Services. –
Any health service corporation may contract to furnish administrative services to any health-related organization, agency, entity, or plan.
Source.
1997, 190:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:26 - Nonliability of Corporation.

420-A:26 Nonliability of Corporation. –
No health service corporation holding a license under this chapter shall be liable for injuries resulting from negligence, malfeasance, nonfeasance, or malpractice on the part of any officer or employee or on the part of any provider in the course of rendering health care service or supplies to subscribers.
Source.
1997, 190:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:27 - Taxation.

420-A:27 Taxation. –
Except as otherwise expressly provided for by law, every health service corporation doing business pursuant to this chapter is hereby declared to be a nonprofit and benevolent organization and to be exempt from all taxes, other than taxes on real property situated within this state, fees on motor vehicles registered in this state, fees prescribed by this chapter, and the premium tax under RSA 400-A:32. Except for payments made by the state of New Hampshire no tax shall be levied on any premiums, fees-for-service and other payments for health, dental, and employee benefit coverages from political subdivisions of the state of New Hampshire, or from employees or retirees of such political subdivisions, either directly or indirectly. Nor shall any tax be levied on any revenues of such a health service corporation that are derived from any business of the corporation where the corporation has assumed no insurance risk and is providing administrative services only.
Source.
1997, 190:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:28 - Relationship of Provider and Patient.

420-A:28 Relationship of Provider and Patient. –
Nothing in this chapter shall be deemed to alter the relationship of physician and patient. No health service corporation shall in any way influence the subscriber in the free choice of hospital or physician or other provider. Nothing in this chapter shall be deemed to abridge the right of any hospital, physician or other provider to decline patients in accordance with lawful standards and practices of such provider.
Source.
1997, 190:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:29 - Foreign Corporations; Reciprocity.

420-A:29 Foreign Corporations;  Reciprocity. –
Any corporation organized under the laws of another state or country which except as to state of organization is a health service corporation and which the commissioner finds has fully complied with the laws of such other state or country, shall be entitled to do business within this state subject to this chapter after obtaining a license as provided in RSA 420-A:4; provided, however, that no such corporation organized under the laws of another state or country shall be entitled to such license, or to do business in this state, unless such other state or country grants substantially similar rights and privileges to health service corporations organized under the laws of this state. The commissioner shall determine whether rights and privileges granted by other states or countries are substantially similar to those granted by this state, and the commissioner's determination shall be final.
Source.
1997, 190:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:31 - Rules.

420-A:31 Rules. –
The commissioner is authorized and empowered to adopt such rules in accordance with RSA 541-A which are reasonable and necessary to administer and enforce the provisions of this chapter.
Source.
1997, 190:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-A - Health Service Corporations › Section 420-A:32 - Workers' Compensation Law Not Affected.

420-A:32 Workers' Compensation Law Not Affected. –
No provision of this chapter or any contract for hospital service by such health service corporation shall in any way affect the operation of workers' compensation laws of the state.
Source.
1997, 190:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:1 - Definitions.

420-B:1 Definitions. –
In this chapter:
I. "Advertising" means:
(a) Printed and published material and descriptive literature of an insurer used in newspapers, magazines, radio and television scripts, billboards, and similar displays;
(b) Descriptive literature and sales aids of all kinds issued by an insurer for presentation to members of the public, including, but not limited to, marketing, educational, or information letters; and
(c) Sales talks, presentations and material prepared by insurers for use by agents and brokers, and representations made by agents and brokers in accordance therewith.
II. "Commissioner" means the insurance commissioner.
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. "Enrolled participant" means a person who has entered into a contractual arrangement or on whose behalf a contractual arrangement has been entered into with a health maintenance organization to receive health care services.
IV. "Evidence of coverage" means any certificate, agreement, or contract issued to an enrolled participant setting out the coverage to which such participant is entitled including those issued pursuant to a contract under section 1876 or section 1833 of the federal Social Security Act (42 U.S.C. section 1395 et seq.) as amended.
V. "Health care services" means physician, hospitalization, laboratory, x-ray service and medical equipment and supplies, which may include but are not limited to: medical, surgical, and dental care; psychological, obstetrical, osteopathic, optometric, optic, podiatric, chiropractic, nursing, physical therapy services, 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 enrolled participants.
VI. "Health maintenance organization" means a public or private organization, organized under the laws of this state or the laws of another state which:
(a) Provides or otherwise makes available to enrolled participants health care services;
(b) Is compensated for the provision of one or more health care services to an enrolled participant on a primarily predetermined periodic rate basis;
(c) Provides physicians' services directly through physicians who are either employees or partners of such an organization, or under arrangements with one or more physicians or groups of physicians.
VII. "Provider" means any physician, hospital or other institution, organization, or other person who furnishes health care services.
Source.
1977, 282:1. 1997, 282:1. 2007, 289:14, eff. Jan. 1, 2008.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:2 - Certificate of Authority.

