reglab/statecodes huggingface dataset:
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-o - Third-Party Payment of Covered, Court-Ordered Services.

420-B:8-o Third-Party Payment of Covered, Court-Ordered Services. –
The existence of a court order under RSA 169-B, RSA 169-C, or RSA 169-D for a service, program, or placement that is covered under any insurance for the minor shall not be considered in determining qualification for third-party payment under such insurance. Benefits for such services shall be subject to the same dollar limits, deductibles, co-payments and co-insurance factors and to the terms and conditions of the policy or certificate, including any managed care provisions. However, the claimant or claimant's representative shall have 48 hours from the commencement of a court-ordered service, placement, or program to seek any pre-authorization, pre-certification, or referral required under the terms of the policy. The determination of these preservice claims for court-ordered services for a minor shall be made as soon as possible, taking into account the medical exigencies, but in no event later than 48 hours after receipt of the request and sufficient information, unless the claimant or claimant's representative fails to provide sufficient information to determine whether, or to what extent, benefits are covered or payable. In the case of such failure, the insurer shall notify the claimant or claimant's representative within 24 hours of receipt of the request and shall advise the claimant or claimant's representative of the specific information necessary to determine to what extent benefits are covered or payable. The claimant or claimant's representative shall be afforded a reasonable amount of time, taking into account the circumstances, but not less than 48 hours, to provide the specified information. Thereafter, notification of the claim determination shall be made as soon as possible, but in no case later than 48 hours after the earlier of:
I. The insurer's receipt of the specified additional information; or
II. The end of the period afforded the claimant or claimant's representative to provide the specified additional information.
Source.
2004, 117:3, eff. Aug. 15, 2004.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-p - Coverage for Certified Midwives.

420-B:8-p Coverage for Certified Midwives. –
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 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, 8:4. 2008, 298:4. 2010, 188:13, eff. Aug. 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-q - Coverage for Dependents.

420-B:8-q Coverage for Dependents. –
If the coverage for dependent children includes coverage for dependent children who are full-time students, as defined by the appropriate educational institution, beyond the age of 18, such dependent coverage shall include coverage for a dependent's medically necessary leave of absence from school for a period not to exceed 12 months or the date on which coverage would otherwise end pursuant to the terms and conditions of the policy, whichever comes first. Any breaks in the school semester shall not disqualify the dependent child from coverage under this section. Documentation and certification of the medical necessity of a leave of absence shall be submitted to the insurer by the student's attending physician and shall be considered prima facie evidence of entitlement to coverage under this section. The date of the documentation and certification of the medical necessity of a leave of absence shall be the date the insurance coverage under this section commences.
Source.
2007, 289:15, eff. Jan. 1, 2008.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:8-r - Coverage for Children's Early Intervention Services.

420-B:8-r Coverage for Children's Early Intervention Services. –
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, rehabilitation, 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 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, 338:4. 2010, 188:13, eff. Aug. 20, 2010. 2020, 26:42, eff. Sept. 18, 2020. 2021, 56:11, eff. July 24, 2021.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:9 - Reports to the Commissioner.

420-B:9 Reports to the Commissioner. –
I. Every organization subject to this chapter annually, on March 1, shall file a report with the commissioner and with the commissioner of health and human services, said report verified by an appropriate official of the organization, showing its financial condition on the last day of the preceding fiscal year.
II. Such report shall be filed on forms prescribed by the commissioner and shall include:
(a) A financial statement of the organization, including its balance sheet and statement of income, and expenditures for the preceding year, certified by an independent public accountant;
(b) Any changes in the information submitted pursuant to RSA 420-B:4; and
(c) Such other information relating to the performance of the health maintenance organization as the commissioner or the commissioner of health and human services may require.
Source.
1977, 282:1. 2001, 224:8, eff. Jan. 1, 2002.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:10 - Examinations.

420-B:10 Examinations. –
I. The commissioner shall make an examination of the affairs of any health maintenance organization and providers with whom such organization has contracts, agreements, or other arrangements as often as he or she deems it necessary, but not less frequently than once in every 5 years. All examinations shall be conducted at the expense of the health maintenance organizations.
II. Every health maintenance organization and provider shall submit its books and records relating its operation to such examinations and in every way facilitate them. For the purpose of examinations, the commissioner may issue subpoenas, administer oaths to, and examine the officers and agents of the health maintenance organization.
Source.
1977, 282:1, eff. Aug. 21, 1977. 2018, 36:2, eff. May 15, 2018.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:11 - Complaint System.

