N.H. Admin. Code § Ins 4105.03

Current through Register No. 50, December 12, 2024

Section Ins 4105.03 - Definitions

For the purposes of this part:

(a) "Actuarial certification" means a written statement signed by a member of the American Academy of Actuaries, stating that to the best of the actuary's knowledge and judgment, the entire rate filing is in compliance with all of the applicable laws and rules and that the benefits are reasonable in relation to the premiums;

(b) "Actuarial memorandum" means the document describing the basis on which rates were determined and that indicates and describes the calculation of the anticipated loss ratio;

(c) "Anticipated loss ratio" means the calculation of the medical loss ratio over a period that is at least as great as the anticipated policy lifetime but does not exceed 20 years;

(d) "Case characteristics" means demographic or other objective characteristics of a small employer that are considered by the small employer stop loss carrier in the determination of premium rates for the small employer;

(e) "Carrier" means any entity that provides stop loss health insurance in this state, including insurance companies, health services corporations, health maintenance organizations, fraternal benefit societies and other entities subject to state insurance regulation;

(f) "Durational medical loss ratio" means the medical loss ratio calculated for a specified duration not to exceed 12 months;

(g) "Earned premium" means all monies paid by a policyholder as a condition of receiving coverage;

(h) "Eligible employee" means any employee who is eligible for the employer's sponsored health benefit plan. The term includes a sole proprietor, a partner of a partnership, and an independent contractor, if these individuals are included as employees under the small employer's health benefit plan;

(i) "Employee" means an employee under Section 3(6) of Title I of the Employee Retirement Income Security Act of 1974 (ERISA);

(j) "Enrolled employee" means an eligible employee who has elected coverage in the employer's sponsored health benefit plan;

(k) "Health coverage" means the health insurance that meets the definition in RSA 420-G:2 IX;

(l) "Incurred claims" means paid claims plus any changes to claim reserves;

(m) "Large employer" means any person, firm, corporation, or partnership that is actively engaged in business that, on at least 50 percent of the working days during the preceding calendar year, employs at least 51 employees who are eligible for employer sponsored coverage, and the majority of whom are employed within this state;

(n) "Medical loss ratio" means the ratio of incurred claims to earned premiums;

(o) "Premium" means the total amount due from a small employer policyholder to a small employer stop loss carrier for the provision of stop loss health coverage;

(p) "Rate" or "premium rate" means an amount per covered person or an amount per enrolled employee used to calculate premium;

(q) "Small employer" means any person, firm, corporation, or partnership that is actively engaged in business that, on at least 50 percent of the working days during the preceding calendar year, employed fewer than 50 employees, the majority of whom were employed within this state;

(r) "Small employer stop loss carrier" means a carrier that offers stop loss health insurance to one or more small employers in this state; and

(s) "Tier" or "tier membership" means a category of enrollment to which enrolled employees can elect coverage, and includes at a minimum, "single employee" and "family" tiers.

N.H. Admin. Code § Ins 4105.03

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

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