Section Lab 304.05 - Self-Insurance, Homogenous Self-Insured Groups and Third Party Administrators(a) Self-insured employers, homogenous self-insured groups and third party administrator shall provide access to all prescribed coverage and claims forms. Supplies of these forms shall not be provided by the department.(b) Self-insured employers, homogenous self-insured groups and third party administrators shall furnish covered businesses with a sufficient number of forms "Notice of Compliance" WCP-1(4-2014), contained in appendix II.(c) The self-insured employers, homogenous self-insured groups and third party administrator shall complete and file "Notice of Workers Compensation Insurance Coverage" form 6WC (4/2008), "Supplemental Notice of Coverage" form 6WC-S (3/2013), "Notice of Termination" form WC 100 (10/1991), "Notice of Reinstatement" form WC-100R (9/2015) as well as an "Exclusion of Executive Officers or Members" form 6WCex (7/2015), all contained in appendix II when applicable as prescribed by Lab 306 and Lab 307.(d) The self-Insured employers, homogenous self-insured groups and third party administrators shall forward by certified mail a copy of the "Exclusion of Executive Officers or Members" form 6WCex (7/2015) contained in appendix II to each of the executive officers or members listed on the form.(e) Self-insured employers, homogenous self-insured groups and third party administrator shall contact the department to be assigned a carrier identification number prior to underwriting coverage in New Hampshire.(f) The self-insured employers, homogenous self-insured groups and third party administrators responsibilities delineated above shall pertain solely to workers' compensation insurance.N.H. Admin. Code § Lab 304.05
Derived From Volume XXXVI Number 14, Filed April 7, 2016, Proposed by #11065, Effective 4/1/2016, Expires 4/1/2026.