N.H. Admin. Code § Ins 6202.03

Current through Register No. 49, December 5, 2024

Section Ins 6202.03 - Minimum Standards for Benefits

The following minimum standards for benefits are prescribed for individual and group ancillary health policies and certificates that provide coverage for hospital confinement and other fixed indemnity:

(a) Hospital confinement coverage shall provide a minimum benefit of $50 per day per covered person and not less than 31 days during each period of confinement for each person insured under the policy or certificate;

(b) A minimum of 1 period of confinement shall be provided per policy year per covered person;

(c) Coverage shall not be excluded due to a preexisting condition for a period greater than 6 months following the effective date of coverage of an insured person;

(d) Except as provided in RSA 415:6, II(3) regarding other insurance with the insurer, benefits shall be paid regardless of other coverage;

(e) The benefit shall be for a specific amount that is event based and shall not be expense based;

(f) The benefit shall not be assignable to a health care provider and shall be paid directly to the subscriber. The policy shall contain a provision prohibiting assignment of the benefit;

(g) The policy, the certificate, and the schedule of benefits shall be written in a manner such that a covered person is able to determine what coverage is provided;

(h) Rates for all indemnity health insurance products shall be submitted pursuant to Ins 4106;

(i) Disclosures shall be provided in accordance with Ins. 6201.05 and Ins 6202.05; and

(j) Indemnity policies and certificates that do not comply with this part or that fail to qualify as an excepted benefit under federal law shall be considered "health coverage" as defined under RSA 420-G and shall be required to meet the requirements of RSA 420-G and RSA 415 provisions applicable to health insurance.

N.H. Admin. Code § Ins 6202.03

Derived From Volume XXXVIII Number 50, Filed December 13, 2018, Proposed by #12659, Effective 11/5/2018, Expires 11/5/2028.

Amended by Volume XL Number 50, Filed December 10, 2020, Proposed by #13137, Effective 11/24/2020, Expires 11/24/2030.