Section Ins 6001.06 - Required Policy Provisions(a) An individual ancillary health policy shall comply with the following provisions: (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 the specifications page;(2) 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;(3) 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;(4) With respect to policies where there exists an option for continuation of coverage at a specified time after the attainment of the individual's Social Security normal retirement date or commencement of Medicare coverage, whichever is earlier, and where the insurer reserves the right to change the coverage, the premium scale, or both for such continuation, such premium scale may be omitted from the policy. All conditions pertaining to the option of continuation of coverage and any changes in coverage shall be contained in the policy;(5) 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;(6) Any individual accident and health policy insuring against loss resulting from accidental bodily injuries only shall specify on the cover of the policy in no less than 14 point, bold face type, "This policy does not insure against loss resulting from sickness.";(7) 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;(8) Diseases sought to be excluded from coverage shall be stated with sufficient clarity to be readily identifiable by the insured;(9) Common terms such as "heart disease," "pulmonary disease" or "disease of the reproductive organs" shall be acceptable;(10) 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;(11) Where the insurer reserves the right to cancel, the provisions of RSA 415:6, II(8) shall be delineated in the policy;(12) 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; andc. A refund amount of not less than 80 percent of the pro-rata unearned premium for such period;(13) In the event of any renewal rate increase, insurers shall provide policyholders with prior notice of any such increase such that a 30 days' notice is provided for policies subject to RSA 415; and(14) In no case shall the benefits provided under the policy or the definitions contained in the policy be less favorable to the insured than the applicable provisions for accident and health benefits set forth in RSA 415.(b) A group ancillary health policy shall contain the following provisions: (1) All master policies and certificates shall contain a clear explanation as to continuance of coverage after termination of the policy;(2) A certificate shall: a. State the benefits applicable to the person insured or state the schedule of benefits applicable to the class to which he or she belongs; orb. Define eligibility and benefit amounts clearly enough for a person to determine whether he or she is an insured and the amount of any benefits to which he or she is entitled;(3) A policy may require that the insured: a. Incur expenses that the insured is legally responsible to pay for;b. Exclude charges that would not have been incurred if no insurance existed; andc. Be responsible for non-covered services;(4) All group certificates shall include a complete statement of the policy provisions regarding coordination or nonduplication of benefits in the event of other coverage;(5) In the event of any renewal rate increase, insurers shall provide policyholders with prior notice of any such increase such that 30 days' notice is provided for policies subject to RSA 415;(6) Declination of renewal or termination of insurance provisions shall be as follows: a. No insurer shall decline to renew a group policy unless the cause of its action is based on one or more of the reasons for declination of renewal stated in the policy;b. Any such reason shall be stated in a group policy and shall be objective in nature;c. Declination of renewal shall be defined so as to include any termination of a group policy by the insurer for any reason except for nonpayment of premiums; andd. Notice of nonrenewal or termination of a group policy by the insurer shall provide for at least 45 days prior notice;(7) In no case shall the benefits provided under the policy or the definitions contained in the policy be less favorable to the insured than the applicable provisions for accident and health benefits set forth in RSA 415;(8) The required provisions for blanket accident and health insurance policies shall be those established in RSA 415:18 and additional requirements as follows:a. Except as provided in b. below: 1. An individual certificate shall not be issued to the person or persons who may receive benefits under group blanket accident and health coverage; and2. A person or persons who receive benefits under blanket policy shall not contribute directly to the premium payment for the policy; andb. Blanket accident and health insurance shall meet all requirements of individual limited benefit health insurance if coverage: 1. Is issued to identified members or subscribers;2. Is based on individual enrollment; and3. Provides that a certificate of coverage to enrolled members shall be issued on an individual basis; and(9) Any group accident and health policy and certificate insuring against loss resulting from accidental bodily injuries only shall specify on the cover of the policy in no less than 14 point, bold face type, "This policy does not insure against loss resulting from sickness".(c) The following provision shall appear in a conspicuous place on the cover page of all ancillary accident and health policies and certificates: "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."
(d) Each policy of individual ancillary health insurance or group ancillary health insurance shall include a renewal, continuation, or nonrenewal provision. The language or specification of the provision shall be consistent with the type of contract to be issued. The provision shall be appropriately captioned, shall appear on the first page of the policy, and shall clearly state the duration, where limited, of renewability and the duration of the term of coverage for which the policy is issued and for which it may be renewed.N.H. Admin. Code § Ins 6001.06
Derived From Volume XXXVIII Number 10, Filed March 8, 2018, Proposed by #12478, Effective 2/12/2018, Expires 2/12/2028.Amended by Volume XXXVIII Number 41, Filed October 11, 2018, Proposed by #12629, Effective 9/28/2018, Expires 9/28/2028.