New Hampshire Code of Administrative Rules
Ins - Commissioner, Insurance Department
Chapter Ins 1900 - ACCIDENT AND HEALTH INSURANCE
Part Ins 1901 - MINIMUM STANDARDS FOR ACCIDENT AND HEALTH INSURANCE
Section Ins 1901.06 - Accident and Health Minimum Standards for Benefits
Universal Citation: NH Admin Rules Ins 1901.06
Current through Register No. 12, March 21, 2024
The following minimum standards for benefits are prescribed for the categories of coverage noted in the following subsections. An individual accident and health insurance policy or group supplemental health insurance policy shall not be delivered or issued for delivery in this state unless it meets the required minimum standards for the specified categories or the commissioner finds that the policies or contracts are approvable as limited benefit health insurance and the outline of coverage complies with the outline of coverage in Ins 1901.07(l) of this part.
This section shall not preclude the issuance of any policy or contract combining 2 or more categories set forth in RSA 415-A:3 I. and II.
(a) General rules.
(1) A "noncancellable," "guaranteed
renewable," or "noncancellable and guaranteed renewable" individual accident
and health policy shall not provide for termination of coverage of the spouse
solely because of the occurrence of an event specified for termination of
coverage of the insured, other than nonpayment of premium. In addition, the
policy shall provide that in the event of the insured's death, the spouse of
the insured, if covered under the policy, shall become the insured.
(2) The terms "noncancellable," "guaranteed
renewable," or "noncancellable and guaranteed renewable" shall not be used
without further explanatory language in accordance with the disclosure
requirements of
Ins
1901.07(a)(1); and
a. The terms "noncancellable" or
"noncancellable and guaranteed renewable" shall be used only in accident and
health policy or certificate that the insured has the right to continue in
force by the timely payment of premiums set forth in the policy or certificate
until the age of 65 or until eligibility for Medicare, during which period the
insurer has no right to make unilaterally any change in any provision of the
policy while the policy is in force.
b. An accident and health or accident-only
policy or certificate that provides for periodic payments, weekly or monthly,
for a specified period during the continuance of disability resulting from
accident or sickness shall provide that the insured has the right to continue
the policy only to age 60 if, at age 60, the insured has the right to continue
the policy in force at least to age 65 while actively and regularly
employed.
c. Except as provided
above, the term "guaranteed renewable" shall be used only in a policy or
certificate that the insured has the right to continue in force by the timely
payment of premiums until the age of 65 or until eligibility for Medicare,
during which period the insurer has no right to make unilaterally any change in
any provision of the policy while the policy is in force, except that the
insurer may make changes in premium rates by classes.
(3) In an individual accident and health
policy or certificate covering both husband and wife, the age of the younger
spouse shall be used as the basis for meeting the age and durational
requirements of the definitions of "noncancellable" or "guaranteed renewable."
However, this requirement shall not prevent termination of coverage of the
older spouse upon attainment of the stated age so long as the policy may be
continued in force as to the younger spouse to the age or for the durational
period as specified in the policy.
(4) When accidental death and dismemberment
coverage is part of the accident and health insurance coverage offered under
the contract, the insured shall have the option to include all insureds under
the coverage and not just the principal insured.
(5) If a policy contains a status-type
military service exclusion or a provision that suspends coverage during
military service, the policy shall provide, upon receipt of written request,
for refund of premiums as applicable to the person on a pro rata
basis.
(6) In the event the insurer
cancels or refuses to renew, policies or certificates providing pregnancy
benefits shall provide for an extension of benefits as to pregnancy commencing
while the policy is in force and for which benefits would have been payable had
the policy remained in force.
(7)
Policies providing convalescent or extended care benefits following
hospitalization shall not condition the benefits upon admission to the
convalescent or extended care facility within a period of less than 14 days
after discharge from the hospital.