420-B:11 Complaint System. –
I. Every health maintenance organization shall establish and maintain a complaint system which has been approved by the commissioner to provide reasonable procedures for the resolution of written complaints initiated by enrolled participants concerning health care services.
II. Every health maintenance organization shall establish and maintain a full log of all written complaints initiated by enrolled participants which shall include a full description of all procedures taken under said complaints and their resolution.
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:13 - Sanctions.

420-B:13 Sanctions. –
Upon satisfactory evidence that any health maintenance organization has violated any law or regulation or in any way has failed in meeting its obligations, the commissioner may, in his discretion, pursue any one or more of the following courses of action:
I. Suspend the certificate of authority to operate as a health maintenance organization under this chapter. When the certificate of authority is suspended, the organization shall not during the period of such suspension enroll any additional enrolled participants except newborn children or other newly acquired dependents of existing enrolled participants, and shall not engage in any advertising or solicitation whatever;
II. Revoke the certificate of authority to operate as a health maintenance organization under this chapter. When the certificate of authority is revoked, such organization shall proceed under the supervision of the commissioner, immediately following the effective date of the order of revocation, to wind up its affairs, and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of such organization. It shall engage in no further advertising or solicitation whatsoever. The commissioner may, by written order, permit such further operation of the organization as he may find to be in the best interest of enrolled participants, to the end that enrolled participants will be afforded the greatest practical opportunity to obtain continuing health care coverage;
III. Impose a penalty of not more than $2,500 for each and every unlawful act committed; each violation shall constitute a separate fineable offense;
IV. Issue an administrative order requiring the health maintenance organization: to cease or modify inappropriate conduct or practices by it or any of the personnel employed or associated with it; to fulfill its contractual obligations; to provide a service which has been improperly denied; or to take appropriate steps to restore the ability of the organization to provide a contracted-for service; and
V. Apply to any court for such legal or equitable relief as the commissioner deems appropriate.
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:14 - Procedure and Appeals.

420-B:14 Procedure and Appeals. –
All procedures under this chapter shall be governed by the provisions of RSA 400-A and any person aggrieved by any order or decision of the commissioner pursuant to this chapter shall be entitled to an appeal in accordance with RSA 541.
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:15 - Investments.

420-B:15 Investments. –
With the exception of investments made in accordance with RSA 420-B:7, the funds of a health maintenance organization shall be invested only in securities or other investments permitted by the laws of this state for the investment of assets constituting the legal reserves of life insurance companies, or such other securities or investments as the commissioner may permit.
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:16 - Fees.

420-B:16 Fees. –
Every organization subject to this chapter shall pay to the commissioner those fees required for payment by hospital and medical service corporations under RSA 400-A:29.
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:17 - Taxation.

420-B:17 Taxation. –
Every organization doing business pursuant to this chapter shall be subject to the premium tax requirements of RSA 400-A:31 and 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 an organization that are derived from any business of the organization where the organization has assumed no insurance risk and is providing administrative services, only.
Source.
1977, 282:1. 1995, 256:3, eff. July 1, 1995.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:18 - Regulation of Agents.

420-B:18 Regulation of Agents. –
All persons engaged in the solicitation or enrollment of enrolled participants shall be duly licensed agents for the sale of health insurance in the state pursuant to the provisions of RSA 402-J.
Source.
1977, 282:1. 2000, 315:23, eff. Jan. 1, 2001.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:19 - Powers of Insurers and Hospital and Medical Service Corporations.