420-B:2 Certificate of Authority. –
I. No person may operate a health maintenance organization without obtaining a certificate of authority from the commissioner. A foreign corporation may qualify under this chapter subject to its registration to do business in this state as a foreign corporation under RSA 293-A.
II. Every health maintenance organization, as of August 21, 1977, shall submit an application for a certificate of authority within 120 days of August 21, 1977. Each such applicant may continue to operate without certificate of authority until the commissioner acts upon the application.
Source.
1977, 282:1, eff. Aug. 21, 1977.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:3 - Application for Certificate of Authority.

420-B:3 Application for Certificate of Authority. –
Each application for a certificate of authority shall be verified by an officer or authorized representative of the applicant and shall be in a form prescribed by the commissioner, containing such information as the commissioner may require.
Source.
1977, 282:1, eff. Aug. 21, 1977.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:4 - Jurisdictional Power of Attorney.

420-B:4 Jurisdictional Power of Attorney. –
Any applicant for a certificate of authority who is not domiciled in this state shall file with its application a power of attorney duly executed appointing the commissioner and his successors in office, and duly authorized deputies, as the true and lawful attorney of such applicant in and for the state upon whom all lawful process in any legal action or proceeding against the health maintenance organization on a cause of action arising in this state may be served.
Source.
1977, 282:1, eff. Aug. 21, 1977.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:5 - Issuance of Certificate of Authority.

420-B:5 Issuance of Certificate of Authority. –
The commissioner shall issue a certificate of authority to any person filing an application within 90 days after filing of a completed application, payment of all required fees and receipt of endorsement or approval of the state health planning and development agency, as provided by law or regulation, if he is satisfied that the applicant is safe, reliable, entitled to confidence, in sound financial condition and that issuing the certificate of authority would be in the public interest.
Source.
1977, 282:1, eff. Aug. 21, 1977.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:5-a - Renewal of Certificate of Authority.

420-B:5-a Renewal of Certificate of Authority. –
The certificate shall be renewed annually on June 14 if the company complies with the requirements of this chapter, the commissioner regards it as safe, reliable, and entitled to confidence, and the company continues to conduct a meaningful business in New Hampshire, as determined by the commissioner.
Source.
1989, 186:2, eff. July 1, 1989.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:5-b - New License Required for Changed Conditions.

420-B:5-b New License Required for Changed Conditions. –
The commissioner shall require a health maintenance organization to apply for a new certificate in accordance with this chapter, if, after notice and hearing, the commissioner finds that the organization has undergone a substantial change in finances or managerial control since its last application for a certificate. The current certificate shall expire upon approval of the new application or 30 days after the decision of the commissioner that a substantial change has occurred, whichever is sooner.
Source.
1989, 186:2, eff. July 1, 1989.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:6 - Pre-Certificate Activities.

420-B:6 Pre-Certificate Activities. –
I. Upon request of any applicant, and subject to any regulations the commissioner may impose, the commissioner, in his discretion, may permit an applicant to contact potential enrolled participants prior to the issuance of a certificate of authority, to discuss the health care services the applicant proposes to offer and the proposed evidences of coverage.
II. The commissioner may, in his discretion in accordance with such regulations as he may impose, permit an organization to contact potential enrolled participants prior to the granting of a certificate of authority, to discuss the health care services such health maintenance organization proposes to offer if a certificate of authority is granted.
Source.
1977, 282:1, eff. Aug. 21, 1977.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-a - Repealed by 1996, 188:14, IV, eff. Jan. 1, 1997.

