Title XXXVII, Insurance

I. No health benefit plan issued or renewed after July 7, 2000 shall contain any provision which establishes or promotes an emergency medical response or transportation system that encourages or directs access by a covered person in competition with or in substitution of the stat…

I. A provider may contract to provide continuing care to a resident who remains at home and does not move immediately into a facility if the provider: (a) Holds a certificate of authority issued under this chapter to provide continuing care. (b) Owns and operates a facility locat…

In the event that a person is covered by more than one plan that requires pre-certification, the member shall obtain pre-certification from the primary plan. Although the member shall not be required to obtain pre-certification from the secondary plan, the secondary plan shall no…

I. Pricing information from the machine-readable files described in RSA 420-J:29 shall be electronically provided to the commissioner in a form and manner as specified in rule adopted by the commissioner under RSA 541-A. The commissioner shall ensure that the required form and ma…

Fraternal benefit societies and life or accident insurance companies are not affected by this chapter.

The commissioner is authorized and empowered to adopt such rules in accordance with RSA 541-A which are reasonable and necessary to administer and enforce the provisions of this chapter.

I. A health plan may satisfy the requirements of this subdivision by entering into a written agreement under which another person, including a third-party administrator or health care claims clearinghouse, provides the disclosures required under this subdivision. II. If a health …

No provision of this chapter or any contract for hospital service by such health service corporation shall in any way affect the operation of workers' compensation laws of the state.

I. The provisions of this subdivision apply for plan years beginning on or after January 1, 2026. II. Nothing in this subdivision alters or otherwise affects a health plan's duty to comply with requirements under other applicable state or federal laws, including those governing t…

I. A health plan that, acting in good faith and with reasonable diligence, makes an error or omission in a disclosure required under this subdivision does not fail to comply with this subdivision solely because of the error or omission if the issuer or administrator corrects the …

Each managed care insurer shall file a report in form and containing such information as the insurance commissioner prescribes when requested by the commissioner. Such report shall include the name of the managed care insurer, its affiliates, a description of each exclusive arran…

Enrollees, subscribers, certificate holders, and individual insureds shall receive in simple and concise written language at least the following information: I. An explanation of benefits provided. II. Any benefit limitations, reductions, exclusions or exceptions to covered servi…

I. A plan under this chapter shall have an expected loss ratio of not less than 85 percent. In reviewing a rate filing or application by a plan, the commissioner may modify the expected minimum loss ratio requirement if the commissioner determines the modification to be in the in…

I. A disclosure statement shall be approved by the department prior to delivery to any prospective resident. Each provider shall provide each prospective resident with a current disclosure statement and a current continuing care contract, which have previously been approved by th…

Delta shall not revise or modify any contract or issue a new contract to a contract holder until it shall have filed with the commissioner a copy of the form of such amendment, modification or contract, including all riders and endorsements, and until the commissioner's approval …

All licensees shall establish and maintain a utilization review procedure by which a claimant or claimant's representative may seek a claim benefit determination. The procedure shall meet the following minimum standards: I. The licensee shall maintain a toll-free telephone number…

To obtain authority to operate as a purchasing alliance, an application shall be completed and filed with the commissioner by an authorized representative of the corporation or other entity established to operate as a purchasing alliance. An application shall not be deemed filed …

I. Health carriers providing health coverage to individuals and small employers under this chapter shall be subject to the following: (a) All premium rates charged shall be guaranteed for a rating period of at least 12 months, and shall not be changed for any reason, including bu…

I. No health service corporation organized under the laws of this state shall do business unless it has obtained a license from the commissioner. II. No health service corporation organized under the laws of any other state or country shall be licensed to do business in this stat…

I. A health carrier shall: (a) Establish written policies and procedures for credentialing verification of all health care professionals with whom the health carrier contracts and apply these standards consistently. (b) Verify the credentials of a health care professional. Prior …

Health benefit plans issued under RSA 420-C:3 may include, but shall not be limited to, the following components which are designed to control the cost and improve the quality of health care for covered persons: I. A per capita payment to preferred providers. II. Differences betw…

I. The board shall: (a) Develop a standard health benefit plan which shall contain benefit and cost sharing levels that reflect the health coverages most commonly sold by small employer carriers in the state. (b) Develop base reinsurance premium rates for the standard health bene…

