reglab/statecodes huggingface dataset:
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-G - Portability, Availability, and Renewability of Health Coverage › Section 420-G:5 - Medical Underwriting.

420-G:5 Medical Underwriting. –
I. Health carriers providing health coverage shall not perform medical underwriting, including the use of health statements or screenings or the use of prior claims history.
II. Regardless of claim experience, health status, or medical history, health carriers providing health coverage for individual or small employers shall not refuse to write or issue any of their available coverages or health benefit plans to any individual or small employer group that elects to be covered under that plan and agrees to make premium payments and meet the other requirements of the plan.
II-a. Health carriers shall not establish any annual or lifetime limits on the dollar value of essential health benefits for any individual, except annual or lifetime limits may be imposed on specific covered benefits that are not essential health benefits to the extent permitted under federal law as of January 1, 2019.
III. Health carriers providing health coverage for small employer groups shall not knowingly provide health coverage to groups where the employer has discriminated based on health status or claims history against any employee or potential employee or his or her dependents with respect to participation in an employer-sponsored health benefit plan.
IV. Health carriers shall not offer riders or endorsements to exclude certain illnesses or health conditions in order to avoid the purpose of this chapter.
V. Individual health insurance carriers shall be responsible for ascertaining the eligibility of any individual applicant or insured for high risk pool coverage. If a carrier determines that an individual meets any of the eligibility criteria set forth in RSA 404-G:5-e, the carrier shall give the individual written notice, with the declination of coverage, the coverage offering or upon a rate increase at renewal. The notice shall include information about available benefits and exclusions of high risk pool coverage and the name, address, and telephone number of the pool administrator or the administrator's designee.
VI. It shall constitute an unfair trade practice under RSA 417 for an insurer, insurance producer, or third party administrator to refer an individual employee to the pool, or arrange for an individual employee to apply to the pool, for the purpose of separating that employee from group health insurance coverage provided in connection with the employee's employment.
VII. Health carriers and health insurance producers shall ensure that persons seeking coverage through a small employer group who are required to complete a health statement have an option to convey the required information directly to the carrier or the producer through a secure means and bypassing the employer.
VIII. [Repealed.]
Source.
1997, 344:1. 1998, 340:11. 2001, 295:12. 2003, 188:7; 201:1, 2. 2004, 251:10, 11. 2005, 225:11. 2006, 125:1. 2009, 235:15. 2011, 189:7, eff. Aug. 13, 2011. 2019, 113:9, eff. Aug. 20, 2019; 220:5, eff. Sept. 10, 2019.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-G - Portability, Availability, and Renewability of Health Coverage › Section 420-G:7 - Preexisting Condition Exclusion Periods.

420-G:7 Preexisting Condition Exclusion Periods. –
A health carrier shall not impose any preexisting condition exclusion with respect to coverage in the individual, small group, or large group market.
Source.
1997, 344:1. 2003, 188:11, 12. 2007, 289:23, eff. Jan. 1, 2008. 2019, 220:8, eff. Sept. 10, 2019.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-G - Portability, Availability, and Renewability of Health Coverage › Section 420-G:9 - Minimum Participation Requirements.

420-G:9 Minimum Participation Requirements. –
I. A health carrier may not require more than the minimum participation percentage of the employees eligible for health coverage in a small employer group to participate in the health carrier's health coverage plan. The minimum participation percentage shall be 75 percent when the health carrier's plan is the sole health coverage plan being sponsored by the employer group, and 37.5 percent when the health carrier's plan is not the sole health coverage plan being sponsored by the employer group.
II. For the purpose of calculating whether or not a small employer group's enrollment meets a carrier's minimum participation requirements:
(a) Any full-time or part-time employees who are covered as a dependent on another person's health coverage shall be excluded from the count.
(b) The total number of full-time employees and part-time employees who are otherwise eligible for health coverage shall be counted.
III. The minimum participation requirements shall be calculated on an employer-by-employer basis if the small employer is part of an association, trust, or other similar arrangement.
IV. In performing the computation to determine the actual enrollment necessary to meet the minimum participation requirement as a small employer group, the health carrier shall round any fractional number to the higher integer.
V. For the purpose of calculating whether or not a small employer group's enrollment meets a carrier's minimum participation requirements:
(a) Any full-time or part-time employee who is covered as a dependent on another person's health coverage or is enrolled in a governmental plan such as Medicare, Medicaid, or TRICARE shall be excluded from the count.
(b) Any full-time or part-time employee who has been found eligible for a premium tax credit and is enrolled in a qualified health plan (QHP) purchased through an exchange shall be excluded from the count.
(c) The total number of full-time employees and part-time employees who are otherwise eligible for health coverage shall be counted.
VI. The requirements under this section shall be the only participation requirements. Minimum employer contributions, or other criteria, shall not be permitted.
Source.
1997, 344:1. 1998, 340:15, eff. Aug. 25, 1998. 2019, 220:10, eff. Sept. 10, 2019.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-G - Portability, Availability, and Renewability of Health Coverage › Section 420-G:10 - Qualified Association Trust and Qualified Purchasing Alliance.

