CHAPTER Ins 6000  PROVISIONS APPLICABLE TO ALL ANCILLARY HEALTH AND BLANKET INSURANCE

 

Statutory Authority:  RSA 400-A:15, I; RSA 415:6, VII; RSA 415:18, I; RSA 415-A:2; RSA 415-A:3, I

 

REVISION NOTE:

 

          Document #12478, effective 2-12-18, adopted Part Ins 6001 titled “Standard Definitions and Policy Provisions” in a new Chapter Ins 6000 titled “Provisions Applicable to All Ancillary Health and Blanket Insurance”.

 

          Part Ins 6001 had formerly been numbered as Ins 1901.01 through Ins 1901.05 in Part Ins 1901 titled “Minimum Standards for Accident and Health Insurance” in Chapter Ins 1900 titled “Accident and Health Insurance.”  Former rules Ins 1901.01 through Ins 1901.05 expired 4-17-14.  The filings affecting one or more of the former rules Ins 1901.01 through Ins 1901.05 included the following documents:

 

          #1900, eff 1-1-82

          #2101, eff 10-1-82

          #2582, eff 1-23-84

          #2732, eff 5-31-84

          #3164, eff 12-24-85

          #4287, eff 7-1-87

          #4811, eff 5-4-90

          #5656, eff 7-1-93

          #5942, eff 1-1-95

          #5943, eff 1-1-95 (Ins 1901.05(e) EXPIRED 1-1-03)

          #7017, INTERIM, eff 7-1-99, EXPIRED 10-29-99

          #8609, eff 4-17-06, EXPIRED 4-17-14

 

PART Ins 6001  STANDARD DEFINITIONS AND POLICY PROVISIONS

 

          Ins 6001.01  Purpose.  The purpose of this part is to implement the provisions of RSA 415-A to standardize and simplify the terms and coverages of individual ancillary health insurance policies, group ancillary health policies and certificates, and blanket policies and certificates providing ancillary health insurance, as defined in this part and sequential chapters as designated within those chapters. 

 

Source. (See Revision Note at chapter heading for Ins 6000) #12478, eff 2-12-18

 

          Ins 6001.02  Applicability and Scope.

 

          (a)  This part applies to all individual health insurance policies, group health policies and certificates, and blanket policies and certificates providing health insurance, unless otherwise specified, which provide coverages that are considered ancillary health insurance and are delivered or issued for delivery in this state on and after the effective date of this part, as provided in RSA 415-A, and that are not specifically exempted from this part.

 

          (b)  This part shall not apply to:

 

(1)  Any policies subject to RSA 420-G;

 

(2)  Medicare supplement policies subject to RSA 415-F; or

 

(3)  Long-term care insurance policies subject to RSA 415-D.

 

          (c)  The requirements contained in this part shall be in addition to any other applicable part previously adopted and still in effect.

 

Source. (See Revision Note at chapter heading for Ins 6000) #12478, eff 2-12-18

 

          Ins 6001.03  Definitions.  For the purposes of all ancillary health insurance, unless stated otherwise, the following definitions shall apply:

 

          (a)  Activities of daily living (ADL)” means activities related to personal care, such as bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet, and eating;

 

          (b)  “Ancillary health insurance” means insurance written under RSA 415-A:3, I (d), (g), (h), (i), (j.), and (k).  Ancillary health insurance does not include credit accident and sickness insurance, subject to RSA 408-A, or travel insurance, subject to RSA 415:18, I-a(e), RSA 415:6, and Ins 4700;

 

(c)  “Group” means:

 

(1)  A policy issued to an employer, or to the trustees of a fund established by an employer, for which the employer or trustees shall be deemed the policyholder, to insure employees of the employer for the benefit of persons other than the employer, subject to the following requirements:

 

a.  The employees eligible for insurance under the policy shall be all of the employees of the employer, or all of any class or classes thereof determined by conditions pertaining to their employment. The policy may provide that the term "employees'' shall include the employees of one or more subsidiary corporations and the employees, individual proprietors, and partners of one or more affiliated corporations, proprietors, or partnerships if the business of the employer and of such affiliated corporations, proprietors, or partnerships is under common control through stock ownership, contract, or otherwise. The policy may provide that the term "employees'' shall include the individual proprietor or partners if the employer is an individual proprietor or a partnership. The policy may provide that the term "employees'' shall include retired employees;

