New Hampshire Administrative Code

(a) If a policy or contract subject to this rule provides for automatic discontinuance of the policy or contract after a premium or subscription charge has remained unpaid through the grace period allowed for such payment, the carrier shall be liable for valid claims for covered …

Any notice of discontinuance shall comply with the provisions of RSA 415:18 and RSA 420-G. Notes N.H. Admin. Code § Ins 1906.04 #8646, eff 6-12-06

(a) Every group policy, contract or certificate subject to this rule issued on or after the effective date of this rule, or under which the level of benefits is altered, modified or amended on or after the effective date of this rule, shall provide a reasonable provision for exte…

(a) This subsection shall indicate the carrier responsible for liability in those instances in which one carrier's policy, contract or certificate replaces a plan of similar benefits of another carrier. (b) After discontinuance of the policy, contract or certificate, the prior ca…

(a) The purpose of this chapter is to incorporate the requirements set forth in the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and federal regulations that prohibit carriers providing health insurance coverage under a health benefit plan in the group mark…

As used in this chapter: (a) "Affiliation period" means a period of time that shall expire before health insurance coverage provided by a carrier becomes effective, and during which the carrier is not required to provide benefits. (b) "Beneficiary" has the meaning stated in Secti…

(a) A carrier subject to this chapter shall not establish a rule for eligibility, including continued eligibility, of an individual to enroll for benefits under the plan that discriminates based on any health factor that relates to the individual or dependent of the individual. (…

(a) A carrier subject to this chapter shall: (1) Not require an individual, as a condition of enrollment or continued enrollment under the plan, to pay a premium or contribution rate that is greater than the premium or contribution rate for a similarly situated individual enrolle…

(a) Subject to (b) and (c) below, Ins 1907.03 does not require a carrier subject to this chapter to provide coverage for any particular benefit to any group of similarly situated individuals. (1) A carrier subject to this chapter shall make the benefits provided under a plan avai…

(a) Except to the extent permitted under (b)(2) or (c) below, in accordance with Ins 1907.03 and Ins 1907.04, a carrier subject to this chapter shall not establish a rule of eligibility or set an individual's premium or contribution rate based on: (1) Whether the individual is co…

(a) The commissioner shall conduct a reasonable investigation based on a complaint received by the commissioner and issue a prompt determination as to whether a violation of this chapter may have occurred. (b) If the commissioner finds from the investigation that a violation of t…

The purpose of this part is to authorize the New Hampshire Individual Health Plan Benefit Association, an existing entity established pursuant to RSA 404-G, to operate a new mechanism for risk adjustment and subsidization to assist health carriers who have issued individual healt…

The requirements of this part shall apply to writers of individual health insurance that are subject to the association's plan of operation under RSA 404-G:5. Notes N.H. Admin. Code § Ins 1908.02 #10023, eff 11-14-11

The definitions in RSA 404-G:2 shall be applicable to this part, except insofar as a defined term is clarified below: (a) "Association" means the New Hampshire Individual Health Plan Benefit Association, established under RSA 404-G:4. (b) "Board" means the association's board of …

(a) Risks shall be shared as follows: (1) Sharing shall be implemented through a risk adjustment and subsidization mechanism whereby all carriers will subsidize losses of certain carriers issuing individual health insurance policies to persons under 19 years old; (2) Only individ…

(a) Each year, the board shall specify its assessment and disbursement plans for eligible subsidies under this part. The assessment and disbursement plans shall each be considered amendments to the association's plan of operations pursuant to RSA 404-G:5 and shall conform to all …

(a) The initial subsidy period shall be for claims incurred during the experience period from September 23, 2010 through December 31, 2011 for individual health insurance child-only policies that meet the requirements of Ins 1908.04. (b) Applications for the initial subsidy perio…

The rules in this chapter shall govern all proceedings before the department. Notes N.H. Admin. Code § Ins 201.01 #2336, eff 4-8-83; ss by #2508, eff 9-23-83; ss by #4287, eff 7-1-87; ss by #5653, eff 7-1-93; ss by #7024, INTERIM, eff 7-1-99, EXPIRES: 10-29-99; ss by #7121, eff 1…

(a) "Adjudicative proceeding" means the procedure to be followed in contested cases, as set forth in RSA 541-A. (b) "Commissioner" means the insurance commissioner. (c) "Complainant" means a consumer who files a complaint or inquiry with the Department. (d) "Confidential document…

(a) All hearings shall be conducted by a hearing officer. (b) The commissioner or deputy commissioner shall act as hearing officer in any summary suspension hearing pursuant to Ins 206.04. For all other hearings, the commissioner or deputy commissioner shall act as hearing office…

(a) Upon the hearing officer's own initiative or upon the motion or request of any party, a hearing officer shall, for good cause, withdraw from any appeal. (b) Good cause shall exist if a hearing officer has a direct interest in the outcome of the hearing or any connection with …

The hearing officer in an adjudicative proceeding shall question witnesses and make such inquiry of witnesses, parties, or counsel as the hearing officer believes appropriate to promote the fair, accurate, and efficient resolution of issues pending before the department. Notes N.…

(a) Any party may appear in a proceeding either in person, by a representative, or both. (b) Each party shall file an appearance in the proceeding indicating an intention to appear on the date of the hearing. (c) If the party is represented, the representative shall file an appea…

