New Hampshire Code of Administrative Rules
Ins - Commissioner, Insurance Department
Chapter Ins 6200 - ANCILLARY HEALTH MINIMUM STANDARDS
Part Ins 6205 - ANCILLARY HEALTH MINIMUM STANDARDS FOR BENEFITS FOR DISABILITY INCOME PROTECTION COVERAGE
Section Ins 6205.05 - Additional Minimum Standards for Benefits for Group Coverage

Universal Citation: NH Admin Rules Ins 6205.05

Current through Register No. 12, March 21, 2024

(a) In group certificates, the elimination period shall be specified in the certificate, and:

(1) The elimination period for a long-term disability benefits plan shall be permitted to be integrated with the benefit period of the short term disability benefits plan;

(2) The elimination period shall be permitted to be integrated with the period of paid time off, including salary continuation or sick leave available to the covered person, but shall not require use of accumulated vacation leave;

(3) The length of time required to satisfy the elimination period shall be permitted to consist of consecutive units of time; and

(4) The certificate shall be permitted to specify a separate elimination period for injury and a separate elimination period for sickness.

(b) Group coverage shall provide for at least 4 weeks of periodic income benefits, for coverage with short term benefit periods up to one year, and 12 months of periodic income benefits, for coverage with long-term benefit periods in excess of one year.

(1) Only by the following other benefits or income sources from:

a. Federal Social Security, Canada Pension Plan, the Quebec Pension Plan disability and retirement benefits, and the Railroad Retirement Act, including benefits that a spouse or child receives as a result of the covered person's disability. If disability begins after the start of a retirement benefit, benefits shall be permitted to be reduced on account of such retirement benefit;

b. Any benefits under a workers' compensation act, except for medical or death benefits, any federal or state occupational disease or injury law, and income received under the Admiralty and Maritime Law; the Maritime Doctrine of Maintenance, Wages, and Cure; the Doctrine of Unseaworthiness; and the Jones Act;

c. Disability benefits under state disability plans;

d. Disability and retirement benefits under a government plan, including state and municipal public employee plans and state teachers plans;

e. Disability and retirement benefits under plans provided by the covered person's policyholder, employer, or collective bargaining unit, as applicable. Such reduction shall be permitted to be limited to employer contributions and some types of retirement plans shall be permitted to be excluded;

f. Another group disability income policy or plan to the extent that such policy or plan covers the same pre-disability income;

g. Lost income benefits through no-fault vehicle insurance;

h. Employer salary continuation plan, sick pay, accumulated sick leave, vacation pay, severance, or other similar paid time off plans;

i. Secondary employment. However, if disability begins after an increase in secondary employment income, the disability benefit shall be permitted to be reduced on account of such increase;

j. Unemployment compensation;

k. Individual insurance disability plans to the extent that cumulative benefits payable would exceed pre-disability earnings;

l. Earnings from any work performed. Such reduction shall be permitted to be calculated differently for the specified months of a return to work period to encourage return to work;

m. Amounts received by a covered person from a third party, minus legal fees, in connection with lost income due to a disability which the covered person suffers because of an act of omission of the third party, and:

1. If the amount received from the third party does not specify the lost income amount, the company shall estimate the amount using a percentage of the settlement amount based on the covered person's pre-disability earnings, prorated to cover the period for which the settlement or judgment was made;

2. If the certificate includes both this right to reduce benefits or income on account of a third party settlement and a subrogation right, the certificate shall state that, with regard to any specific claim, if the insurance company elects to reduce a disability benefit on account of other benefits or incomes for amounts received, minus legal fees, for lost income due to a disability because of an act of omission of the third party, the insurance company shall not be permitted to elect subrogation for that same claim; and

3. Amounts received from compromises as a result of a claim for any one of the sources referenced in (1)a. - m. above;

(2) The certificate shall specify which reductions shall be dollar for dollar and which shall be based on a formula specified in the certificate;

(3) The certificate shall be permitted to state that if a covered person is eligible for other benefits or income, the insurance company reserves the right to reduce the disability benefit available under the certificate as if the covered person is receiving such benefits or income and to estimate the amount, and:

a. Estimated reductions based on the benefits or income specified in Ins 6205.04(e)(1) shall not be permissible if the covered person provides evidence of application for benefits and agrees in writing to repay any overpayment; and

b. Benefits or income from a retirement plan and lost income benefits from no-fault vehicle insurance or third-party settlements shall not be subject to estimation; and

(4) The certificate shall be permitted to state that reductions specified in (3) above shall not result in a disability benefit payment for less than a specified minimum amount in the certificate.

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