RSA 420-G:12-a · Health Plan Loss Information

420-G:12-a Health Plan Loss Information. –

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I.

To ensure maximum competition in the purchase of group health insurance, all large employers shall be entitled to receive their specific health plan loss information upon request and without charge. No contract between any health carrier, third-party administrator, employer group, or pool of employers shall abridge this right in any manner.

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II.

Upon written request from any large employer, every health carrier, third-party administrator, pooled risk management program under RSA 5-B or any other type of multiple employer health plan shall provide that employer's loss information within 30 calendar days of receipt of the request. The loss information shall include all physician, hospital, prescription drug, and other covered medical claims specific to the employer's group plan incurred for the 12-month period paid through the 14 months which end within the 60-day period prior to the date of the request. It shall also include deidentified large claim information for claimants over $50,000 to include medical and pharmacy claims, primary and secondary diagnosis, coverage type (employee, spouse, or dependent), and employment status (active or termed), to the extent such disclosure does not violate state or federal law. An employer shall not be entitled by this section to more than 4 loss information requests in any 12-month period; however, nothing shall prohibit a carrier from fulfilling more frequent requests on a mutually agreed-upon basis.

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III.

If an employer requests loss information from an insurance agent or other authorized representative, including an administrator of a pooled risk management program or a multiple employer health plan, the agent or authorized representative shall transmit the request to the health carrier or carriers or third-party administrator within 4 working days. Source. 2001, 120:2. 2003, 127:1; 188:9. 2004, 187:14, eff. July 31, 2004. 2025, 141:376, eff. July 1, 2025.

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