CHAPTER Ins 6100 DISCONTINUANCE AND REPLACEMENT OF ANCILLARY
HEALTH AND BLANKET COVERAGE
Statutory Authority: RSA 400-A:15, I; RSA 415:18, I; RSA 415-A:2,
I
REVISION NOTE #1:
Document
#12471, effective 1-31-18, adopted Chapter Ins 6100 titled “Discontinuance and
Replacement of Group Ancillary Health and Blanket Coverage” containing Part Ins
6101 titled the same.
Chapter Ins 6100 had formerly been
numbered as Part Ins 1906 titled “Discontinuance and Replacement of Group
Accident and Health Coverage” in Chapter Ins 1900 titled “Accident and Health
Insurance.” Former Part Ins 1906 expired
6-12-14. The filing affecting the former
Ins 1906 was Document #8646, effective 6-12-06.
REVISION NOTE #2:
Document
#12560, effective 6-25-18, adopted Part Ins 6102 titled “Replacement of
Ancillary Health Coverage”.
Part Ins 6102 had been based on the
former rule Ins 1901.08 titled “Requirements for Replacement of Individual Accident and
Health Insurance”, which had expired 4-17-14.
The former Ins 1901.08 had been in Part Ins 1901 titled “Minimum
Standards for Accident and Health Insurance”, which in turn had been in Chapter
Ins 1900 titled “Accident and
Health Insurance.” Part Ins 6102
replaces the provisions in the former Ins 1901.08. The filings affecting the former Ins 1901.08
include the following documents:
#1900, effective 1-1-82
#4287, effective 7-1-87
#5656, effective 7-1-93
#7017, INTERIM, effective 7-1-99,
EXPIRED 10-29-99
#8609, effective 4-17-06, EXPIRED
4-17-14
PART Ins 6101 DISCONTINUANCE AND REPLACEMENT OF GROUP
ANCILLARY HEALTH AND BLANKET COVERAGE
Ins 6101.01 Scope and Applicability. This chapter is applicable to all ancillary
health insurance policies and certificates issued or provided by a carrier on a
group basis.
Source.
(See Revision Note #1 at chapter heading for Ins 6100) #12471, eff
1-31-18
Ins 6101.02 Effective Date of Discontinuance for
Nonpayment of Premium.
(a)
If a policy or contract subject to this part provides for automatic
discontinuance of the policy or contract after a premium has remained unpaid
through the grace period allowed for such payment, pursuant to RSA 415:18, the
carrier shall be liable for valid claims for covered losses incurred prior to
the end of the grace period.
(b)
If the actions of the carrier after the end of the grace period indicate
that it considers the policy or contract as continuing in force beyond the end
of the grace period, such as by continuing to recognize claims subsequently
incurred, the carrier shall be liable for valid claims for losses beginning
prior to the effective date of written notice of discontinuance to the
policyholder or other entity responsible for making payments to the
carrier. The effective date of
discontinuance shall not be prior to midnight at the end of the third scheduled
business day after the date upon which the notice is delivered.
Source.
(See Revision Note #1 at chapter heading for Ins 6100) #12471, eff
1-31-18
Ins
6101.03 Requirements for Notice of
Discontinuance. Any notice of
discontinuance shall comply with the provisions of RSA 415:18.
Source.
(See Revision Note #1 at chapter heading for Ins 6100) #12471, eff
1-31-18
Ins
6101.04 Extension of Benefits. Every group policy, contract, or certificate
subject to this part, except dental expense coverage, issued on or after the
effective date of this part, or under which the level of benefits is altered,
modified, or amended on or after the effective date of this part, shall provide
a provision for a period of no less than 90 days extension of benefits in the
event of total disability at the date of discontinuance of the group policy,
contract, or certificate as required by the following paragraphs of this
section.
(a) In the case of a group plan that contains a
disability benefit extension of any type (e.g., premium waiver extension, extended
death benefit in event of total disability, or payment of income for a
specified period during total disability), the discontinuance of the group
policy, contract, or certificate shall not operate to terminate the extension.
(b) In the case of a group plan providing
benefits for loss of time from work or specific indemnity during hospital
confinement, discontinuance of the group policy, contract, or certificate
during a disability shall have no effect on benefits payable for that
disability or confinement.