420-B:8-a Repealed by 1996, 188:14, IV, eff. Jan. 1, 1997. –
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-aa - Dependent Coverage.

420-B:8-aa 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.
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 child 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 this section.
(b) Such notice shall include information regarding the required special open enrollment period.
Source.
2007, 352:3. 2009, 235:11. 2010, 243:10, eff. Sept. 23, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-c - Cancellation or Nonrenewal of Group Health Maintenance Organization Contracts.

420-B:8-c Cancellation or Nonrenewal of Group Health Maintenance Organization Contracts. –
No group health maintenance organization contract, authorized under this chapter, may be cancelled or nonrenewed by the health maintenance organization, except for nonpayment of premium, unless the group contract holder receives either a notice of cancellation or nonrenewal or an offer of renewal in accordance with this section. The notice of cancellation or nonrenewal or offer of renewal shall be delivered to the group contract holder or mailed to the group contract holder's last address as shown in the records of the health maintenance organization at least 45 days prior to the renewal date of the contract. Notice of cancellation for lack of participation, if permitted by the terms of the contract, shall be delivered to the group contract holder or mailed to the group contract holder's last address as shown in the records of the health maintenance organization, at least 30 days prior to the effective date of the cancellation.
Source.
1990, 194:4. 1991, 23:4, eff. Jan. 1, 1992.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-d - Cancellation or Nonrenewal of Non-Group Health Maintenance Organization Contracts.

420-B:8-d Cancellation or Nonrenewal of Non-Group Health Maintenance Organization Contracts. –
No non-group health maintenance organization contract, authorized under this chapter, may be cancelled or nonrenewed by the health maintenance organization except for nonpayment of premium, unless the enrolled participant receives either a notice of cancellation or nonrenewal or an offer of renewal in accordance with this section. The notice of cancellation or nonrenewal or offer of renewal shall be delivered to the enrolled participant or mailed to the enrolled participant's last address as shown in the records of the health maintenance organization at least 30 days prior to the renewal date of the contract.
Source.
1990, 194:4. 1991, 23:5, eff. Jan. 1, 1992.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-e - Repealed by 2010, 61:3, III, eff. May 18, 2010.

420-B:8-e Repealed by 2010, 61:3, III, eff. May 18, 2010. –
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-ee - Coverage for Dental Procedures.

420-B:8-ee Coverage for Dental Procedures. –
I. Every health maintenance organization and every other similar corporation licensed under the laws of another state that issues or renews any group policy of accident or health insurance providing benefits for medical or hospital expenses, shall provide to each covered individual or certificate holder who is a resident of New Hampshire coverage for the medically necessary hospital or surgical day care facility charges and administration of general anesthesia administered by a licensed anesthesiologist or anesthetist for dental procedures performed 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 primary care physician to have a dental condition of significant dental complexity which requires certain dental procedures to be performed in a surgical day care facility or hospital setting; or
(b) Is a person who has exceptional medical circumstances or a developmental disability as determined by a licensed primary care 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, 280:4. 2003, 278:4. 2010, 188:10, eff. Aug. 20, 2010. 2018, 188:8, eff. Aug. 7, 2018.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-f - Benefits for Scalp Hair Prostheses.

420-B:8-f Benefits for Scalp Hair Prostheses. –
I. Benefits for scalp hair prostheses shall conform to the requirements of RSA 415:18-d. Such benefits shall not be subject to any greater deductible than any other prostheses benefits provided by the health maintenance organization. The coinsurance required by the enrolled participant shall not exceed the amount allowed under the contract for the reasonable and customary charge for the services provided. Such coverage, however, shall be subject to a written recommendation by the treating physician stating that the hair prosthesis is a medical necessity. Such coverage shall be subject to the same limitations and guidelines as other prostheses.
II. For the purposes of this section:
(a) "Prostheses" means artificial appliances used to replace lost natural structures. Prostheses include, but are not limited to, artificial arms, legs, breasts or glass eyes.
(b) "Scalp hair prostheses" means artificial substitutes for scalp hair that are made specifically for a specific individual.
Source.
1992, 246:5. 2001, 276:5, eff. Sept. 14, 2001.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-ff - Coverage for Nonprescription Enteral Formulas.