420-G:10 Qualified Association Trust and Qualified Purchasing Alliance. –
I. A qualified association trust or other entity, as defined in RSA 420-G:2, XV, and a qualified purchasing alliance, as defined in RSA 420-M:2, X, shall:
(a) Comply with the rating restrictions outlined in RSA 420-G:4 for all small employer members with 50 or fewer employees based upon the association's or alliance's group experience, except that for a qualified association trust, no rating factor shall be utilized without the express written consent of the association.
(b) Offer all eligible members, as defined under the applicable trust or other documents, coverage and rates on a guaranteed issue and renewable basis.
(c) Comply with the regulations concerning medical underwriting in RSA 420-G:5.
(d) Comply with the preexisting conditions provision of RSA 420-G:7.
(e) Prohibit any employer that voluntarily discontinues participation in either a qualified association trust or a qualified purchasing alliance from rejoining for a period of at least 24 months.
II. Nothing in this chapter shall be interpreted to limit the size of employers who may participate in coverage with a qualified association trust or a qualified purchasing alliance.
Source.
1997, 344:1. 2003, 188:8. 2010, 346:10, eff. July 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-G - Portability, Availability, and Renewability of Health Coverage › Section 420-G:10-a - Voluntary Small Employer Health Insurance Purchasing Alliances; Rulemaking.

420-G:10-a Voluntary Small Employer Health Insurance Purchasing Alliances;  Rulemaking. –
I. The commissioner shall have the regulatory oversight authority to set standards for the licensure and conduct of purchasing alliances authorized under this section and to enforce such standards.
II. Each applicant and each duly licensed purchasing alliance shall file with the commissioner such information or documents as the commissioner shall adopt by rule as necessary to perform oversight function.
III. [Repealed.]
IV. [Repealed.]
V. The commissioner shall adopt such rules, under RSA 541-A, and issue such orders as may be necessary to carry out the commissioner's oversight responsibilities under this section.
Source.
2000, 2:2. 2010, 346:3, II, eff. July 20, 2010.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-G - Portability, Availability, and Renewability of Health Coverage › Section 420-G:11-a - Development of a Comprehensive Health Care Information System.

420-G:11-a Development of a Comprehensive Health Care Information System. –
I. The department, the department of justice, and the department of health and human services shall enter into a memorandum of understanding for collaboration in the development of a comprehensive health care information system, the sharing of submitted data fields, and the role of each in the security of transferred health care data. The memorandum of understanding shall include a description of the data sets that will be included in the comprehensive health care information system, the criteria and procedures for the development of limited use data sets, the criteria and procedures to ensure that Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant limited use data sets are accessible, and a proposed time frame for the creation of a comprehensive health care information system. To the extent allowed by HIPAA, the data shall be available as a resource for insurers, employers, providers, purchasers of health care, and state agencies to continuously review health care utilization, expenditures, and performance in New Hampshire and to enhance the ability of New Hampshire consumers and employers to make informed and cost-effective health care choices. In presenting data for public access, comparative considerations shall be made regarding geography, demographics, general economic factors, and institutional size. Notwithstanding HIPAA or any other provision of law, the comprehensive health care information system shall not include or disclose any data that contains direct personal identifiers. For the purposes of this section, "direct personal identifiers" include information relating to an individual that contains primary or obvious identifiers.
II. The commissioner of the department of health and human services, with the approval of the commissioner of the insurance department, shall adopt rules, under RSA 541-A, as may be necessary to provide for the release of claims data from the comprehensive health care information system (CHIS).
III. The department shall make available to the public a public use data set for purposes of facilitating transparency in health care costs.
Source.
2003, 292:6. 2005, 248:19. 2015, 210:1, eff. Sept. 4, 2015. 2019, 233:6, eff. July 12, 2019.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-G - Portability, Availability, and Renewability of Health Coverage › Section 420-G:12 - Rating Practices and Filings.

