N.H. Admin. Code § Ins 4103.04

Current through Register No. 50, December 12, 2024

Section Ins 4103.04 - Underwriting and Issue Requirements

(a) A small employer carrier:

(1) Shall make all of its small employer health insurance plans available for purchase;

(2) Shall not make available for offer any coverage that has been discontinued in accordance with RSA 420-G:5;

(3) May limit coverage offers and renewals to small employer groups having one employee to specified time periods, as follows:

a. All small employer carriers shall offer and renew all available small employer health coverages to small employers having one employee during the months of April and October; and

b. Carriers electing to limit the time periods during which it offers and renews coverages to small employer groups having one employee shall act uniformly with respect to all such small employers; and

(4) May refuse to issue or renew coverage to any small employer where the number of enrolled employees is not at least as great as the minimum participation percentage times the total number of eligible employees.

(b) The minimum participation percentage shall be:

(1) Seventy-five percent when the plan is the sole plan being sponsored by the employer group; and

(2) Thirty-seven point five percent when the plan is one of two or more plans being sponsored by the employer group.

(c) For the purposes of (a)(4) above, the total number of eligible employees shall not include eligible employees who decline coverage and are covered as a dependent on another person's health coverage.

(d) Carriers shall only vary rates for health coverage provided to small employers by using allowable case characteristics that shall include:

(1) The attained ages of the covered population;

(2) The tier categories;

(3) The number of enrolled employees; and

(4) The type of industry in which the small employer is engaged.

(e) For purposes of (d) above, small employer carriers may use approximations to calculate allowable case characteristics provided such approximation methods:

(1) Are used uniformly for all small employer groups;

(2) Use the attained ages of enrolled employees with tier based membership factors to approximate the attained ages of the covered population; and

(3) Use a prior census to estimate the actual enrollment.

(f) Rates calculated at issue, or at renewal, shall not change throughout the policy year if the allowable case characteristics of a small employer group change.

N.H. Admin. Code § Ins 4103.04

#9690, eff 4-9-10; ss by #9938, eff 6-10-11; ss by #10212, eff 11-1-12

The amended version of this section by New Hampshire Register Volume 39, Number 24, eff.6/10/2019 is not yet available.