I. Implementation of the program shall be commensurate with the size and complexity of the licensee, the nature and scope of the licensee's activities, including its use of third-party service providers, and the sensitivity of the nonpublic information used by the licensee or in …

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…

I. Health carriers shall credential qualified entities administering community mental health programs as defined under RSA 135-C:7, entities administering community substance use disorder treatment programs as defined under RSA 172:2-c, and community health centers as facilities …

Every continuing care contract shall contain the following notice in 10-point bold face type or larger, directly above the space provided before the signature of the resident: NOTICE TO THE RESIDENT: YOU HAVE THE RIGHT TO CANCEL THIS CONTRACT OR AGREEMENT BY SENDING OR DELIVERING…

I. Beginning July 1, 2017, all health insurers, health maintenance organizations, health services corporations, medical services corporations, and preferred provider programs may, when requiring prior authorization for a prescription drug, use and accept the prior authorization p…

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…

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…

The following prior authorization requirements apply to utilization review entities conducting prior authorization review determinations for managed care plans operating subject to RSA 420-J. I. Timeliness standards for processing prior authorization requests submitted electronic…

I. Any carrier that offers small group health coverage in the state shall make its small employer group coverage available with a limited open enrollment period to individual employees of small employers when the coverage is purchased through a premium only cafeteria plan that sa…

In the event that a person is covered by more than one plan that requires pre-certification, the member shall obtain pre-certification from the primary plan. Although the member shall not be required to obtain pre-certification from the secondary plan, the secondary plan shall no…

I. All health coverage offered by health carriers to individuals or small employers shall include coverage for essential health benefits and provide essential health benefits in a plan substantially equivalent to New Hampshire's essential health benefit benchmark plan in effect f…

I. In addition to any other requirements of law, no policy forms, except as stated in RSA 420-H:3, shall be delivered or issued for delivery in this state on or after the dates such forms must be approved under this chapter unless: (a) The text achieves a minimum score of 40 on t…

No person who is party to an exclusive arrangement on the effective date of this chapter shall renew or extend any such exclusive arrangement after the effective date of this act. No provision of any contract or agreement establishing an exclusive arrangement shall be effective a…

I. The commissioner may revoke, deny, or suspend a certificate of authority upon notice and hearing, which hearing notice may be waived if there are exigent circumstances requiring the commissioner to act without a hearing such hearing to be held as soon as possible after action …

Beginning January 1, 2006 and ending June 30, 2008, members may reinsure with the pool health coverage provided to small employers as follows: I. The pool shall reinsure the level of coverage provided up to, but not exceeding, the level of coverage provided in the standard health…

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…

I. Health carriers providing health coverage shall not perform medical underwriting, including the use of health statements or screenings or the use of prior claims history. II. Regardless of claim experience, health status, or medical history, health carriers providing health co…

The directors of a health service corporation: I. Shall at all times include representation from the following groups: (a) The general public exclusive of those falling within subparagraphs (b) and (c) and paragraph II. (b) Physicians actively engaged in practice. (c) Administrat…

The commissioner shall have authority to: I. Make, adopt, and amend rules and regulations pursuant to RSA 541-A for, or as an aid to, the administration of any provision of the Act relating to insurance; II. Apply for any public or private grant funds available under the Act; III…

Every carrier or other licensed entity shall establish and shall maintain a written procedure by which a claimant or a representative of the claimant, shall have a reasonable opportunity to appeal a claim denial to the carrier or other licensed entity, and under which there shall…

Every contract between Delta and a contract holder shall be in writing, a copy of which shall be furnished to the contract holder and shall contain the following provisions: I. A statement of the amount payable to Delta by the contract holder and the manner in which such amount i…

I. An institution shall establish reserves with the amounts necessary to satisfy all contractual obligations and liabilities of the plan, including: (a) Funds for the payment of claims and expenses thereon reported but not yet paid, and claims and expenses thereon incurred but no…

I. If the licensee learns that a cybersecurity event has or may have occurred, the licensee or an outside vendor and/or service provider designated to act on behalf of the licensee, shall conduct a prompt investigation. II. During the investigation, the licensee, or an outside ve…

No health care insurer shall discriminate against any provider on the basis of religion, race, color, national origin, age, sex, gender identity, sexual orientation, or marital status. Reasonable terms and conditions including, but not limited to, those based on economic or geogr…