TITLE XXXVII
INSURANCE
Chapter 415-I
DISCOUNT MEDICAL PLAN ORGANIZATIONS
Section 415-I:1
415-I:1 Title. –
This chapter shall be known as the Discount Medical Plan Act.
Source. 2008, 206:1, eff. Jan. 1, 2009.
Section 415-I:2
415-I:2 Purpose. –
The purpose of this chapter is to promote the public interest by establishing standards for discount medical plans to protect consumers from unfair or deceptive marketing, sales, or enrollment practices and to facilitate consumer understanding of the role and function of discount medical plan organizations in providing access to medical or ancillary services.
Source. 2008, 206:1, eff. Jan. 1, 2009.
Section 415-I:3
415-I:3 Definitions. –
In this chapter:
I. "Ancillary services" includes, but is not limited to, audiology, dental, vision, mental health, substance abuse, chiropractic, and podiatry services.
II. "Commissioner" means the insurance commissioner.
III. "Discount medical plan" means a business arrangement or contract in which a person, in exchange for fees, dues, charges, or other consideration, offers access for its members to providers of medical or ancillary services and the right to receive discounts on medical or ancillary services provided under the discount medical plan from those providers. "Discount medical plan" does not include:
(a) Any discount arrangement that involves the transfer of insurance risk from a subscriber to another entity, or arrangement or contract for claim processing functions.
(b) A plan that does not charge a membership or other fee to the member to use the plan's discount medical card.
(c) A plan that provides a Medicare Part D prescription drug benefit in accordance with the requirements of the federal Medicare Prescription Drug Improvement and Modernization Act of 2003.
(d) A plan that provides direct primary care meeting the requirements of RSA 329:1-e.
IV. "Discount medical plan organization" means an entity that, in exchange for fees, dues, charges, or other consideration, provides access for discount medical plan members to providers of medical or ancillary services and the right to receive medical or ancillary services from those providers at a discount. "Discount medical plan organization" is the organization that contracts with providers, provider networks, or other discount medical plan organizations to offer access to medical or ancillary services at a discount and determines the charge to discount medical plan members. "Discount medical plan organization" does not include a provider that offers discounts to its own patients without any cost or fee of any kind to the patient. "Discount medical plan organization" shall not include providers of direct primary care meeting the requirements of RSA 329:1-e.
V. "Health care professional" means a physician, pharmacist, or other health care practitioner who is licensed, accredited, or certified to perform specified medical or ancillary services within the scope of his or her license, accreditation, certification, or other appropriate authority and consistent with state law.
VI. "Health carrier" 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, arrange for, pay for, or reimburse any of the costs of health care services, including a sickness and accident insurance company, a health maintenance organization, a nonprofit hospital and health service corporation, or any other entity providing a plan of health insurance, health benefits, or medical or ancillary services.
VII. "Marketer" means a person or entity that markets, promotes, sells, or distributes a discount medical plan, including a private label entity that places its name on and markets or distributes a discount medical plan pursuant to a marketing agreement with a discount medical plan organization.
VIII. "Medical services" means any service, supply, or drug intended for the maintenance care of, or preventive care for, the human body or the care, or treatment of an illness or dysfunction of, or injury to, the human body. "Medical services" includes, but is not limited to, physician care, inpatient care, hospital surgical services, emergency services, ambulance services, laboratory services, pharmaceutical supplies, prescription drugs, and medical equipment and supplies. "Medical services" does not include ancillary services.
IX. "Member" means any individual who pays fees, dues, charges, or other consideration for the right to receive the benefits of a discount medical plan.
X. "Participating provider" means any health care professional or facility that has contracted, directly or indirectly, with a discount medical plan organization to provide medical or ancillary services to members.
XI. "Person" means an individual, a corporation, a partnership, an association, a joint venture, a joint stock company, a trust, an unincorporated organization, any similar entity, or any combination of the foregoing.
XII. "Provider" means an institution or individual that offers medical or medically-related services in a health care setting.
