HB 1242-FN – AS AMENDED BY THE HOUSE

20Mar2014… 0896h

2014 SESSION

14-2239

01/04

HOUSE BILL 1242-FN

AN ACT relative to deductibles, coinsurance, and out-of-pocket maximums under health insurance policies.

SPONSORS: Rep. Sherman, Rock 24; Rep. Rosenwald, Hills 30; Sen. Fuller Clark, Dist 21

COMMITTEE: Commerce and Consumer Affairs

AMENDED ANALYSIS

This bill requires insurers issuing accident and health insurance polices to credit insured members who maintain continuous coverage, for member cost sharing made during the prior policy period when the new policy is for fewer than 12 months.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

20Mar2014… 0896h

14-2239

01/04

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Fourteen

AN ACT relative to deductibles, coinsurance, and out-of-pocket maximums under health insurance policies.

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

1 New Section; Insurance; Individual; Yearly Cost Sharing. Amend RSA 415 by inserting after section 6-r the following new section:

415:6-s Credit for Cost Sharing. Each insurer that issues or renews any individual policy, plan, or contract of health insurance that constitutes health coverage, shall credit insured members who maintain continuous coverage, for member cost sharing made during the prior policy period when the new policy is for fewer than 12 months. Credit shall apply to the annual policy deductible, coinsurance, or annual out-of-pocket maximum stated in the new policy. Credit shall be given for cost sharing paid and applied to claims with a date of service within 12 months prior to the termination date of the new policy. This section shall apply regardless of whether the covered member changes carriers, or moves from the group market or self-funded market to the individual market. Credit shall be provided for covered health care services that require cost sharing under the new policy. Nothing in this section shall be construed to require carriers to adopt a 12-month rolling cost sharing cycle.

2 New Section; Insurance; Group; Yearly Cost Sharing. Amend RSA 415 by inserting after section 18-w the following new section:

415:18-x Credit for Cost Sharing. Each insurer that issues or renews any group policy, plan, or contract of health insurance that constitutes health coverage, shall credit insured members who maintain continuous coverage, for member cost sharing made during the prior policy period when the new policy is for fewer than 12 months. Credit shall apply to the annual policy deductible, coinsurance, or annual out-of-pocket maximum stated in the new policy. Credit shall be given for cost sharing paid and applied to claims with a date of service within 12 months prior to the termination date of the new policy. This section shall apply regardless of whether the covered member changes carriers, or moves from the self-funded market to the group market. Credit shall be provided for covered health care services that require cost sharing under the new policy. Nothing in this section shall be construed to require carriers to adopt a 12-month rolling cost sharing cycle.

3 Applicability. This act shall take effect for policies effective on or after January 1, 2015, and carriers shall apply credit for member cost sharing payments made up to 11 months prior to this date.

4 Health Service Corporations; Yearly Cost Sharing. Amend RSA 420-A:2 to read as follows:

420-A:2 Applicable Statutes. Every health service corporation shall be governed by this chapter and the relevant provisions of RSA 161-H, and shall be exempt from this title except for the provisions of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415-A, RSA 415-F, RSA 415:6, II(4), RSA 415:6-g, RSA 415:6-k, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-s, RSA 415:18, V, RSA 415:18, VII(g), RSA 415:18, XVI and XVII, RSA 415:18, VII-a, RSA 415:18-a, RSA 415:18-j, RSA 415:18-o, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-x, RSA 415:22, RSA 417, RSA 417-E, RSA 420-J, and all applicable provisions of title XXXVII wherein such corporations are specifically included. Every health service corporation and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.

5 Health Maintenance Corporations; Yearly Cost Sharing. Amend RSA 420-B:20, III to read as follows:

III. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-m, RSA 415:6-o, RSA 415:6-r, RSA 415:6-s, RSA 415:18, VII(g), RSA 415:18, VII-a, RSA 415:18, XVI and XVII, RSA 415:18-j, RSA 415:18-r, RSA 415:18-t, RSA 415:18-u, RSA 415:18-v, RSA 415:18-w, RSA 415:18-x, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.

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

LBAO

14-2239

Amended 04/04/14

HB 1242-FN FISCAL NOTE

AN ACT relative to deductibles, coinsurance, and out-of-pocket maximums under health insurance policies.

FISCAL IMPACT:

METHODOLOGY: