New Hampshire Code of Administrative Rules
Ins - Commissioner, Insurance Department
Chapter Ins 7000 - SHORT TERM LIMITED DURATION HEALTH INSURANCE
Part Ins 7001 - MINIMUM STANDARDS FOR SHORT TERM LIMITED DURATION HEALTH INSURANCE
Section Ins 7001.06 - Required Policy Provisions
Universal Citation: NH Admin Rules Ins 7001.06
Current through Register No. 12, March 21, 2024
(a) A short term limited duration health insurance policy shall comply with the following provisions:
(1) The date of delivery shall be
the date shown by the policyholder's records or by his or her memory, unless
the insurer has adopted a procedure to obtain a policyholder's dated and signed
receipt for the delivery of the policy;
(2) Diseases to be excluded from coverage
shall be stated with sufficient clarity to be readily identifiable by the
insured;
(3) A policy may:
a. Require that the insured incur expenses
that he or she is legally required to pay; and
b. Exclude charges that would not have been
made if no insurance existed;
(5) Where the insurer reserves the right to
cancel, the provisions of
RSA 415:6,
II(8) shall be delineated in the
policy;
(6) With respect to all
short term limited duration health insurance policies to which the refund
provisions of
RSA 415:6,
II(8) do not apply, the insurer shall
provide:
a. A refund of unearned premium upon
a request for cancellation of the policy by the insured;
b. The period for which a refund is to be
made measured from the date the request for cancellation is received by the
insurer, or such later date as may be specified in the request, to the date to
which premiums have been paid; and
c. A refund amount of not less than 80
percent of the pro-rata unearned premium for such period;
(7) Hospital, medical, and surgical expenses
shall be covered, to an aggregate maximum of not less than $1,000,000 per
covered member;
(8) Policyholder
coinsurance percentage per policy period per covered person shall not exceed 50
percent of covered charges, provided that the coinsurance or co-payment
out-of-pocket maximum after any deductibles shall not exceed $10,000 per person
per policy period;
(9) The maximum
out-of-pocket per family per policy period shall not exceed 3 times the
individual out-of-pocket maximum;
(10) Covered services shall include, at a
minimum:
a. Daily hospital room and board
expenses at the semiprivate room rate;
b. Hospital services and supplies;
c. Surgical services:
d. Anesthesia services;
e. In-hospital medical and diagnostic
services;
f. Emergency care
services;
g. All individual policy
mandates under New Hampshire statute;
h. In-hospital prescription drugs and
medications;
i. 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
j. 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;
(11) The minimum benefits required by (10)
above may be subject to all applicable deductible, coinsurance, and general
policy exceptions and limitations; and
(12) Except as authorized by this part
through the application of special or internal limitations, a short term
limited duration health policy shall be designed to cover, after any
deductibles or coinsurance provisions are met, the usual and customary or
reasonable and customary charges, as determined consistently by the carrier, or
another rate agreed to between the insurer and provider for covered services up
to the lifetime policy maximum.
(b) Short term limited duration health insurance policies that are network based shall comply with individual policy provisions of RSA 420-J and Ins 2700.
(c) The schedule of benefits shall be included within the policy.
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.
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