(c) An applicable extension of benefits or
accrued liability shall be described in any policy or contract involved as well
as in group insurance certificates as follows:
(1)
The benefits payable during any period of extension of benefits or
accrued liability may be subject to the policy’s, contract’s, or certificate’s
regular benefit limits, such as benefits ceasing at exhaustion of a benefit
period or of maximum benefits; and
(2) The benefit payments for hospital or medical
expense coverages may be limited to payments applicable to the disability
condition only.
(d) Every group policy, contract, or certificate
subject to this part, including dental expense coverage, must provide for
continuation of coverage for confinement or courses of treatment that commenced
prior to termination of coverage.
Source.
(See Revision Note #1 at chapter heading for Ins 6100) #12471, eff 1-31-18
Ins
6101.05 Continuance of Coverage in
Situations Involving Replacement of One Carrier by Another. This section shall indicate the carrier
responsible for liability in those instances in which one carrier’s policy or
certificate replaces a plan of similar benefits of another carrier.
(a) After discontinuance of the policy or
certificate, the prior carrier remains liable only to the extent of its accrued
liabilities and extensions of benefits.
The position of the prior carrier shall be the same whether the group
policyholder or other entity secures replacement coverage from a new carrier,
self-insures, or foregoes the provision of coverage.
(b) If the individual was validly covered under
the prior plan on the date of discontinuance, each individual who is eligible
for coverage in accordance with the succeeding carrier’s plan of benefits with
respect to the class or classes of individuals eligible for coverage under the
succeeding carrier’s plan shall be enrolled and covered by the succeeding carrier’s
plan of benefits as follows:
(1)
Each person not covered under the succeeding carrier’s plan of benefits
in accordance with the above shall nevertheless be covered by the succeeding
carrier in accordance with the following rules if the individual was validly
covered, including benefit extension, under the prior plan on the date of
discontinuance and if the individual is a member of the class or classes of
individuals eligible for coverage under the succeeding carrier’s plan. Any reference in the following rules to an
individual who was or was not totally disabled is a reference to the
individual’s status immediately prior to the date the succeeding carrier’s
coverage becomes effective, and:
a.
The minimum level of benefits to be provided by the succeeding carrier
shall be the applicable level of benefits of the prior carrier’s plan reduced
by any benefits payable by the prior plan;
b.
Coverage shall be provided by the succeeding carrier on the earliest of
the following dates:
1.
The date the individual becomes eligible under the succeeding carrier’s
plan as
described
in Ins 6101.05(b);
2.
For each type of coverage, the date the individual’s coverage would
terminate in accordance with the succeeding carrier’s plan provisions
applicable to individual termination of coverage such as at termination of
employment or ceasing to be an eligible dependent; or
3.
In the case of an individual who was totally disabled, and in the case
of a type of coverage for which Ins 6101.04 requires an extension of benefits
or accrued liability, the end of any period of extension or accrued liability
that is required of the prior carrier by Ins 6101.04 or, if the prior carrier’s
policy, contract, or certificate is not subject to that section but would have
been required of the prior carrier had the policy, contract, or certificate
been subject to Ins 6101.04 at the time the prior carrier’s plan was discontinued
and replaced by the succeeding carrier’s plan;
(2)
In the case of a preexisting conditions limitation included in the
succeeding carrier’s plan, the level of benefits applicable to preexisting
conditions of individuals becoming covered by the succeeding carrier’s plan in
accordance with this paragraph during the period of time this limitation
applies under the new plan shall be the lesser of:
a. The benefits of the new plan determined
without application of the preexisting conditions limitations; or
b. The benefits of the prior plan;
(3) The succeeding carrier, in applying any
deductibles or coinsurance amounts applicable to the out-of-pocket maximum or waiting
periods in its plan, shall give credit for the satisfaction or partial
satisfaction of the same or similar provisions under a prior plan providing
similar benefits. In the case of
deductible provisions or coinsurance amounts applicable to the out-of-pocket
maximums, the credit shall apply for the same or overlapping benefit periods
and shall be given for expenses actually incurred and applied against the
deductible or coinsurance provisions of the prior carrier’s plan during the 90
days preceding the effective date of the succeeding carrier’s plan but only to
the extent these expenses are recognized under the terms of the succeeding
carrier’s plan and are subject to a similar deductible or coinsurance
provision; and
(4) In any situation where a determination of the
prior carrier’s benefit is required by the
succeeding
carrier, at the succeeding carrier’s request, the prior carrier shall furnish a
statement
of the benefits
available or pertinent information sufficient to permit verification of the
benefit determination or the determination itself by the succeeding
carrier. For the purposes of this
subparagraph, benefits of the prior plan shall be determined in accordance with
all of the definitions, conditions, and covered expense provisions of the prior
plan rather than those of the succeeding plan.
