Section Ins 401.06 - Individual Accident and Health(a) Travel insurance policies shall comply with RSA 415:18, I-a(e) and Ins 4700. Long-term care policies shall comply with RSA 415-D and Ins 3600. Medicare supplemental insurance policies shall comply with RSA 415-F and Ins 1902 or Ins 1905. All other individual accident and health policy forms submitted shall comply with the provisions of RSA 415 and RSA 415-A.(b) Additional policy form filing standards, with the exception of policies regulated by Ins 3600, Ins 4700, Ins 1902, or Ins 1905, shall be as follows:(1) If the policy provides for any reduction in benefits or benefit period because of the attainment of a specified age limit, reference thereto shall be set forth on the first or specifications page;(2) Loss of time policies shall not require that the loss from accidental injury commence within less than 30 days after the date of an accident;(3) No policy of health and accident insurance shall be approved that contains a provision that the disability period shall be considered to commence with the date on which written notice is actually received by the company;(4) Noncancellable policies with premium rates that are not presumed level but are expected to change periodically with the insured's attained age shall include the entire premium scale applicable to the insured;(5) All other policies with premium rates that are not presumed level but are expected to change periodically with the insured's attained age shall not be required to include the entire premium scale applicable to the insured but shall disclose on the face page or the specifications page that the premium rates are subject to change based on the attained age of the insured and also identify the attained ages at which such changes will occur;(6) With respect to policies where there exists an option for continuation of coverage at a specified time after attainment of age 65 or commencement of Medicare coverage, whichever is earlier, and where the insurer reserves the right to change the coverages and/or the premium scale for such continuation, such premium scale may be omitted from the policy;(7) For the purposes of subparagraphs (5) and (6) above, all conditions pertaining to the option of continuation of coverage and any changes in coverage shall be contained in the policy;(8) Except in those instances where riders are prohibited by RSA 420-G:5 IV, any rider or endorsement that reduces or eliminates coverage under the policy shall provide for signed acceptance by the policyholder except in the case of a rider or endorsement that is used only at the time of policy issue;(9) Any individual accident and health policy insuring against loss resulting from accidental bodily injuries only shall specify on the face of the policy in no less than 14 point, bold face type, "This policy does not insure against loss resulting from sickness";(10) The following provision shall appear in a conspicuous place on the face page of all accident and health policies: "This policy may, at any time within 30 days after its receipt by the policyholder, be returned by delivering it or mailing it to the company or the agent through whom it was purchased. Immediately upon such delivery or mailing, the policy will be deemed void from the beginning, and any premium paid on it will be refunded."
(11) Unless the insurer has adopted a procedure to obtain a policyholder's dated and signed receipt for the delivery of the policy, it shall be presumed that the date of delivery is the date shown by the policyholder's records or by his or her memory;(12) Any provision that excludes coverage by use of the terms "chronic disease" or "organic disease" shall not be permitted;(13) Diseases sought to be excluded from coverage shall be stated with sufficient clarity to be readily identifiable;(14) Common terms such as "heart disease," "pulmonary disease" or "disease of the generative organs" shall be acceptable;(15) A policy may: a. Require that the insured incur expenses that he or she is legally required to pay; andb. Exclude charges that would not have been made if no insurance existed;(16) Where the insurer reserves the right to cancel, the provisions of RSA 415:6, II (8) or RSA 420-G:6, VI or VII shall be delineated in the policy;(17) In order to close a block of business, the insurer shall make such request in writing and include in such request:a. The number of New Hampshire policies currently in force;b. An explanation of the classification of risk involved therein to indicate that such classification is reasonable and nondiscriminatory; andc. Statistical data sufficient to indicate that the cancellation or nonrenewal requested is reasonable and nondiscriminatory;(18) With respect to all individual accident and health policies, including those sold on a franchise basis, to which the refund provisions of RSA 415:6, II(8) do not apply, the insurer shall provide:a. A refund of unearned premium upon a request for cancellation of the policy by the insured;b. The period for which a refund is to be made measured from the date the request for cancellation is received by the insurer, or such later date as may be specified in the request, to the date to which premiums have been paid;c. A refund amount of not less than 80 percent of the pro-rata unearned premium for such period; andd. That no refund need be made if premiums are payable monthly;(19) In the event of any renewal rate increase, insurers shall provide policyholders with prior notice of any such increase such that:a. A 30 days' notice is provided for policies subject to RSA 415, which are not subject to RSA 420-G provisions; andb. A 60 days' notice is provided for policies subject to RSA 420-G; and(20) All policies of accident and health insurance shall define terms in the policy in a manner at least as favorable as the policy definition requirements contained in Ins 401.03.N.H. Admin. Code § Ins 401.06
Amended by Volume XXXVII Number 15, Filed April 13, 2017, Proposed by #12126, Effective 3/8/2017, Expires 3/8/2027.