RSA 420-G:5 · Medical Underwriting

420-G:5 Medical Underwriting. –

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I.

Health carriers providing health coverage shall not perform medical underwriting, including the use of health statements or screenings or the use of prior claims history.

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II.

Regardless of claim experience, health status, or medical history, health carriers providing health coverage for individual or small employers shall not refuse to write or issue any of their available coverages or health benefit plans to any individual or small employer group that elects to be covered under that plan and agrees to make premium payments and meet the other requirements of the plan. II-a. Health carriers shall not establish any annual or lifetime limits on the dollar value of essential health benefits for any individual, except annual or lifetime limits may be imposed on specific covered benefits that are not essential health benefits to the extent permitted under federal law as of January 1, 2019.

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III.

Health carriers providing health coverage for small employer groups shall not knowingly provide health coverage to groups where the employer has discriminated based on health status or claims history against any employee or potential employee or his or her dependents with respect to participation in an employer-sponsored health benefit plan.

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IV.

Health carriers shall not offer riders or endorsements to exclude certain illnesses or health conditions in order to avoid the purpose of this chapter.

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V.

Individual health insurance carriers shall be responsible for ascertaining the eligibility of any individual applicant or insured for high risk pool coverage. If a carrier determines that an individual meets any of the eligibility criteria set forth in RSA 404-G:5-e, the carrier shall give the individual written notice, with the declination of coverage, the coverage offering or upon a rate increase at renewal. The notice shall include information about available benefits and exclusions of high risk pool coverage and the name, address, and telephone number of the pool administrator or the administrator's designee.

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VI.

It shall constitute an unfair trade practice under RSA 417 for an insurer, insurance producer, or third party administrator to refer an individual employee to the pool, or arrange for an individual employee to apply to the pool, for the purpose of separating that employee from group health insurance coverage provided in connection with the employee's employment.

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VII.

Health carriers and health insurance producers shall ensure that persons seeking coverage through a small employer group who are required to complete a health statement have an option to convey the required information directly to the carrier or the producer through a secure means and bypassing the employer.

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VIII.

[Repealed.] Source. 1997, 344:1. 1998, 340:11. 2001, 295:12. 2003, 188:7; 201:1, 2. 2004, 251:10, 11. 2005, 225:11. 2006, 125:1. 2009, 235:15. 2011, 189:7, eff. Aug. 13, 2011. 2019, 113:9, eff. Aug. 20, 2019; 220:5, eff. Sept. 10, 2019.

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