The benefit determination shall be made as if coverage had not been
replaced by the succeeding carrier.
Source.
(See Revision Note #1 at chapter heading for Ins 6100) #12471, eff
1-31-18
PART Ins 6102 REPLACEMENT OF INDIVIDUAL ANCILLARY HEALTH COVERAGE
Statutory
Authority: RSA 400-A:15, I; RSA 415-A:2,
I
Ins 6102.01 Scope and Applicability. This section is applicable to all ancillary
health insurance policies issued or provided by a carrier on an individual
basis.
Source.
(See Revision Note #2 at chapter heading for Ins 6100) #12560, eff
6-25-18
Ins 6102.02 Requirements for Replacement of Individual
Ancillary Health Insurance.
(a)
An application form shall include a question designed to elicit
information as to whether the
insurance
to be issued is intended to replace any other ancillary health insurance
subject to this part and presently in
force. A supplementary application or other
form to be signed by the applicant containing the question may be used.
(b)
Upon determining that a sale will involve replacement, an insurer, other
than a direct response
insurer,
or its agent shall furnish the applicant, prior to issuance or delivery of the
policy, the notice described in paragraph (c) below. The insurer shall retain a copy of the
notice. A direct response insurer shall
deliver to the applicant, upon issuance of the policy, the notice described in
paragraph (d) below. In no event,
however, will the notices be required in solicitation of accident-only and
single-premium nonrenewable policies.
(c) The notice required by paragraph (b) above for an insurer, other than a direct response insurer, shall provide, in substantially the following form:
NOTICE
TO APPLICANT REGARDING REPLACEMENT
OF
ANCILLARY HEALTH INSURANCE
According
to [your application] [information you have furnished], you intend to lapse or
otherwise terminate existing ancillary health insurance and replace it with a
policy to be issued by [insert company name] Insurance Company. For your own information and protection, you
should be aware of and seriously consider certain factors that may affect the
insurance protection available to you under the new policy.
(1) Health conditions which you may presently
have, such as preexisting conditions, may not be immediately or fully covered
under the new policy. This could result
in denial or delay of a claim for benefits present under the new policy,
whereas a similar claim might have been payable under your present policy.
(2) You may wish to secure the advice of your
present insurer or its agent regarding the proposed replacement of your present
policy. This is not only your right, but
it is also in your best interests to make sure you understand all the relevant
factors involved in replacing your present coverage.
(3) If, after due consideration, you still wish
to terminate your present policy and replace it with new coverage, be certain
to truthfully and completely answer all questions on the application concerning
your medical/health history. Failure to
include all material medical information on an application may provide a basis
for the company to deny any future claims and to refund your premium as though
your policy had never been in force.
After the application has been completed and before you sign it, reread
it carefully to be certain that all information has been properly recorded.
The
above “Notice to Applicant” was delivered to me on:
______________________________
(Date)
______________________________
(Applicant’s
Signature)
(d)
The notice required by paragraph (b) above for a direct response insurer
shall be as follows:
NOTICE
TO APPLICANT REGARDING REPLACEMENT
OF
ANCILLARY HEALTH INSURANCE
According
to [your application] [information you have furnished] you intend to lapse or
otherwise terminate existing ancillary health insurance and replace it with the
policy delivered herewith issued by [insert company name] Insurance
Company. At any time within 30 days
after your receipt of your new policy, you may decide, without cost, whether
you desire to keep the policy. For your
own information and protection you should be aware of and seriously consider
certain factors that may affect the insurance protection available to you under
the new policy.
(1) Health conditions that you may presently
have, such as preexisting conditions, may not be immediately or fully covered
under the new policy. This could result
in denial or delay of a claim for benefits under the new policy, whereas a
similar claim might have been payable under your present policy.