420-B:19 Powers of Insurers and Hospital and Medical Service Corporations. –
I. An insurance company licensed in this state, or a hospital, medical or health service corporation authorized to do business in this state, either directly or through a subsidiary or affiliate, may organize and operate a health maintenance organization under the provisions of this chapter. An insurance company licensed in this state, or a hospital, medical or health services corporation shall obtain a certificate of authority pursuant to RSA 420-B:2 and shall comply with all of the provisions of this chapter with respect to its health maintenance organization activities. Notwithstanding any other law which may be inconsistent herewith, any 2 or more such insurance companies, hospitals or medical service corporations, or subsidiaries or affiliates thereof, may jointly organize and operate a health maintenance organization. The business of insurance is deemed to include the providing of health care services by a health maintenance organization owned or operated by an insurer or a subsidiary thereof.
II. Notwithstanding any provisions of the laws of this state relating to insurance corporations engaged in the business of insurance, or any provisions of RSA 420-A relating to health service corporations, an insurer or health service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of failure of the health maintenance organization to meet its obligations. The enrolled participants of a health maintenance organization constitute a permissible group under such laws. Under the contracts set forth in this paragraph, the insurer or health service corporation may make benefit payments to health maintenance organizations for health care services rendered by providers pursuant to the health care plan.
Source.
1977, 282:1. 1997, 190:15. 2011, 39:1, eff. July 8, 2011.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:20 - Statutory Construction and Relationship to Other Laws.

420-B:20 Statutory Construction and Relationship to Other Laws. –
I. A health maintenance organization shall be considered an insurance company, however, except as provided in this chapter, title XXXVII shall not be applicable to any health maintenance organization granted a certificate of authority under this chapter; provided that this provision does not apply to an insurer or hospital or medical service corporation licensed and regulated pursuant to the insurance laws or the hospital or medical service corporation laws of this state, except with respect to its health maintenance organization activities authorized and regulated pursuant to this chapter.
II. The solicitation of enrolled participants or the provision of factually accurate information regarding coverage, rates, locations and hours of service, concepts and programs for the delivery of health care services, names of affiliated institutions, and credentials of participating providers, by a health maintenance organization or its agents to potential enrolled participants and to the general public shall not be construed to be violative of any provision of the laws of this state relating to solicitation or advertising by health professionals, nor be grounds for revocation or suspension of the license of a physician or surgeon under RSA 329:17.
III. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-t, RSA 415:6-u, RSA 415:6-v, RSA 415:6-w, RSA 415:6-x, RSA 415:6-y, RSA 415:6-z, RSA 415:6-a1, RSA 415:18, VII-a, RSA 415:18, XVI and XVII, RSA 415:18-i, RSA 415:18-j, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-y, RSA 415:18-z, RSA 415:18-aa, RSA 415:18-bb, RSA 415:18-cc, RSA 415:18-dd, RSA 415:18-ee, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.
Source.
1977, 282:1. 1989, 186:4. 1990, 114:2, 3. 1994, 166:10. 1995, 112:18. 1996, 188:11. 1997, 344:8, 16; 345:6. 1999, 323:8. 2000, 207:7. 2006, 187:4. 2007, 289:36. 2008, 389:4. 2010, 362:4. 2011, 133:4; 189:9, 11. 2012, 278:4. 2014, 299:4, eff. Sept. 30, 2014; 299:7, eff. Oct. 1, 2017. 2015, 263:10, eff. Jan. 1, 2017; 263:11, eff. Oct. 1, 2017 at 12:01 a.m.; 263:13, eff. Jan. 1, 2021. 2016, 326:6, eff. Aug. 23, 2016; 326:7, eff. Oct. 1, 2017 at 12:02 a.m.; 326:8, eff. Jan. 1, 2021 at 12:01 a.m.; 326:10, eff. Jan. 1, 2017 at 12:01 a.m. 2018, 4:15, eff. Feb. 8, 2018; 4:16, eff. Jan. 1, 2021 at 12:02 a.m.; 361:6, eff. Jan. 1, 2019; 361:7, eff. Jan. 1, 2021 at 12:02 a.m. 2019, 113:6, eff. Aug. 20, 2019; 113:7, eff. Jan. 1, 2021 at 12:03 a.m. 2020, 13:13, eff. Sept. 14, 2020; 13:14, eff. Jan. 1, 2021 at 12:04 a.m.; 30:13, eff. Sept. 21, 2020; 30:14, eff. Jan. 1, 2021 at 12:04 p.m.; 39:8, eff. Jan. 1, 2021 at 12:04 a.m.; 39:24, eff. June 30, 2021; 39:25, eff. Jan. 1, 2021 at 12:05 p.m.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:21 - Regulations.

