Section Ins 6201.04 - Ancillary Health Minimum StandardsThe following minimum standards for benefits shall apply to all ancillary health policies and certificates which are subject to Ins 6201:
(a) A "noncancellable", "guaranteed renewable", or "noncancellable and guaranteed renewable" individual ancillary health policy shall not provide for termination of coverage of the spouse solely because of the occurrence of an event specified for termination of coverage of the insured, other than nonpayment of premium. In addition, the policy shall provide that, in the event of the insured's death, the spouse of the insured, if covered under the policy, shall become the insured;(b) In an individual ancillary health policy covering both spouses, the age of the younger spouse shall be used as the basis for meeting the age and durational requirements of the definitions of "noncancellable" or "guaranteed renewable." However, when the older spouse attains the stated age, the coverage for that spouse may be terminated, provided that the policy continues in force for the younger spouse until either that spouse attains the stated age or at the end of the durational period specified in the policy;(c) An individual ancillary health policy that provides for periodic payments, weekly or monthly, for a specified period during the continuance of disability resulting from accident or sickness may provide that the insured has the right to continue the policy at least to Social Security retirement age;(d) A group ancillary health policy or certificate that provides for periodic payments, weekly or monthly, for a specified period during the continuance of disability resulting from accident or sickness may provide that the insured has the right to continue the policy at least to Social Security retirement age;(e) When individual accidental death and dismemberment coverage is part of the ancillary health insurance coverage offered under the policy, the insured shall have the option to include all insureds under the coverage and not just the principal insured;(f) If a policy or certificate contains a status-type military service exclusion or a provision that suspends coverage during military service, the policy shall provide for refund of premiums as applicable to the person on a pro rata basis within 30 days;(g) In the event the insurer cancels or refuses to renew, policies or certificates providing pregnancy benefits shall provide for an extension of benefits as to pregnancy commencing while the policy or certificate is in force and for which benefits would have been payable had the policy or certificate remained in force;(h) Policies or certificates providing convalescent or extended care benefits following hospitalization shall not condition the benefits upon admission to the convalescent or extended care facility within a period of less than 14 days after discharge from the hospital and shall not require a minimum hospital stay;(i) Ancillary health insurance policies or certificates of coverage shall continue for a dependent child who is mentally or physically incapable of earning his or her own living on the date as of which such dependent's status as a covered family member would otherwise expire because of age, in accordance with RSA 415:5, I(3-a)(a);(j) A policy or certificate providing expense based coverage for the recipient in a transplant operation shall also provide reimbursement for any medical expenses of a live donor to the extent that benefits remain and are available under the recipient's policy or certificate, after benefits for the recipient's own expenses have been paid;(k) A policy or certificate may contain a provision relating to recurrent disabilities, but a provision relating to recurrent disabilities shall not specify that a recurrent disability be separated by a period greater than 6 months;(l) Termination of the policy or certificate shall be without prejudice to a continuous loss that commenced while the policy or certificate was in force, pursuant to Ins 6101. The continuous total disability of the insured shall be a condition for the extension of benefits beyond the period the policy was in force, limited to the earlier of either the duration of the benefit period, if any, or payment of the maximum benefits;(m) Policies covering a single specified disease or combination of specified diseases shall only be sold or offered for sale as stand-alone specified disease policies;(n) Policies and certificates shall be delivered to the policyholder within 45 days of the effective date; and(o) If there is any reduction of benefits under a group policy, then the insurer shall issue and deliver updated certificates to the policyholder.N.H. Admin. Code § Ins 6201.04
Derived From Volume XXXVIII Number 32, Filed August 9, 2018, Proposed by #12600, Effective 8/3/2018, Expires 8/3/2028.