New Hampshire Administrative Code

All producers of health maintenance organizations shall be licensed pursuant to RSA 402-J. Notes N.H. Admin. Code § Ins 2201.08 #1900, eff 1-1-82; ss by #4287, eff 7-1-87; ss by #5655, eff 7-1-93; ss by #7018, INTERIM, eff 7-1-99, EXPIRED: 10-29-99 New. #9335, eff 12-5-08 Amended…

(a) The transition, under the employment-related group health insurance plan, from a traditional indemnity or nonprofit health service corporation mode of coverage to a health maintenance organization shall: (1) Be effected in every case without application of waiting periods or …

(a) The transition, under the employment-related group health insurance plan, from a traditional indemnity or nonprofit health service corporation mode of coverage to a health maintenance organization shall: (1) B e effected in every case without application of waiting periods or…

Health maintenance organizations that qualify as tax exempt organizations for federal income tax purposes under section 501(c) of the United States Internal Revenue Code shall be considered tax exempt for the purposes of payment of premium taxes pursuant to RSA 420-B:17. Notes N.…

The purpose of this part is to provide for the regulation and licensing of third party administrators and to set forth rules and procedural requirements which the commissioner deems necessary to carry out the provisions of RSA 402-H. Notes N.H. Admin. Code § Ins 2301.01 #5787, ef…

(a) "Administrator" means "third party administrator (TPA)" as defined in RSA 402-H:1, I. (b) "Affiliate" means "affiliate" as defined in RSA 402-H:1, II. The term includes "affiliated". (c) "Commissioner" means the commissioner of insurance. (d) "Control" means "control" as defi…

(a) An administrator shall not operate as an administrator in this state without a certificate of authority or exemption from the department. Administrators wishing to do business in this state shall complete an application, an exemption registration, which shall be filed annuall…

(a) Each applicant for a certificate of authority as an administrator shall indicate on the application whether the applicant has: (1) Ever been denied a license or certificate of authority as an insurance agent, broker, or administrator; (2) Been licensed or authorized as an ins…

(a) An administrator that administers benefit plans for an insurer that is not licensed in New Hampshire, a multiple employer welfare arrangement, or a church plan shall include a surety bond in a minimum amount of $100,000 or 10 percent of the administrator's average daily clien…

(a) Each renewal of a certificate of authority shall be accompanied by the applicant's current audited financial statement. (b) The financial statement shall reflect a positive net worth in order to be acceptable as proof of the applicant's financial responsibility. (c) The depar…

(a) An administrator shall not act on behalf of an insurer without a written agreement with an insurer or other person for whom the services are performed. (b) Pursuant to RSA 402-H:2, the agreement shall be retained by the administrator and the insurer for the period of the cont…

(a) Any money received by a TPA as premium or return premium on or under any policy of insurance or application therefor shall be received by the TPA in its fiduciary capacity. (b) Any TPA who appropriates to its own use, or with intent to appropriate to its own use, takes, secre…

(a) Each TPA that collects premium or return premiums shall establish a premium trust account for New Hampshire business. (b) If the account is interest bearing, the requirements of Ins 2301.11 shall be observed. (c) Fiduciary funds on New Hampshire business shall at all times be…

(a) Under no circumstances shall a TPA place fiduciary funds in a personal or business operating account. The TPA may retain commission income or other funds in its premium trust account in order to advance premiums, establish reserves for paying return commissions or for such co…

A TPA shall only utilize interest-bearing accounts that require no advance notice for the withdrawal of funds, and the TPA shall arrange all such interest-bearing accounts so that funds therein contained shall be immediately available during normal business hours. Notes N.H. Admi…

The TPA shall retain the return premium in the trust account until remittance to the client is made. Remittance to the client shall occur no later than 45 days from the date the return premium is determined. If the return premium cannot be delivered to the insured entitled theret…

(a) The following records relative to the premium trust account shall be maintained at all times by the TPA:(1) Periodic statements of account supplied by the bank for all premium trust accounts maintained pursuant to this part; (2) Records of all deposits made into each premium …

(a) The commissioner shall examine an administrator pursuant to RSA 402-H:4, II on a regularly scheduled basis or pursuant to RSA 402-H:13 when an evaluation of any submission to the department by the administrator, insurer, policyholder or publication indicates potential financi…

(a) The insurer shall be responsible for determining benefits, premium rates, underwriting criteria, and claims payment procedures applicable to the coverage and for securing reinsurance. (b) The standards pertaining to (a) above shall be provided in writing by the insurer to the…

(a) All advertising conducted by the TPA on behalf of the insurer shall be approved in writing by the insurer in advance of its use. (b) Advertisements of insurance shall comply with the provisions of Ins 2600. Notes N.H. Admin. Code § Ins 2301.16 #5787, eff 2-14-94; ss by #7023,…

(a) An administrator shall be subject to the provisions of RSA 402-H:14 and RSA 402-H:16 for the following reasons: (1) Failure to comply with any provisions of these rules or of RSA 402-H; (2) Failure to comply with any lawful order of the commissioner; (3) Committing an unfair …

(a) The commissioner shall address any inquiries to the administrator concerning its TPA business. The administrator shall reply in writing to any inquiry made by the commissioner pursuant to Ins 1001.01(c). (b) An administrator shall keep all complaints on file for a period of 5…