420-B:8-ff Coverage for Nonprescription Enteral Formulas. –
I. Every health maintenance organization and every other similar corporation licensed under the laws of another state that issues or renews any policy of individual or group health insurance providing benefits for medical or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the provision of nonprescription enteral formulas for the treatment of impaired absorption of nutrients caused by disorders affecting the absorptive surface, functional length, or motility of the gastrointestinal tract. Such coverage shall be provided when the prescribing physician has issued a written order stating that the enteral formula is needed to sustain life, is medically necessary, and is the least restrictive and most cost effective means for meeting the needs of the patient.
II. Every health maintenance organization and every other similar corporation licensed under the laws of another state that issues or renews any policy of individual or group health insurance providing benefits for medical or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are resident of this state, coverage for the provision of nonprescription enteral formulas and food products required for persons with inherited diseases of amino acids and organic acids. Such coverage shall be provided when the prescribing physician has issued a written order stating that the enteral formula or food product is medically necessary and is the least restrictive and most cost effective means for meeting the needs of the patient. Coverage for inherited diseases of amino acids and organic acids shall, in addition to the enteral formula, include food products modified to be low protein in an amount not to exceed $1,800 annually for any insured individual.
III. The benefits included in this section shall not be subject to any greater deductible than any other benefits provided by the insurer. The coinsurance required by the enrolled participant shall not exceed the amount allowed under the contract for the reasonable and customary charge for the service provided.
Source.
1995, 235:5. 1996, 131:6. 2010, 188:11, eff. Aug. 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-g - Coverage During Adoption Proceedings.

420-B:8-g Coverage During Adoption Proceedings. –
All contracts issued by a health maintenance corporation which provide coverage for a family member of the subscriber shall, as to such family member's coverage, also provide that health insurance benefits applicable for children are payable with respect to any minor from the date such minor is placed in the custody of the subscriber pursuant to an adoption proceeding under the provisions of RSA 170-B. Such health insurance benefits shall terminate upon dismissal or withdrawal of the petition for adoption.
Source.
1992, 222:9, eff. Jan. 1, 1993.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-gg - Coverage for Prescription Contraceptive Drugs and Prescription Contraceptive Devices and for Contraceptive Services.

420-B:8-gg Coverage for Prescription Contraceptive Drugs and Prescription Contraceptive Devices and for Contraceptive Services. –
Every health maintenance organization and every other similar corporation licensed under the laws of another state that issues or renews any policy of group health insurance providing benefits for medical or hospital expenses, which provides coverage for outpatient services 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 outpatient contraceptive services under the same terms and conditions as for other outpatient services. "Outpatient contraceptive services" means consultations, examinations, and medical services, provided on an outpatient basis, including the initial screening provided through a pharmacy pursuant to RSA 318:47-l at a rate established by contract between the pharmacy and the insurer or its pharmacy benefits manager, and related to the use of contraceptive methods to prevent pregnancy which has been approved by the U.S. Food and Drug Administration. Each health maintenance organization and every other similar corporation licensed under the laws of another state that issues or renews any group health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover all prescription contraceptive drugs and prescription contraceptive devices approved by the U.S. Food and Drug Administration under the same terms and conditions as other prescription drugs. Nothing in this section shall be construed as altering the terms and conditions of a contract relating to prescription drugs and outpatient services.
Source.
1999, 252:3. 2010, 188:13, eff. Aug. 20, 2010. 2018, 205:6, eff. Jan. 1, 2019.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-h - Notification of Allowable Benefit.

420-B:8-h Notification of Allowable Benefit. –
All health maintenance organizations shall provide to each subscriber, on request, a written statement of the dollar amount of allowable benefit for any procedure which is requested by the appropriate procedure code.
Source.
1993, 102:6, eff. Jan. 1, 1994.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-i - Incontestable Provision.