(8) Accident and health insurance policies or
certificates coverage[s] shall continue for a dependent child who is incapable
of self-sustaining employment due to mental or physical handicap on the date
that the child's coverage would otherwise terminate under the policy due to the
attainment of a specified age for children and who is chiefly dependent on the
insured for support and maintenance. The policy may require that within 31 days
of the date the company receives due proof of the incapacity in order for the
insured to elect to continue the policy in force with respect to the child, or
that a separate converted policy be issued at the option of the insured or
policyholder.
(9) A policy or
certificate providing coverage for the recipient in a transplant operation
shall also provide reimbursement for any medical expenses of a live donor to
the extent that benefits remain and are available under the recipient's policy
or certificate, after benefits for the recipient's own expenses have been
paid.
(10) A policy may contain a
provision relating to recurrent disabilities; but a provision relating to
recurrent disabilities shall not specify that a recurrent disability be
separated by a period greater than 6 months.
(11) Accidental death and dismemberment
benefits shall be payable if the loss occurs within 90 days from the date of
the accident, irrespective of total disability. Disability income benefits, if
provided, shall not require the loss to commence less than 30 days after the
date of accident, nor shall any policy that the insurer cancels or refuses to
renew require that it be in force at the time the disability commences if the
accident occurred while the coverage was in force.
(12) Specific dismemberment benefits shall
not be in lieu of other benefits unless the specific benefit equals or exceeds
the other benefits.
(13) An
accident-only policy or certificate providing benefits that vary according to
the type of accidental cause shall prominently set forth in the outline of
coverage the circumstances under which benefits are payable that are lesser
than the maximum amount payable under the policy.
(14) Termination of the policy or certificate
shall be without prejudice to a continuous loss that commenced while the policy
or certificate was in force. The continuous total disability of the insured may
be a condition for the extension of benefits beyond the period the policy was
in force, limited to the duration of the benefit period, if any, or payment of
the maximum benefits.
(15) A policy
or certificate providing coverage for fractures or dislocations shall not
provide benefits only for "full or complete" fractures or
dislocations.
(b) Basic Hospital Expense Coverage. "Basic hospital expense coverage" is a policy of accident and health insurance that provides coverage for a period of not less than 31 days during a continuous hospital confinement for each person insured under the policy, for expenses incurred for necessary treatment and services rendered as a result of accident or sickness for at least the following:
(1) Daily hospital room and board in an
amount not less than the lesser of:
a. Eighty
percent of the charges for semiprivate room accommodations or
b. One hundred dollars per day;
(2) Miscellaneous hospital
services for expenses incurred for the charges made by the hospital for
services and supplies that are customarily rendered by the hospital and
provided for use only during any one period of confinement in an amount not
less than either 80 percent of the charges incurred up to at least $3,000 or 10
times the daily hospital room and board benefits; and
(3) Hospital outpatient services consisting
of:
a. Hospital services on the day surgery is
performed,
b. Hospital services
rendered within 72 hours after injury, in an amount not less than $150;
and
c. X-ray and laboratory tests
to the extent that benefits for the services would have been provided in an
amount of less than $100 if rendered to an in-patient of the
hospital.
(4) Benefits
provided under paragraphs (1) and (2) of this subsection may be provided
subject to a combined deductible amount not in excess of $100.
(c) Basic Medical-Surgical Expense Coverage. "Basic medical-surgical expense coverage" is a policy or certificate of accident and health insurance that provides coverage for each person insured under the policy for the expenses incurred for the necessary services rendered by a physician for treatment of an injury or sickness for at least the following:
(1) Surgical services:
a. In amounts not less than those provided on
a fee schedule based on the relative values contained in the current edition of
the Current Procedure Terminology (CPT) coding or other acceptable relative
value schedule, up to a maximum of at least $1,000 for one procedure;
or
b. Not less than 80 percent of
the reasonable charges.
(2) Anesthesia services, consisting of
administration of necessary general anesthesia and related procedures in
connection with covered surgical service rendered by a physician other than the
physician (or the physician assistant) performing the surgical services:
a. In an amount not less than 80 percent of
the reasonable charges; or
b.
Fifteen percent of the surgical service benefit.
