N.H. Admin. Code § Ins 4104.03

Current through Register No. 50, December 12, 2024

Section Ins 4104.03 - Definitions

For the purposes of this part:

(a) "Actuarial certification" means a written statement signed by a member of the American Academy of Actuaries, stating that to the best of the actuary's knowledge and judgment, the entire rate filing is in compliance with all of the applicable laws and rules and that the benefits are reasonable in relation to the premiums;

(b) "Actuarial memorandum" means the document describing the basis on which rates were determined and that indicates and describes the calculation of the anticipated loss ratio;

(c) "Anticipated loss ratio" means the calculation of the medical loss ratio over a period that is at least as great as the anticipated policy lifetime but does not exceed 20 years;

(d) "Case characteristics" means demographic or other objective characteristics of a large employer that are considered by the large employer carrier in the determination of premium rates for the large employer;

(e) "Carrier" means any entity that provides health insurance in this state, including insurance companies, health services corporations, health maintenance organizations, fraternal benefit societies and other entities subject to state insurance regulation;

(f) "Covered person" means any person covered through large employer group health insurance and includes enrolled employees and, if applicable, their dependents;

(g) "Durational medical loss ratio" means the medical loss ratio calculated for a specified duration not to exceed 12 months.

(h) "Earned premium" means premium revenue pursuant to 45 CFR Part 158.130;

(i) "Eligible employee" means any employee who is eligible for the employer's sponsored health benefit plan and who regularly works at least 15 hours per week, or at least half the weekly hours full-time employees work, whichever is greater. The term includes a sole proprietor, a partner of a partnership, and an independent contractor, if these individuals are included as employees under the large employer's health benefit plan;

(j) "Employee" means an employee under Section 3(6) of Title I of the Employee Retirement Income Security Act of 1974 (ERISA);

(k) "Enrolled employee" means an eligible employee who has elected coverage in the employer's sponsored health benefit plan;

(l) "Health coverage" means the health insurance that meets the definition in RSA 420-G:2 IX;

(m) "Incurred claims" means reimbursements for clinical services provided to enrollees, pursuant to 45 CFR Part 158.140 plus amounts expended for activities that improve health care quality pursuant to 45 CFR Part 158.150;

(n) "Large employer" means any person, firm, corporation, or partnership that is actively engaged in business that, on at least 50 percent of the working days during the preceding calendar year, employs at least 51 employees who are eligible for employer sponsored coverage, and the majority of whom are employed within this state;

(o) "Large employer carrier" means a carrier that offers health insurance to one or more large employers in this state;

(p) "Medical loss ratio" means "medical loss ratio" as defined in 45 CFR Part 158.221 (a); and

(q) "Tier" or "tier membership" means a category of enrollment to which enrolled employees can elect coverage, and includes at a minimum, single employee, couple, and family tiers.

N.H. Admin. Code § Ins 4104.03

#9690, eff 4-9-10; ss by #9938, eff 6-10-11

The amended version of this section by New Hampshire Register Volume 39, Number 24, eff.6/10/2019 is not yet available.