420-B:21 Regulations. –
The commissioner in accordance with RSA 541-A may promulgate reasonable rules for the implementation of the provisions of this chapter.
Source.
1977, 282:1, eff. Aug. 21, 1977.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:22 - Federal Legislation.

420-B:22 Federal Legislation. –
Nothing in this chapter shall prohibit any health maintenance organization from meeting the requirements of any federal law which would authorize such health maintenance organization to receive federal financial assistance or enroll beneficiaries assisted by federal funds, or shall be interpreted or applied to prevent qualification of an organization holding a certificate of authority under this chapter from qualifying as a "health maintenance organization" under Public Law 93-222 as defined in 42 U.S.C. section 300e(a).
Source.
1977, 282:1, eff. Aug. 21, 1977.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:23 - Systems Failing to Meet Requirements of This Chapter; Operation, Licensing and Regulation.

420-B:23 Systems Failing to Meet Requirements of This Chapter;  Operation, Licensing and Regulation. –
Notwithstanding the provisions of this chapter, a person proposing to operate a system of health care delivery and financing which is to be offered to individuals, whether or not as members of groups, in exchange for a fixed payment and organized so that providers and the organization are in some part at risk for the cost of services in a manner similar to a health maintenance organization, but who fails to meet the requirements set forth in this chapter, may operate such a system if the commissioner finds that the proposed operation will benefit persons who will be served by it. The operation shall be licensed and regulated in the same manner as a health maintenance organization under this chapter, except to the extent that the commissioner determines that the regulation is inappropriate to the system of health care delivery and financing. A person operating a system of health care delivery and financing pursuant to this section shall not advertise or solicit or in any way identify itself in a manner implying to the public that it is a health maintenance organization licensed under this chapter.
Source.
1986, 56:1, eff. July 4, 1986.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:24 - Notification of Option to Enroll in Health Maintenance Organization.

420-B:24 Notification of Option to Enroll in Health Maintenance Organization. –
I. Each employer, public or private, in this state which offers its employees a health benefit plan and employs at least 25 employees, and each employee benefit fund in this state which offers its members any form of health benefit, shall make available to and inform its employees or members of the option to enroll in at least one health maintenance organization holding a valid certificate of authority which provides health care services in the geographic areas in which a substantial number of such employees or members reside; provided, however, that such employer or employee benefit fund shall not be required to make available or inform its employees or members about such option if no health maintenance organization is available to such employer or employee benefit plan. Where there is a prevailing collective bargaining agreement, the selection of the available health maintenance organizations shall be made pursuant to the agreement.
II. No employer in this state shall be required to pay more for health benefits as a result of the application of this section than would otherwise be required by any prevailing collective bargaining agreement or other contract for the provision of health benefits to its employees, provided that the employer or benefits fund shall pay to the health maintenance organization chosen by each employee or member an amount equal to the lesser of:
(a) The amount paid on behalf of its other employees or members for health benefits; or
(b) The health maintenance organization's charge for coverage approved by the commissioner.
III. Should federal legislation requiring employers to offer to employees the option to enroll in a health maintenance organization be repealed or expire, the provisions of RSA 420-B:24, I and II shall no longer apply.
Source.
1989, 186:5, eff. July 1, 1989.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:25 - Capital Requirements.