 

b.  The premium for the policy shall be paid by the policyholder, either from the employer's funds, or from funds contributed by the insured employees, or from both. A policy on which no part of the premium is to be derived from funds contributed by the insured employees shall insure all eligible employees; and

 

c.  The amounts of insurance under the policy shall be based upon a plan precluding individual selection either by the employees or by the employer or trustees;

 

(2)  A policy issued to a labor union or Taft-Hartley Trust for the benefit of the members of the labor union, which shall be deemed the policyholder, to insure members of such union for the benefit of persons other than the union or any of its officials, representatives,            or agents, is subject to the following requirements:

 

a.  The members eligible for insurance under the policy shall be all of the members of the union, or all of any class or classes thereof determined by conditions pertaining to their employment, or to membership in the union, or both;

 

b.  The premium for the policy shall be paid by the policyholder, either wholly from the union's funds or from funds contributed by the insured members specifically for the insurance, or from both. A policy on which no part of the premium is to be derived from funds contributed by the insured members specifically for their insurance shall insure all eligible members; and

 

c.  The amounts of insurance under the policy shall be based upon a plan precluding individual selection either by the members or by the union;

 

(3)  A policy issued to an association, which shall be deemed the policyholder, that meets the following criteria:

 

a.  The association has been in existence for a period of at least 5 years and is organized

for purposes other than obtaining insurance;

 

b.  The association can elect to insure their members, employees, or both;

 

c.  Insurance premiums are paid by members, employees, or both, of the association, with or without contribution by the association;

 

d.  The amounts of insurance under the policy shall be based upon a plan precluding individual selection by the persons insured;

 

e.  The association does not condition membership on any health status-related factor relating to an individual;

 

f.  The association makes ancillary health insurance coverage offered through the association available to all individual members and employees of the association regardless of any health status-related factor relating to the members or employees, or individuals eligible for coverage through an individual member or employee; and

 

g.  The association does not make ancillary health insurance coverage, offered through the association, available other than in connection with an individual member or employee of the association; and

 

(4)  Notwithstanding the above, any such policy of group ancillary health insurance issued pursuant to paragraphs (1) – (3) may be extended to provide group ancillary health insurance for an employee, or other member of the group, their spouse, child or children, or other dependents;

 

          (d) “Medicare” means The Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as Then Constituted or Later Amended; and

 

          (e)  “Preexisting condition”:

 

(1)  With respect to disability insurance, preexisting condition shall not be defined more restrictively than the following:  “Preexisting condition means the existence of symptoms that would cause an ordinarily prudent person to seek diagnosis, care, or treatment within a 24-month period preceding the effective date of the coverage of the insured person or a condition for which medical advice or treatment was recommended by a physician within a 24-month period preceding the effective date of the coverage of the insured person”; and 

 

(2)  With respect to other  insurance, preexisting condition shall not be defined more restrictively than the following:  “Preexisting condition means the existence of symptoms that would cause an ordinarily prudent person to seek diagnosis, care, or treatment within a 6-month period preceding the effective date of the coverage of the insured person or a condition for which medical advice or treatment was recommended by a physician within a 6-month period preceding the effective date of the coverage of the insured person.”

 

Source. (See Revision Note at chapter heading for Ins 6000) #12478, eff 2-12-18

 

          Ins 6001.04  Policy Definition Requirements.  Except as provided in this part, an individual ancillary health policy or group ancillary health insurance certificate delivered or issued for delivery to any person in this state and to which this part applies shall contain definitions respecting matters set forth below that comply with the requirements of this section.

 

          (a)  “Accident”, “accidental injury”, and “accidental means” shall be defined to employ “result” language and shall not include words that establish an accidental means test or use words such as “external, violent, visible wounds” or similar words of description or characterization, and:

 

(1)  The definition shall not be more restrictive than the following: “Injury” or “injuries” means accidental bodily injury sustained by the insured person that is the direct cause of the condition for which benefits are provided, independent of disease or bodily infirmity or any other cause and that occurs while the insurance is in force; and

 

(2)  The definition may provide that injuries shall not include injuries for which benefits are provided under workers’ compensation, employers’ liability or similar law; or injuries occurring while the insured person is engaged in any activity pertaining to a trade, business, employment or occupation for wage or profit.

