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; |
Ins 6001.07 |
RSA 400-A:15, I |