420-B:8-i Incontestable Provision. –
The validity of the contract shall not be contested except for nonpayment of premiums, after it has been in force for 2 years from its date of issue. No statement made by any person covered under the contract relating to insurability shall be used in contesting the validity of the insurance with respect to which such statement was made after such insurance has been in force prior to the contest for a period of 2 years during such person's lifetime, and not unless it is contained in a written instrument signed by the person making such statement. No such provision, however, shall preclude the assertion, at any time, of defenses based upon the person's ineligibility for coverage under the plan or upon other provisions in the plan, except for any provisions establishing, as a requirement of eligibility, the furnishing of satisfactory evidence of insurability to the health maintenance organization.
Source.
1993, 167:4, eff. Jan. 1, 1994.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-j - Newborn Children.

420-B:8-j Newborn Children. –
I. All individual and group health maintenance organization contracts shall provide that the health insurance benefits applicable for children are payable with respect to a newly born child of the insured or subscriber or a dependent child of the insured or the subscriber from the moment of birth.
II. Coverage for newly born children shall consist of coverage of injury or sickness including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities.
III. If payment of a specific premium or subscription fee is required to provide coverage for a child, the contract may require that notification of birth of a newly born child and payment of the required premium or fee must be furnished to the health maintenance organization within 31 days after the date of birth in order to have the coverage continue beyond such 31-day period. Unless the contract specifically provides that grandchildren of the insured or subscriber are eligible for coverage, coverage for newly born children of a dependent child of the insured or subscriber shall not continue beyond the initial 31-day period following birth. Nor shall such newly born children be considered dependents of the insured for any purpose addressed in this title.
IV. This section applies to all health maintenance organization contracts delivered or issued for delivery or renewed in this state on or after January 1, 1997.
Source.
1996, 188:10, eff. Jan. 1, 1997.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-k - Coverage for Diabetes Services and Supplies.

420-B:8-k Coverage for Diabetes Services and Supplies. –
Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing benefits for medical or hospital expenses, shall provide to each individual or group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state, coverage for the medically appropriate and necessary outpatient self-management training and educational services, pursuant to a written order of a primary care physician or practitioner, including but not limited to medical nutrition therapy for the treatment of diabetes, provided by a certified, registered, or licensed health care professional with expertise in diabetes, subject to the terms and conditions of the policy. Each health maintenance organization that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides a prescription rider shall cover medically appropriate or necessary insulin, oral agents, and equipment used to treat diabetes subject to the terms and conditions of the policy. Each health maintenance organization that provides coverage for prescription insulin drugs shall cap the total amount that a covered person is required to pay for each covered insulin drug prescription at an amount not to exceed $30 for each 30-day supply of each insulin prescription. The maximum $30 copayment for each 30-day supply of each covered insulin drug prescription shall apply when an original prescription is dispensed as well as when refills of the prescription are dispensed, including early refills. Coverage for prescription insulin drugs shall not be subject to any deductible. Each health maintenance organization that issues or renews any individual or group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses which provides for durable medical equipment coverage shall provide coverage for medically appropriate or necessary equipment used to treat diabetes subject to the terms and conditions of the policy.
Source.
1997, 258:6. 2010, 188:13, eff. Aug. 20, 2010. 2020, 13:4, eff. Sept. 14, 2020.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-l - Medicare Risk Contracts.

420-B:8-l Medicare Risk Contracts. –
I. The requirements of RSA 417-E, RSA 420-B:8-b, RSA 420-B:8-e, RSA 420-B:8-f, and RSA 420-B:8-ff shall not apply to a Medicare risk policy issued pursuant to a contract under section 1876 or section 1833 of the federal Social Security Act (42 U.S.C. section 1395 et seq.) as amended.
II. In the event of termination of the contract between the Centers for Medicare and Medicaid Services (CMS) and the contractor, all current enrollees of the contractor who will lose their coverage as a result of this contract termination, shall be given an opportunity to enroll, without evidence of insurability, in any Medicare Supplement policy approved for sale in this state which is then being offered by the contractor.
Source.
1997, 282:3. 2003, 145:6, eff. Aug. 16, 2003.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-m - Patients' Bill of Rights.

420-B:8-m Patients' Bill of Rights. –
All health maintenance organizations shall provide to each new subscriber who is a resident of this state a copy of the patients' bill of rights law under RSA 151:21.
Source.
1997, 331:17, eff. Aug. 22, 1997.