RSA 404-G:2 · Definitions

404-G:2 Definitions. – In this chapter:

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I.

"Assessable entity" means any:

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(a)

Health maintenance organization, as defined by RSA 420-B:1, VI.

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(b)

Third party administrator, as defined by RSA 402-H:1, I.

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(c)

Entity providing administrator services and required to register with the insurance commissioner under RSA 402-H:11-a or RSA 402-H:11-b.

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(d)

Insurance company licensed pursuant to RSA 401:1, IV.

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(e)

Health service corporation, as defined by RSA 420-A:1, III.

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(f)

Any entity providing group excess loss insurance to an employer with a principal place of business in New Hampshire or to an employer that covers lives in New Hampshire.

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II.

"Assessment" means the liability of the assessable entity to the association under RSA 404-G:5-a.

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III.

"Association" means the New Hampshire individual health plan benefit association, also known as, the "New Hampshire health plan," a not-for-profit, voluntary corporation created as directed under this chapter in order to promote the purposes and carry out the requirements of this chapter under the oversight of the commissioner.

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IV.

"Commissioner" means the insurance commissioner.

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V.

"Covered lives" shall include all persons who are:

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(a)

Covered under an individual health insurance policy issued or delivered in New Hampshire;

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(b)

Covered under a group health insurance policy that is issued or delivered in New Hampshire;

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(c)

Covered under a group health insurance policy evidenced by a certificate of insurance that is issued or delivered in New Hampshire;

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(d)

Protected, in part, by a group excess loss insurance policy where the policy or certificate of coverage has been issued or delivered in New Hampshire;

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(e)

Protected by health insurance as defined in RSA 404-G:2, VII where the person is a New Hampshire resident. V-a. "Group excess loss insurance" means coverage purchased by an employer against the risk that any one claim made against the employer's health plan will exceed a specified dollar amount or coverage purchased by an employer against the risk that the employer's total liability for the health plan will exceed a specified amount.

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VI.

"Group health insurance" means health insurance coverage other than individual health insurance coverage.

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VII.

"Health insurance" means health insurance coverage issued in accordance with RSA 415, 420-A, or 420-B. For the purposes of this chapter, health insurance shall not include accident only, credit, dental, vision, Medicare supplement, Medicare Risk, Medicare Advantage, Managed Medicaid, long-term care, disability income (or similar insurance products regulated by administrative rule Ins 8000), coverage issued as a supplement to a liability insurance, workers' compensation or similar insurance, automobile medical payment insurance, policies or certificates of specified disease, hospital confinement indemnity, limited benefit health insurance (or similar insurance products regulated by administrative rule Ins 6000), and coverage provided through the Federal Employees' Program. Health insurance does include group excess loss insurance.

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VIII.

"Individual health insurance" means health insurance sold directly to an individual and not on a group remittance basis. Individual health insurance shall include franchise health insurance.

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IX.

"Program" means any initiative undertaken by the association with the approval of the commissioner to fulfill any stated purpose of this chapter or any other statutory requirement, including but not limited to the reinsurance program authorized under RSA 420-N:6-a and supporting the New Hampshire granite advantage health care program under RSA 126-AA. Source. 1998, 340:6. 2001, 295:5, 6. 2003, 276:1, 2. 2008, 375:3, 4. 2010, 243:3, 4. 2016, 13:8, 9, eff. Apr. 5, 2016. 2018, 342:16, 24, I, eff. Dec. 31, 2018. 2020, 37:8, eff. July 29, 2020. 2023, 92:2, eff. Jan. 1, 2024.

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