Current through Register No. 12, March 21, 2024
(a) Travel
insurance policies shall comply with
RSA
415:18, I-a(e) and Ins 4700. Long-term care
insurance policies shall comply with RSA 415-D and Ins 3600. Medicare
Supplemental insurance policies shall comply with RSA 415-F and Ins 1902 or Ins
1905. Required provisions for all other group accident and health insurance
policies shall be those established in
RSA
415:18.
(b) Other group accident and health policy
standards, with the exception of policies regulated by Ins 3600, Ins 4700, Ins
1902, or Ins 1905, shall be as follows:
(1)
Exclusions that are ambiguous or unfairly discriminatory shall be
prohibited;
(2) All master policies
and certificates shall contain a clear explanation as to continuance of
coverage after termination of the policy;
(3) No group accident and health policy shall
contain a provision for automatic termination of an individual's coverage upon
the happening of a loss, except a loss that has exhausted all possible benefits
under the policy;
(4) A certificate
shall:
a. State the benefits applicable to
the person insured or state the schedule of benefits applicable to the class to
which he or she belongs; or
b.
Define eligibility and benefit amounts clearly enough for a person to determine
whether he or she is an insured and the amount of any benefits to which he or
she is entitled;
(5) A
policy may require that the insured:
a. Incur
expenses that the insured is legally responsible to pay for;
b. Exclude charges that would not have been
made if no insurance existed; and
c. Be responsible for non-covered
services;
(6) All group
certificates shall include a complete statement of the policy provisions
regarding coordination or nonduplication of benefits in the event of other
coverage;
(7) In the event of any
renewal rate increase, insurers shall provide policyholders with prior notice
of any such increase such that:
a. A 30 days'
notice is provided for policies subject to RSA 415, which are not subject to
RSA 420-G provisions; and
b. A 60
days' notice is provided for policies subject to RSA 420-G;
(8) Declination of renewal or
termination of insurance provisions shall be as follows:
a. No insurer shall decline to renew a group
policy unless the cause of its action is based on one or more of the reasons
for declination of renewal stated in the policy;
b. Any such reason shall be stated in a group
policy and shall be objective in nature;
c. Declination of renewal shall be defined so
as to include any termination of a group policy by the insurer for any reason
except for nonpayment of premiums; and
d. Notice of nonrenewal or termination of a
group policy by the insurer shall provide for at least 45 days prior notice,
except policies subject to
RSA
420-G:6 VI. and VII;
(9) Non-duplication of coverage and
subrogation provisions shall be as follows:
a. Benefit provisions for group medical
expense insurance coverages may provide for non-duplication or coordination
with any plan or government program providing benefits or services for medical
or dental care and treatment;
b.
All policies with non-duplication or coordination of benefit provisions shall:
1. Clearly stipulate how these provisions
will be administered; and
2. Be at
least as favorable to the insured as the provisions of Ins 1904; and
c. Group policies providing
medical expense insurance coverages may include subrogation provisions or
provisions that are similar in their intent and purpose; and
(10) In no case shall
the benefits provided under the policy or the definitions contained in the
policy be less favorable to the insured than the minimum standards for
individual accident and health benefits set forth in RSA
415.
(c) Medical expense
policies and certificates shall comply with preexisting condition requirements
of
RSA
420-G:7.
(d) Group excess policies shall be
prohibited.
(e) The required
provisions for blanket accident and health insurance policies shall be those
established in
RSA
415:18.
(f) Other blanket policy requirements shall
be as follows:
(1) Except as provided in (2)
below:
a. An individual certificate shall not
be issued to the person or persons who may receive benefits under group blanket
accident and health coverage; and
b. A person or persons who receive benefits
under blanket policy shall not contribute directly to the premium payment for
the policy; and
(2)
Blanket accident and health insurance shall meet all requirements of individual
limited benefit health insurance if coverage:
a. Is issued to identified members or
subscribers;
b. Is based on
individual enrollment; and
c.
Provides that a certificate of coverage to enrolled members shall be issued on
an individual basis.
(g) File and use provisions for complete
filings shall be as follows:
(1) A form shall
be deemed approved for use after the form has:
a. Been received by the commissioner as
complete;
b. Been under review by
the commissioner for at least 30 days from the date of filing; and
c. Not been objected to or rejected by the
commissioner within 30 days from the date of filing;
(2) In order for a form to be deemed approved
pursuant to subparagraph (1) above, the company shall notify the commissioner
in writing of the date such form was deemed; and
(3) When a company withdraws from use any
form that it has used in this state, written notice of such withdrawal shall be
provided to the commissioner advising the commissioner of the date of such
withdrawal.