(3) In-hospital medical services, consisting
of physician services rendered to a person who is a bed patient in a hospital
for treatment of sickness or injury other than that for which surgical care is
required, in an amount not less than 80 percent of the reasonable charges, or
$50 per day for not less than 21 days during one period of
confinement.
(d) Basic Hospital/Medical-Surgical Expense Coverage. "Basic hospital/medical-surgical expense coverage" is a combined coverage and shall meet the requirements of both subsections (b) and (c).
(e) Hospital Confinement Indemnity Coverage.
(1)
"Hospital confinement indemnity coverage" is a policy or certificate of
accident and health insurance that provides daily benefits for hospital
confinement on an indemnity basis in an amount not less than $40 per day and
not less than 31 days during each period of confinement for each person insured
under the policy.
(2) Coverage
shall not be excluded due to a preexisting condition for a period greater than
12 months following the effective date of coverage of an insured person unless
the preexisting condition is specifically and expressly excluded.
(3) Except for the NAIC uniform provision
regarding other insurance with the insurer, benefits shall be paid regardless
of other coverage.
(f) Major Medical Expense Coverage.
(1) "Major
medical expense coverage" is an accident and health insurance policy or
certificate that provides hospital, medical and surgical expense coverage, to
an aggregate maximum of not less than $500,000; coinsurance percentage per year
per covered person not to exceed 50% of covered charges, provided that the
coinsurance out-of-pocket maximum after any deductibles shall not exceed
$10,000 per year; a deductible stated on a per person, per family, per illness,
per benefit period, or per year basis, or a combination of these bases not to
exceed 5 percent of the aggregate maximum limit under the policy for each
covered person for at least:
a. Daily
hospital room and board expenses subject only to limitations based on average
daily cost of the semiprivate room rate in the area where the insured
resides;
b. Miscellaneous hospital
services;
c. Surgical
services;
d. Anesthesia
services;
e. In-hospital medical
services;
f. Out-of-hospital care,
consisting of physicians' services rendered on an ambulatory basis where
coverage is not provide elsewhere in the policy for diagnosis and treatment of
sickness or injury, diagnostic x-ray, laboratory services, radiation therapy,
and hemodialysis ordered by a physician; and
g. Not fewer than 3 of the following
additional benefits:
1. In-hospital private
duty registered nurse services;
2.
Convalescent nursing home care;
3.
Diagnosis and treatment by a radiologist or physiotherapist;
4. Rental of special medical equipment, as
defined by the insurer in the policy;
5. Artificial limbs or eyes, casts, splints,
trusses or braces;
6. Treatment for
functional nervous disorders, and mental and emotional disorders; or
7. Out-of-hospital prescription drugs and
medications.
(2) The minimum benefits required by (f)(1)
above may be subject to all applicable deductible, coinsurance and general
policy exceptions and limitations. A major medical expense policy may also have
special or internal limitations for prescription drugs, nursing facilities,
intensive care facilities, mental health treatment, alcohol or substance abuse
treatment, transplants, experimental treatments, mandated benefits required by
law and those services covered under (f)(l)g. above and other such special or
internal limitations as are authorized or approved by the commissioner. Except
as authorized by this subsection through the application of special or internal
limitations, a major medical expenses policy shall be designed to cover, after
any deductibles or coinsurance provisions are met, the usual, customary and
reasonable charges, as determined consistently by the carrier and as subject to
approval by the commissioner, or another rate agreed to between the insurer and
provider, for covered services up to the lifetime policy maximum.
(g) Basic Medical Expense Coverage.
