AN ACT relative to a health insurance access program.

SPONSORS: Rep. Winters, Hills 17

COMMITTEE: Commerce and Consumer Affairs


This bill establishes the New Hampshire health care access program which is to be administered by the department of health and human services and the department of insurance.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.




In the Year of Our Lord Two Thousand Nine

AN ACT relative to a health insurance access program.

Be it Enacted by the Senate and House of Representatives in General Court convened:

1 Statement of Purpose. The general court finds that a significant number of state residents are unable to obtain affordable health insurance coverage. Therefore, it is the intent of the general court to expand the availability of health care options for uninsured residents by developing an affordable health care product that emphasizes coverage for basic and preventive health care services; provides inpatient hospital, urgent, and emergency care services; and is offered statewide by approved health insurers.

2 New Chapter; New Hampshire Health Access Program. Amend RSA by inserting after chapter 126-R the following new chapter:



126-S:1 Definitions. In this chapter:

I. “Commissioner” means the commissioner of the department of health and human services.

II. “Cover New Hampshire plan” means a consumer choice benefit plan approved under this chapter which guarantees payment or coverage for specified benefits provided to an enrollee.

III. “Cover New Hampshire plan coverage” means health care services that are covered as benefits under a cover New Hampshire plan.

IV. “Cover New Hampshire plan entity” means a health insurer, health maintenance organization, health-care-provider-sponsored organization, or health care district that develops and implements a cover New Hampshire plan and is responsible for administering the plan and paying all claims for cover New Hampshire plan coverage by enrollees.

V. “Cover New Hampshire plus” means a supplemental insurance product, such as for additional catastrophic coverage or dental, vision, or cancer coverage, approved under this chapter and offered to all enrollees.

VI. “Department” means the department of health and human services.

VII. “Enrollee” means an individual who has been determined to be eligible for and is receiving health insurance coverage under a cover New Hampshire plan.

126-S:2 Program Established.

I. The commissioner of the department and the insurance commissioner shall jointly establish and administer the cover New Hampshire health care access program.

II. General cover New Hampshire plan components shall require that:

(a) Plans are offered on a guaranteed-issue basis to enrollees, subject to exclusions for preexisting conditions approved by the department and the insurance department.

(b) Plans are portable such that the enrollee remains covered regardless of employment status or the cost-sharing of premiums.

(c) Plans provide for cost containment through limits on the number of services, caps on benefit payments, and copayments for services.

(d) In order to provide for consumer choice, cover New Hampshire plan entities develop 2 alternative benefit option plans having different cost and benefit levels, including at least one plan that provides catastrophic coverage.

(e) Plans without catastrophic coverage provide coverage options for services including, but not limited to:

(1) Preventive health services, including immunizations, annual health assessments, well-woman and well-care services, and preventive screenings such as mammograms, cervical cancer screenings, and noninvasive colorectal or prostate screenings.

(2) Incentives for routine preventive care.

(3) Office visits for the diagnosis and treatment of illness or injury.

(4) Office surgery, including anesthesia.

(5) Behavioral health services.

(6) Durable medical equipment and prosthetics.

(7) Diabetic supplies.

(f) Plans providing catastrophic coverage, at a minimum, provide coverage options for all of the services listed under subparagraph (e); however, such plans may include, but are not limited to, coverage options for:

(1) Inpatient hospital stays.

(2) Hospital emergency care services.

(3) Urgent care services.

(4) Outpatient facility services, outpatient surgery, and outpatient diagnostic services.

(g) All plans offer prescription drug benefit coverage, use a prescription drug manager, or offer a discount drug card.

(h) Plan enrollment materials provide information in plain language on policy benefit coverage, benefit limits, cost-sharing requirements, and exclusions and a clear representation of what is not covered in the plan. Such enrollment materials shall include a standard disclosure form adopted by rule under RSA 541-A by the commissioner, to be reviewed and executed by all consumers purchasing cover New Hampshire plan coverage.

(i) Plans offered through a qualified employer shall meet the requirements of section 125 of the Internal Revenue Code.

126-S:3 Program Approval.

I. Public or private entities may design programs to encourage New Hampshire citizens to participate in the cover New Hampshire health care access program or to encourage employers to cosponsor some share of cover New Hampshire plan premiums for employees.

