Chapter 431 — Chapter 431

§431:10A-120 Medical foods and low-protein modified food products; treatment of inborn error of metabolism; notice. (a) Each policy of accident and health or sickness insurance, other than life insurance, disability income insurance, and long-term care insurance, issued or renewe…

§431:10A-121 Coverage for diabetes. Each policy of accident and health or sickness insurance providing coverage for health care, other than an accident-only, specified disease, hospital indemnity, medicare supplement, long-term care, or other limited benefit health insurance poli…

§431:10A-131 REPEALED. L 2009, c 149, §9.

§431:10A-132 Orthodontic services for orofacial anomalies; benefits and coverage; notice. (a) Each individual and group accident and health or sickness insurance policy, contract, plan, or agreement issued or renewed in this State after December 31, 2015, shall provide to the pol…

§431:10A-134 Human immunodeficiency virus and acquired immunodeficiency syndrome screening coverage. (a) Each policy of accident and health or sickness insurance issued or renewed in this State, except for policies that only provide coverage for specified diseases or other limite…

§431:10A-140 Formulary; accessibility requirements. (a) Each insurer offering or renewing an individual or group accident and health or sickness insurance policy on or after January 1, 2017, shall provide the following information via a public website and through a toll-free numb…

PART II. GROUP AND BLANKET DISABILITY INSURANCE §431:10A-201 Definitions. For the purposes of this article: "Blanket disability insurance policy" means any policy or contract of accident and health or sickness insurance which does not require individual applications for covered p…

§431:10A-202 Health care groups. A policy of group disability insurance may be issued to a corporation, as policyholder, existing primarily for the purpose of assisting individuals who are its subscribers in securing medical, hospital, dental, and other health care services for t…

§431:10A-203 Standard provisions. Every policy of group or blanket disability insurance shall contain in substance the following provisions, or provisions which in the opinion of the commissioner are more favorable to the individuals insured, or at least as favorable to such indi…

§431:10A-204 Optional provision, examination and autopsy. There may be a provision that the insurer shall have the right and opportunity to examine the person of any individual covered under the policy when and so often as it may reasonably require during the pendency of claim un…

§431:10A-205 Payment of benefits. (a) The benefits payable under any policy or contract of group or blanket disability insurance shall be payable to the insured member of the group or to the beneficiary designated by the insured member, other than the policyholder, subject to pro…

§431:10A-206 Coverage of newborn children. All group or blanket disability policies providing family coverage, as defined in section 431:10A-103 and reciprocal beneficiary family coverage, as defined in section 431:10A-601, on an expense incurred basis shall provide coverage for …

§431:10A-207 Coverage for specific services. Every person insured under a group or blanket disability insurance policy shall be entitled to the reimbursements and coverages specified in section 431:10A-116. [L 1987, c 347, pt of §2; am L 2002, c 155, §63]

PART III. MEDICARE SUPPLEMENT POLICIES §431:10A-301 Definitions. For the purposes of this part: "Applicant" means: "Certificate" means any certificate delivered or issued for delivery in this State under a group medicare supplement policy. "Certificate form" means the form on whi…

§431:10A-302 Applicability and scope. (a) Notwithstanding any provision in this part to the contrary, this part shall apply to: (b) This part shall not apply to a policy of one or more employers or labor organizations, or of the trustees of a fund established by one or more emplo…

§431:10A-303 REPEALED. L 1990, c 84, §10.

§431:10A-304 Standards for policy provisions. (a) No medicare supplement policy or certificate in force in the State shall contain benefits that duplicate benefits provided by medicare. (b) The commissioner shall adopt reasonable rules to establish specific standards for the prov…

§431:10A-305 Rules. (a) The commissioner shall adopt reasonable rules to establish minimum standards for benefits and claims payment, marketing practices, compensation arrangements, and reporting practices for medicare supplement policies and certificates. (b) The commissioner ma…

§431:10A-306 Loss ratio standards. Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The commissioner shall adopt reasonable rules to establish minimum standards for loss ratios of medicare supplement poli…

§431:10A-307 Disclosure standards. (a) In order to provide for full and fair disclosure in the sale of medicare supplement policies, no medicare supplement policy or certificate shall be delivered or issued for delivery in this State unless an outline of coverage is delivered to …

§431:10A-308 Notice of free examination. Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the applicant shall have the right to return the policy or c…

§431:10A-309 Filings; approval of forms. (a) No medicare supplement policy or certificate shall be delivered or issued for delivery in this State after the date specified in rules adopted by the commissioner unless the form of the policy or certificate is approved in accordance w…

§431:10A-310 Filing requirements for advertising. (a) Every issuer of medicare supplement insurance policies or certificates in this State shall file a copy of any medicare supplement advertisement intended for use in this State whether through written, radio, or television mediu…

§431:10A-311 Penalties. In addition to any other applicable penalties for violations of this chapter, pursuant to section 431:2-203, the commissioner may require issuers violating any provision of this part or rules adopted pursuant to this part to cease marketing or selling any …

§431:10A-312 Severability. If any provision of this part or the application thereof to any person or circumstances is for any reason held to be invalid, the remainder of the part and the application of such provision to other persons or circumstances shall not be affected thereby…