(1) "Basic medical expense
coverage" is an accident and health insurance policy or certificate that
provides hospital, medical and surgical expense coverage, to an aggregate
maximum of not less than $250,000; coinsurance percentage per year per covered
person not to exceed 50 percent of covered charges, provided that the
coinsurance out-of-pocket maximum after any deductibles shall not exceed
$25,000 per year; a deductible stated on a per person, per family, per illness,
per benefit period, or per year basis, or a combination of these bases not to
exceed 10 percent of the aggregate maximum limit under the policy for each
covered person for at least:
a. Daily hospital
room and board expenses subject only to limitations based on average daily cost
of the semiprivate room rate in the area where the insured resides or such
other rate agreed to between the insurer and provider for a period of not less
than 31 days during continuous hospital confinement;
b. Miscellaneous hospital services;
c. Surgical services;
d. Anesthesia services;
e. In-hospital medical services;
f. Out-of-hospital care, consisting of
physicians' services rendered on an ambulatory basis where coverage is not
provided elsewhere in the policy for diagnosis and treatment of sickness or
injury, diagnostic x-ray, laboratory services, radiation therapy and
hemodialysis ordered by a physician; and
g. Not fewer than 3 of the following
additional benefits:
1. In-hospital private
duty graduate registered nurse services;
2. Convalescent nursing home care;
3. Diagnosis and treatment by a radiologist
or physiotherapist;
4. Rental of
special medical equipment, as defined by the insurer in the policy.
5. Artificial limbs or eyes, casts, splints,
trusses or braces;
6. Treatment for
functional nervous disorders, and mental and emotional disorders; or
7. Out-of-hospital prescription drugs and
medications.
(2) The minimum benefits required by (g)(1)
above may be subject to all applicable deductibles, coinsurance and general
policy exceptions and limitations. A basic medical expense policy or
certificate may also have special or internal limitations for prescription
drugs, nursing facilities, intensive care facilities, mental health treatment,
alcohol or substance abuse treatment, transplants, experimental treatments,
mandated benefits required by law and those services covered under (g)(1)g.
above and other such special or internal limitations as are authorized or
approved by the commissioner. Except as authorized by this subsection through
the application of special or internal limitations, an individual basic medical
expense policy shall be designed to cover, after any deductibles or coinsurance
provisions are met, the usual customary and reasonable charges, as determined
consistently by the carrier and as subject to approval by the commissioner, or
another rate agreed to between the insurer and provider, for covered services
up to the lifetime policy maximum.
(h) Disability Income Protection Coverage. "Disability income protection coverage" is a policy or certificate that provides for periodic payments, weekly or monthly, for a specified period during the continuance of disability resulting from either sickness or injury or a combination of them that:
(1) Provides
that period payments that are payable at ages after 62 and reduced solely on
the basis of age are at least 50 percent of amounts payable immediately prior
to 62;
(2) Contains an elimination
period no greater than:
a. Ninety days in the
case of a coverage providing a benefit of one year or less;
b. One hundred and eighty days in the case of
coverage providing a benefit of more than one year but not greater than 2
years; or
c. Three hundred sixty
five days in all other cases during the continuance of disability resulting
from sickness or injury;
(3) Has a maximum period of time for which it
is payable during disability of at least 6 months except in the case of a
policy covering disability arising out of pregnancy, childbirth or miscarriage
in which case the period for the disability may be one month. No reduction in
benefits shall be put into effect because of an increase in social security or
similar benefits during a benefit period.
Ins
1901.06(h) does not apply to those
policies providing business buy-out coverage;
(4) Where a policy provides total disability
benefits and partial disability benefits, only one elimination period may be
required.
(i) Accident Only Coverage. "Accident only coverage" is a policy or certificate that provides coverage, singly or in combination, for death, dismemberment, disability or hospital and medical care caused by accident. Accidental death and double dismemberment amounts under the policy shall be at least $1,000 and a single dismemberment amount shall be at least $500.
(j) Specified Disease Coverage.
(1) "Specified disease coverage" pays
benefits for the diagnosis and treatment of a specifically named disease or
diseases. A specified disease policy shall meet the following rules and one of
the following sets of minimum standards for benefits:
a. Insurance covering cancer only or cancer
in conjunction with other conditions or diseases shall meet the standards of
paragraphs (4), (5) or (6) of this subsection.
b. Insurance covering specified diseases
other than cancer shall meet the standards of paragraphs (3) and (6) of this
subsection.