XIII. "Third party administrator" means a third party administrator as defined by RSA 402-H.
Source. 2008, 206:1, eff. Jan. 1, 2009. 2019, 330:2, 3, eff. Oct. 15, 2019.
Section 415-I:4
415-I:4 Applicability and Scope. –
I. This chapter applies to all discount medical plan organizations doing business in or from this state.
II. This chapter shall not apply to any discount medical plan offered by, or in cooperation with, or pursuant to an agreement with the state of New Hampshire or any political subdivision of the state.
Source. 2008, 206:1, eff. Jan. 1, 2009.
Section 415-I:5
415-I:5 Registration Requirement. –
I. Before doing business in or from this state as a medical discount plan organization, a person or entity:
(a) Shall be authorized to transact business in this state under RSA 293-A or RSA 294-A; and
(b) Shall register with the commissioner to operate as a discount medical plan organization on a form prescribed by the commissioner. The registration form shall be filed annually by June 1 of each year.
II. The provisions of subparagraph I(b) shall not apply to any person licensed in this state as a health insurer, hospital service corporation, medical service corporation, or fraternal benefit society, or any affiliate owned or controlled by such health insurer, hospital service corporation, medical service corporation, or fraternal benefit society, which may offer medical discount plans in this state pursuant to such licensure and in accordance with the provisions of this chapter.
III. Each applicant for a certificate of registration shall make an application to the commissioner upon a form to be furnished by the commissioner and fee paid pursuant to RSA 400-A:29, XXII(a). The application shall include or be accompanied by the following information and documents:
(a) Whether a previous application for a certificate of registration has been denied, revoked, suspended, or terminated for cause in any jurisdiction.
(b) Whether the applicant is under investigation for or the subject of any pending action or has been found in violation of a statute or regulation in any jurisdiction within the previous 5 years.
(c) Information, as the commissioner may require, that permits the commissioner, after reviewing all of the information submitted pursuant to this section, to make a determination that the applicant:
(1) Is financially responsible and maintains a net worth of at least $150,000 at all times;
(2) Has adequate expertise or experience to operate a discount medical plan organization; and
(3) Is competent, trustworthy, financially responsible, or of good personal and business reputation.
IV. Each certificate of registration shall expire each year on June 1. At least 60 days before a certificate of registration expires, the discount medical plan organization shall submit a renewal application to the commissioner upon a form to be furnished by the commissioner and fee paid pursuant to RSA 400-A:29, XXII(b).
Source. 2008, 206:1, eff. Jan. 1, 2009. 2022, 214:1, eff. Aug. 16, 2022.
Section 415-I:6
415-I:6 Suspension and Revocation of Registration. –
I. The commissioner may suspend or revoke the registration of a discount medical plan organization to operate in the state if the commissioner finds that any of the following conditions exist:
(a) The discount medical plan organization is not operating in compliance with this chapter.
(b) The discount medical plan organization has advertised, merchandised, or attempted to merchandise its services in such a manner as to misrepresent its services or capacity for service or has engaged in a deceptive, misleading, or unfair practice.
(c) The discount medical plan organization is not fulfilling its obligations as a discount medical plan organization.
(d) The discount medical plan organization does not have the minimum net worth as required RSA 415-I:5, III(c)(1).
(e) The continued operation of the discount medical plan organization would be hazardous to its members.
II. If the commissioner has cause to believe that grounds for the non-renewal, suspension, or revocation of the registration exists, the commissioner shall notify the discount medical plan organization in writing stating the grounds for the action and may pursue a hearing on the matter.
III. When the registration of a discount medical plan organization is suspended or revoked, the discount medical plan organization shall proceed, immediately following the effective date of the order of revocation or, in the case of a non-renewal, the date of expiration of the license, to wind up its affairs transacted. The discount medical plan organization shall not engage in any further advertising, solicitation, collecting of fees, or renewal of contracts.