420-B:25 Capital Requirements. –
I. Before issuing a certificate of authority under this chapter, the commissioner shall require that the health maintenance organization have an initial net worth of $6,000,000 and that the minimum net worth required under paragraph II is maintained.
II. Every health maintenance organization shall maintain a minimum net worth equal to the greater of:
(a) $6,000,000; or
(b) Seven and one-half percent of annual premium revenues as reported on the most recent annual financial statement filed with the commissioner. The minimum net worth shall be met by the health maintenance organization upon expiration of the certificate of authority.
III. In addition to paragraphs I and II, if at any time uncovered expenditures exceed 15 percent of the total health care expenditures, a health maintenance organization shall increase the required minimum net worth by 120 percent of the health maintenance organization's outstanding liability for uncovered expenditures for enrollees including incurred but not reported claims which shall be calculated as of the first date of the month and retained for the remainder of the month. The increase to minimum net worth required by this paragraph shall not exceed $5,000,000. Health maintenance organizations shall file a report within 45 days after the end of the calendar quarter with information sufficient to demonstrate compliance with this section.
IV. In addition to paragraphs I, II and III, the commissioner shall require additional capital if he finds that the health maintenance organization does not have reasonable and adequate specific stop-loss reinsurance for its individual members.
V. Every health maintenance organization shall, when determining liabilities, include an amount estimated in the aggregate to provide for any unearned premium and for the payment of all claims for health care expenditures which have been incurred, whether reported or unreported, which are unpaid and for which such organization is or may be liable, and to provide for the expense of adjustment of settlement of such claims.
VI. Such liabilities shall be computed in accordance with rules adopted by the commissioner upon reasonable consideration of the ascertained experience and character of the health maintenance organization.
Source.
1989, 186:5. 1990, 114:4, eff. July 1, 1990.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-B - Health Maintenance Organizations › Section 420-B:26 - Repealed by 1997, 345:8, II, eff. Jan. 1, 1998.

420-B:26 Repealed by 1997, 345:8, II, eff. Jan. 1, 1998. –
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-C - Preferred Provider Agreements › Section 420-C:1 - Purpose.

420-C:1 Purpose. –
The purpose of this chapter is to assure that health benefit plans encourage covered persons to seek health care services from preferred providers and that contracts or agreements between preferred providers and health care insurers are fair and in the public interest. Further, this chapter establishes reasonable regulatory requirements for health care insurers in a manner to contain health care costs while preserving the quality of care.
Source.
1987, 112:1, eff. July 5, 1987.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-C - Preferred Provider Agreements › Section 420-C:2 - Definitions.

420-C:2 Definitions. –
In this chapter:
I. "Commissioner" means the insurance commissioner.
II. "Covered person" means an individual entitled to reimbursement for expenses of health care services under a policy issued or administered by a health care insurer.
II-a. "Date of enrollment" means the first day of coverage under the plan, or, if there is a waiting period, the first day of the waiting period, which is typically the first day of work.
III. "Health benefit plan" means the contract between the covered person or policyholder and the health care insurer which defines the services covered.
IV. "Health care insurer" means an insurance company, including nonprofit (tax exempt) health service corporations as defined in RSA 420-A, authorized in this state to issue policies that provide reimbursement for expenses of health care services.
V. "Health care services" means services or products rendered by a preferred provider which may include physician, hospitalization, laboratory, and x-ray services, and medical equipment and supplies, and which further may include, but are not limited to: medical, surgical, and dental care; psychological, obstetrical, osteopathic, optometric, optic, podiatric, chiropractic, nursing, physical therapy, and pharmaceutical services; health education; preventive medical, rehabilitative, and home health services; inpatient and outpatient hospital services, extended care, nursing home care, convalescent institutional care, laboratory and ambulance services, appliances, drugs, medicines, and supplies; and any other care, service, or treatment of disease, correction of defects, or the maintenance of the physical and mental well-being of the insured.
VI. "Preferred provider" means a licensed provider or group of providers who have contracted with or been designated by the health care insurer to provide health care services to covered persons under a health benefit plan.
VII. "Provider" means any physician, hospital or other institution, organization, or other person who furnishes health care services.
Source.
1987, 112:1. 2007, 289:17, eff. Jan. 1, 2008.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-C - Preferred Provider Agreements › Section 420-C:3 - Reimbursement Agreements.

420-C:3 Reimbursement Agreements. –
Notwithstanding any other law to the contrary, a health care insurer may:
I. Enter into contracts or other agreements with preferred providers for the delivery of health care services to covered persons. Such contracts or agreements may:
(a) Establish the amount and method of payment to the preferred provider;
(b) Establish a procedure for the review and control of utilization of health care services; and
(c) Establish a mechanism for determining whether the health care services rendered are medically necessary.
II. Issue or administer policies or contracts which provide incentives for the covered person to use the health care services of preferred providers.
III. Issue or administer policies or contracts which provide benefits for health care services only if the services have been rendered by a preferred provider.
Source.
1987, 112:1, eff. July 5, 1987.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-C - Preferred Provider Agreements › Section 420-C:4-a - Dependent Coverage.

