RSA 400-B:2 · Definitions

400-B:2 Definitions. – All definitions contained in RSA 417 are hereby incorporated by reference. In addition, for the purposes of this chapter:

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I.

"Application and accompanying records" means any written or electronic application form, any enrollment form, any document or record thereof, used to add coverage under any existing policy, questionnaire, telephone interview form, paramedical interview form, or any other document used to question or underwrite an applicant for any policy issued by an insurer or for any declination of coverage by an insurer.

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II.

"Claim file and accompanying records" means the file maintained to show clearly the inception, handling, and disposition of each claim. The claim file shall be sufficiently clear and specific so that pertinent events and dates of these events can be reconstructed.

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III.

"Complaint" means any written or electronically transmitted communication primarily expressing a grievance.

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IV.

"Declination" or "declined underwriting file" means all written or electronic records concerning coverage for which an application has been submitted to the insurer or its producer but the insurer has made a determination not to issue a policy or not to add additional coverage when requested.

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V.

"Department" means the insurance department.

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VI.

"Examiner" means a market conduct examiner or any other examiner authorized or designated by the commissioner to conduct an examination pursuant to this chapter.

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VII.

"Grievance" for health insurance purposes, means a written complaint submitted by or on behalf of a covered person regarding the:

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(a)

Availability, delivery, or quality of health services, including a complaint regarding an adverse determination made pursuant to utilization review;

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(b)

Claims payment, handling, or reimbursement for health care services; or

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(c)

Matters pertaining to the contractual relationship between a covered person and a health carrier.

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VIII.

"Inquiry" means a specific question, criticism, or request made in writing to an insurer by an examiner.

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IX.

"Related entity" includes a person authorized to act on behalf of the insurer in connection with the business of insurance. Source. 2005, 221:1. 2006, 196:14. 2009, 178:2, eff. Sept. 11, 2009.

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