Section Ins 2702.07 - Nonquantitative Treatment Limitations(a) General rule. Group health insurance coverage issued to a large group employer shall not impose a nonquantitative treatment limitation with respect to mental health or substance use disorder benefits in any classification unless, under the terms of the group health insurance coverage, as written and in operation, any processes, strategies, evidentiary standards, or other factors used in applying the nonquantitative treatment limitation to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the limitation with respect to medical/surgical benefits in the classification, except to the extent that recognized clinically appropriate standards of care may permit a difference.(b) Nonquantitative treatment limitations. Nonquantitative treatment limitations include: (1) Medical management standards limiting or excluding benefits based on medical necessity or medical appropriateness, or based on whether the treatment is experimental or investigative;(2) Formulary design for prescription drugs;(3) Standards for provider admission to participate in a network, including reimbursement rates;(4) Plan methods for determining usual, customary, and reasonable charges;(5) Refusal to pay for higher-cost therapies until it can be shown that a lower-cost therapy is not effective, also known as fail-first policies or step therapy protocols; and(6) Exclusions based on failure to complete a course of treatment.N.H. Admin. Code § Ins 2702.07
The amended version of this section by New Hampshire Register Volume 38, Number 50, eff. 12/3/2018 is not yet available.