420-G:12 Rating Practices and Filings. –
I. Each health carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation which demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles.
II. Each health carrier shall file each March 1, with the commissioner, an actuarial certification stating that the health carrier is in compliance with this section and that the rating methods of the health carrier are actuarially sound.
III. A health carrier shall make the information and documentation described in paragraph I available to the commissioner upon request.
IV. Each health carrier shall provide, at the time it gives a premium quote to a group, a rating disclosure form that identifies the health coverage plan rate and any adjustments to that rate resulting from the application of rating factors, including age, industry, and group size. The health carrier shall submit the rate disclosure form to the department for approval. Health carriers shall provide their insureds with renewal premium quotes at least 60 days prior to the expiration date of the policy.
Source.
1997, 344:1. 2006, 125:2, eff. July 14, 2006.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-G - Portability, Availability, and Renewability of Health Coverage › Section 420-G:12-a - Health Plan Loss Information.

420-G:12-a Health Plan Loss Information. –
I. To ensure maximum competition in the purchase of group health insurance, all large employers shall be entitled to receive their specific health plan loss information upon request and without charge. No contract between any health carrier, third-party administrator, employer group, or pool of employers shall abridge this right in any manner.
II. Upon written request from any large employer, every health carrier, third-party administrator, pooled risk management program under RSA 5-B or any other type of multiple employer health plan shall provide that employer's loss information within 30 calendar days of receipt of the request. The loss information shall include all physician, hospital, prescription drug, and other covered medical claims specific to the employer's group plan incurred for the 12-month period paid through the 14 months which end within the 60-day period prior to the date of the request. An employer shall not be entitled by this section to more than 2 loss information requests in any 12-month period; however, nothing shall prohibit a carrier from fulfilling more frequent requests on a mutually agreed-upon basis.
III. If an employer requests loss information from an insurance agent or other authorized representative, including an administrator of a pooled risk management program or a multiple employer health plan, the agent or authorized representative shall transmit the request to the health carrier or carriers or third-party administrator within 4 working days.
Source.
2001, 120:2. 2003, 127:1; 188:9. 2004, 187:14, eff. July 31, 2004.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-G - Portability, Availability, and Renewability of Health Coverage › Section 420-G:13 - Approval of Rate Filings.

420-G:13 Approval of Rate Filings. –
No policy or contract of insurance or any certificate under such policy or contract or other evidence of coverage shall be issued to a small employer or an individual under this chapter until the premium rates have been filed and approved by the commissioner. The commissioner shall approve or disapprove such rates within 30 days of receipt. The commissioner may disapprove rate filings if the commissioner finds such rates to be excessive, inadequate, or contrary to the intent of this chapter.
Source.
1997, 344:1, eff. July 1, 1997.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-G - Portability, Availability, and Renewability of Health Coverage › Section 420-G:14 - Rulemaking Authority.

420-G:14 Rulemaking Authority. –
I. (a) The commissioner may adopt rules, under RSA 541-A, relative to:
(1) Uniform age rating levels that are consistent with 45 C.F.R. 147.102.
(2) Special enrollment periods designed to allow employees to purchase individual coverage on the exchange during their employer's open enrollment period, even if the employer's open enrollment period does not coincide with the open enrollment period in the individual market.
(3) Essential health benefits, in accordance with RSA 420-G:4-d, II and III.
(b) The commissioner may adopt further rules, pursuant to RSA 541-A, necessary to the proper administration of this chapter.
II. The commissioner, with the approval of the commissioner of the department of health and human services, shall adopt rules, under RSA 541-A, defining the content, format, and schedule for the filing of encrypted claims data and HEDIS information under RSA 420-G:11.
Source.
1997, 344:1. 2002, 207:50. 2003, 292:5, eff. July 18, 2003. 2019, 220:11, eff. Sept. 10, 2019.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-G - Portability, Availability, and Renewability of Health Coverage › Section 420-G:14-b - Prohibited Transactions.

