New Hampshire Administrative Code

(a) In recommending the purchase or replacement of any medicare supplement policy or certificate an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement. (b) Any sale of medicare supplement coverage which will provide an in…

(a) On or before March 1 of each year, every insurer or other entity providing medicare supplement insurance coverage in this state shall report the following information for every individual resident of this state for which the insurer or entity has in force more than one medica…

Ins 1902.14 Prohibition Against Preexisting Conditions, Waiting Periods, Elimination Periods and Probationary Periods in Replacement Policies or Certificates. If a medicare supplement policy or certificate replaces another medicare supplement policy or certificate, the replacing …

(a) Benefits eliminated by operation of the Medicare Catastrophic Coverage Act of 1988 transition provisions shall be restored. (b) For medicare supplement policies subject to the minimum standards adopted by the states pursuant to Medicare Catastrophic Coverage Act of 1988, the …

The purpose of this part is to assure the orderly implementation and conversion of medicare supplement insurance benefits and premiums due to changes in the federal medicare program. Notes N.H. Admin. Code § Ins 1903.01 #4553, eff 12-7-88; ss by #5656, eff 7-1-93; ss by #7017, IN…

(a) This part shall take precedence over other rules and requirements relating to medicare supplement policies or contracts only to the extent necessary to assure that benefits are not duplicated, that applicants receive adequate notice and disclosure of changes in medicare suppl…

(a) "Applicant" means: (1) In the case of an individual medicare supplement policy or subscriber contract, the person who seeks to contract for insurance benefits; and (2) In the case of group medicare supplement policy or subscriber contract, the proposed certificateholder. (b) …

(a) No medicare supplement insurance policy, contract or certificate in force in this state shall contain benefits which duplicate benefits provided by medicare. (b) No later than 30 days prior to the annual effective date of medicare benefit changes mandated by the Medicare Cata…

(a) No medicare supplement policy, contract or certificate shall be issued or issued for delivery in this state which provides benefits which duplicate benefits provided by medicare. No such policy, contract or certificate shall provide less benefits than those required under Ins…

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 this part and the application of such provision to other persons or circumstances shall not be affected thereby. Notes N.H. Admin. Code §…

This part applies to all group or blanket insurance plans subject to RSA 415, RSA 420-A and RSA 420-B, except those coverages listed under RSA 415-A:3, I(d), (g), (h), (i), (j), (k) and (m). Notes N.H. Admin. Code § Ins 1904.01 #3164, eff 12-24-85; ss by #4287, eff 7-1-87; ss by …

The purpose of this rule is to: (a) Establish a uniform order of benefit determination under which plans pay claims; (b) Reduce duplication of benefits by permitting a reduction of the benefits to be paid by plans that, pursuant to rules established by this rule, do not have to p…

As used in this rule, these words and terms have the following meanings, unless the context clearly indicates otherwise: (a) "Allowable Expense", except as set forth below or where a statute requires a different definition, means: (1) Any health care expense, including coinsuranc…

(a) Appendix A contains a model COB provision for use in contracts. The use of this model COB provision is subject to the provisions of (b), (c) and (d) below and the provisions of Ins 1904.05. (b) Appendix B is a plain language description of the COB process that explains to the…

When a person is covered by 2 or more plans: (a) The rules for determining the order of benefit payments are as follows:(1) The primary plan shall pay or provide its benefits as if the secondary plan or plans did not exist; (2) If the primary plan is a closed panel plan and the s…

In determining the amount to be paid by the secondary plan on a claim, should the plan wish to coordinate benefits, the secondary plan shall calculate the benefits it would have paid on the claim in the absence of other health care coverage and apply that calculated amount to any…

A plan shall, in its explanation of benefits provided to covered persons, include the following language; "If you are covered by more than one health benefit plan, you should file all your claims with each plan." Notes N.H. Admin. Code § Ins 1904.07 #3164, eff 12-24-85; ss by #42…

(a) A secondary plan that provides benefits in the form of services may recover the reasonable cash value of the services from the primary plan, to the extent that benefits for the services are covered by the primary plan and have not already been paid or provided by the primary …

(a) A contract that provides health care benefits and that was issued before the effective date of this rule shall be brought into compliance with this rule by: (1) The later of: a. The next anniversary date or renewal date of the contract; or b. Twelve months following the effec…

Any insurer, producer, or any person, firm, association or corporation who knowingly violates any provision of this part shall be subject to the provisions of RSA 400-A:15, III. Notes N.H. Admin. Code § Ins 1904.10 #8402, eff 8-1-05; ss by #10371, eff 8-1-13 Amended by Number 45,…

(a) The commissioner, upon the commissioner's own initiative or upon request by an insurer, shall waive any requirement of this chapter if such waiver does not contradict the objective or intent of the rule and: (1) Applying the rule provision would cause confusion or would be mi…