420-C:4-a Dependent Coverage. –
I. A policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any other person dependent upon the policyholder. In the event a carrier elects to provide coverage for dependent children, the term "dependent child" shall include a subscriber's child by blood or by law, who is under age 26.
I-a. The coverage of any family member insured by such policy, pursuant to paragraph I, who is mentally or physically incapable of earning his or her own living as of the date on which such dependent's status as a covered family member would otherwise expire because of age, shall continue under such policy while such policy remains in force or is replaced by another policy as long as such incapacity continues and as long as such dependent remains chiefly financially dependent on the policyholder or the employee or his or her estate is chargeable for the care of such dependent; provided, that due proof of such incapacity is received by the insurer within 31 days of such expiration date. If such coverage is continued in accordance with this paragraph, such dependent shall be entitled upon the termination of such incapacity to coverage offered by the New Hampshire high risk pool under RSA 404-G.
II. Nothing in this section shall be construed to require:
(a) Coverage for services provided to a dependent before the effective date of this section; or
(b) That an employer pay all or part of the cost of family coverage that includes a dependent as provided pursuant to this section.
III. A subscriber that elects family coverage during any applicable open enrollment period may enroll any dependent eligible pursuant to this section.
IV. Coverage for a dependent provided pursuant to this section shall be provided until the earlier of the following:
(a) The dependent is disqualified for dependent status as set forth in paragraph I of this section; or
(b) The date upon which the employer under whose contract coverage is provided to a dependent ceases to provide coverage to the subscriber.
V. Nothing in this section shall be construed to permit a health insurance carrier to refuse an election for coverage by a dependent pursuant to paragraph III, based upon the dependent's prior disqualification pursuant to subparagraph IV(a).
VI. (a) Notice regarding coverage for a dependent as provided pursuant to this section shall be provided to a subscriber:
(1) In the certificate of coverage prepared for subscribers on or about the date of commencement of coverage; and
(2) Within 30 days following the effective date of the passage of this law.
(b) Such notice shall also include information regarding the required special open enrollment period.
Source.
2007, 352:4. 2009, 235:13. 2010, 243:11, eff. Sept. 23, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-C - Preferred Provider Agreements › Section 420-C:4-b - Coverage for Dependents.

420-C:4-b Coverage for Dependents. –
If the coverage for dependent children includes coverage for dependent children who are full-time students, as defined by the appropriate educational institution, beyond the age of 18, such dependent coverage shall include coverage for a dependent's medically necessary leave of absence from school for a period not to exceed 12 months or the date on which coverage would otherwise end pursuant to the terms and conditions of the policy, whichever comes first. Any breaks in the school semester shall not disqualify the dependent child from coverage under this section. Documentation and certification of the medical necessity of a leave of absence shall be submitted to the insurer by the student's attending physician and shall be considered prima facie evidence of entitlement to coverage under this section. The date of the documentation and certification of the medical necessity of a leave of absence shall be the date the insurance coverage under this section commences.
Source.
2007, 289:18, eff. Jan. 1, 2008.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-C - Preferred Provider Agreements › Section 420-C:4-c - Pre-certification Requirement.

420-C:4-c Pre-certification Requirement. –
In the event that a person is covered by more than one plan that requires pre-certification, the member shall obtain pre-certification from the primary plan. Although the member shall not be required to obtain pre-certification from the secondary plan, the secondary plan shall not be required to treat such services as covered services if the services do not meet its certification criteria. The secondary plan shall not refuse payment for such services solely on the basis that the services were not pre-certified by the secondary plan.
Source.
2007, 289:18, eff. Jan. 1, 2008.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-C - Preferred Provider Agreements › Section 420-C:5 - Discrimination Prohibited.

420-C:5 Discrimination Prohibited. –
No health care insurer shall discriminate against any provider on the basis of religion, race, color, national origin, age, sex, gender identity, sexual orientation, or marital status. Reasonable terms and conditions including, but not limited to, those based on economic or geographic considerations, certain affiliations, or professional privileges shall not be prohibited under this section.
Source.
1987, 112:1, eff. July 5, 1987. 2019, 332:18, eff. Oct. 15, 2019.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-C - Preferred Provider Agreements › Section 420-C:5-a - Prohibiting Limitations on Liability; Disclosure of Information.