420-G:14-b Prohibited Transactions. –
No health care provider shall submit a claim for reimbursement, or otherwise accept payment, for health care services provided to a patient covered by individual health insurance if the provider has paid the premium for such individual health insurance.
Source.
1998, 340:16, eff. Aug. 25, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-G - Portability, Availability, and Renewability of Health Coverage › Section 420-G:14-c - Repealed by 2003, 188:17, eff. Jan. 1, 2009.

420-G:14-c Repealed by 2003, 188:17, eff. Jan. 1, 2009. –
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-G - Portability, Availability, and Renewability of Health Coverage › Section 420-G:15 - Severability.

420-G:15 Severability. –
If any provision of this chapter or the application thereof to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of the chapter which can be given effect without the invalid provisions or applications, and to this end the provisions of this chapter are severable.
Source.
1997, 344:1, eff. July 1, 1997.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-G - Portability, Availability, and Renewability of Health Coverage › Section 420-G:16 - Penalties for Violations.

420-G:16 Penalties for Violations. –
Any health carrier who proposes, advertises, solicits, issues or delivers to any person or entity in this state any form which does not comply with this chapter or who shall in any way violate this chapter may:
I. Be prohibited from marketing, selling, or otherwise administering to the individual or small employer market if the commissioner finds a health carrier to be in violation of RSA 420-G.
II. Be subject to an administrative fine not to exceed $2,500 for each violation. Repeated violations of the same chapter shall constitute separate fineable offenses.
III. Have its certificate of authority indefinitely suspended or revoked at the discretion of the commissioner.
Source.
1997, 344:1, eff. July 1, 1997.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-H - Explanation of Benefits › Section 420-H:1 - Purpose.

420-H:1 Purpose. –
The legislature finds and declares that:
I. Current and prospective beneficiaries, and enrollees and subscribers of group and individual health policies and hospital service plans, nonprofit health service plans, medical service plans, and health maintenance organizations do not always understand the medical services that will and will not be covered by such third-party payors, or the payment schedule contained in such policies or plans.
II. Third-party payors should be required to provide such information regarding covered services in clear and simple terms with an easily understandable schedule of payment for services covered to current and potential beneficiaries, enrollees and subscribers.
Source.
1994, 359:1, eff. Jan. 1, 1997.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-H - Explanation of Benefits › Section 420-H:2 - Definitions.

420-H:2 Definitions. –
As used in this chapter:
I. "Certificate" means a document received by an insured, enrollee, or subscriber from an insurer in lieu of a policy or contract which evidences the coverage to which the insured, enrollee or subscriber is entitled.
II. "Commissioner" means the commissioner of the insurance department.
III. "Company" or "insurer" means any life or health insurance company, fraternal benefit society, nonprofit health service corporation, nonprofit hospital service corporation, nonprofit medical service corporation, prepaid health plan, dental care plan, vision care plan, pharmaceutical plan, health maintenance organization, and all similar type organizations.
IV. "Policy" or "policy form" means any policy, contract, certificate, plan or agreement of life or health insurance, including credit life insurance and credit health insurance, delivered or issued for delivery in this state by any company subject to this chapter; any certificate, contract or policy issued by a fraternal benefit society; and any certificate issued pursuant to a group insurance policy delivered or issued for delivery in this state.
Source.
1994, 359:1, eff. Jan. 1, 1997.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-H - Explanation of Benefits › Section 420-H:3 - Scope.

420-H:3 Scope. –
This chapter shall apply to all policies delivered or issued for delivery in this state by any company on or after the date such forms must be approved under this chapter, but nothing in this chapter, shall apply to:
I. Any policy which is a security subject to federal jurisdiction;
II. Any group policy covering a group of 1,000 or more lives at date of issue, other than a group credit life insurance policy or a group credit health insurance policy; however, this shall not exempt any certificate issued pursuant to a group policy delivered or issued for delivery in this state;
III. Any group annuity contract which serves as a funding vehicle for pension, profit sharing or deferred compensation plans;
IV. Any form used in connection with, as a conversion from, as an addition to, or in exchange pursuant to a contractual provision for, a policy delivered or issued for delivery on a form approved or permitted to be issued prior to the dates such forms must be approved under this chapter;
V. The renewal of a policy delivered or issued for delivery prior to the dates such forms must be approved under this chapter.
Source.
1994, 359:1, eff. Jan. 1, 1997.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-H - Explanation of Benefits › Section 420-H:4 - Requirements.

