Section Ins 4005.02 - Exclusions from Filing Requirements(a) Carriers and third-party administrators shall not be required to submit health care claims data files, Health Care Effectiveness Data and Information Set (HEDIS®) data, or Consumer Assessment of Health Plans Survey (CAHPS) survey data if they meet the following criteria:(1) For carriers that do not offer any products on the health insurance exchange for residents of New Hampshire and that did not cover more than 9,999 members in New Hampshire at any point in any medical, pharmacy, or dental coverage class during the prior calendar year; or(2) For third-party administrators that did not cover more than 9,999 members in New Hampshire at any point in any medical, pharmacy, or dental coverage class during the prior calendar year.(b) Carriers and third-party administrators shall perform the calculation for (a) above at the entity level, meaning the level at which major governance decisions are made under a senior leadership team, regardless of the number of companies operating under separate corporate divisions. Carriers or third-party administrators experiencing a drop in membership below the de minimis threshold shall submit claims data and any corrections to membership files for a period of 180 days from the point the carrier or third-party administrator meets the de minimis exemption.(c) Carriers and third-party administrators shall not be required to submit health care claims data about coverage that is not part of a comprehensive medical insurance policy, including the following: (8) Durable medical equipment; or(9) Blanket health insurance.N.H. Admin. Code § Ins 4005.02
#8279, eff 2-3-05; ss by #9500, eff 7-6-09
Amended by Volume XXXV Number 32, Filed August 13, 2015, Proposed by #10877, Effective 7/10/2015, Expires7/10/2025.Amended by Volume XL Number 50, Filed December 10, 2020, Proposed by #13136, Effective 11/24/2020, Expires 11/24/2030