420-C:5-a Prohibiting Limitations on Liability;  Disclosure of Information. –
I. No contract between a health care insurer and a physician, for the purpose of delineating the rights and obligations of the parties within the provider network, shall limit the liability of the health care insurer for any actions of the physician for which the health care insurer might otherwise be liable.
II. No contract between a health care insurer and a health care provider shall limit what information such health care provider may disclose to patients or to prospective patients regarding the provisions, terms, or requirements of the health care insurer's products as they relate to the needs of such provider's patients except for trade secrets of significant competitive value.
III. No contract shall use the term physician for the purpose of allowing a health care insurer to avoid contracting with other health care professionals for health care services. A physician shall mean a person licensed to practice medicine under RSA 329. Nothing in this section shall be construed to require a health care insurer to contract with a health care provider.
IV. No contract between a health care insurer and a health care provider shall limit coverage for preexisting conditions beyond 9 consecutive months from the date of enrollment.
Source.
1995, 126:5. 1996, 149:5. 1998, 377:2. 2007, 289:19, eff. Jan. 1, 2008.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-C - Preferred Provider Agreements › Section 420-C:6 - Rulemaking.

420-C:6 Rulemaking. –
I. The commissioner may adopt rules under RSA 541-A necessary for the implementation and administration of this chapter, relative to:
(a) The length of time necessary for health care insurers to comply with this chapter; and
(b) The information he shall require health care insurers to provide to demonstrate compliance with this chapter.
II. The commissioner may adopt rules under RSA 541-A relative to the administration of this chapter.
Source.
1987, 112:1. 2002, 207:30, eff. July 15, 2002.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-C - Preferred Provider Agreements › Section 420-C:8 - Other Applicable Statutes.

420-C:8 Other Applicable Statutes. –
Preferred provider agreements and health benefit plans subject to this chapter shall also be governed by the provisions of RSA 420-G and RSA 420-J.
Source.
1997, 344:9, eff. July 1, 1997; 344:17, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-D - Continuing Care Communities › Section 420-D:2 - Certificate of Authority.

420-D:2 Certificate of Authority. –
I. No person or provider may solicit funds, accept payments of any kind, or otherwise engage in providing any form of continuing care without a certificate of authority issued under this chapter. An application for a certificate shall include the proposed disclosure statement required under RSA 420-D:4 and in addition to any other state or federal licensure or certification which may be required, a statement indicating that all of the requirements under this chapter have been met. The commissioner shall take prompt action on requests for a certificate and shall, within a reasonable time, issue a certificate or a written rejection. If he rejects an application, he may do so outright or state the conditions which must be met before a certificate shall be issued. The applicant may request reconsideration and shall be granted a hearing in accordance with rules adopted by the commissioner. Certificates issued under this section shall continue in effect until revoked by the commissioner or until sale or transfer of management control to another owner or provider.
II. [Repealed.]
III. Continuing care facilities which reported to or were under the supervision of the director of charitable trusts of the department of justice under RSA 7:19 through 32-a on January 1, 1989, shall be exempt from the provisions of this chapter. However, any such facility may elect by a one-time irrevocable election to be subject to the provisions of this chapter by filing an application for a permanent certificate of authority with the commissioner.
Source.
1988, 44:2. 1990, 36:1. 1999, 249:2, 6, I, eff. Sept. 7, 1999.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-D - Continuing Care Communities › Section 420-D:3 - Renewal of Certificate of Authority.

420-D:3 Renewal of Certificate of Authority. –
Certificates of authority shall continue in effect until revoked by the commissioner. Certificates shall not be transferred during this time to another provider or owner. The commissioner shall establish a fee for applications for certificates of authority by rules adopted under RSA 541-A.
Source.
1988, 44:2, eff. Jan. 1, 1989.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-D - Continuing Care Communities › Section 420-D:3-a - Continuing Care at Home Contracts.