420-H:4 Requirements. –
Enrollees, subscribers, certificate holders, and individual insureds shall receive in simple and concise written language at least the following information:
I. An explanation of benefits provided.
II. Any benefit limitations, reductions, exclusions or exceptions to covered services, including an explanation of any restrictions on a subscriber's access to network practitioners based upon the subscriber's choice of primary care physician. The explanation of restrictions shall include a section regarding "referrals to other providers or other medical specialists" that shall urge enrollees, subscribers, certificate holders, and individual insureds to inquire about their primary care provider's referral group within the insurer's network. Such explanation shall include a general statement regarding the existence of physician hospital organizations within the insurer's network, to which primary care providers may be associated.
III. The nature of any payments required of the beneficiary, enrollee or subscriber such as copayments or deductibles.
IV. The nature of any limitations on payment by the insurer, including limitations based on the use of network or out-of-network health care providers.
V. The credentials of any health care provider the health care plan holds out as a specialist denoting board eligibility or board certification for such specialty.
VI. For companies or insurers providing health insurance through a managed care system of health care delivery or reimbursement, a description of the grievance procedures as required pursuant to RSA 420-J:5.
VII. For enrollees, subscribers, certificate holders, or individual insureds whose health insurance is provided through a managed care system of health care delivery and reimbursement, an explanation of a covered person's option to receive direct access to certain obstetrical-gynecological care, pursuant to RSA 420-J:6-a.
Source.
1994, 359:1. 1998, 216:1; 319:2. 2001, 207:16. 2002, 59:1, eff. June 25, 2002.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-H - Explanation of Benefits › Section 420-H:6 - Powers of the Commissioner.

420-H:6 Powers of the Commissioner. –
The commissioner may authorize a lower score than the Flesch reading ease score required in RSA 420-H:5, I(a) whenever he finds that a lower score:
I. Will provide a more accurate reflection of the readability of a policy form;
II. Is warranted by the nature of a particular policy form or type or class of policy forms; or
III. Is caused by certain policy language which is drafted to conform to the requirements of any state law, rule or agency interpretation.
Source.
1994, 359:1, eff. Jan. 1, 1997.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-H - Explanation of Benefits › Section 420-H:7 - Approval of Forms.

420-H:7 Approval of Forms. –
A policy form meeting the requirements of RSA 420-H:5, I shall be approved notwithstanding the provisions of any other laws which specify the content of policies, if the policy form provides the policyholders and claimants protection not less favorable than they would be entitled to under such laws.
Source.
1994, 359:1, eff. Jan. 1, 1997.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-I - Prohibition of Exclusive Arrangements With Managed Care Insurers › Section 420-I:1 - Definitions.

420-I:1 Definitions. –
In this chapter:
I. An "affiliate" of a specific person means any person directly or indirectly controlling, controlled by or under common control with such specific person.
II. "Exclusive arrangement" means any agreement, contract, combination or conspiracy, including, without limitation, acquisition, purchase, affiliation or consulting agreements with medical practitioners or group practices and contracts of employment, between a managed care insurer and any person or persons which has the purposes or effect of:
(a) Committing any person providing physician services to accept and treat as patients the subscribers to or participants in a managed care plan to the exclusion of persons who have coverage from any or all other managed care insurers;
(b) Providing reimbursement on sliding scales, capitation rates, payment schedules or other payment arrangements as a financial incentive for persons providing physician services to restrict treatment of persons who have coverage from some or all other managed care insurers; or
(c) Providing reimbursement on sliding scales, capitation rates, payment schedules or other payment arrangements which contain a financial disincentive for failing to restrict treatment of persons who have coverage through any or all other managed care insurers.
III. "Managed care" means any arrangement for the provision of physician services which is characterized by some measure of risk-sharing through capitated or other shared-risk compensation formulae, and which are characterized by the establishment and maintenance of a provider network available to subscribers or participants, and which provides incentives for subscribers or participants to use that network for covered services, and which ordinarily limit coverage or the extent of such coverage to physician services provided by that network. "Managed care" shall include any managed care products or services or similar products including but not limited to those governed by RSA 415, RSA 419, RSA 420, RSA 420-A, RSA 420-B, and RSA 420-C. "Managed care" shall not include direct primary care services which meet the requirements of RSA 329:1-e.
IV. "Managed care insurer" means a person offering or underwriting managed care and any affiliate thereof.
V. "Managed care plan" means any medical insurance plan offering or underwriting managed care.
VI. "Person" includes natural persons, trusts, corporations, limited liability companies, partnerships, limited partnerships, proprietorships, incorporated or unincorporated associations, and any other legal entity, and any and all of their affiliates.
Source.
1996, 134:2, eff. May 21, 1996. 2019, 330:4, eff. Oct. 15, 2019.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-I - Prohibition of Exclusive Arrangements With Managed Care Insurers › Section 420-I:2 - Prohibition of Exclusive Arrangements.

