N.H. Admin. Code § Ins 6001.03

Current through Register No. 50, December 12, 2024

Section Ins 6001.03 - Definitions

For the purposes of all ancillary health insurance, unless stated otherwise, the following definitions shall apply:

(a) "Activities of daily living (ADL)" means activities related to personal care, such as bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet, and eating;

(b) "Ancillary health insurance" means insurance written under RSA 415-A:3 (d), (g), (h), (i), I, (j.), and (k). Ancillary health insurance does not include credit accident and sickness insurance, subject to RSA 408-A, or travel insurance, subject to RSA 415:18, I-a(e), RSA 415:6, and Ins 4700;

(c) "Group" means:

(1) A policy issued to an employer, or to the trustees of a fund established by an employer, for which the employer or trustees shall be deemed the policyholder, to insure employees of the employer for the benefit of persons other than the employer, subject to the following requirements:

a. The employees eligible for insurance under the policy shall be all of the employees of the employer, or all of any class or classes thereof determined by conditions pertaining to their employment. The policy may provide that the term "employees'' shall include the employees of one or more subsidiary corporations and the employees, individual proprietors, and partners of one or more affiliated corporations, proprietors, or partnerships if the business of the employer and of such affiliated corporations, proprietors, or partnerships is under common control through stock ownership, contract, or otherwise. The policy may provide that the term "employees'' shall include the individual proprietor or partners if the employer is an individual proprietor or a partnership. The policy may provide that the term "employees'' shall include retired employees;

b. The premium for the policy shall be paid by the policyholder, either from the employer's funds, or from funds contributed by the insured employees, or from both. A policy on which no part of the premium is to be derived from funds contributed by the insured employees shall insure all eligible employees; and

c. The amounts of insurance under the policy shall be based upon a plan precluding individual selection either by the employees or by the employer or trustees;

(2) A policy issued to a labor union or Taft-Hartley Trust for the benefit of the members of the labor union, which shall be deemed the policyholder, to insure members of such union for the benefit of persons other than the union or any of its officials, representatives, or agents, is subject to the following requirements:

a. The members eligible for insurance under the policy shall be all of the members of the union, or all of any class or classes thereof determined by conditions pertaining to their employment, or to membership in the union, or both;

b. The premium for the policy shall be paid by the policyholder, either wholly from the union's funds or from funds contributed by the insured members specifically for the insurance, or from both. A policy on which no part of the premium is to be derived from funds contributed by the insured members specifically for their insurance shall insure all eligible members; and

c. The amounts of insurance under the policy shall be based upon a plan precluding individual selection either by the members or by the union;

(3) A policy issued to an association, which shall be deemed the policyholder, that meets the following criteria:

a. The association has been in existence for a period of at least 5 years and is organized for purposes other than obtaining insurance;

b. The association canelect to insure their members, employees, or both;

c. Insurance premiums are paid by members, employees, or both, of the association, with or without contribution by the association;

d. The amounts of insurance under the policy shall be based upon a plan precluding individual selection by the persons insured;

e. The association does not condition membership on any health status-related factor relating to an individual;

f. The association makes ancillary health insurance coverage offered through the association available to all individual members and employees of the association regardless of any health status-related factor relating to the members or employees, or individuals eligible for coverage through an individual member or employee; and

g. The association does not make ancillary health insurance coverage, offered through the association, available other than in connection with an individual member or employee of the association; and

(4) Notwithstanding the above, any such policy of group ancillary health insurance issued pursuant to paragraphs (1) - (3) may be extended to provide group ancillary health insurance for an employee, or other member of the group, their spouse, child or children, or other dependents;

(d) "Medicare" means The Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as Then Constituted or Later Amended; and

(e) "Preexisting condition":

(1) With respect to disability insurance, preexisting condition shall not be defined more restrictively than the following: "Preexisting condition means the existence of symptoms that would cause an ordinarily prudent person to seek diagnosis, care, or treatment within a 24-month period preceding the effective date of the coverage of the insured person or a condition for which medical advice or treatment was recommended by a physician within a 24-month period preceding the effective date of the coverage of the insured person"; and

(2) With respect to other insurance, preexisting condition shall not be defined more restrictively than the following: "Preexisting condition means the existence of symptoms that would cause an ordinarily prudent person to seek diagnosis, care, or treatment within a 6-month period preceding the effective date of the coverage of the insured person or a condition for which medical advice or treatment was recommended by a physician within a 6-month period preceding the effective date of the coverage of the insured person."

N.H. Admin. Code § Ins 6001.03

Derived From Volume XXXVIII Number 10, Filed March 8, 2018, Proposed by #12478, Effective 2/12/2018, Expires 2/12/2028.