II. The department and the insurance department shall announce, no later than 6 months after the effective date of this chapter, an invitation to negotiate for cover New Hampshire plan entities to design a cover New Hampshire plan proposal in which benefits and premiums are specified.

III. The invitation to negotiate shall include guidelines for the review of cover New Hampshire plan applications, policy forms, and all associated forms and provide regulatory oversight of cover New Hampshire plan advertisement and marketing procedures. A plan shall be disapproved or withdrawn if the plan:

(a) Contains any ambiguous, inconsistent, or misleading provisions or any exceptions or conditions that deceptively affect or limit the benefits purported to be assumed in the general coverage provided by the plan.

(b) Provides benefits that are unreasonable in relation to the premium charged or contains provisions that are unfair or inequitable, that are contrary to the public policy of this state, that encourage misrepresentation, or that result in unfair discrimination in sales practices.

(c) Cannot demonstrate that the plan is financially sound and that the applicant is able to underwrite or finance the health care coverage provided.

(d) Does not guarantee that enrollees may participate in the cover New Hampshire plan entity’s comprehensive network of providers, as determined by the department, the insurance department, and the contract.

126-S:4 License Not Required. The insurance licensing requirements relating to health maintenance organizations shall not apply to a cover New Hampshire plan approved under this chapter unless expressly made applicable. However, for the purpose of prohibiting unfair trade practices, cover New Hampshire plans are considered to be insurance subject to RSA 417.

126-S:5 Eligibility. Eligibility to enroll in a cover New Hampshire plan shall be limited to residents of this state who meet all of the following requirements:

I. Are between 19 and 64 years of age.

II. Are not covered by a private insurance policy and are not eligible for coverage through a public health insurance program, such as Medicare, Medicaid, or Healthy Kids, unless eligibility for coverage lapses due to no longer meeting income or categorical requirements.

III. Have not been covered by any health insurance program at any time during the past 6 months, unless coverage under a health insurance program was terminated within the previous 6 months due to:

(a) Loss of a job that provided an employer-sponsored health benefit plan;

(b) Exhaustion of coverage that was continued under COBRA;

(c) Reaching the limiting age under the policy; or

(d) Death of, or divorce from, a spouse who was provided an employer-sponsored health benefit plan.

IV. Have applied for health care coverage through a cover New Hampshire plan and have agreed to make any payments required for participation, including periodic payments or payments due at the time health care services are provided.

126-S:6 Records. Each cover New Hampshire plan shall maintain enrollment data and provide network data and reasonable records to enable the department and the insurance department to monitor plans and to determine the financial viability of the cover New Hampshire plan, as necessary.

126-S:7 Nonentitlement. Coverage under a cover New Hampshire plan is not an entitlement, and a cause of action shall not arise against the state, a local government entity, any other political subdivision of the state, or the department or the insurance department for failure to make coverage available to eligible persons under this chapter.

126-S:8 Program Evaluation. The department and the insurance department shall:

I. Evaluate the cover New Hampshire health care access program and its effect on the entities that seek approval as cover New Hampshire plans, on the number of enrollees, and on the scope of the health care coverage offered under a cover New Hampshire plan.

II. Provide an assessment of the cover New Hampshire plans and their potential applicability in other settings.

III. Use cover New Hampshire plans to gather more information to evaluate low-income, consumer-driven benefit packages.

IV. Jointly submit by November 2010, and annually thereafter, a report to the speaker of the house of representatives, the president of the senate, and the governor which provides the information specified in paragraphs I-III and recommendations relating to the successful implementation and administration of the program.

126-S:9 Rulemaking. The commissioner, jointly with the insurance commissioner, shall adopt rules, pursuant to RSA 541-A, relative to:

I. Guidelines to ensure that cover New Hampshire plans meet minimum standards for quality of care and access to care.

II. Grievance procedures.

III. Format and content of all forms required under this chapter.

IV. Regulatory oversight and changes in cover New Hampshire plan benefits, premiums, and policy forms.

3 Effective Date. This act shall take effect 60 days after its passage.





AN ACT relative to a health insurance access program.