420-I:2 Prohibition of Exclusive Arrangements. –
I. No managed care insurer may enter into any new exclusive arrangement or renew any exclusive arrangement with any person on or after the effective date of this act.
II. No managed care insurer shall maintain exclusive arrangements or engage in any act or practice that would result in exclusive arrangements with any person, except in accordance with paragraph III of this section, on or after June 30, 1997.
III. The provisions of paragraph II of this section shall not apply to physicians employed by a managed care insurer until June 30, 1999.
Source.
1996, 134:2, eff. May 21, 1996.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-I - Prohibition of Exclusive Arrangements With Managed Care Insurers › Section 420-I:3 - Penalties.

420-I:3 Penalties. –
In addition to those actions authorized under RSA 420-B:13, the commissioner may impose a penalty on any managed care insurer of not more than $2,500 for each day such managed care insurer shall be a party to a contract, arrangement, conspiracy, act or practice declared unlawful under RSA 420-I:2.
Source.
1996, 134:2, eff. May 21, 1996.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-I - Prohibition of Exclusive Arrangements With Managed Care Insurers › Section 420-I:4 - Reports to Insurance Commissioner.

420-I:4 Reports to Insurance Commissioner. –
Each managed care insurer shall file a report in form and containing such information as the insurance commissioner prescribes when requested by the commissioner. Such report shall include the name of the managed care insurer, its affiliates, a description of each exclusive arrangement to which it is a party and, as applicable, the date on which exclusive arrangement has been or will be terminated.
Source.
1996, 134:2. 2000, 166:4, eff. July 22, 2000.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-I - Prohibition of Exclusive Arrangements With Managed Care Insurers › Section 420-I:5 - Effect on Current Contracts.

420-I:5 Effect on Current Contracts. –
No person who is party to an exclusive arrangement on the effective date of this chapter shall renew or extend any such exclusive arrangement after the effective date of this act. No provision of any contract or agreement establishing an exclusive arrangement shall be effective after the earliest date on which any party to the arrangement may terminate the exclusive nature of the arrangement. All exclusive arrangements shall be unlawful on and after the date set out at RSA 420-I:2, II. Any exclusive arrangement entered into, extended or maintained in violation of this chapter shall be void and unenforceable.
Source.
1996, 134:2, eff. May 21, 1996.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-I - Prohibition of Exclusive Arrangements With Managed Care Insurers › Section 420-I:6 - Limitation on Termination of Patient Relations.

420-I:6 Limitation on Termination of Patient Relations. –
No exclusive arrangement between a managed care insurer and any person shall require a primary care physician to terminate any existing patient relationship with an individual who is covered by another managed care insurer. The physician shall continue to offer to provide services to existing patients for at least 5 years from the commencement date of this exclusive relationship or the effective date of the change of coverage, whichever is later. During such period, the physician will be reimbursed by the managed care insurer covering the patient at a rate which is not more than the highest rate paid by the insurer for similar services in the same service area.
Source.
1996, 134:2, eff. May 21, 1996.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-I - Prohibition of Exclusive Arrangements With Managed Care Insurers › Section 420-I:7 - Provisions Severable.

420-I:7 Provisions Severable. –
If any provision of this chapter or the application thereof to any person or circumstances is held to be invalid for any reason, such invalidity shall not affect any other provision or application of this chapter which may be effected without the invalid provision or application.
Source.
1996, 134:2, eff. May 21, 1996.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:1 - Purpose and Intent.

