Section Ins 2701.04 - Basic Access Requirement(a) Each health carrier offering a network plan shall maintain a network of primary care providers, dental providers, specialists, institutional providers, and other ancillary health care personnel that is sufficient in numbers and types of providers to ensure that all covered health care services are accessible to covered persons without unreasonable delay.(b) A health carrier's network of participating providers shall be considered sufficient to meet the basic access requirement in Ins 2701.04(a) if it meets all of the standards contained in Ins 2701.04 through Ins 2701.13. The evaluation of network adequacy shall be based on the most recent United States census data for populations under 65 years of age.(c) The basic access requirement in Ins 2701.04(a) shall be met in each county in which the health carrier is actively marketing a health benefit plan. For the purpose of this paragraph, "actively marketing" means advertising in publications published within the county or initiating contact with a potential policyholder in person, by phone, or by mail.(d) In any county in which compliance with Ins 2701.04(a) is required and in which a health carrier's network is insufficient to meet one of the access standards in Ins 2701.06 and in which the carrier has not been granted an exception pursuant to Ins 2701.08 or Ins 2701.14, the health carrier shall cover services provided by a non-participating provider located within the applicable geographic area at no greater cost to the covered person than if the services were obtained from a participating provider. Coverage under this paragraph shall be subject to all other terms and conditions of the covered person's health benefit plan, including, but not limited to, referral and authorization requirements. Nothing in this paragraph shall be construed to require a health carrier to provide coverage for services provided by a non-participating provider who has been excluded from the health carrier's network for failing to meet any applicable credentialing standards.(e) A health carrier shall not actively solicit new policyholders in any county in which compliance with Ins 2701.04(a) is required and in which it does not meet the access standards in Ins 2701.06, unless the health carrier has been granted an exception under Ins 2701.08.(f) Nothing in (e) above shall be construed to prohibit a health carrier from: (1) Advertising in publications distributed within the county which are published outside of the county;(2) Responding to inquiries initiated by a potential policyholder; or(3) Issuing or renewing coverage as required by federal or state law, including RSA 420-G.N.H. Code Admin. R. Ins 2701.04
#7701, eff 8-1-02; ss by #9722, eff 8-1-10 (from Ins 2701.02 )
Amended by Volume XXXVIII Number 28, Filed July 12, 2018, Proposed by #12565, Effective 8/1/2018, Expires 8/1/2028.