Title XXXVII, Insurance

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 covered person shall have the right to independent external review of a determination by a health carrier or its designee utilization review entity when all of the following conditions apply: (a) The subject of the request for external review is an adverse determination; (b)…

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…

Standard external review shall be conducted as follows: I. Within 7 business days after the date of receipt of a request for external review, the commissioner shall complete a preliminary review of the request to determine whether: (a) The individual is or was a covered person un…

Expedited external review shall be conducted as follows: I. Expedited external review shall be available when the covered person's treating health care provider certifies to the commissioner that adherence to the time frames specified in RSA 420-J:5-b would seriously jeopardize t…

I. The certification of independent review organizations shall be conducted as follows: (a) The commissioner shall certify independent review organizations eligible to be selected to conduct external reviews under this section to ensure that an independent review organization sat…

I. The health carrier against which a request for external review is filed shall pay the cost of the external review. Except under the circumstances described below in this paragraph, such costs shall not exceed $1,500. The commissioner shall notify the independent review organiz…

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…

I. The commissioner may adopt rules under RSA 541-A necessary for the implementation and administration of this chapter, relative to: (a) The length of time necessary for health care insurers to comply with this chapter; and (b) The information he shall require health care insure…

Any person aggrieved by the action of the commissioner or the commissioner of the department of health and human services in revoking, suspending, or refusing to grant or reissue a certificate has the right to a hearing and appeal in accordance with the provisions of RSA 541.

The commissioner or designee may conduct periodic reviews of the operations of the entities licensed under this chapter to ensure that they continue to meet the minimum standards set in RSA 420-E:4 and any applicable rules adopted by the commissioner. The commissioner may perform…

Delta shall file with the insurance commissioner a full schedule of the rates to be paid by contract holders and shall obtain the commissioner's approval prior to implementing any rate changes. The commissioner may refuse such approval if he finds the rates are excessive, inadequ…

I. Health carriers shall not establish rules of eligibility, including continued eligibility, for health coverage in relation to the following health status related factors of any employee or dependent: (a) Health status. (b) Medical condition, including both physical and mental …

The commissioner may authorize a lower score than the Flesch reading ease score required in RSA 420-H:5, I(a) whenever he finds that a lower score: I. Will provide a more accurate reflection of the readability of a policy form; II. Is warranted by the nature of a particular polic…

No exclusive arrangement between a managed care insurer and any person shall require a primary care physician to terminate any existing patient relationship with an individual who is covered by another managed care insurer. The physician shall continue to offer to provide service…

I. Written standards and procedures. [Paragraph I(a) effective until January 1, 2027; see also paragraph I(a) set out below.] (a) Each health carrier conducting utilization review directly or indirectly through a contracted utilization review entity shall have written procedures …

I. Each licensee shall notify the commissioner within 3 business days of a determination that a cybersecurity event has occurred when either of the following criteria has been met: (a) New Hampshire is the licensee's state of domicile, in the case of an insurer, or this state is …

I. Following the close of each fiscal year, the administrator shall determine the net premiums, the pool expenses of administration and the incurred losses for the year, taking into account investment income and other appropriate gains and losses. (a) Each member's assessment for…

I. The following intentional acts shall constitute grounds for denial, non-renewal, suspension, or revocation of an application or existing license, following notice and an opportunity for hearing: (a) Failure to comply with the provisions of RSA 420-G; (b) Failure to comply with…

I. A health service corporation may indemnify any person who serves as director, officer, or trustee of such corporation by contract or by including an indemnity provision in its articles of agreement or bylaws substantially in accordance with RSA 293-A:8.50 through RSA 293-A:8.5…

I. Within 120 days of the close of its fiscal year, an institution of higher education operating under a certificate of authority issued under this chapter shall file with the commissioner a report that contains: (a) An annual financial statement, verified by the oath of the chie…

I. Health plans shall not require prior authorization by a covered person's primary care provider for coverage of the following services provided by participating providers who specialize in obstetrics and gynecology: (a) Maternity care; (b) An annual gynecological visit; and (c)…