(a) A representative shall be either an attorney-at-law, licensed in New Hampshire, or an officer or employee designated to represent a business entity. (b) Designation of an attorney-at-law or other representative shall:(1) Be in writing; and (2) Contain the following informatio…

Any party in a proceeding may be represented by counsel. Parties shall retain counsel at their own expense and requests for appointment of counsel shall not be granted. Notes N.H. Admin. Code § Ins 204.03 #2336, eff 4-8-83; ss by #2508, eff 9-23-83; ss by #4287, eff 7-1-87; ss by…

(a) "Misconduct" means any act or non-act which would constitute misconduct of an attorney-at law as defined in the New Hampshire supreme court rules of professional conduct. (b) The department shall, after notice and opportunity for hearing, upon a finding of misconduct as defin…

(a) Staff members of the department shall only participate in a proceeding as witnesses, technical assistants, technical advisors, or as otherwise provided in this chapter. (b) The staff advocate shall be that person authorized to represent the department in an adjudicative proce…

Unless called as witnesses or granted intervenor status, a complainant shall have no role during enforcement or disciplinary hearings beyond the role of witness or intervenor. Notes N.H. Admin. Code § Ins 204.06 #7121, eff 10-29-99, EXPIRED: 10-29-07 New. #9052-A, eff 1-2-08; ss …

(a) Once an adjudicative proceeding has commenced, unless required for the disposition of ex parte matters authorized by law or exempt herein, no party shall communicate, directly or indirectly, with the commissioner, the hearing officer, or any assistant or advisor to the hearin…

(a) All decisions, orders, notices, or other written correspondence or documents issued by or at the direction of the department shall be refutably presumed to have been issued on the date noted on the document. (b) All written documents governed by these rules shall be deemed to…

(a) All correspondence, pleadings, motions, or other documents filed under these rules shall:(1) Include the title and docket number of the proceeding, if known; (2) Be clearly printed on durable paper, 81/2 by 11 inches in size; (3) Be signed by the party or proponent of the doc…

(a) Copies of all petitions, motions, exhibits, memoranda, or other documents filed by any party to a proceeding governed by this rule shall be delivered by that party to all other parties to the proceeding. (b) All proposed and final notices, orders, decisions, or other document…

(a) Unless otherwise specified, all time periods referenced in this chapter shall be calendar days. (b) Computation of any period of time referred to in this chapter shall begin with the day after the action which sets the time period in motion and shall include the last day of t…

(a) Unless presented during an oral session of a proceeding, motions and all replies thereto shall be in written form and filed with the hearing officer, unless made in response to a matter asserted for the first time at the hearing or on the basis of information which was not re…

(a) Except as otherwise provided by statute or rule, all pleadings, attachments to pleadings, and exhibits submitted at hearings shall be available for public inspection. (b) A confidential document shall not be accepted in a pleading if it is neither required for filing nor mate…

(a) In any adjudicative proceeding before the department, all motions, requests, and actions shall be conducted pursuant to RSA 541-A:31 through 38. (b) Hearings shall be conducted with the respondent, the department, and any witnesses physically present before the hearing office…

The hearing officer, upon the hearing officer's own initiative or upon the motion or petition of any interested person, shall waive any requirement or limitation imposed by this chapter not otherwise contrary to law, upon reasonable notice to affected persons, when the proposed w…

(a) Failure to comply with the rules in this chapter shall result in the denial of any petition or motion so failing to comply, or the rejection of any document so failing to comply, or the issuance of an order adverse to the person so failing to comply. (b) If any party, to whom…

In the case of summary suspensions, the following general provisions shall apply: (a) When the commissioner finds that public health, safety, or welfare requires emergency action, and incorporates a finding to that effect in such order, summary suspension of a license shall be or…

(a) For purposes of this section, "proof by a preponderance of the evidence" means what is sought to be proved is more probable than not. (b) In a hearing held to determine whether a certification, license, permit, or other approval that has already been issued should be suspende…

(a) The hearing officer shall for good cause, upon request or upon the hearing officer's own initiative, advance or postpone the time and date set for any hearing. (b) If a postponement is requested by a party to the hearing, it shall be granted if the hearing officer determines …

(a) At any time following the notice of hearing of an adjudicatory proceeding, the hearing officer, upon motion or upon his or her own initiative, shall direct all interested parties to attend one or more prehearing conferences to aid in the disposition of the proceeding. (b) The…

(a) Any party wishing discovery against another party shall, by motion, seek leave to do so and shall identify the exact type of discovery requested. (b) Discovery shall be permitted when: (1) It appears that the parties cannot adequately address the factual issues at the time fi…

(a) Subpoenas for the attendance of witnesses at or the production of evidence in adjudicatory proceedings shall be issued only upon the order of the commissioner or pursuant to authority delegated by the commissioner. Subpoenas shall be issued in response to a motion when the co…

(a) Receipt of evidence shall be governed by RSA 541-A:33. (b) All documents, materials, and objects offered as exhibits shall be admitted into evidence unless excluded by the presiding officer as irrelevant, immaterial, unduly repetitious, or legally privileged. (c) All objectio…

(a) Any party may submit proposed findings of fact and conclusions of law to the presiding officer prior to or at the hearing. (b) Upon request of any party, or if the presiding officer determines that proposed findings of fact and conclusions of law would serve to clarify the is…

The entirety of all oral proceedings shall be recorded verbatim. Upon the written request to the commissioner by any party, or upon the department's own initiative, such record shall be transcribed and the requesting party shall pay all reasonable costs for such transcription. No…