The purpose of this part is to provide for the reasonable standardization of coverage and simplification of terms and benefits of Medicare supplement policies, to facilitate public understanding and comparison of such policies, to eliminate provisions contained in such policies w…

(a) Except as otherwise specifically provided in Ins 1905.06, Ins 1905.15, Ins 1905.16, Ins 1905.19, and Ins 1905.24, this part shall apply to: (1) All Medicare supplement policies delivered or issued for delivery in this state on or after the effective date of this part; and (2)…

(a) "Applicant" means: (1) In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and (2) In the case of a group Medicare supplement policy, the proposed certificate holder. (b) "Bankruptcy" means when a Medicare Advantag…

No policy or certificate may be advertised, solicited or issued for delivery in this state as a Medicare supplement policy or certificate unless the policy or certificate contains definitions or terms that conform to the requirements of this section as follows: (a) "Accident", "a…

(a) Except for permitted preexisting condition clauses as described in Ins 1905.06(b)(1) and (2), Ins 1905.07(b)(1), and Ins 1905.08(a)(1) of this rule, no policy or certificate may be advertised, solicited or issued for delivery in this state as a Medicare supplement policy if t…

(a) No policy or certificate shall be advertised, solicited, or issued for delivery in this state as a Medicare supplement policy or certificate unless it meets or exceeds the minimum standards set forth in this section. These are minimum standards and do not preclude the inclusi…

(a) The standards set forth in this section are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state on or after July 1, 1992 and prior to June 1, 2010. No policy or certificate may be advertised, solicited, delivered, or i…

The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered, or issued for delivery in this state as a Medicare…

(a) An issuer shall make available to each prospective policyholder and certificate holder a policy form or certificate form containing only the basic core benefits, as defined in Ins 1905.07(c)of this rule. (b) No groups, packages or combinations of Medicare supplement benefits …

The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered or issued for delivery in this state as a Medicare …

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires that the following standards are applicable to all Medicare supplement policies or certificates delivered, or issued for delivery in this state, to individuals newly eligible for Medicare on or after Januar…

(a) This section shall apply to Medicare Select policies and certificates, as defined in this section. (b) No policy or certificate may be advertised as a Medicare Select policy or certificate unless it meets the requirements of this section. (c) For the purposes of this section:…

(a) An issuer shall not deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this state, nor discriminate in the pricing of a policy or certificate because of the health status, claims experience, receipt of health…

(a) Guaranteed issue shall be for: (1) Eligible persons are those individuals described in (b) who: a. Seek to enroll under the policy during the period specified in Ins 1905.14(c); and b. Submit evidence of the date of termination or disenrollment, or Medicare Part D enrollment …

(a) An issuer shall comply with Section 1882(c)(3) of the Social Security Act, as enacted by Section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987, OBRA, 1987, Public Law No. 100-203 by: (1) Accepting a notice from a Medicare carrier on dually assigned claims sub…

(a) Loss ratio standards shall be as follows: (1) A Medicare supplement policy or certificate form shall not be delivered or issued for delivery unless the policy form or certificate form can be expected, as estimated for the entire period for which rates are computed to provide …

(a) An issuer shall not deliver or issue for delivery a policy or certificate to a resident of this state unless the policy form or certificate form has been filed with and approved by the commissioner in accordance with filing requirements and procedures prescribed by the commis…

(a) An issuer or other entity may provide commission or other compensation to an agent or other representative for the sale of a Medicare supplement policy or certificate only if the first year commission or other first year compensation is no more than 200% of the commission or …

(a) General rules shall be as follows:(1) Medicare supplement policies and certificates shall include a renewal or continuation provision. The language or specifications of the provision shall be consistent with the type of contract issued. The provision shall be appropriately ca…

(a) Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant currently has Medicare supplement, Medicare Advantage, Medicaid coverage, or another health insurance policy or certificate i…

An issuer shall provide a copy of any Medicare supplement advertisement intended for use in this state whether through written, radio or television medium to the commissioner of insurance of this state for review or approval by the commissioner to the extent it may be required un…

(a) An issuer, directly or through its producers, shall: (1) Establish marketing procedures to assure that any comparison of policies by its agents or other producers will be fair and accurate; (2) Establish marketing procedures to assure excessive insurance is not sold or issued…

(a) In recommending the purchase or replacement of any Medicare supplement policy or certificate an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacement. (b) Any sale of a Medicare supplement policy or certificate that will…

(a) On or before March 1 of each year, an issuer shall report the following information for every individual resident of this state for which the issuer has in force more than one Medicare supplement policy or certificate: (1) Policy and certificate number; and (2) Date of issuan…

(a) If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate, the replacing issuer shall waive any time periods applicable to preexisting conditions, waiting periods, elimination periods, and probationary periods in the new Medicar…

This section applies to all policies with policy years beginning on or after May 21, 2009. (a) An issuer of a Medicare supplement policy or certificate: (1) Shall not deny or condition the issuance or effectiveness of the policy or certificate, including the imposition of any exc…