(2) You may wish to secure the advice of your
present insurer or its agent regarding the proposed replacement of your present
policy. This is not only your right, but
it is also in your best interests to make sure you understand all the relevant
factors involved in replacing your present coverage.
(3) [To be included only if the application is
attached to the policy.] If, after due
consideration, you still wish to terminate your present policy and replace it
with new coverage, read the copy of the application attached to your new policy
and be sure that all questions are answered fully and correctly. Omissions or misstatements in the application
could cause an otherwise valid claim to be denied. Carefully check the application and write to
[insert company name and address] within 10 days if any information is not
correct and complete, or if any past medical history has been left out of the
application.
[COMPANY NAME]
Source.
(See Revision Note #2 at chapter heading for Ins 6100) #12560, eff
6-25-18
Ins 6102.03 Waiver of Rules.
(a) The commissioner, upon the commissioner’s own
initiative or upon request by an insurer, shall waive any requirement of this
part 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 #2 at chapter heading for Ins 6100) #12560, eff
6-25-18
PART Ins 6103 DISCONTINUANCE OF INDIVIDUAL ANCILLARY HEALTH
COVERAGE
Statutory Authority: RSA 400-A:15, I; RSA 415:6, VII; RSA 415-A:2,
I
Ins
6103.01 Applicability and Scope. This
part shall be applicable to all ancillary health insurance policies issued or
provided by a carrier on an individual basis, except dental and vision expense
policies.
Source.
#12630, eff 9-28-18
Ins
6103.02 Definitions.
(a) “Block of business” means the total number
of policies written by one insurance company using
the same policy forms.
Source.
#12630, eff 9-28-18
Ins
6103.03 Requirements for Discontinuance
of Individual Ancillary Health Coverage.
(a) In order to discontinue a block of business,
the insurer shall make such request in writing and through the System for
Electronic Rate and Form Filings (SERFF) at https://www.serff.com/ to the
commissioner 60 days prior to the date of discontinuance and include in such
request:
(1) The number of New Hampshire policies
currently in force;
(2) The total number of covered lives;
(3) The total annual premium of the policies in
force;
(4) An explanation of the
classification of risk involved therein to indicate that such classification is
reasonable and nondiscriminatory; and
(5) Statistical data sufficient to indicate that the
cancellation or nonrenewal requested is reasonable and nondiscriminatory.
(b)
Where the insurer reserves the right to cancel, the provisions of RSA
415:6, II(8) shall be delineated in the policy.
Source.
#12630, eff 9-28-18
Ins
6103.04 Notification requirements.
(a) Notice shall be provided to policyholders at
least 30 days prior to the date of discontinuance and include:
(1) The policy number and coverage type;
(2) The date of discontinuance of such policy;
and
(3) Company contact information, including a
toll-free telephone number.
Source.
#12630, eff 9-28-18
Ins
6103.05 Waiver of Rules.
(a) The commissioner, upon the commissioner’s own
initiative or upon request by an insurer, shall waive any requirement of this
part 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.
#12630, eff 9-28-18
APPENDIX
Rule |
Specific
State Statute the Rule Implements |
|
|
Ins 6101.01 |
RSA 400-A:15, I; RSA 415:18, I; RSA
415-A:2, I |
Ins 6101.02 |
RSA 400-A:15, I; RSA 415:18; RSA
415-A:2, I |
Ins 6101.03 |
RSA 400-A:15, I; RSA 415:18; RSA
415-A:2, I |
Ins 6101.04 |
RSA 400-A:15, I; RSA 415:18; RSA
415-A:2, I |
Ins 6101.05 |
RSA 400-A:15, I; RSA 415:18; RSA
415-A:2, I |
|
|
Ins
6102.01 |
RSA
400-A:15, I; RSA 415-A:2, I |
Ins
6102.02 |
RSA
400-A:15, I; RSA 415-A:2, I(l) |
Ins
6102.03 |
RSA
400-A:15, I; RSA 541-A:22, IV |
|
|
Ins 6103.01 |
RSA 400-A:15, I; RSA 415-A:2, I |
Ins 6103.02 |
RSA 400-A:15, I; RSA 415:6 |
Ins 6103.03 |
RSA 400-A:15, I; RSA 415:6 |
Ins 6103.04 |
RSA 400-A:15, I; RSA 415:6 |
Ins 6103.05 |
RSA 400-A:15, I; RSA 541-A:22, IV |