 

          (b)  “Convalescent nursing home”, “extended care facility”, or “skilled nursing facility” shall be defined in relation to its status, facility, and available services, and:

 

(1)  A definition of the home or facility shall not be more restrictive than one requiring that it:

 

a.  Be operated pursuant to law;

 

b.  Be approved for payment of Medicare benefits or be qualified to receive approval for payment of Medicare benefits, if so requested;

 

c.  Be primarily engaged in providing, in addition to room and board accommodations, skilled  nursing care under the supervision of a duly licensed physician;

 

d.  Provide continuous 24-hour-a-day nursing service by or under the supervision of a registered nurse; and

 

e.  Maintain a daily medical record of each patient; and

 

(2)  The definition of the home or facility may provide that the term shall not be inclusive of:

 

a.  A home, facility, or part of  a home or facility used primarily for rest;

 

b.  A home or facility for the aged or for the care of individuals diagnosed with substance use disorders; or

 

c.  A home or facility primarily used for the care and treatment of mental diseases or disorders, or for custodial or educational care.

 

          (c)  “Guaranteed renewable” shall be used only in a policy that the insured has the right to continue in force by the timely payment of premiums until the individual’s eligibility for Social Security normal retirement age, during which period the insurer has no right to make unilaterally any change in any provision of the policy while the policy is in force, except that the insurer may make changes in premium rates by classes.

 

          (d)  “Hospital” may be defined in relation to its status, facilities, and available services or to reflect its accreditation by The Joint Commission, previously known as The Joint Commission on Accreditation of Healthcare Organizations, and:

 

(1)  The definition of the term “hospital” shall not be more restrictive than one requiring that the hospital:

 

a.  Be an institution licensed to operate as a hospital pursuant to law;

 

b.  Be primarily and continuously engaged in providing or operating, either on its premises or in facilities available to the hospital on a prearranged basis and under the supervision of a staff of licensed physicians, medical, diagnostic, and major surgical facilities for the medical care and treatment of sick or injured persons on an in-patient basis for which a charge is made; and

 

c.  Provide 24 hour nursing service by or under the supervision of registered nurses; and

 

(2)  The definition of the term “hospital” may state that the term shall not be inclusive of:

 

a.  Convalescent homes or convalescent, rest, or nursing facilities;

 

b.  Facilities affording primarily custodial, educational, or rehabilitative care;

 

c. Facilities for the aged, or for the care of individuals diagnosed with substance use disorders; or

 

d.  A military or veterans’ hospital, a soldiers’ home, or a hospital contracted for or operated by any national government or governmental agency for the treatment of members or ex-members of the armed forces, except for services rendered on an emergency basis where a legal liability for the patient exists for charges made to the individual for the services.

 

          (e)  “Medicare” means The Health Insurance for the Aged Act, Title XVIII of the Social Security

Amendments of 1965 as Then Constituted or Later Amended.

 

          (f)  “Mental or nervous disorder” shall not be defined more restrictively than a definition including

neurosis, psychoneurosis, psychosis, or mental or emotional disease or disorder of any kind.

 

          (g)  “Noncancellable” or “noncancellable and guaranteed renewable” shall be used only in an ancillary health policy that the insured has the right to continue in force by the timely payment of premiums set forth in the policy until the individual’s eligibility for Social Security normal retirement age, during which period the insurer has no right to make unilaterally any change in any provision of the policy while the policy is in force.

 

          (h)  “Nurse” may be defined so that the description of nurse is restricted to a type of nurse, such as a registered nurse, a licensed practical nurse, or a licensed vocational nurse.  If the words “nurse”, “trained nurse”, or “registered nurse” are used without specific instruction, then the use of these terms requires the insurer to recognize the services of any individual who qualifies under the terminology in accordance with the applicable statutes or administrative rules of the licensing or registry board of New Hampshire.

 

          (i)  “One period of confinement” shall not be defined more restrictively than consecutive days of in-hospital services received as an in-patient, or successive confinements when discharge from and readmission to the hospital occurs within a period of time not more than 90 days or 3 times the maximum number of days of in-hospital coverage provided by the policy to a maximum of 180 days.

 

          (j)  “Partial disability” shall be defined in relation to the individual’s inability to perform one or more but not all of the “major”,  important”, or “essential” duties of employment or occupation, or may be related to a percentage of time worked or to a specified number of hours or to compensation.