420-D:3-a Continuing Care at Home Contracts. –
I. A provider may contract to provide continuing care to a resident who remains at home and does not move immediately into a facility if the provider:
(a) Holds a certificate of authority issued under this chapter to provide continuing care.
(b) Owns and operates a facility located in New Hampshire where the resident has the right to receive board, lodging, or both, and other services.
(c) Satisfies the commissioner that the proposal to offer continuing care contracts to residents who do not move immediately into the facility will not place the provider in an unsound financial condition and will not be injurious or hazardous to any resident contracting with the provider for continuing care.
(d) Otherwise complies with all requirements of this section and RSA 420-D.
II. Any provider that issues contracts under this section shall:
(a) Be in good standing with the commissioner, not subject to action pursuant to RSA 420-D:5.
(b) Be responsible for all services the provider or any third party provides to the resident in the resident's home pursuant to the contract, and shall exercise direct control and oversight over any individual or entity providing those services.
(c) Have procedures to ensure that any third party providing services to the resident in the resident's home pursuant to the contract is trustworthy and certified, licensed, or otherwise qualified under state law to provide those services.
III. The provider and any person employed by the provider that assists in delivery of services to the resident in the resident's home shall have a business location within the state of New Hampshire, hold appropriate licenses and shall be available to address complaints, questions, and concerns of residents.
Source.
2010, 144:6, eff. Jan. 1, 2011.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-D - Continuing Care Communities › Section 420-D:5 - Revocation or Suspension of Certificate of Authority; Liens.

420-D:5 Revocation or Suspension of Certificate of Authority;  Liens. –
I. The commissioner may revoke, deny, or suspend a certificate upon notice and hearing with written findings of fact if he finds that any of the following conditions exist:
(a) Violation by a provider of any provisions of this chapter or any rule adopted pursuant to it.
(b) Failure to continue to meet the requirements of the certificate of authority.
(c) Lack of any qualifications necessary under this chapter for the certificate of authority.
(d) Failure to file a disclosure statement under RSA 420-D:4 or failure to disclose such to a prospective resident.
(e) Fraud or misrepresentation of a material fact in the disclosure statement.
(f) Failure to comply with a cease and desist order under RSA 420-D:24.
(g) Misappropriation, conversion, or wrongful withholding of money.
(h) A demonstrated lack of fitness or trustworthiness.
(i) Failure to make a new application for certificate of authority in accordance with RSA 420-D:13 when there is a sale, transfer of ownership, or partial ownership, or transfer of control.
(j) Such unsound financial condition or any other practice which may be hazardous or injurious to residents or to the general public.
(k) Failure to maintain a complete list of all entrance fees paid by each resident or prospective resident by the provider or his escrow agent.
(l) Failure to file an annual report in accordance with RSA 420-D:7.
II. If necessary to protect the interests of the residents, the commissioner shall file a lien in accordance with RSA 420-D:9 on the real and personal property of the provider and shall take any other action necessary to protect the residents of the facility.
Source.
1988, 44:2. 2010, 144:7, eff. Jan. 1, 2011.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-D - Continuing Care Communities › Section 420-D:6 - Appeal.

420-D:6 Appeal. –
Any person, corporation, partnership, or association aggrieved by the action of the commissioner in revoking, suspending, or refusing to grant or reissue a certificate has the right to a rehearing and appeal in accordance with the provisions of RSA 541.
Source.
1988, 44:2, eff. Jan. 1, 1989.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-D - Continuing Care Communities › Section 420-D:8 - Liquid Reserves.

420-D:8 Liquid Reserves. –
Liquid reserves of each facility subject to this chapter shall be maintained equal to 12 months' principal and interest payments plus that portion of 2 months' operating expenses which relates to life care residents. Other reserves or trust accounts under the exclusive control of the provider shall be considered in making this determination. The commissioner may adopt rules pursuant to RSA 541-A relative to the definition of liquid reserves. The commissioner may require liquid reserves to be placed in escrow and shall prescribe escrow conditions and shall approve the escrow agent. If the provider contracts with any resident to return any portion of the entrance fee to such resident or his estate, the commissioner may make a finding if necessary to protect the best interests of the resident that a reserve be established by the provider in accordance with rules adopted by the commissioner.
Source.
1988, 44:2, eff. Jan. 1, 1989.