Current through Register No. 52, December 26, 2024
Section Ins 8001.03 - Minimum Standards for Benefits for All Policies and Certificates(a) All policies shall provide wage replacement benefits that pay a minimum of 60% of the insured's average weekly wage for absence from employment for at least the following reasons: (1) To care for the insured's parent, spouse, or child who has a serious health condition;(2) Bonding with the employee's child during the first twelve months after the child's birth, or the first 12 months after the placement of the child for adoption or foster care with the employee; and(3) Because of any qualifying exigency arising from foreign deployment with the armed forces, or to care for a service member with a serious injury or illness as permitted under the federal Family and Medical Leave Act, 29 U.S.C. section 2612(a)(1)(e), if the insured is the service member's spouse, child, parent, or next of kin.(b) All policies shall contain a provision on wages which identifies the various income sources or components that are considered wages and those that are not. The provision on wages shall exclude benefits such as formal sick pay plans, individual and group disability income insurance plans, and retirement plans.(c) In the calculation of wage replacement benefits: (1) Wages just before qualifying leave began may be considered on a periodic basis so long as the periodic basis is consistent with the treatment of other terms referring to an insured's wages used in the policy and used to arrive at certain wage replacement benefit payment amounts for a claim; and(2) The base period used in determining wage replacement benefits may include wages of an insured which occurred in excess of one year but no more than 2 years just prior to the qualifying leave for which the claim is made. If the base period used is longer than the immediately preceding 12 months, the provision shall include policy language which allows for use of the highest level of wages during a calendar year or consecutive 12-month basis of an insured occurring during the period in excess of one year but no more than 2 years.(d) All policies shall provide a minimum of 6 weeks of wage replacement benefits during a 12- month benefit period as a result of qualifying leave pursuant to (a) above. Policies may provide additional benefits for the insured's own serious health condition, treatment therefore, or recovery therefrom that makes the employee unable to perform the functions of the employee's job. Benefits shall be capped at a maximum of 12 total combined weeks of wage replacement during a 12-month benefit period.(e) Benefits shall be available in increments of at least 4 hours on any one day on an intermittent and continuous basis.(f) A policy may require an insured to utilize employer sponsored paid time off benefits before insurance benefits under the policy or certificate will be paid.(g) A policy may require an elimination period, subject to the following: (1) The elimination period shall not be longer than 7 calendar days;(2) The insured's intermittent leave for a qualifying reason, consisting of at least 4 hours on any one day, shall count toward satisfying an elimination period;(3) The policy or certificate shall not: a. Require more than one elimination period per benefit period; orb. Specify a separate elimination period for injury and a separate elimination period for sickness; and(4) The policy shall not require a separate elimination period for medical leave and a separate elimination period for family leave.(h) A policy may contain a benefit waiting period of up to 7 months before coverage provides benefits.(i) A policy or certificate may reserve a subrogation right for payment of wage replacement benefits where the insured receives a payment for lost income from a third party because an act or omission of the third party caused the serious health condition for which leave was taken.(j) "Noncancellable" or "noncancellable and guaranteed renewable" shall be used only in a policy that the insured has the right to continue in force by the timely payment of premiums set forth in the policy until the individual's eligibility for Social Security normal retirement age, during which period the insurer shall not unilaterally change any provision of the policy while the policy is in force.(k) Termination of the policy or certificate shall be without prejudice to a loss that commenced while the policy or certificate was in force. The loss 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.N.H. Admin. Code § Ins 8001.03
Derived from Number 2, Filed January 12, 2023, Proposed by #13499, Effective 11/30/2022, Expires 11/30/2032