 

          (k)  “Physician” may be defined by including words such as “qualified physician” or “licensed physician.”  The use of these terms requires an insurer to recognize and to accept, to the extent of its obligation under the contract, all providers of medical care and treatment when the services are within the scope of the provider’s licensed authority and are provided pursuant to applicable laws, including Advanced Practice Registered Nurses and Physician’s Assistants.

 

          (l)  “Preexisting condition”:

 

(1)  With respect to disability insurance, preexisting condition shall not be defined more restrictively than the following:  “Preexisting condition means the existence of symptoms that would cause an ordinarily prudent person to seek diagnosis, care or treatment within a 24-month period preceding the effective date of the coverage of the insured person or a condition for which medical advice or treatment was recommended by a physician within a 24-month period preceding the effective date of the coverage of the insured person”; and 

 

(2)  With respect to other insurance, preexisting condition shall not be defined more restrictively than the following:  “Preexisting condition means the existence of symptoms that would cause an ordinarily prudent person to seek diagnosis, care or treatment within a 6-month period preceding the effective date of the coverage of the insured person or a condition for which medical advice or treatment was recommended by a physician within a 6-month period preceding the effective date of the coverage of the insured person.

 

          (m)  “Sickness” shall not be defined to be more restrictive than the following: “Sickness means illness,

disease, or medical condition, including pregnancy, of an insured person that first manifests itself after the effective date of insurance and while the insurance is in force.”  The definition may be further modified to exclude sickness or disease for which benefits are provided under workers’ compensation, occupational disease, employers’ liability or similar law.

 

          (n)  “Substance use disorder benefits” means the benefits with respect to services for substance use disorders.

 

          (o)  “Total disability”:

 

(1)  A general definition of “total disability” shall not be more restrictive than one requiring that the individual who is totally disabled not be engaged in any employment or occupation for which he or she is or becomes qualified by reason of education, training or experience; and is not in fact engaged in any employment or occupation for wage or profit;

 

(2)  “Total disability” may be defined in relation to the inability of the person to perform duties but shall not be based solely upon an individual’s inability to:

 

a.  Perform “any occupation whatsoever”, “any occupational duty”, or “any and every duty of his occupation”;

 

b.  Engage in a training or rehabilitation program; or

 

c.  Perform activities of daily living (ADLs);

 

(3)  An insurer may require the complete inability of the person to perform all of the substantial and material duties of his or her regular occupation or words of similar import; or if the person is not employed, the inability to perform the usual activities of an individual of the same age and gender; and

 

(4)  An insurer may require care by a physician other than the insured or a member of the insured’s immediate family.

 

Source. (See Revision Note at chapter heading for Ins 6000) #12478, eff 2-12-18

 

          Ins 6001.05  Prohibited Policy Provisions.

 

          (a)  Except as provided in Ins 6001.04(l), an ancillary health policy or certificate shall not contain provisions establishing a probationary or waiting period during which no coverage is provided under the policy, except for specified disease coverage.  Elimination periods shall be prohibited in accident-only and hospital confinement indemnity coverages, unless otherwise stated herein.

 

          (b)  A policy, certificate, or rider for additional coverage may not be issued as a dividend unless an equivalent cash payment is offered as an alternative to the dividend policy, certificate or rider. 

 

(1)  A dividend policy, certificate, or rider for additional coverage shall not be issued for an initial term of less than 6 months; and

 

(2)  The initial renewal subsequent to the issuance of a policy, certificate, or rider as a dividend shall clearly disclose that the policyholder or certificate holder is renewing the coverage that was provided as a dividend for the previous term and that the renewal is optional.

 

          (c)  In all circumstances in which an insurer does not request information about an applicant’s health history or medical treatment in the application process, the policy must cover the loss consistent with RSA 415-A:5(I).  Otherwise, a policy or certificate shall not exclude coverage for a loss due to a preexisting condition for a period of greater than 6 months following the issuance of the policy or certificate where the policy or certificate is issued on a guaranteed issue basis, except for disability income protection policies in which coverage may be excluded for 24 months due to a preexisting condition.

