N.H. Admin. Code § Ins 401.08

Current through Register No. 50, December 12, 2024

Section Ins 401.08 - Group and Blanket Accident and Health

(a) Travel insurance policies shall comply with RSA 415:18, I-a(e) and Ins 4700. Long-term care insurance policies shall comply with RSA 415-D and Ins 3600. Medicare Supplemental insurance policies shall comply with RSA 415-F and Ins 1902 or Ins 1905. Required provisions for all other group accident and health insurance policies shall be those established in RSA 415:18.

(b) Other group accident and health policy standards, with the exception of policies regulated by Ins 3600, Ins 4700, Ins 1902, or Ins 1905, shall be as follows:

(1) Exclusions that are ambiguous or unfairly discriminatory shall be prohibited;

(2) All master policies and certificates shall contain a clear explanation as to continuance of coverage after termination of the policy;

(3) No group accident and health policy shall contain a provision for automatic termination of an individual's coverage upon the happening of a loss, except a loss that has exhausted all possible benefits under the policy;

(4) A certificate shall:

a. State the benefits applicable to the person insured or state the schedule of benefits applicable to the class to which he or she belongs; or

b. Define eligibility and benefit amounts clearly enough for a person to determine whether he or she is an insured and the amount of any benefits to which he or she is entitled;

(5) A policy may require that the insured:

a. Incur expenses that the insured is legally responsible to pay for;

b. Exclude charges that would not have been made if no insurance existed; and

c. Be responsible for non-covered services;

(6) All group certificates shall include a complete statement of the policy provisions regarding coordination or nonduplication of benefits in the event of other coverage;

(7) In the event of any renewal rate increase, insurers shall provide policyholders with prior notice of any such increase such that:

a. A 30 days' notice is provided for policies subject to RSA 415, which are not subject to RSA 420-G provisions; and

b. A 60 days' notice is provided for policies subject to RSA 420-G;

(8) Declination of renewal or termination of insurance provisions shall be as follows:

a. No insurer shall decline to renew a group policy unless the cause of its action is based on one or more of the reasons for declination of renewal stated in the policy;

b. Any such reason shall be stated in a group policy and shall be objective in nature;

c. Declination of renewal shall be defined so as to include any termination of a group policy by the insurer for any reason except for nonpayment of premiums; and

d. Notice of nonrenewal or termination of a group policy by the insurer shall provide for at least 45 days prior notice, except policies subject to RSA 420-G:6 VI. and VII;

(9) Non-duplication of coverage and subrogation provisions shall be as follows:

a. Benefit provisions for group medical expense insurance coverages may provide for non-duplication or coordination with any plan or government program providing benefits or services for medical or dental care and treatment;

b. All policies with non-duplication or coordination of benefit provisions shall:

1. Clearly stipulate how these provisions will be administered; and

2. Be at least as favorable to the insured as the provisions of Ins 1904; and

c. Group policies providing medical expense insurance coverages may include subrogation provisions or provisions that are similar in their intent and purpose; and

(10) In no case shall the benefits provided under the policy or the definitions contained in the policy be less favorable to the insured than the minimum standards for individual accident and health benefits set forth in RSA 415.

(c) Medical expense policies and certificates shall comply with preexisting condition requirements of RSA 420-G:7.

(d) Group excess policies shall be prohibited.

(e) The required provisions for blanket accident and health insurance policies shall be those established in RSA 415:18.

(f) Other blanket policy requirements shall be as follows:

(1) Except as provided in (2) below:

a. An individual certificate shall not be issued to the person or persons who may receive benefits under group blanket accident and health coverage; and

b. A person or persons who receive benefits under blanket policy shall not contribute directly to the premium payment for the policy; and

(2) Blanket accident and health insurance shall meet all requirements of individual limited benefit health insurance if coverage:

a. Is issued to identified members or subscribers;

b. Is based on individual enrollment; and

c. Provides that a certificate of coverage to enrolled members shall be issued on an individual basis.

(g) File and use provisions for complete filings shall be as follows:

(1) A form shall be deemed approved for use after the form has:

a. Been received by the commissioner as complete;

b. Been under review by the commissioner for at least 30 days from the date of filing; and

c. Not been objected to or rejected by the commissioner within 30 days from the date of filing;

(2) In order for a form to be deemed approved pursuant to subparagraph (1) above, the company shall notify the commissioner in writing of the date such form was deemed; and

(3) When a company withdraws from use any form that it has used in this state, written notice of such withdrawal shall be provided to the commissioner advising the commissioner of the date of such withdrawal.

N.H. Admin. Code § Ins 401.08

#8726, eff 9-18-06

Amended by Volume XXXVII Number 15, Filed April 13, 2017, Proposed by #12126, Effective 3/8/2017, Expires 3/8/2027.