Section Ins 1906.06 - Continuance of Coverage in Situations Involving Replacement of One Carrier by Another(a) This subsection shall indicate the carrier responsible for liability in those instances in which one carrier's policy, contract or certificate replaces a plan of similar benefits of another carrier.(b) After discontinuance of the policy, contract or certificate, the prior carrier remains liable only to the extent of its accrued liabilities and extensions of benefits. The position of the prior carrier shall be the same whether the group policyholder or other entity secures replacement coverage from a new carrier, self-insures, or foregoes the provision of coverage.(c) If the individual was validly covered under the prior plan on the date of discontinuance, each individual who is eligible for coverage in accordance with the succeeding carrier's plan of benefits with respect to the class or classes of individuals eligible for coverage under the succeeding carrier's plan shall be enrolled and covered by the succeeding carrier's plan of benefits. (1) Each person not covered under the succeeding carrier's plan of benefits in accordance with the above, shall nevertheless be covered by the succeeding carrier in accordance with the following rules if the individual was validly covered, including benefit extension, under the prior plan on the date of discontinuance and if the individual is a member of the class or classes of individuals eligible for coverage under the succeeding carrier's plan. Any reference in the following rules to an individual who was or was not totally disabled is a reference to the individual's status immediately prior to the date the succeeding carrier's coverage becomes effective. a. The minimum level of benefits to be provided by the succeeding carrier shall be the applicable level of benefits of the prior carrier's plan reduced by any benefits payable by the prior plan;b. Coverage shall be provided by the succeeding carrier until the earliest of the following dates: 1. The date the individual becomes eligible under the succeeding carrier's plan as described in paragraph Ins 1906.05(c);2. For each type of coverage, the date the individual's coverage would terminate in accordance with the succeeding carrier's plan provisions applicable to individual termination of coverage such as at termination of employment or ceasing to be an eligible dependent; or3. In the case of an individual who was totally disabled, and in the case of a type of coverage for which Ins 1906.04 of this rule requires an extension of benefits or accrued liability, the end of any period of extension or accrued liability that is required of the prior carrier by Ins 1906.04 of this rule, or if the prior carrier's policy, contract or certificate is not subject to that section, but would have been required of the prior carrier had the policy, contract or certificate been subject to Ins 1906.04 of this rule at the time the prior carrier's plan was discontinued and replaced by the succeeding carrier's plan.(2) For health insurance coverage, in the case of an individual who was totally disabled at the time the prior carrier's plan was discontinued and replaced by the succeeding carrier's plan, and in the case of which Ins 1906.04 of this rule requires an extension of benefits or accrued liability, the minimum level of benefits to be provided by the succeeding carrier shall be the applicable level of benefits of the prior carrier's plan reduced by any benefits paid by the prior plan.(3) In the case of a preexisting conditions limitation included in the succeeding carrier's plan, the level of benefits applicable to preexisting conditions of individuals becoming covered by the succeeding carrier's plan in accordance with this paragraph during the period of time this limitation applies under the new plan shall be the lesser of: a. The benefits of the new plan determined without application of the preexisting conditions limitation; orb. The benefits of the prior plan.(4) The succeeding carrier, in applying any deductibles or coinsurance amounts applicable to the out-of-pocket maximums or waiting periods in its plan, shall give credit for the satisfaction or partial satisfaction of the same or similar provisions under a prior plan providing similar benefits. In the case of deductible provisions or coinsurance amounts applicable to the out-of-pocket maximums, the credit shall apply for the same or overlapping benefit periods and shall be given for expenses actually incurred and applied against the deductible or coinsurance provisions of the prior carrier's plan during the 90 days preceding the effective date of the succeeding carrier's plan but only to the extent these expenses are recognized under the terms of the succeeding carrier's plan and are subject to a similar deductible or coinsurance provision.(5) In any situation where a determination of the prior carrier's benefit is required by the succeeding carrier, at the succeeding carrier's request the prior carrier shall furnish a statement of the benefits available or pertinent information, sufficient to permit verification of the benefit determination or the determination itself by the succeeding carrier. For the purposes of this paragraph, benefits of the prior plan shall be determined in accordance with all of the definitions, conditions, and covered expense provisions of the prior 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.(d)Whenever there is a replacement of a carrier's benefit plan by the benefit plan of another carrier, the insureds, subscribers or members who were active recipients of mental health services under the prior carrier's plan shall be entitled to continue to receive mental health services from the same mental health provider who provided the services received while the insured, subscriber or member was an active recipient of mental health services under the prior carrier's plan.(e) The entitlement to receive services pursuant to (d) above shall: (1) Continue for one year following the effective date of the new carrier's benefit plan;(2) Override any provisions in the replacing carrier's plan requiring the insured, subscriber or member to receive mental health services from mental health providers who have contracted with the replacing carrier to be part of the replacing carrier's provider network;(3) Override any provisions in the replacing carrier's plan that reduce or eliminate benefits for mental health services whenever such services are received from a mental health provider who has not contracted to be part of the replacing carrier's network;(4) Be provided to any insured, subscriber or member who, during an open enrollment period, changed from a benefit plan sponsored by the employer to another benefit plan sponsored by the employer;(5) Be subject to any provisions of the replacing carrier's plan requiring mental health services to be medically necessary, as defined in the replacing carrier's plan;(6) Be subject to any provisions of the replacing carrier's plan requiring mental health services to be preauthorized by the replacing carrier or its utilization review agent;(7) Be subject to the provision of proof of receipt of prior services while the prior carrier's plan was in effect as follows:a. The insured, subscriber or member shall be responsible for providing such proof in the form of:1. An explanation of benefits form from the prior carrier;2. A letter from the provider who provided the services attesting to the fact that services were provided together with the dates such services were rendered; or3. Any other documentation which the replacing carrier determines to be acceptable as proof; and(8) Be subject to verification that the provider of services under the prior carrier is protected by a malpractice policy with coverage of at least $1,000,000 per single incident and at least $3,000,000 in the aggregate.(f) While the entitlement provided pursuant to (d) above is in effect, benefits shall be paid by the replacing carrier as if the insured, subscriber or member were receiving mental health services from a mental health provider who has contracted with the replacing carrier.(g) Compliance with the provisions of (d) and (e) above, shall not require the replacing carrier to make direct benefit payments to a non-network provider or increase the replacing carrier's liability above what its liability would be if the mental health services were received from a contracting mental health provider who is reimbursed on a fee-for-service basis.N.H. Admin. Code § Ins 1906.06