RSA 420-G:6 · Guaranteed Issue and Renewability

420-G:6 Guaranteed Issue and Renewability. –

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I.

Health carriers shall not establish rules of eligibility, including continued eligibility, for health coverage in relation to the following health status related factors of any employee or dependent:

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(a)

Health status.

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(b)

Medical condition, including both physical and mental illness.

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(c)

Claims experience.

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(d)

Receipt of health care.

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(e)

Medical history.

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(f)

Genetic information.

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(g)

Evidence of insurability, including conditions arising out of domestic violence.

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(h)

Disability.

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II.

Paragraph I shall not be construed to require health carriers to provide particular benefits under the terms of such health coverage, or to prevent health carriers from limiting or restricting the amount, level, extent or nature of the benefits for similarly situated persons under the health coverage. Paragraph I shall also not be construed to require health carriers to issue health coverage to an individual with existing health coverage, except where the individual indicates an intent to replace the existing health coverage. II-a. [Repealed.]

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III.

Health carriers shall actively market, issue, and renew all of the health coverages they sell in the individual and small employer market to all individuals and small employers in that market. Health carriers offering health coverage to small employers shall permit small employers to purchase health coverage at any point during the year, with the small employer's health coverage consisting of the 12-month period beginning with the small employer's effective date of coverage. III-a. A health carrier shall not rescind health coverage issued to an individual or with respect to an individual covered under health coverage issued to a small or large employer, including a group to which the individual belongs or family coverage in which the individual is included, after the individual is covered under the plan, unless:

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(a)

The individual, or a person seeking coverage on behalf of the individual, performs an act, practice, or omission that constitutes fraud; or

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(b)

The individual makes an intentional misrepresentation of material fact, as prohibited by the terms of the plan or coverage. III-b. For the purposes of subparagraph III-a(a), a person seeking coverage on behalf of an individual shall not include a producer, or an employee or authorized representative of the health carrier. III-c. A health carrier in the individual, small group, or large group market shall provide individuals equal access to all health programs, coverage, or activities without discrimination on the basis of sex, sexual orientation, gender identity, race, creed, color, marital status, familial status, physical or mental disability, or national origin, as those terms are defined under RSA 354-A.

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IV.

[Repealed.]

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V.

Health coverages subject to this chapter shall be renewable to all individuals, regardless of age or eligibility for Medicare, or to employees and eligible dependents at the option of the small or large employer, except for the following reasons:

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(a)

Nonpayment of required premiums.

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(b)

Fraud or intentional misrepresentation on the part of an individual or an individual's representative, or on the part of an employer, employee, dependent, or an employee's representative.

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(c)

[Repealed.]

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(d)

Failure of an employer sponsoring group coverage to meet the minimum employee participation number or percentage requirement of the health coverage.

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(e)

The employer medically underwrites or otherwise violates a provision of this chapter.

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(f)

The health carrier is ceasing to offer health coverage in such market, in accordance with paragraph VII. V-a. Health carriers shall not underwrite insureds at time of renewal.

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VI.

Where a health carrier decides to discontinue a particular type of health coverage offered in the individual, large employer or small employer market, the health carrier must:

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(a)

Provide at least 90-days notice of such discontinuation to each individual or employer with such health coverage and to all covered persons;

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(b)

Offer to each individual or employer with such health coverage, the option to purchase any other health coverage currently being offered by the health carrier in the relevant market;

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(c)

Act uniformly without regard to the claims experience of those employers, and without regard to any health status related factor of any covered person or any individual, employee, or eligible dependent who may become a covered person; and

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(d)

Make no adjustments in the health status factor applied to individuals moving from a discontinued product of that health carrier to another product of that health carrier if the individual was newly covered under the previous product within the last 5 years, or a health status factor adjustment was made with respect to that individual within the last 5 years.

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VII.

Where a health carrier decides to discontinue all of its health coverage in the individual market, small employer market, large employer market or any combination thereof, the health carrier must provide at least 180-days notice of such discontinuation to the commissioner, to each individual or employer with such health coverage and to all covered persons; and

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(a)

The health carrier may not renew any health coverages issued, or delivered for issuance, in such discontinued market or markets; and

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(b)

The health carrier may not provide health coverage in such discontinued market or markets during the 5-year period beginning on the date of the discontinuation of the last health coverage not so renewed except that the commissioner may waive or otherwise reduce the 5-year period in which the health carrier may not provide coverage in the discontinued market for good cause shown.

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VIII.

A health carrier may, at the time of coverage renewal, modify the health coverage it offers to:

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(a)

Large employers; and to

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(b)

Small employers and individuals, provided that such modification is in accordance with state law and applied uniformly among all small employers and/or individuals with such health coverage.

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IX.

A health carrier which has discontinued coverage in the individual market, the small employer market, or any combination thereof, in accordance with paragraph VII, shall continue to be liable for the payment of claims in accordance with the following:

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(a)

This section shall apply only to terminating carriers of insureds who obtain creditable replacement health coverage. This paragraph shall be effective with respect to all in-force policies, certificates, or other evidences of coverage as of the effective date of this paragraph.

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(b)

The terminating carrier shall continue to be liable for the payment of claims if the succeeding carrier's policy requires the satisfaction of any deductibles, individual or family stop-loss provisions limiting out-of-pocket payments, or waiting periods in its plan but only to the extent satisfaction or partial satisfaction of the same or similar provisions were included in the terminated plan providing similar benefits. In the case of deductible provisions and stop-loss provisions, the liability shall be for the same or overlapping benefit periods and shall be for expenses actually incurred and applied against the deductible and stop-loss provisions of the terminating carrier's plan but only to the extent those expenses are recognized under the terms of the succeeding carrier's plan and are subject to a similar stop-loss or deductible provision. The terminating company shall inform its insureds at the time of cancellation that this provision is applicable to them and that this is a requirement of New Hampshire statute. The provision should also appear in all policies or certificates where the provision about termination of the insurance company appears. Nothing in this subparagraph shall be deemed to prevent a succeeding carrier's plan from having stop-loss levels or deductible amounts that are higher than those specified in the terminating carrier's plan.

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(c)

Whenever a determination of the terminating carrier's benefits is required by the succeeding carrier, at the succeeding carrier's request the terminating carrier shall furnish, in a timely manner, but in no event later than 30 days, a statement of the benefits available or pertinent information, sufficient to permit verification of the terminating carrier's liability to the succeeding carrier. Any determination of the liability of the terminating plan shall be made in accordance with all the definitions, conditions, and covered expense provisions of the terminating plan rather than those of the succeeding plan. The benefit determination shall be made as if coverage had not been replaced by the succeeding carrier. The succeeding carrier shall notify the terminating carrier as to its liabilities pursuant to RSA 420-G:6, IX(b) and shall indemnify the insured for the same. Upon determination of any liability of the terminating plan, the terminating plan shall pay the succeeding plan in a timely manner, in no event later than 15 days, upon receipt of said claim information. Source. 1997, 344:1. 1998, 158:1; 329:2; 340:12-14; 375:2-4. 2001, 295:3, 13. 2002, 1:1. 2005, 248:17. 2009, 235:16, eff. Sept. 14, 2009. 2019, 220:6, 7, eff. Sept. 10, 2019.

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