Title XXXVII, Insurance

Preferred provider agreements and health benefit plans subject to this chapter shall also be governed by the provisions of RSA 420-G and RSA 420-J.

I. Every contract between a health carrier and a participating provider shall set forth a hold harmless provision specifying protection for covered persons. This provision shall include language substantially as follows: (a) Provider agrees that in no event, including but not lim…

I. Each small employer group shall have an annual employee open enrollment period 60 days in length, occurring prior to the small employer group's anniversary date. During open enrollment, employees or eligible dependents may apply to the small employer for health coverage or mak…

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…

Delta shall invest its funds as provided for in RSA 411-A.

I. No health service corporation shall enter into any contract with subscribers until it shall have filed with the commissioner a copy of the form of such contract, including all riders and endorsements to the contract and until the commissioner's approval thereof shall have been…

The contracts entered into by the alliance shall: I. Establish performance standards for specific contractual elements; II. Set liquidated damages for breach of the contract; III. Require the insurer to notify the member employers of cancellation of the policy; IV. Require the me…

I. The commissioner may take appropriate action against a licensee which fails to meet the standards under this chapter or any rules adopted by the commissioner, or who fails to respond in a timely manner to corrective actions ordered by the commissioner. The commissioner may imp…

I. In the event a federally-facilitated exchange is established for New Hampshire, the commissioner shall retain authority with respect to insurance products sold in New Hampshire on the federally-facilitated exchange to the maximum extent possible by law as provided in title XXX…

I. Any documents, materials, or other information in the control or possession of the department that are furnished by a licensee or an employee or agent thereof acting on behalf of licensee pursuant to RSA 420-P:4, IX, RSA 420-P:6, II(b), (c), (d), (e), (h), (j), and (k), or tha…

The commissioner may make such investigations as he or she deems necessary both within and outside the state in accordance with the provisions of RSA 400-A:16 and RSA 400-A:20-22.

I. (a) Health carriers issuing health benefit plans subject to this chapter shall pay claims submitted by health care providers for services rendered in New Hampshire to covered persons within 30 calendar days upon receipt of a clean non-electronic claim or 15 calendar days upon …

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. In this section, "retroactive denial of a previously paid claim" means any attempt by a health carrier to retroactively collect payments already made to a health care provider with respect to a claim by requiring repayment of such payments, reducing other payments currently ow…

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…

I. Pursuant to RSA 420-J:4, I, health carriers issuing health benefit plans subject to this chapter shall pay claims for covered services rendered to covered persons by a health care provider who, at the time of submission of a clean and complete credentialing application, has a …

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. 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…

Nonparticipating providers or emergency facilities and health carriers shall have access to a state-based independent dispute resolution (IDR) process for determining the fair value of certain health care items or services as follows: I. Determination through open negotiation. (a…

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. No insurer, health care service contractor, health maintenance organization, dental insurer, or any other similar entity, including Delta Dental Plan of New Hampshire Inc., subject to regulation by the insurance department that covers dental services, and no contract or partic…

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 …

I. Each insurer that issues or renews any policy of health insurance providing benefits for emergency services shall cover emergency services provided by a nonparticipating provider or nonparticipating emergency facility in the same manner and without imposing any additional requ…

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…

I. Each health carrier that issues or renews any policy of health insurance shall cover services provided by nonparticipating providers at a participating facility in the same manner and without imposing any additional requirements as if the services were provided by a participat…

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…

In addition to other remedies, the commissioner may file a lien on all real and personal property of a provider if the commissioner deems it necessary to protect the interests of the residents. Such lien shall be effective for the period determined necessary by the commissioner a…

I. Delta shall file with the commissioner, on March 1, a report verified by an appropriate official of Delta, showing its financial condition on the last day of the preceding fiscal year. II. Such report shall include: (a) Delta's financial statements, including its balance sheet…

I. To qualify as a participating carrier, a carrier shall demonstrate the following characteristics: (a) That it is licensed and in good standing with the insurance department; (b) That it has the ability to administer health coverage, to provide adequate service, and to comply w…

I. A health carrier shall: (a) Establish and maintain a written quality assessment program designed to collect and evaluate information regarding the quality of the health care processes used by the health carrier and the health outcomes of its covered persons. (b) Establish and …

Every contract between a health service corporation and a subscriber shall be in writing, a copy of which shall be furnished to the subscriber and shall contain the following provisions: I. A statement of the amount payable to the health service corporation by the subscriber and …

I. A health carrier may not require more than the minimum participation percentage of the employees eligible for health coverage in a small employer group to participate in the health carrier's health coverage plan. The minimum participation percentage shall be 75 percent when th…

I. The commissioner may suspend or revoke a certificate of authority issued to an institution under this chapter upon a finding, after notice and hearing, that the institution has failed to comply with any requirement imposed on it under this chapter or necessary to maintain mini…