IV. In lieu of or in addition to revoking a discount medical plan organization's registration under paragraph II, whenever the discount medical plan organization has been found to have violated any provision of this chapter, the commissioner may:
(a) Issue and cause to be served upon the organization charged with the violation a copy of the findings and an order requiring the organization to cease and desist from engaging in the act or practice that constitutes the violation; and
(b) Impose a civil penalty of not more than $2,500 for each violation.
V. Each registered discount medical plan organization shall notify the commissioner immediately whenever the discount medical plan organization's certificate of registration or other form of authority, to operate as a discount medical plan organization in another state is suspended, revoked, or non-renewed in that state.
Source. 2008, 206:1, eff. Jan. 1, 2009. 2022, 214:2, eff. Aug. 16, 2022.
Section 415-I:7
415-I:7 Examinations and Investigations. –
I. The commissioner may examine or investigate the business and affairs of any discount medical plan organization as necessary to protect the interests of the residents of this state.
II. An examination or investigation conducted as provided in paragraph I shall be performed in accordance with RSA 400-A:37.
III. The commissioner may:
(a) Order any discount medical plan organization or applicant that operates a discount medical plan organization to produce any records, books, files, advertising and solicitation materials or other information; and
(b) Take statements under oath to determine whether the discount medical plan organization or applicant is in violation of the law or is acting contrary to the public interest.
IV. The discount medical plan organization or applicant that is the subject of the examination or investigation shall pay the expenses reasonably incurred in conducting the examination or investigation. Failure by the discount medical plan organization or applicant to pay the expenses is grounds for denial of authority to operate as a discount medical plan organization or revocation of a registration as a discount medical plan organization.
Source. 2008, 206:1, eff. Jan. 1, 2009.
Section 415-I:8
415-I:8 Fees; Refund Requirements; Bundling of Services. –
I. A discount medical plan organization may charge a periodic charge as well as a reasonable one-time processing fee for a discount medical plan.
II. If a member cancels his or her membership in the discount medical plan within the first 30 days after the date of receipt of the written document for the discount medical plan described in RSA 415-I:11, IV, the member shall receive a reimbursement of all periodic charges.
(a) Cancellation occurs when notice of cancellation is given to the discount medical plan organization.
(b) Notice of cancellation is deemed given when delivered by hand or deposited in a mailbox, properly addressed and postage prepaid to the mailing address of the discount medical plan organization or e-mailed to the e-mail address of the discount medical plan organization.
III. A discount medical plan organization shall return within 30 days any periodic charge charged or collected after the member has given the discount medical plan organization notice of cancellation.
IV. If the discount medical plan organization cancels a membership for any reason other than nonpayment of fees by the member, the discount medical plan organization shall reimburse within 30 days all periodic charges collected for membership from the date of cancellation to the member.
Source. 2008, 206:1, eff. Jan. 1, 2009.
Section 415-I:9
415-I:9 Provider Agreements; Participating Provider Listing Requirements. –
I. (a) A discount medical plan organization shall have a written provider agreement with all participating providers. The written provider agreement shall be entered into directly with the provider or indirectly with a provider network to which the provider belongs.
(b) An agreement between a discount medical plan organization and a participating provider shall include the following:
(1) A list of the medical or ancillary services and products to be provided at a discount;
(2) The amount or amounts of the discounts or, alternatively, a fee schedule that reflects the provider's discounted rates; and
(3) A statement that the provider will not charge members more than the discounted rates.
(c) An agreement between a discount medical plan organization and a provider network shall require that the provider network have written agreements with its providers that:
(1) Contain the provisions described in subparagraph (b);
(2) Authorize the provider network to contract with the discount medical plan organization on behalf of the provider; and
(3) Require the provider network to maintain an up-to-date list of its contracted providers and to provide the list on a monthly basis to the discount medical plan organization.
(d) An agreement between a discount medical plan organization and an entity that contracts with a provider network shall require that the entity, in its contract with the provider network, require the provider network to have written agreements with its providers that comply with subparagraph (c).