PART IV. EXTENDED HEALTH INSURANCE §431:10A-401 Purpose. It is the purpose of this part to provide a means of more adequately meeting the needs of persons who are sixty-five years of age or older and their spouses for insurance coverage against financial loss from accident or dis…

§431:10A-402 Definitions. Unless the context otherwise requires, for the purposes of this part:

§431:10A-403 Association of insurers; policyholder; policy. (a) Any insurer may join with one or more other insurers to plan, develop, underwrite, offer and provide to any person who is sixty-five years of age or older and to the spouse of such person, extended health insurance a…

§431:10A-404 Persons authorized to transact insurance. Notwithstanding the provisions of article 9A, any person licensed to transact accident and health or sickness insurance as a producer may transact extended health insurance and may be paid a commission in accordance with comm…

§431:10A-405 Association; powers, process; examination. Any association formed for the purposes of this part may hold title to property, may enter into contracts, and may limit the liability of its members to their respective pro rata shares of the liability of such association. …

§431:10A-406 Forms; rates; approval. (a) The forms of the policies, applications, certificates, or other evidence of insurance coverage, commission schedules, and applicable premium rates relating thereto shall be filed with the commissioner. (b) No policy, contract, certificate,…

§431:10A-407 Duplication of benefits; adjustment. If and when a program of hospital, surgical, and medical benefits is enacted by the federal government or by the State, the extended health insurance benefits provided by policies issued under this section shall be adjusted to avo…

§431:10A-408 Annual report filed by association. The association shall submit an annual report to the commissioner which shall become public information and shall include the following: The commissioner shall require the association to provide any and all information concerning t…

§431:10A-409 Articles of association; agent, membership list; deception. (a) Any association formed in accordance with this part shall file the following with the commissioner: (b) The name of any association or any advertising or promotional material used in connection with exte…

§431:10A-410 Violation of other laws. No act done, action taken, or agreement made pursuant to the authority conferred by this part shall constitute a violation of or grounds for prosecution or civil proceedings under any other law of this State which does not specifically refer …

PART V. LONG-TERM CARE INSURANCE--REPEALED §§431:10A-521 to 431:10A-531 REPEALED. L 1999, c 93, §8.

§431:10A-602 Federally funded programs; exemption. Requirements relating to mandated coverages shall not be applicable to any insurer offering accident and health or sickness insurance under a federally funded program under the Social Security Act, as amended; provided that this …

§431:10A-603 Self-employed persons, exemption. The requirements of this article related to mandated coverages for persons insured under accident and health or sickness policies shall not apply to accident and health or sickness policies for self-employed persons in this State; pr…

ARTICLE 10B CREDIT LIFE INSURANCE AND CREDIT DISABILITY INSURANCE §431:10B-101 Purpose. The purpose of this article is to promote the public welfare by regulating credit life insurance and credit disability insurance. Nothing in this article is intended to prohibit or discourage …

§431:10B-102 Scope. All life insurance and all accident and health or sickness insurance in connection with loans or other credit transactions shall be subject to this article, except such insurance in connection with a loan or other credit transaction of more than ten years' dur…

§431:10B-103 Definitions. For the purpose of this article: "Credit disability insurance" means insurance on a debtor to provide indemnity for payments becoming due on a specific loan or other credit transaction while the debtor is disabled as defined in the policy. "Credit life i…

§431:10B-104 Forms of credit life insurance and credit disability insurance. Credit life insurance and credit disability insurance shall be issued only in the following forms:

§431:10B-106 Term of credit life and credit disability insurance. The term of any credit life insurance or credit disability insurance shall, subject to acceptance by the insurer, commence on the date when the debtor becomes obligated to the creditor; except that where a group po…

§431:10B-107 Provisions of policies and certificates of insurance: disclosure to debtors. (a) Credit life insurance and credit disability insurance subject to this article shall be evidenced by an individual policy, or in the case of group insurance by a certificate of insurance,…

§431:10B-108 Filing, approval, and withdrawal of forms and premium rates. (a) All policies, certificates of insurance, notices of proposed insurance, applications for insurance, endorsements, and riders delivered or issued for delivery in this State and the schedules of premium r…

§431:10B-109 Premiums and refunds. (a) Any insurer may revise its schedules of premium rates from time to time, and shall file the revised schedules for approval with the commissioner. No insurer shall issue any credit life insurance policy or credit disability insurance policy f…

§431:10B-110 Issuance of policies. (a) All policies of credit life insurance and credit disability insurance shall be delivered or issued for delivery in this State only by an insurer authorized to do an insurance business in this State, and shall be issued only through holders o…

§431:10B-111 Claims. (a) All claims shall be promptly reported to the insurer or its designated claim representative, and the insurer shall maintain adequate claim files. All claims shall be settled as soon as possible and in accordance with the terms of the insurance contract. (…

§431:10B-112 Existing insurance and choice of insurer. When credit life insurance or credit disability insurance is required as additional security for any indebtedness, the creditor shall give the debtor written notice of the debtor's option to furnish the required insurance thr…

§431:10B-113 Enforcement. (a) The commissioner may, after notice and hearing as provided in chapter 91, issue such rules and regulations as the commissioner deems appropriate for the supervision of this article. (b) Whenever the commissioner finds that there has been a violation …