Current through Register No. 40, October 3, 2024
(a) The transition,
under the employment-related group health insurance plan, from a traditional
indemnity or nonprofit health service corporation mode of coverage to a health
maintenance organization shall:
(1) B e
effected in every case without application of waiting periods or exclusions or
limitations based on health status as conditions of enrollment or transfer;
and
(2) P rovide all basic health
services, as defined in section 1302(1) of the Health Maintenance Organization
Act of 1973 ( 42USCA 300e - 1(1) as amended, that exist under the applicable
traditional indemnity or nonprofit health service corporation mode of coverage
from which transfer is made.
(b) Whenever there is a replacement of a
carrier's benefit plan by the benefit plan of another carrier, the insureds,
subscribers or members who were active recipients of mental health services
under the prior carrier's plan shall be entitled to continue to receive mental
health services from the same mental health provider who provided the services
received while the insured, subscriber or member was an active recipient of
mental health services under the prior carrier's plan.
(c) The entitlement to receive services
pursuant to (b) above shall:
(1) Continue for
one year following the effective date of the new carrier's benefit
plan;
(2) Override any provisions
in the replacing carrier's plan requiring the insured, subscriber or member to
receive mental health services from mental health providers who have contracted
with the replacing carrier to be part of the replacing carrier's provider
network;
(3) Override any
provisions in the replacing carrier's plan that reduce or eliminate benefits
for mental health services whenever such services are received from a mental
health provider who has not contracted to be part of the replacing carrier's
network;
(4) Be provided to any
insured, subscriber or member who, during an open enrollment period, changed
from a benefit plan sponsored by the employer to another benefit plan sponsored
by the same employer;
(5) Be
subject to any provisions of the replacing carrier's plan requiring mental
health services to be medically necessary, as defined in the replacing
carrier's plan;
(6) Be subject to
any provisions of the replacing carrier's plan requiring mental health services
to be preauthorized by the replacing carrier or its utilization review
agent;
(7) Be subject to the
provision of proof of receipt of prior services while the prior carrier's plan
was in effect as follows:
a. The insured,
subscriber or member shall be responsible for providing such proof in the form
of:
1. An explanation of benefits form from
the prior carrier;
2. A letter from
the provider who provided the services attesting to the fact that services were
provided together with the dates such services were rendered; or
3. Any other documentation which the
replacing carrier determines to be acceptable as proof; and
(8) Be subject to
verification that the provider of services under the prior carrier is protected
by a malpractice policy with coverage of at least $1,000,000 per single
incident and at least $3,000,000 in the aggregate.
(d) While the entitlement provided pursuant
to (b) above is in effect, benefits shall be paid by the replacing carrier as
if the insured, subscriber or member were receiving mental health services from
a mental health provider who has contracted with the replacing
carrier.
(e) The replacing carrier
shall not be required to make direct benefit payments to a non-network provider
nor shall this provision operate in any way to increase the liability of the
replacing carrier above what its liability would be if the mental health
services were received from a contracting mental health provider who is
reimbursed on a fee-for-service basis.
#1900, eff 1-1-82; ss by #4287, eff 7-1-87; ss by #5655,
eff 7-1-93; ss by #7018, INTERIM, eff 7-1-99, EXPIRED: 10-29-99
New. #9335, eff
12-5-08
The amended
version of this section by
New
Hampshire Register Volume 36, Number 41, eff.12/5/2016 is not yet
available.