(2) General
Rules. Except for cancer coverage provided on an expense-incurred basis, either
as cancer-only coverage or in combination with one or more other specified
diseases, the following rules shall apply to specified disease coverages in
addition to all other rules imposed by this part. In cases of conflict between
the following and other rules, the following shall govern:
a. Policies covering a single specified
disease or combination of specified diseases shall not be sold or offered for
sale other than as specified disease coverage under this section.
b. Any policy issued pursuant to this section
that conditions payment upon pathological diagnosis of a covered disease shall
also provide that if the pathological diagnosis is medically inappropriate, a
clinical diagnosis will be accepted instead.
c. Notwithstanding any other provision of
this part, specified disease policies shall provide benefits to any covered
person not only for the specified diseases but also for any other conditions or
diseases, directly caused or aggravated by the specified diseases or the
treatment of the specified disease.
d. Individual accident and health policies
containing specified disease coverage shall be at least guaranteed
renewable.
e. No policy issued
pursuant to this section shall contain a waiting or probationary period greater
than 30 days. A specified disease policy may contain a waiting or probationary
period following the issue or reinstatement date of the policy or certificate
in respect to a particular covered person before the coverage becomes effective
as to that covered person.
f. An
application or enrollment form for specified disease coverage shall contain a
statement above the signature of the applicant or enrollee that a person to be
covered for specified disease is not covered also by any Title XIX program
(Medicaid, MediCal or any similar name). The statement may be combined with any
other statement for which the insurer may require the applicant's or enrollee's
signature.
g. Payments shall be
conditioned upon an insured person's receiving medically necessary care, given
in a medically appropriate location, under a medically accepted course of
diagnosis or treatment.
h. Except
as otherwise specifically provided by statute, benefits for specified disease
coverage shall be paid regardless of other coverage.
i. After the effective date of the coverage
(or applicable waiting period, if any) benefits shall begin with the first day
of care or confinement if the care or confinement is for a covered disease even
though the diagnosis is made at some later date. The retroactive application of
the coverage shall not be less than 90 days prior to the diagnosis.
j. Policies providing expenses benefits shall
not use the term "actual" when the policy only pays up to a limited amount of
expenses. Instead, the term "charge" or substantially similar language shall be
used that does not have misleading or deceptive effect of the phrase "actual
charges".
k. "Preexisting
condition" shall not be defined to be more restrictive than the following:
"Preexisting condition means a condition for which medical advice, diagnosis,
care or treatment was recommended or received from a physician within the 6
month period preceding the effective date of coverage of an insured
person."
l. Coverage for specified
diseases shall not be excluded due to a preexisting condition for a period
greater than 6 months following the effective date of coverage of an insured
person unless the preexisting condition is specifically excluded.
m. Hospice Care.
1. "Hospice" means a facility licensed,
certified or registered in accordance with state law that provides a formal
program of care that is:
(i) For terminally
ill patients whose life expectancy is less than 6 months;
(ii) Provided on an inpatient or outpatient
basis; and
(iii) Directed by a
physician.
2. Hospice
care is an optional benefit. However, if a specified disease insurance product
offers coverage for hospice care, it shall meet the following minimum
standards:
(i) Eligibility for payment of
benefits when the attending physician of the insured provides a written
statement that the insured person has a life expectancy of 6 months or
less;
(ii) A fixed-sum payment of
at least $50 per day; and
(iii) A
lifetime maximum benefit limit of at least $10,000.
3. Hospice care does not cover nonterminally
ill patients who may be confined in a:
(i)
Convalescent home;
(ii) Rest or
nursing facility;
(iii) Skilled
nursing facility;
(iv)
Rehabilitation unit; or
(v)
Facility providing treatment for persons suffering from mental diseases or
disorders or care for the aged or substance abusers.
