Title XXXVII, Insurance

Upon satisfactory evidence that any health maintenance organization has violated any law or regulation or in any way has failed in meeting its obligations, the commissioner may, in his discretion, pursue any one or more of the following courses of action: I. Suspend the certifica…

All procedures under this chapter shall be governed by the provisions of RSA 400-A and any person aggrieved by any order or decision of the commissioner pursuant to this chapter shall be entitled to an appeal in accordance with RSA 541.

With the exception of investments made in accordance with RSA 420-B:7, the funds of a health maintenance organization shall be invested only in securities or other investments permitted by the laws of this state for the investment of assets constituting the legal reserves of life…

Every organization subject to this chapter shall pay to the commissioner those fees required for payment by hospital and medical service corporations under RSA 400-A:29.

Every organization doing business pursuant to this chapter shall be subject to the premium tax requirements of RSA 400-A:31 and 32. Except for payments made by the state of New Hampshire, no tax shall be levied on any premiums, fees-for-service and other payments for health, dent…

All persons engaged in the solicitation or enrollment of enrolled participants shall be duly licensed agents for the sale of health insurance in the state pursuant to the provisions of RSA 402-J.

I. An insurance company licensed in this state, or a hospital, medical or health service corporation authorized to do business in this state, either directly or through a subsidiary or affiliate, may organize and operate a health maintenance organization under the provisions of t…

I. No person may operate a health maintenance organization without obtaining a certificate of authority from the commissioner. A foreign corporation may qualify under this chapter subject to its registration to do business in this state as a foreign corporation under RSA 293-A. I…

I. A health maintenance organization shall be considered an insurance company, however, except as provided in this chapter, title XXXVII shall not be applicable to any health maintenance organization granted a certificate of authority under this chapter; provided that this provis…

The commissioner in accordance with RSA 541-A may promulgate reasonable rules for the implementation of the provisions of this chapter.

Nothing in this chapter shall prohibit any health maintenance organization from meeting the requirements of any federal law which would authorize such health maintenance organization to receive federal financial assistance or enroll beneficiaries assisted by federal funds, or sha…

Notwithstanding the provisions of this chapter, a person proposing to operate a system of health care delivery and financing which is to be offered to individuals, whether or not as members of groups, in exchange for a fixed payment and organized so that providers and the organiz…

I. Each employer, public or private, in this state which offers its employees a health benefit plan and employs at least 25 employees, and each employee benefit fund in this state which offers its members any form of health benefit, shall make available to and inform its employee…

I. Before issuing a certificate of authority under this chapter, the commissioner shall require that the health maintenance organization have an initial net worth of $6,000,000 and that the minimum net worth required under paragraph II is maintained. II. Every health maintenance …

Each application for a certificate of authority shall be verified by an officer or authorized representative of the applicant and shall be in a form prescribed by the commissioner, containing such information as the commissioner may require.

Any applicant for a certificate of authority who is not domiciled in this state shall file with its application a power of attorney duly executed appointing the commissioner and his successors in office, and duly authorized deputies, as the true and lawful attorney of such applic…

The commissioner shall issue a certificate of authority to any person filing an application within 90 days after filing of a completed application, payment of all required fees and receipt of endorsement or approval of the state health planning and development agency, as provided…

The certificate shall be renewed annually on June 14 if the company complies with the requirements of this chapter, the commissioner regards it as safe, reliable, and entitled to confidence, and the company continues to conduct a meaningful business in New Hampshire, as determine…

The commissioner shall require a health maintenance organization to apply for a new certificate in accordance with this chapter, if, after notice and hearing, the commissioner finds that the organization has undergone a substantial change in finances or managerial control since i…

I. Upon request of any applicant, and subject to any regulations the commissioner may impose, the commissioner, in his discretion, may permit an applicant to contact potential enrolled participants prior to the issuance of a certificate of authority, to discuss the health care se…

The powers of a holder of a certificate of authority issued pursuant to RSA 420-B:5 shall include, in addition to any powers conferred by the law under which the health maintenance organization is organized, and subject to all restrictions imposed in this chapter, or by the commi…

