420-C:1 Purpose. – The purpose of this chapter is to assure that health benefit plans encourage covered persons to seek health care services from preferred providers and that contracts or agreements between preferred providers and health care insurers are fair and in the public interest. Further, this chapter establishes reasonable regulatory requirements for health […]
420-C:2 Definitions. – In this chapter: I. "Commissioner" means the insurance commissioner. II. "Covered person" means an individual entitled to reimbursement for expenses of health care services under a policy issued or administered by a health care insurer. II-a. " Date of enrollment " means the first day of coverage under the plan, or, […]
420-C:3 Reimbursement Agreements. – Notwithstanding any other law to the contrary, a health care insurer may: I. Enter into contracts or other agreements with preferred providers for the delivery of health care services to covered persons. Such contracts or agreements may: (a) Establish the amount and method of payment to the preferred provider; (b) […]
420-C:4 Health Benefit Plans. – 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 between the benefit levels […]
420-C:4-a Dependent Coverage. – 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 other person dependent […]
420-C:4-b Coverage for Dependents. – 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 absence from school for a period not to exceed […]
420-C:4-c Pre-certification Requirement. – 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 not be required to treat such services […]
420-C:5 Discrimination Prohibited. – 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 geographic considerations, certain affiliations, or professional privileges shall not […]
420-C:5-a Prohibiting Limitations on Liability; Disclosure of Information. – I. No contract between a health care insurer and a physician, for the purpose of delineating the rights and obligations of the parties within the provider network, shall limit the liability of the health care insurer for any actions of the physician for which the […]
420-C:6 Rulemaking. – 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 insurers to provide to demonstrate compliance with […]
420-C:7 Notice. – Any health care insurer commencing a preferred provider agreement shall notify the commissioner within 30 days. Source. 1987, 112:1, eff. July 5, 1987.
420-C:8 Other Applicable Statutes. – 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. Source. 1997, 344:9, eff. July 1, 1997; 344:17, eff. Jan. 1, 1998.