 

          (d)  A disability income protection policy or certificate may contain a “return of premium” or “cash value benefit” so long as the return of premium or cash value benefit is not reduced by an amount greater than the aggregate of claims paid under the policy and the insurer demonstrates that the reserve basis for the policies is adequate.  No other policy or certificate subject to RSA 415-A and this chapter shall provide a return of premium or cash value benefit, except return of unearned premium upon termination or suspension of coverage, retroactive waiver of premium paid during disability, payment of dividends on participating policies or certificates, or experience rating refunds.

 

          (e)  Policies or certificates providing hospital confinement indemnity or other fixed indemnity coverage shall not contain provisions excluding coverage because of confinement in a hospital operated by the federal government.

 

          (f)  A policy or certificate shall not limit or exclude coverage by type of sickness, accident, treatment, or medical condition, except as follows:

 

(1)  Preexisting conditions or diseases other than congenital anomalies of a covered dependent child;

 

(2)  Mental or emotional disorders and substance use disorders;

 

(3)  Sickness, treatment, or medical condition arising out of:

 

a.  War or act of war (whether declared or undeclared); participation in a felony, riot, or insurrection; service in the armed forces or units auxiliary to it;

 

b.  Suicide, sane or insane, attempted suicide, or intentionally self-inflicted injury;

 

c.  Aviation, except as a fare-paying passenger;

 

d.  Professional sports;

 

e.  Incarceration, with respect to disability income protection policies;

 

f.  The voluntary consumption of drugs that are not prescribed by the insured’s physician or are not used in the manner prescribed; and

 

g.  Driving under the influence of drugs or alcohol or any combination thereof;

 

(4)  Cosmetic surgery, except that “cosmetic surgery” shall not include reconstructive surgery when the service is incidental to or follows surgery resulting from trauma, infection, or other diseases of the involved part, and reconstructive surgery because of congenital disease or anomaly of a covered dependent child that has resulted in a functional defect;

 

(5)  Foot care in connection with corns, calluses, flat feet, fallen arches, weak feet, chronic foot strain, or symptomatic complaints of the feet;

 

(6)  Care in connection with the detection and correction by manual or mechanical means of structural imbalance, distortion, or subluxation in the human body for purposes of removing nerve interference and the effects of it, where the interference is the result of or related to distortion, misalignment of subluxation of, or in the vertebral column;

 

(7)  Treatment provided in a government hospital, benefits provided under Medicare or other governmental program (except Medicaid), a state or federal workers’ compensation, employers’ liability or occupational disease law services rendered by employees of hospitals, laboratories or other institutions; services performed by a member of the covered person’s immediate family; and services for which no charge is normally made in the absence of insurance;

 

(8)  Dental care or treatment;

 

(9)  Eye glasses, hearing aids, and examinations for the prescription or fitting of them;

 

(10)  Rest cures, custodial care, transportation, and routine physical examinations; and

 

(11)  Territorial limitations.

 

          (g)  This part shall not impair or limit the use of waivers to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases, physical condition, or extra hazardous activity.  Where waivers are required as a condition of issuance, renewal, or reinstatement, signed acceptance by the insured is required unless on initial issuance the full text of the waiver is contained either on the first page or specification page.

 

          (h)  Except as specifically provided in other ancillary health administrative rules, coordination of benefits shall be prohibited for the following products:  

 

(1)  Hospital confinement and other fixed indemnity;

 

(2)  Accident-only and specified accident;

 

(3)  Specified disease; and

 

(4)  Limited benefit.

 

          (i)  Excess insurance shall be prohibited.

 

          (j)  Arbitration provisions shall be prohibited.

 

          (k)  No policy of health and accident insurance shall be approved that contains a provision that the disability period shall be considered to commence with the date on which written notice is actually received by the company.

 

          (l)  Any provision that excludes coverage by use of the terms "chronic disease" or "organic disease" shall be prohibited.

 

          (m)  No group accident and health policy shall contain a provision for automatic termination of an individual's coverage upon the occurrence of a loss, except a loss that has exhausted all possible benefits under the policy.

 

          (n)  Policy or certificate provisions precluded in this section shall not be construed as a limitation on the authority of the commissioner to disapprove other policy provisions in accordance with RSA 415-A that in the opinion of the commissioner are unjust, unfair, or unfairly discriminatory to the policyholder, beneficiary, or a person insured under the policy or certificate.

 

Source. (See Revision Note at chapter heading for Ins 6000) #12478, eff 2-12-18; amd by #12629, eff 9-28-18; amd by #13113, eff 9-28-20

 

         Ins 6001.06  Required Policy Provisions.