(e) The discount medical plan organization shall maintain a copy of each active provider agreement into which it has entered.
II. Each discount medical plan organization shall maintain on an Internet website page an up-to-date list of the names and addresses of the providers with which it has contracted directly or through a provider network. The Internet website address shall be prominently displayed on all of its advertisements, marketing materials, brochures, and discount medical plan cards.
Source. 2008, 206:1, eff. Jan. 1, 2009.
Section 415-I:10
415-I:10 Marketing Requirements. –
I. A discount medical plan organization may market directly or contract with other marketers for the distribution of its product.
II. The discount medical plan organization shall have an executed written agreement with a marketer prior to the marketer's marketing, promoting, selling, or distributing the discount medical plan.
III. The agreement between the discount medical plan organization and the marketer shall prohibit the marketer from using advertising, marketing materials, brochures, and discount medical plan cards without the discount medical plan organization's approval in writing.
IV. The discount medical plan organization shall be bound by and responsible for the activities of the marketer that are within the scope of the marketer's agency relationship with the organization.
V. A discount medical plan organization shall approve in writing all advertisements, marketing materials, brochures, and discount cards used by marketers to market, promote, sell, or distribute the discount medical plan prior to their use.
VI. Upon request, a discount medical plan organization shall provide to the commissioner any advertising, marketing materials, and brochures regarding a discount medical plan requested by the commissioner.
Source. 2008, 206:1, eff. Jan. 1, 2009.
Section 415-I:11
415-I:11 Marketing Restrictions and Disclosure Requirement. –
I. All advertisements, marketing materials, brochures, discount medical plan cards, and any other communications of a discount medical plan organization provided to prospective members and members shall be truthful and not misleading in fact or in implication.
II. An advertisement, any marketing material, brochure, discount medical plan card, or other communication is misleading in fact or in implication if it has a capacity or tendency to mislead or deceive based on the overall impression that it is reasonably expected to create within the segment of the public to which it is directed.
III. A discount medical plan organization shall not:
(a) Except as a disclaimer of any relationship between discount medical plan benefits and insurance or as a description of an insurance product connected with a discount medical plan, use in its advertisements, marketing material, brochures, and discount medical plan cards the term insurance.
(b) Use in its advertisements, marketing material, brochures, and discount medical plan cards the terms "health plan," "coverage," "copay," "copayments," "deductible," "preexisting conditions," "guaranteed issue," "premium," "PPO," "preferred provider organization," or other terms in a manner that could mislead an individual into believing that the discount medical plan is health insurance.
(c) Use language in its advertisements, marketing material, brochures, and discount medical plan cards with respect to being registered by the state insurance department in a manner that could mislead an individual into believing that the discount medical plan is insurance or has been endorsed by the state.
(d) Make misleading, deceptive, or fraudulent representations regarding the discount or range of discounts offered by the discount medical plan or the access to any range of discounts offered by the discount medical plan.
(e) Have restrictions on access to discount medical plan providers, including, except for hospital services, waiting periods and notification periods.
(f) Pay providers any fees for medical or ancillary services or collect or accept money from a member to pay a provider for medical or ancillary services provided under the discount medical plan, unless the discount medical plan organization has an active certificate of authority to act as a health carrier or as a third party administrator in accordance with RSA 402-H:11.
IV. (a) Each discount medical plan organization shall make the following disclosures to prospective members.
(1) That the plan is not insurance.
(2) That the discounts for medical or ancillary services provided under the plan are available only from participating providers and will vary depending on the provider and medical or ancillary service received.
(3) That the discount medical plan organization does not make payments to providers for the medical or ancillary services received under the discount medical plan.
(4) That the plan member is obligated to pay for all medical or ancillary services, but will receive a discount from those providers that have contracted with the discount medical plan organization.
(5) The toll-free telephone number and Internet website address for the licensed discount medical plan organization for prospective members and members to obtain additional information about and assistance on the discount medical plan and up-to-date list of providers participating in the discount medical plan.
