New Hampshire Code of Administrative Rules
Ins - Commissioner, Insurance Department
Chapter Ins 1900 - ACCIDENT AND HEALTH INSURANCE
Part Ins 1902 - MINIMUM STANDARDS FOR MEDICARE SUPPLEMENT POLICIES ISSUED PRIOR TO ADOPTION OF INSURANCE REGULATION 1905
Section Ins 1902.08 - Requirements for Application Forms and Replacement Coverage

(a) Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant has another medicare supplement policy or certificate in force or whether a medicare policy or certificate is intended to replace any other accident and sickness policy or certificate presently in force:

(b) A supplementary application or other form signed by the applicant and agent, except where the coverage is sold without an agent, containing the questions outlined in (a) may be used to satisfy the requirements set forth in (a) above.

(c) Agents shall list on the applicant's application form, supplementary application or other form, whichever is used, any other health insurance policies they have sold to the applicant. In addition, the agent shall list those policies sold which are still in force and those policies sold in the past 5 years which are no longer in force.

(d) Upon determining that a sale will involve replacement, an insurer, other than a direct response insurer, or its agent, shall furnish the applicant, prior to issuance or delivery of the medicare supplement policy or certificate, a notice regarding replacement of medicare supplement insurance. One copy of such notice signed by the applicant and the agent, except where the coverage is sold without an agent, shall be provided to the applicant and an additional signed copy shall be retained by the insurer. A direct response insurer shall deliver to the applicant at the time of the issuance of the policy the notice regarding replacement of medicare supplement insurance.