415-A:1 Definitions. – In this chapter: I. " Accident and health insurance " means insurance written under RSA 415, RSA 21-I:99-21-I:111, RSA 282-B, and coverages written under RSA 415-E, RSA 420-A, RSA 420-B, and RSA 420-C. For purposes of this chapter, multiple-employer welfare arrangements, nonprofit health service corporations, health maintenance organizations, and preferred provider […]
415-A:2 Standards for Policy Provisions. – I. The commissioner shall adopt rules to establish specific standards, including standards of full and fair disclosure, that set forth the manner, content and required disclosure for the sale of all policies of accident and health insurance which shall be in addition to, and in accordance with, applicable […]
415-A:2-a Insurance Contracts; Welfare Recipients. – No accident or health insurance policy issued or renewed after August 28, 1981 shall contain any provision denying or limiting insurance benefits because services are rendered to an insured or a dependent who is eligible for or who receives medical assistance under RSA 167 or RSA 161. Source. […]
415-A:2-b Use of Term Physician in Provider Contracts. – No contract shall use the term physician for the purpose of allowing a health care insurer to avoid contracting with other health care professionals for health care services. A physician shall mean a person licensed to practice medicine under RSA 329. Nothing in this section […]
415-A:3 Minimum Standards for Benefits. – I. The commissioner may adopt rules to establish minimum standards for benefits under each of the following categories of coverage: (a) Basic hospital expense coverage. (b) Basic medical-surgical expense coverage. (c) Basic hospital/medical-surgical expense coverage. (d) Hospital confinement indemnity coverage. (e) Major medical expense coverage. (f) Basic medical […]
415-A:4 Outline of Coverage. – I. In order to provide for full and fair disclosure in the sale of all policies of accident and health insurance, no such policy shall be delivered or issued for delivery in this state unless: (a) In the case of a direct response insurance product, the outline of coverage […]
415-A:4-a Minimum Standards for Claim Review; Accident and Health Insurance. – Any carrier that offers group health plans and employee benefit plans shall establish and maintain written procedures by which a claimant may obtain a determination of claims and by which a claimant may appeal a claim denial. I. The procedures for determination of […]
415-A:4-b Appeal Procedure. – Every carrier or other licensed entity which offers group health insurance or employee benefit plans shall file with the insurance department, by April 1 of each year, and shall maintain a written procedure by which a claimant, or a representative of the claimant, shall have a reasonable opportunity to appeal […]
415-A:5 Preexisting Conditions. – I. If an insurer or a nonprofit hospital or medical service association elects to use a simplified application form for a policy other than a Medicare supplement policy, with or without a question as to the applicant’s health at the time of application, but without any questions concerning the insured’s […]
415-A:5-a Access to Enhanced 911 System. – I. No accident or health insurance policy 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 an insured or enrollee in competition with or in substitution of the […]
415-A:6 Adoption of Rules. – I. Rules promulgated pursuant to this chapter shall be subject to notice and hearing pursuant to RSA 541-A. When a rule adopted pursuant to this chapter so provides, a policy of insurance issued subsequent to the rule’s effective date and any optionally renewable policy of insurance renewed subsequent to […]
[RSA 415-A:7 repealed by 2020, 15:2, effective July 1, 2024.] 415-A:7 Establishing Excess Cost Sharing. – I. In this section: (a) " Insurer " means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, […]