If such action is supported by the recommendations of actuarial experts retained by the department as being consistent with the purposes of RSA 404-G:1, I, the commissioner shall, at the earliest practicable date, submit an application on behalf of the state to the United States …

A health benefit plan under this chapter offering chiropractic benefits shall provide benefits to a covered person who utilizes services of a chiropractic provider (doctor of chiropractic) by self-referral for 12 visits under the following conditions: I. Unless otherwise provided…

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…

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…

Health carriers shall provide coverage for medically necessary dental services resulting from an accidental injury to sound natural teeth and gums when the course of treatment for the accidental injury is received or authorized within 3 months of the date of the injury. Treatment…

I. A purchasing alliance shall: (a) Offer health benefit plans that are available to all member employers; (b) Establish administrative and accounting procedures for operating the alliance, for providing services to member employers and enrollees, and for preparing an annual budg…

Any health care insurer commencing a preferred provider agreement shall notify the commissioner within 30 days.

I. No contract with a contract holder authorized under this chapter shall be cancelled by Delta, except for nonpayment of premium, unless the contract holder receives a notice of cancellation in accordance with this section. Notice of cancellation for breach of the contract by th…

A policy form meeting the requirements of RSA 420-H:5, I shall be approved notwithstanding the provisions of any other laws which specify the content of policies, if the policy form provides the policyholders and claimants protection not less favorable than they would be entitled…

A health carrier shall not impose any preexisting condition exclusion with respect to coverage in the individual, small group, or large group market.

I. No New Hampshire state agency, department, or political subdivision shall plan, create, participate in or enable a state-based exchange for health insurance under the Act, or contract with any private entity to do so. II. State agencies or departments may interact with the fed…

The commissioner shall adopt rules, under RSA 541-A and after public hearing, relative to: I. Procedures for application for license under RSA 420-E:2. II. Initial application fees and annual license fees. III. The time period for notification of determination as required under R…

I. No person, for himself or in behalf of any person, shall sell or offer to sell any such health service as is provided for in this chapter without being licensed therefor by the commissioner pursuant to RSA 402-J. II. Upon written notice by a health service corporation licensed…

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. Neither the participation in the pool as members, the establishment of rates, forms, or procedures, nor any other joint or collective action required by this chapter shall be the basis of any legal action against the pool or any of its members. II. Any person or member made a …

The commissioner may, pursuant to RSA 400-A:37, make an examination into the affairs of any institution, with regard to a student health plan issued by the institution, as often as the commissioner deems it expedient for the protection of the interests of the people of New Hampsh…

I. Annually, 120 days after the end of each fiscal year, a provider shall submit a report to the commissioner relative to the financial condition of the provider together with any other information required by the commissioner. The commissioner may require more frequent reports o…

I. A health carrier shall maintain a network that is sufficient in numbers, types, and geographic location of providers to ensure that all services to covered persons will be accessible without unreasonable delay. II. The commissioner shall adopt rules under RSA 541-A for a healt…

If any provision of this chapter or the application thereof to any person or circumstances is held to be invalid for any reason, such invalidity shall not affect any other provision or application of this chapter which may be effected without the invalid provision or application.

I. The commissioner shall have power to examine and investigate the affairs of any licensee to determine whether the licensee has been or is engaged in any conduct in violation of this chapter. This power is in addition to the powers which the commissioner has under RSA 400-A:16 …

I. The following financial statements shall be submitted quarterly by the 45th day after the end of the quarter as follows: (a) Capital expenditures as a percentage of depreciation ratio (CED). (b) Unrestricted cash and investments to long-term debt ratio (CD). (c) Days cash on h…

I. (a) Every health benefit plan that provides prescription drug benefits is required to provide prospective enrollees, and covered persons, a description of the prescription drug benefit plan. Among the specific items that shall be included in the description are: (1) The proced…

A physician who is part of a health carrier's provider network on December 31, 2000, shall not be disqualified from participating in that network solely because such physician is not certified by a member board of the American Board of Medical Specialties.

The commissioner may extend the period of continued access to care subsequent to a provider contract termination provided for under RSA 420-J:8, XI for up to an additional 60-day period.