(6) Information that generally describes or summarizes the terms and conditions of the discount medical plan, including any limitations or restrictions on the refund of any processing fees or periodic charges associated with the discount medical plan.
(b) The disclosures required under subparagraph IV(a) shall be in writing in at least 12-point font and shall be provided along with any enrollment forms given to a prospective member and on the first content page of any advertisements, marketing materials, or brochures made available to the public relating to the discount medical plan. If the initial contact with a prospective member is by telephone, the disclosures required under subparagraph IV(a) shall be made orally and included in the initial written materials that describe the benefits under the discount medical plan provided to the prospective or new member.
(c) Each discount medical plan organization shall provide to each new member a written document that contains the terms and conditions of the discount medical plan. This written document shall be clear and include the following information:
(1) The name of the member.
(2) The benefits to be provided under the discount medical plan.
(3) Any processing fees and periodic charges associated with the discount medical plan, including any limitations or restrictions on the refund of any processing fees and periodic charges.
(4) The mode of payment for any processing fees and periodic charges and procedures for changing the mode of payment.
(5) Any limitations, exclusions, or exceptions regarding the receipt of discount medical plan benefits.
(6) Procedures for obtaining discounts under the discount medical plan, such as requiring members to contact the discount medical plan organization to make an appointment with a provider on the member's behalf.
(7) Cancellation procedures, including information on the member's 30-day cancellation rights and refund requirements and procedures for obtaining refunds.
(8) Renewal, termination, and cancellation terms and conditions.
(9) Procedures for adding new members to a family discount medical plan, if applicable.
(10) Procedures for filing complaints under the discount medical plan organization's complaint system and information that, if the member remains dissatisfied after completing the organization's complaint system, the plan member may contact his or her local state insurance department.
(11) The name and mailing address of the licensed discount medical plan organization or other entity where the member can make inquiries about the plan, send cancellation notices, and file complaints.
Source. 2008, 206:1, eff. Jan. 1, 2009.
Section 415-I:12
415-I:12 Notice of Change in Name or Address. –
Each discount medical plan organization shall provide the commissioner at least 30 days' advance notice of any change in the discount medical plan organization's name, address, principal business address or mailing address, or Internet website address.
Source. 2008, 206:1, eff. Jan. 1, 2009.
Section 415-I:13
415-I:13 Administrative Penalties. –
In addition to the penalties and other enforcement provisions of this chapter, any person who willfully violates this chapter is subject to administrative penalties of up to $2,500 per violation.
Source. 2008, 206:1, eff. Jan. 1, 2009.
Section 415-I:14
415-I:14 Injunctions. –
I. In addition to the penalties and other enforcement provisions of this chapter, the commissioner may seek both temporary and permanent injunctive relief when:
(a) A discount medical plan is being operated by a person or entity that is not registered pursuant to this chapter; or
(b) Any person, entity, or discount medical plan organization has engaged in an activity prohibited by this chapter or rule adopted pursuant to this chapter.
II. The commissioner's authority to seek injunctive relief is not conditioned on having conducted any proceeding pursuant to the provisions of RSA 400-A:15 or RSA 541-A.
Source. 2008, 206:1, eff. Jan. 1, 2009.
Section 415-I:15
415-I:15 Additional Penalties. –
Any violation of RSA 415-A:11, I, II, and III shall constitute an unfair or deceptive act or practice within the meaning of RSA 417:4.
Source. 2008, 206:1, eff. Jan. 1, 2009.
Section 415-I:16
415-I:16 Rules. –
The commissioner may adopt rules, pursuant to RSA 541-A, to carry out the provisions of this chapter.
Source. 2008, 206:1, eff. Jan. 1, 2009.
Section 415-I:17
415-I:17 Severability. –
If any provision of this chapter, or the application thereof to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of the chapter which can be given effect without the invalid provisions or applications, and to this end the provisions of this chapter are severable.
Source. 2008, 206:1, eff. Jan. 1, 2009.