RSA 417-G:1 · Definitions

417-G:1 Definitions. – In this chapter:

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I.

"Commissioner" means the insurance commissioner.

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II.

"Experimental infertility procedure" means a procedure for which the published medical evidence regarding risks, benefits, and overall safety and efficacy is not sufficient to regard the procedure as an established medical practice.

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III.

"Fertility treatment" means health care services or products provided with the intent to achieve a pregnancy that results in a live birth with healthy outcomes.

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IV.

"Health carrier" means an entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including an insurance company, a health maintenance organization, a health service corporation, or any other entity providing a plan of health insurance, health benefits, or health services.

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V.

"Infertility" means a disease, caused by an illness, injury, underlying disease, or condition, where an individual's ability to become pregnant or to carry a pregnancy to live birth is impaired, or where an individual's ability to cause pregnancy and live birth in the individual's partner is impaired.

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VI.

"Medically necessary" means health care services or products provided to an enrollee for the purpose of preventing, stabilizing, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease in a manner that is:

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(a)

Consistent with generally accepted standards of medical practice;

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(b)

Clinically appropriate in terms of type, frequency, extent, site, and duration;

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(c)

Demonstrated through scientific evidence to be effective in improving health outcomes;

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(d)

Representative of "best practices" in the medical profession; and

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(e)

Not primarily for the convenience of the enrollee or physician or other health care provider.

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VII.

"Standard fertility preservation services" means procedures consistent with established medical practices and professional guidelines published by the American Society for Reproductive Medicine or the American Society of Clinical Oncology. Source. 2019, 307:2, eff. Jan. 1, 2020.

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