N.H. Admin. Code § Ins 1906.02

Current through Register No. 45, November 7, 2024

Section Ins 1906.02 - Definitions

For the purposes of this part the following definitions shall apply:

(a) "Active recipient of mental health services" means an insured, subscriber or member of a replacing carrier's health insurance benefit plan who received mental health services from a mental health provider while covered by the prior carrier's benefit plan provided such services were received for a purpose other than monitoring medications and were received at least as often as:

(1) In the case of outpatient services:

a. For 2 separate days during the 30 day period immediately prior to the effective date of the replacing carrier's plan; or

b. For 3 separate days during the 90 day period immediately prior to the effective date of the replacing carrier's plan; or

c. For 5 separate days during the 12 month period immediately preceding the effective date of the replacing carrier's plan; and

(2) In the case of inpatient services, one inpatient confinement during the 12 month period immediately prior to the effective date of the replacing carrier's plan.

(b) "Carrier" means a person or an entity that offers or provides a policy, contract or certificate of insurance coverage in this state.

(c) "Carrier" includes an insurer, a health maintenance organization, a nonprofit service corporation or any other person or entity providing a policy, contract or certificate of insurance coverage subject to state insurance regulation.

(d) "Group-type basis" means a benefit plan, other than a "salary budget" plan utilizing individual insurance policies or subscriber contracts, which meets the following conditions:

(1) Coverage is provided through insurance policies or subscriber contracts to classes of employees or members defined in terms or conditions pertaining to employment or membership;

(2) The coverage is not available to the general public and can be obtained and maintained only because of the covered person's membership in or in connection with the particular organization or group;

(3) There are arrangements for bulk payment of premiums or subscription charges to the carrier; and

(4) There is sponsorship of the plan by the employer, union, association or trust.

(e) "Health insurance coverage" means a hospital and/or medical expense incurred policy, a nonprofit health care service plan contract, a health maintenance organization subscriber contract, or any other health care plan or arrangement that pays for or furnishes medical or health care services whether by insurance or otherwise.

(f) "Health insurance coverage" shall not include one or more, or any combination of, the following:

(1) Coverage only for accident, or disability income insurance, or any combination thereof;

(2) Coverage issued as a supplement to liability insurance;

(3) Liability insurance, including general liability insurance and automobile liability insurance;

(4) Workers' compensation or similar insurance;

(5) Automobile medical payment insurance;

(6) Credit-only insurance;

(7) Coverage for on-site medical clinics; and

(8) Other similar insurance coverage, specified in federal regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996 (HIPAA) ( Pub.L.No. 104-191 ), under which benefits for medical care are secondary or incidental to other insurance benefits.

(g) "Health insurance coverage" shall not include the following benefits if they are provided under a separate policy, certificate or contract of insurance or are otherwise not an integral part of the coverage:

(1) Limited scope dental or vision benefits;

(2) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination thereof; or

(3) Other similar, limited benefits specified in federal regulations issued pursuant to HIPAA.

(h) "Health insurance coverage" shall not include the following benefits if the benefits are provided under a separate policy, certificate or contract of insurance, there is no coordination between the provision of the benefits and any exclusion of benefits under any group plan maintained by the same plan sponsor, and the benefits are paid with respect to an event without regard to whether the benefits are provided with respect to such an event under any group health plan maintained by the same plan sponsor:

(1) Coverage only for a specified disease or illness; or

(2) Hospital indemnity or other fixed indemnity insurance.

(i) "Health insurance coverage" shall not include the following if offered as a separate policy, certificate or contract of insurance:

(1) Medicare supplemental health insurance as defined under Section 1882(g)(1) of the Social Security Act;

(2) Coverage supplemental to the coverage provided under Chapter 55 of Title 10, United States Code; or

(3) Similar supplemental coverage provided to coverage under a group health plan.

(j) "Mental health provider" means any professional or institution listed under RSA 415:18-a, IV.

N.H. Admin. Code § Ins 1906.02

#8646, eff 6-12-06