N.H. Admin. Code § Ins 4106.03

Current through Register No. 50, December 12, 2024

Section Ins 4106.03 - Definitions

For the purposes of this part:

(a) "Actuarial certification" means a written statement signed by a member of the American Academy of Actuaries 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) "Blanket accident and health insurance" means:

(1) That form of accident and health insurance:

a. Not requiring individual applications from covered persons;

b. Not requiring a carrier to furnish each person with a certificate of coverage;

c. Not constituting health coverage as that term is defined in RSA 420-G:2, IX; and

d. Covering special groups of persons as enumerated in one of the following:

1. Under a policy issued to any common carrier, which shall be deemed the policyholder, covering a group defined as all or any class of persons who may become passengers on such common carrier;

2. Under a policy issued to an employer, who shall be deemed the policyholder, covering all employees or any group of employees defined solely by reference to exceptional hazards incident to such employment; and

3. Under a policy issued to a college, school, or other institution of learning or to the head or principal thereof, who or which are deemed the policyholder, covering students;

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

(f) "Earned premium" means all monies paid by a policyholder as a condition of receiving coverage;

(g) "Group supplemental health insurance" means any accident or health policy or certificate that is sold or issued to a small employer, large employer, licensed purchasing alliance, or a qualified association trust, that does not constitute health coverage as that term is defined under RSA 420-G:2, IX;

(h) "Incurred claims" means paid claims plus any changes to claim reserves;

(i) "Medical loss ratio" means the ratio of incurred claims to earned premiums; and

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

N.H. Admin. Code § Ins 4106.03

#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.