(3) The following
minimum benefits standards apply to non-cancer coverages:
a. Coverage for each insured person for a
specifically named disease (or diseases) with a deductible amount not in excess
of $250 and an overall aggregate benefit limit of no less than $10,000 and a
benefit period of not less than 2 years for at least the following incurred
expenses:
1. Hospital room and board and any
other hospital furnished medical services or supplies;
2. Treatment by a legally qualified physician
or surgeon;
3. Private duty
services of a registered nurse (R.N.);
4. X-ray, radium and other therapy procedures
used in diagnosis and treatment;
5.
Professional ambulance for local service to or from a local hospital;
6. Blood transfusions, including expense
incurred for blood donors;
7. Drugs
and medicines prescribed by a physician;
8. The rental of an iron lung or similar
mechanical apparatus;
9. Braces,
crutches and wheelchairs as are deemed necessary by the attending physician for
the treatment of the disease;
10.
Emergency transportation if in the opinion of the attending physician it is
necessary to transport the insured to another locality for treatment of the
disease; and
11. May include
coverage of any other expenses necessarily incurred in the treatment of the
disease.
b. Coverage for
each insured person for a specifically named disease (or diseases) with no
deductible amount, and an overall aggregate benefit limit of not less than
$25,000 payable at the rate of not less than $50 a day while confined in a
hospital and a benefit period of not less than 500 days.
(4) A policy that provides coverage for each
insured person for cancer-only coverage or in combination with one or more
other specified diseases on an expense incurred basis for services, supplies,
care and treatment of cancer, in amounts not in excess of the usual and
customary charges, with a deductible amount not in excess of $250, and an
overall aggregate benefit limit of not less than $10,000 and a benefit period
of not less than 3 years shall provide at least the following minimum
provisions:
a. Treatment by, or under the
direction of, a legally qualified physician or surgeon;
b. X-ray, radium chemotherapy and other
therapy procedures used in diagnosis and treatment;
c. Hospital room and board and any other
hospital furnished medical services or supplies;
d. Blood transfusions and their
administration, including expense incurred for blood donors;
e. Drugs and medicines prescribed by a
physician;
f. Professional
ambulance for local service to or from a local hospital;
g. Private duty services of a registered
nurse provided in a hospital;
h.
May include coverage of any other expenses necessarily incurred in the
treatment of the disease; however, subparagraphs a., b., d., e. and g. plus at
least the following also shall be included, but may be subject to copayment by
the insured person not to exceed 20 percent of covered charges when rendered on
an out-patient basis;
i. Braces,
crutches and wheelchairs deemed necessary by the attending physician for the
treatment of the disease;
j.
Emergency transportation if in the opinion of the attending physician it is
necessary to transport the insured to another locality for treatment of the
disease; and
k. Home health care
that is necessary care and treatment provided at the insured person's residence
by a home health care agency or by others. The program of treatment shall be
prescribed in writing by the insured person's attending physician, who shall
approve the program prior to its start. The physician shall certify that
hospital confinement would be otherwise required.
1. A "home health care agency":
(i) Is an agency approved under Medicare,
or
(ii) Is licensed to provide home
health care under applicable state law, or
(iii) Meets all of the following
requirements:
i. It is primarily engaged in
providing home health care services;
ii. Its policies are established by a group
of professional personnel including at least one physician and one registered
nurse;
iii. A physician or a
registered nurse provides supervision of home health care services;
iv. It maintains clinical records on all
patients; and
v. It has a full time
administrator.
2. Home health includes, but is not limited
to:
(i) Part-time or intermittent skilled
nursing services provided by a registered nurse or a licensed practical
nurse;
(ii) Part-time or
intermittent home health aide services that provide support services in the
home under the supervision of a registered nurse or a physical, speech or
hearing occupational therapists;
(iii) Physical, occupational or speech and
hearing therapy; and
(iv) Medical
supplies, drugs and medicines prescribed by a physician and related
pharmaceutical services, and laboratory services to the extent the charges or
costs would have been covered if the insured person had remained in the
hospital.
l.