 

         (a)  An individual ancillary health policy shall comply with the following provisions:

 

(1)  If the policy provides for any reduction in benefits or benefit period because of the attainment of a specified age limit, reference thereto shall be set forth on the first or the specifications page;

 

(2)  Noncancellable policies with premium rates that are not presumed level but are expected to change periodically with the insured's attained age shall include the entire premium scale applicable to the insured;

 

(3)  All other policies with premium rates that are not presumed level but are expected to change periodically with the insured's attained age shall not be required to include the entire premium scale applicable to the insured but shall disclose on the face page or the specifications page that the premium rates are subject to change based on the attained age of the insured and also identify the attained ages at which such changes will occur;

 

(4)  With respect to policies where there exists an option for continuation of coverage at a specified time after the attainment of the individual’s Social Security normal retirement date or commencement of Medicare coverage, whichever is earlier, and where the insurer reserves the right to change the coverage, the premium scale, or both for such continuation, such premium scale may be omitted from the policy.  All conditions pertaining to the option of continuation of coverage and any changes in coverage shall be contained in the policy;

 

(5)  Any rider or endorsement that reduces or eliminates coverage under the policy shall provide for signed acceptance by the policyholder, except in the case of a rider or endorsement that is used only at the time of policy issue;

 

(6)  Any individual accident and health policy insuring against loss resulting from accidental bodily injuries only shall specify on the cover of the policy in no less than 14 point, bold face type, "This policy does not insure against loss resulting from sickness.";

 

(7)  Unless the insurer has adopted a procedure to obtain a policyholder's dated and signed receipt for the delivery of the policy, it shall be presumed that the date of delivery is the date shown by the policyholder's records or by his or her memory;

 

(8)  Diseases sought to be excluded from coverage shall be stated with sufficient clarity to be readily identifiable by the insured;

 

(9)  Common terms such as "heart disease," "pulmonary disease" or "disease of the reproductive organs" shall be acceptable;

 

(10)  A policy may:

 

a.  Require that the insured incur expenses that he or she is legally required to pay; and

 

b.  Exclude charges that would not have been made if no insurance existed;

 

(11)  Where the insurer reserves the right to cancel, the provisions of RSA 415:6, II(8) shall be delineated in the policy; 

 

(12)  With respect to all individual accident and health policies, including those sold on a franchise basis, to which the refund provisions of RSA 415:6, II(8) do not apply, the insurer shall provide:

 

a.  A refund of unearned premium upon a request for cancellation of the policy by the insured;

 

b.  The period for which a refund is to be made measured from the date the request for cancellation is received by the insurer, or such later date as may be specified in the request, to the date to which premiums have been paid; and

 

c.  A refund amount of not less than 80 percent of the pro-rata unearned premium for such period;

 

(13)  In the event of any renewal rate increase, insurers shall provide policyholders with prior notice of any such increase such that a 30 days’ notice is provided for policies subject to RSA 415; and

 

(14)  In no case shall the benefits provided under the policy or the definitions contained in the policy be less favorable to the insured than the applicable provisions for accident and health benefits set forth in RSA 415. 

 

         (b) A group ancillary health policy shall contain the following provisions:

 

(1)  All master policies and certificates shall contain a clear explanation as to continuance of coverage after termination of the policy;

 

(2)  A certificate shall:

 

a.  State the benefits applicable to the person insured or state the schedule of benefits applicable to the class to which he or she belongs; or

 

b.  Define eligibility and benefit amounts clearly enough for a person to determine whether he or she is an insured and the amount of any benefits to which he or she is entitled;

 

(3)  A policy may require that the insured:

 

a.  Incur expenses that the insured is legally responsible to pay for; 

 

b.  Exclude charges that would not have been incurred if no insurance existed; and

 

c.  Be responsible for non-covered services;

 

(4)  All group certificates shall include a complete statement of the policy provisions regarding coordination or nonduplication of benefits in the event of other coverage;

 

(5)  In the event of any renewal rate increase, insurers shall provide policyholders with prior notice of any such increase such that 30 days’ notice is provided for policies subject to RSA 415;

 

(6)  Declination of renewal or termination of insurance provisions shall be as follows:

 

a.  No insurer shall decline to renew a group policy unless the cause of its action is based on one or more of the reasons for declination of renewal stated in the policy; 