I. No evidence of coverage, or amendment thereto, shall be issued to any person in this state until a copy of the evidence of coverage, or amendment thereto including all rates to be charged, has been filed with and approved by the commissioner. II. Every health maintenance organ…

I. A policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any…

I. (a) Benefits for mental or nervous conditions shall conform to the requirements of RSA 415:18-a or alternatively with the basic health services requirements of the Health Maintenance Organization Act of 1973 (P.L. 93-222), any amendments, and federal regulations issued under t…

No group health maintenance organization contract, authorized under this chapter, may be cancelled or nonrenewed by the health maintenance organization, except for nonpayment of premium, unless the group contract holder receives either a notice of cancellation or nonrenewal or an…

No non-group health maintenance organization contract, authorized under this chapter, may be cancelled or nonrenewed by the health maintenance organization except for nonpayment of premium, unless the enrolled participant receives either a notice of cancellation or nonrenewal or …

I. Every health maintenance organization and every other similar corporation licensed under the laws of another state that issues or renews any group policy of accident or health insurance providing benefits for medical or hospital expenses, shall provide to each covered individu…

I. Benefits for scalp hair prostheses shall conform to the requirements of RSA 415:18-d. Such benefits shall not be subject to any greater deductible than any other prostheses benefits provided by the health maintenance organization. The coinsurance required by the enrolled parti…

I. Every health maintenance organization and every other similar corporation licensed under the laws of another state that issues or renews any policy of individual or group health insurance providing benefits for medical or hospital expenses, shall provide to each individual or …

All contracts issued by a health maintenance corporation which provide coverage for a family member of the subscriber shall, as to such family member's coverage, also provide that health insurance benefits applicable for children are payable with respect to any minor from the dat…

Every health maintenance organization and every other similar corporation licensed under the laws of another state that issues or renews any policy of group health insurance providing benefits for medical or hospital expenses, which provides coverage for outpatient services shall…

All health maintenance organizations shall provide to each subscriber, on request, a written statement of the dollar amount of allowable benefit for any procedure which is requested by the appropriate procedure code.

The validity of the contract shall not be contested except for nonpayment of premiums, after it has been in force for 2 years from its date of issue. No statement made by any person covered under the contract relating to insurability shall be used in contesting the validity of th…

I. All individual and group health maintenance organization contracts shall provide that the health insurance benefits applicable for children are payable with respect to a newly born child of the insured or subscriber or a dependent child of the insured or the subscriber from th…

Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing benefits for medical or hospital expenses, shall provide to each indi…

I. The requirements of RSA 417-E, RSA 420-B:8-b, RSA 420-B:8-e, RSA 420-B:8-f, and RSA 420-B:8-ff shall not apply to a Medicare risk policy issued pursuant to a contract under section 1876 or section 1833 of the federal Social Security Act (42 U.S.C. section 1395 et seq.) as amen…

All health maintenance organizations shall provide to each new subscriber who is a resident of this state a copy of the patients' bill of rights law under RSA 151:21.

I. A health maintenance organization may offer a point-of-service plan in accordance with the requirements of this section. A point-of-service plan is a health maintenance organization contract which includes coverage for both in-network services and coverage for services provide…

The existence of a court order under RSA 169-B, RSA 169-C, or RSA 169-D for a service, program, or placement that is covered under any insurance for the minor shall not be considered in determining qualification for third-party payment under such insurance. Benefits for such serv…

Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing maternity benefits shall also provide to each group, or to the portio…

If the coverage for dependent children includes coverage for dependent children who are full-time students, as defined by the appropriate educational institution, beyond the age of 18, such dependent coverage shall include coverage for a dependent's medically necessary leave of a…

Every health maintenance organization and every similar corporation licensed under the laws of another state that issues or renews any policy, plan, or contract of individual or group health insurance providing benefits for medical, rehabilitation, or hospital expenses, shall pro…

I. Every organization subject to this chapter annually, on March 1, shall file a report with the commissioner and with the commissioner of health and human services, said report verified by an appropriate official of the organization, showing its financial condition on the last d…