420-J:1 Purpose and Intent. –
The purpose and intent of this chapter is to provide standards for certain fundamental operations of licensed entities providing health insurance through a managed care system of health care delivery and reimbursement. The establishment of these standards will ensure regulatory and quality consistency among the several and various licensees offering managed care type benefit plans and will enable consumers to make informed decisions in their relationships with managed care insurers. This chapter is intended to apply only to those insurers offering managed care plans. It is not intended to apply to traditional indemnity systems of reimbursement and fee-for-service forms of health care expense coverage. Health insurers which do not significantly limit covered persons' choices of providers shall not be subject to this chapter.
Source.
1997, 345:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:2 - Applicability and Scope.

420-J:2 Applicability and Scope. –
This chapter shall apply to all health carriers offering a managed care plan in this state.
Source.
1997, 345:1, eff. Jan. 1, 1998.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:3-a - Access to Enhanced 911 System.

420-J:3-a Access to Enhanced 911 System. –
I. No health benefit plan issued or renewed after July 7, 2000 shall contain any provision which establishes or promotes an emergency medical response or transportation system that encourages or directs access by a covered person in competition with or in substitution of the state enhanced 911 system or other state, county, or local government emergency medical services system.
II. Notwithstanding paragraph I, a health carrier subject to this chapter may use transportation outside the enhanced 911 or other government emergency medical services system for services that are not in response to an emergency medical condition, as defined in RSA 420-J:3, XV.
III. No health benefit plan issued or renewed after July 7, 2000 shall contain any provision requiring a covered person to obtain prior authorization before accessing the enhanced 911 system or other state, county, or local government emergency medical services system for response and/or transportation for emergency services, as defined in RSA 420-J:3, XVI.
IV. No person who issues a health benefit plan subject to this chapter shall use false or misleading language in its enrollment sales materials or in any other materials provided to covered persons to discourage or prohibit covered persons from accessing the enhanced 911 system for response and/or transportation for emergency services.
Source.
2000, 104:2, eff. July 7, 2000.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:3-b - Pre-certification Requirement.

420-J:3-b 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, 289:26, eff. Jan. 1, 2008.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:4-a - Facility Credentialing.

420-J:4-a Facility Credentialing. –
I. Health carriers shall credential qualified entities administering community mental health programs as defined under RSA 135-C:7, entities administering community substance use disorder treatment programs as defined under RSA 172:2-c, and community health centers as facilities when paneling and enrolling participating providers, consistent with health carriers' facility credentialing standards and practices, unless the entity requests professional level credentialing. Health carriers shall not be required to credential entities who do not meet the health carriers' facility credentialing eligibility standards. If an entity disagrees with the outcome of a health carrier's application of its facility credentialing standards and practices, the entity may request a formal hearing and review of the carrier's decision by the New Hampshire insurance department pursuant to RSA 400-A:17 and/or file a complaint with the New Hampshire insurance department's health care provider complaint process.
II. Nothing in this section shall be construed to require a health carrier to select or enroll a specific facility as a participating provider.
Source.
2021, 183:9, eff. Sept. 9, 2021.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:6-a - Obstetrical-Gynecological Coverage.

420-J:6-a Obstetrical-Gynecological Coverage. –
I. Health plans shall not require prior authorization by a covered person's primary care provider for coverage of the following services provided by participating providers who specialize in obstetrics and gynecology:
(a) Maternity care;
(b) An annual gynecological visit; and
(c) Follow-up care for obstetrical or gynecological conditions identified during such maternity care or annual gynecological visit.
II. Health plans may establish reasonable requirements for participating obstetricians and gynecologists to communicate with the covered person's primary care provider regarding the covered person's condition, treatment, and any need for follow-up care.
Source.
1998, 319:1, eff. Jan. 1, 1999.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:6-b - Self-Referrals for Chiropractic Care.