Physical, speech, hearing and occupational therapy;
m. Special equipment including hospital bed,
toilette, pulleys, wheelchairs, aspirator, chux, oxygen, surgical dressings,
rubber shields, colostomy and eleostomy appliances;
n. Prosthetic devices including wigs and
artificial breasts;
o. Nursing home
care for noncustodial services; and
p. Reconstructive surgery when deemed
necessary by the attending physician.
(5) The following minimum benefits standards
apply to cancer coverages written on a per diem indemnity basis. These
coverages shall offer insured persons:
a. A
fixed-sum payment of at least $100 for each day of hospital confinement for at
least 365 days;
b. A fixed-sum
payment equal to one half the hospital inpatient benefit for each day of
hospital or nonhospital outpatient surgery, chemotherapy and radiation therapy,
for at least 365 days of treatment; and
c. A fixed-sum payment of at least $50 per
day for blood and plasma, which includes their administration whether received
as an inpatient or outpatient for at least 365 days of treatment.
(6) Benefits tied to confinement
in a skilled nursing home or to receipt of home health care are optional. If a
policy offers these benefits, they shall equal the following:
a. A fixed-sum payment equal to one-fourth
the hospital inpatient benefit for each day of skilled nursing home confinement
for at least 100 days.
b. A
fixed-sum payment equal to one-fourth the hospital inpatient benefit for each
day of home health care for at least 100 days.
c. Benefit payments shall begin with the
first day of care or confinement after the effective date of coverage if the
care or confinement is for a covered disease even though the diagnosis of a
covered disease is made at some later date (but not retroactive more than 30
days from the date of diagnosis) if the initial care or confinement was for
diagnosis or treatment of the covered disease.
d. Notwithstanding any other provisions of
this part, any restriction or limitation applied to the benefits in (6)a. and
(6)b. whether by definition or otherwise, shall be no more restrictive than
those under Medicare.
(7) The following minimum standards apply to
lump-sum indemnity coverage of any specified disease:
a. These coverages shall pay indemnity
benefits on behalf of insured persons of a specifically named disease or
diseases. The benefits are payable as a fixed, one-time payment made within 30
days of submission to the insurer of proof of diagnosis of the specified
disease. Dollar benefits shall be offered for sale only in even increments of
$1,000.
b. Where coverage is
advertised or otherwise represented to offer generic coverage of a disease or
diseases, the same dollar amounts shall be payable regardless of the particular
subtype of the disease with one exception. In the case of clearly identifiable
subtypes with significantly lower treatments costs, lesser amounts may be
payable so long as the policy clearly differentiates that subtype and its
benefits.
(k) Specified Accident Coverage. "Specified accident coverage" is a policy or certificate that provides coverage for a specifically identified kind of accident (or accidents) for each person insured under the policy for accidental death or accidental death and dismemberment combined, with a benefit amount not less than $1,000 for accidental death, $1,000 for double dismemberment, $500 for single dismemberment.
(l) Limited Benefit Health Coverage.
(1) "Limited
benefit health coverage" is a policy, contract or certificate, other than a
policy, contract, or certificate covering only a specified disease or diseases,
that provides benefits that are less than the minimum standards for benefits
required under (b), (c), (d), (e), (f), (g), (i) and (k). These policies,
contracts or certificates may be delivered or issued for delivery in this state
only if the outline of coverage required by
Ins
1901.07(l) of this part is completed
and delivered as required by
Ins
1901.07(b) of this part and the
policy or certificate is clearly labeled as a limited benefit policy or
certificate as required by
Ins
1901.07(a)(18). A policy covering a
single specified disease or combination of diseases shall meet the requirements
of (j) above and shall not be offered for sale as a "limited
coverage."
#1900, eff 1-1-82; ss by #4287, eff 7-1-87; amd by #4811, eff 5-4-90; ss by #5656, eff 7-1-93; ss by #7017, INTERIM, eff 7-1-99, EXPIRED: 10-29-99
New. #8609, eff 4-17-06
Disclaimer: These regulations may not be the most recent version. New Hampshire may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
This site is protected by reCAPTCHA and the Google
Privacy Policy and
Terms of Service apply.