Prior to denying an application or a renewal application or suspending or revoking a certificate issued under this part, a certificate holder shall be provided with written notice of the commissioner's allegations and provided an opportunity for a hearing as provided in RSA 400-A…

(a) Non-compliance with Ins 2301.03 through Ins 2301.16 shall be a violation under RSA 402-H. The department shall specify which sections, including specific subsections if any, of RSA 402-H are allegedly violated in any enforcement action brought under this section. (b) In addit…

(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…

(a) The purpose of this part is to prescribe: (1) Requirements for statements of actuarial opinion that are to be submitted in accordance with RSA 410, and for memoranda in support thereof; (2) Rules applicable to the appointment of an appointed actuary; and (3) Guidance as to th…

(a) This part shall apply to all life insurance companies and fraternal benefit societies doing business in this state and to all life insurance companies and fraternal benefit societies that are authorized to reinsure life insurance, annuities, or accident and health insurance b…

(a) "Actuarial opinion" means the opinion of an appointed actuary regarding the adequacy of the reserves and related actuarial items based on an asset adequacy analysis in accordance with Ins 2401.05 and with applicable actuarial standards of practice. (b) "Actuarial standards bo…

(a) Submission of Statement of Actuarial Opinion:(1) There is to be included on or attached to Page 1 of the annual statement for each year, beginning with the year in which this part becomes effective, the statement of an appointed actuary, entitled "Statement of Actuarial Opini…

(a) General Description. The statement of actuarial opinion submitted in accordance with this section shall consist of: (1) A paragraph identifying the appointed actuary and his or her qualifications; (2) A scope paragraph identifying the subjects on which an opinion is to be exp…

(a) General; (1) In accordance with RSA 410, the appointed actuary shall prepare a memorandum to the company describing the analysis done in support of his or her opinion regarding the reserves. The memorandum shall be made available for examination by the commissioner upon his o…

(a) The commissioner, upon the commissioner's own initiative or upon request by an insurer, shall waive any requirement of this part 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 misle…

The purpose of this part is to prescribe requirements for statements of actuarial opinion that are to be submitted in accordance with RSA 400-A:36, and for memoranda in support thereof. Notes N.H. Admin. Code § Ins 2402.01 #9892, eff 4-1-11 Amended by Volume XXXIX Number 02, File…

This part shall apply to every property and casualty insurance company doing business in this state, unless otherwise exempted by the domiciliary commissioner. Notes N.H. Admin. Code § Ins 2402.02 #9892, eff 4-1-11 Amended by Volume XXXIX Number 02, Filed January 10, 2019, Propos…

Every property and casualty insurance company doing business in this state, unless otherwise exempted by the domiciliary commissioner, shall: (a) Annually submit the opinion of an appointed actuary entitled "statement of actuarial opinion"; and (b) File the opinion in accordance …

(a) Every property and casualty insurance company domiciled in this state that is required to submit a statement of actuarial opinion shall: (1) Annually submit an actuarial opinion summary, written by the company's appointed actuary; (2) File the opinion summary in accordance wi…

(a) An actuarial report and underlying workpapers as required by the appropriate NAIC property and casualty annual statement instructions shall be prepared to support each actuarial opinion. (b) If the insurance company fails to provide a supporting actuarial report or workpapers…

(a) The statement of actuarial opinion shall be provided with the annual statement in accordance with the appropriate NAIC property and casualty annual statement instructions and shall be treated as a public document. (b) Documents, materials or other information in the possessio…

(a) The commissioner, upon the commissioner's own initiative or upon request by an insurer, shall waive any requirement of this part 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 misle…

The purpose of the advertisements of accident and health insurance part is to establish minimum criteria to assure proper and accurate description and to protect prospective purchasers with respect to the advertisement of accident and health insurance in the same manner as the ru…

(a) This part shall apply to individual and group accident and health insurance (except Medicare supplement insurance or any other insurance that is covered by a separate state statute) "advertisement," as that term is defined in Ins 2601.03(b), (g), (h) and (i) unless otherwise …

(a) (1) "Accident and health insurance policy" means a policy, plan, certificate, contract, agreement, statement of coverage, rider or endorsement that provides accident or health benefits or medical, surgical or hospital benefits, whether on an indemnity, reimbursements, service…

(a) All information, exceptions, limitations, reductions and other restrictions required to be disclosed by this part shall be set out conspicuously and in close conjunction to the statements to which the information relates or under appropriate captions of such prominence that i…

(a) The format and content of an advertisement of an accident or health insurance policy shall be sufficiently complete and clear to avoid deception or the capacity or tendency to mislead or deceive. Format means the arrangement of the text and the captions. (b) Distinctly differ…

(a) Covered benefits. (1) The use of deceptive words, phrases or illustrations in advertisements of accident and health insurance is prohibited. (2) An advertisement that fails to state clearly the type of insurance coverage being offered is prohibited. (3) An advertisement shall…

(a) An advertisement that is an invitation to contract shall disclose the provisions relating to renewability, cancellability and termination and any modification of benefits, losses covered, or premiums because of age or for other reasons, in a manner that shall not minimize or …

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