 

b. Any such reason shall be stated in a group policy and shall be objective in nature;

 

c.  Declination of renewal shall be defined so as to include any termination of a group policy by the insurer for any reason except for nonpayment of premiums; and

 

d.  Notice of nonrenewal or termination of a group policy by the insurer shall provide for at least 45 days prior notice;

 

(7)  In no case shall the benefits provided under the policy or the definitions contained in the policy be less favorable to the insured than the applicable provisions for accident and health benefits set forth in RSA 415;

 

(8)  The required provisions for blanket accident and health insurance policies shall be those established in RSA 415:18 and additional requirements as follows:

 

a.  Except as provided in b. below:

 

1.  An individual certificate shall not be issued to the person or persons who may receive benefits under group blanket accident and health coverage; and

 

2.  A person or persons who receive benefits under blanket policy shall not contribute

directly to the premium payment for the policy; and

 

b.  Blanket accident and health insurance shall meet all requirements of individual limited benefit health insurance if coverage:

 

1.  Is issued to identified members or subscribers;

 

2.  Is based on individual enrollment; and

 

3.  Provides that a certificate of coverage to enrolled members shall be issued on an

individual basis; and

 

(9)  Any group accident and health policy and certificate insuring against loss resulting from accidental bodily injuries only shall specify on the cover of the policy in no less than 14 point, bold face type, "This policy does not insure against loss resulting from sickness".

 

         (c)  The following provision shall appear in a conspicuous place on the cover page of all ancillary accident and health policies and certificates:

 

"This policy may, at any time within 30 days after its receipt by the policyholder, be returned by delivering it or mailing it to the company or the agent through whom it was purchased.  Immediately upon such delivery or mailing, the policy will be deemed void from the beginning, and any premium paid on it will be refunded."

 

          (d)  Each policy of individual ancillary health insurance or group ancillary health insurance shall include a renewal, continuation, or nonrenewal provision.  The language or specification of the provision shall be consistent with the type of contract to be issued.  The provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state the duration, where limited, of renewability and the duration of the term of coverage for which the policy is issued and for which it may be renewed.

 

Source. (See Revision Note at chapter heading for Ins 6000) #12478, eff 2-12-18; ss by #12629, eff 9-28-18

 

          Ins 6001.07  Waiver or Suspension of Rules.

 

          (a)  The commissioner, upon the commissioner’s own initiative or upon request by an insurer, shall waive any requirement of this chapter if such waiver does not contradict the objective or intent of the rule and:

 

(1)  Applying the rule provision would cause confusion or would be misleading to consumers;

 

(2)  The rule provision is in whole or in part inapplicable to the given circumstances;

 

(3)  There are specific circumstances unique to the situation such that strict compliance with the rule would be onerous without promoting the objective or intent of the rule provision; or

 

(4)  Any other similar extenuating circumstances exist such that application of an alternative standard or procedure better promotes the objective or intent of the rule provision.

 

          (b)  No requirement prescribed by statute shall be waived unless expressly authorized by law.

 

          (c)  Any person or entity seeking a waiver shall make a request in writing.

 

          (d)  A request for a waiver shall specify the basis for the waiver and proposed alternative, if any.

 

Source. (See Revision Note at chapter heading for Ins 6000) #12478, eff 2-12-18


 

 

APPENDIX

 

Rule

Specific State Statute the Rule Implements

 

 

Ins 6001.01

RSA 400-A:15, I; RSA 415-A

Ins 6001.02

RSA 400-A:15, I; RSA 415-A

Ins 6001.03

RSA 400-A:15, I; RSA 415:18; RSA 415-A:2, I(n); RSA 415-F:1, V

Ins 6001.04

RSA 400-A:15, I; RSA 415:6; RSA 415:18; RSA 415-A-2; RSA 415-A:3

Ins 6001.05

RSA 400-A:15, I; RSA 415:5; RSA 415:6; RSA 415:18; RSA 415-A-2;

RSA 415-A:3

Ins 6001.06

RSA 400-A:15, I; RSA 415:1; RSA 415:5; RSA 415:6; RSA 415:6-f;
RSA 415:6-h; RSA 415:18; RSA 415:18-k; RSA 415-A:2; RSA 415-A:3

Ins 6001.07

RSA 400-A:15, I