420-J:6-b Self-Referrals for Chiropractic Care. –
A health benefit plan under this chapter offering chiropractic benefits shall provide benefits to a covered person who utilizes services of a chiropractic provider (doctor of chiropractic) by self-referral for 12 visits under the following conditions:
I. Unless otherwise provided for by the health benefits plan, self-referral visits shall not apply to wellness care visits.
II. A covered person may utilize the services of a doctor of chiropractic as defined in RSA 316-A, without discrimination relative to access and fees, subject to the terms and conditions of the policy.
III. The health benefit plan shall fully disclose to the certificate holder in clear and understandable language the exact terms and conditions of each option that the certificate holder has purchased along with the co-payments or other cost-sharing features of each option.
IV. Within 10 working days of the first visit or consultation, the doctor of chiropractic shall send to the health benefit plan, or its designee, the chiropractic case findings. This shall be sufficient documentation for the initial 12 visits.
V. After 12 self-referral visits, a covered person who is continuing chiropractic care may be subject to utilization review from the health plan, or its designee, for the purpose of continued care. A provider of the same specialty shall be consulted when making any utilization review determination under this section.
VI. If the chiropractic provider recommends care beyond 12 visits, the participating doctor of chiropractic shall send to the insurer, or its designee, documentation containing information on the covered person's progress and necessity of care as well as a care plan for extended chiropractic care. The care recommendation shall be deemed authorized if the health benefit plan does not respond to the care recommendation within 7 business days. If the doctor of chiropractic fails to provide the required documentation, the insured or its covered person shall not be liable to the chiropractic provider for any unpaid fees.
VII. The covered person shall retain the right to choose chiropractic care on an elective, self-pay, fee-for-service basis; no entity regulated under this chapter shall prohibit a doctor of chiropractic from continuing care on an elective, self-pay, fee-for-service basis.
VIII. Nothing in this section is intended to limit the health plan's ability to credential providers or structuring with network providers.
Source.
2000, 14:1, eff. April 18, 2000.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:6-c - Third-Party Payment of Covered, Court-Ordered Services.

420-J:6-c 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, 117:4, eff. Aug. 15, 2004.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:6-d - Coverage for Dependents.

420-J:6-d 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, 289:29, eff. Jan. 1, 2008.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:6-e - Coverage for Medically Necessary Dental Services.

420-J:6-e Coverage for Medically Necessary Dental Services. –
Health carriers shall provide coverage for medically necessary dental services resulting from an accidental injury to sound natural teeth and gums when the course of treatment for the accidental injury is received or authorized within 3 months of the date of the injury. Treatment made necessary due to injury to the jaw and oral structures other than teeth shall be covered without time limit. Coverage under this section shall be subject to such other terms and conditions of the policy that may apply.
Source.
2019, 113:3, eff. Aug. 20, 2019.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:7 - Network Adequacy.

420-J:7 Network Adequacy. –
I. A health carrier shall maintain a network that is sufficient in numbers, types, and geographic location of providers to ensure that all services to covered persons will be accessible without unreasonable delay.
II. The commissioner shall adopt rules under RSA 541-A for a health carrier's network adequacy. Such rules shall establish, but not be limited to:
(a) Waiting times for appointments for non-emergency care.
(b) Choice of and access to providers for specialty care, specifically addressing the needs of the chronically ill, mentally ill, persons with substance use disorder, developmentally disabled or those with a life threatening illness.
(c) Standards for geographic accessibility, which shall include standards for access to the provision of durable medical equipment requiring a prescription. However, such standards shall not restrict an insurer's ability to provide prescriptions for durable medical equipment that are shipped to the patient by postal service or other common or private carrier, and shall not apply to durable medical equipment devices used exclusively for the administration of medication.
(d) Hours of operation for the carrier, including any entities performing prior approval or pre-authorization functions.
(e) Standards for addressing in-network access to hospital based providers, such as anesthesiologists, radiologists, pathologists, and emergency medicine physicians.
III. The health carrier shall keep, at its place of business, a detailed description of the health carrier's compliance with rules adopted pursuant to RSA 420-J:7, II as well as its procedures for monitoring network adequacy.
IV. Annually, the health carrier shall submit a report to the commissioner demonstrating compliance with the rules for network adequacy.
V. The commissioner shall provide a report annually on the findings associated with network adequacy review to the chairpersons of the house and senate committees having jurisdiction over insurance issues.
Source.
1997, 345:1. 2008, 311:1, eff. Aug. 31, 2008. 2017, 214:1, eff. Jan. 1, 2018. 2018, 356:3, 4, eff. July 1, 2018.
2023 New Hampshire Revised Statutes › Title XXXVII - Insurance › Chapter 420-J - Managed Care Law › Section 420-J:7-c - Disqualification of Certain Physicians Prohibited.

420-J:7-c Disqualification of Certain Physicians Prohibited. –
A physician who is part of a health carrier's provider network on December 31, 2000, shall not be disqualified from participating in that network solely because such physician is not certified by a member board of the American Board of Medical Specialties.
Source.
2000, 248:1, eff. Aug. 8, 2000.