Revision: Jan. 21, 2010, midnight
HB 615-FN – AS INTRODUCED
2005 SESSION
05/01
HOUSE BILL 615-FN
AN ACT relative to insurance coverage for court-ordered counseling services.
SPONSORS: Rep. Bickford, Straf 3; Rep. Gargasz, Hills 5; Rep. Franklin, Sull 2
This bill prohibits an insurance provider from considering the existence of a court order for counseling or a psychological evaluation in determining whether such services are covered under the claimant’s insurance policy.
This bill is a request of the task force on family law, established in 2002, 250.
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Explanation: Matter added to current law appears in bold italics.
Matter removed from current law appears [in brackets and struckthrough.]
Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
05-0525
05/01
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Five
AN ACT relative to insurance coverage for court-ordered counseling services.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Coverage for Court-Ordered Counseling; Individual. Amend RSA 415 by inserting after section 6-k the following new section:
415:6-l Coverage for Court-Ordered Counseling. No insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for mental health services shall consider the existence of a court order for counseling or a psychological evaluation in a divorce or child custody proceeding under RSA 458 in determining whether such services are covered under the certificate holder’s policy, plan, or contract. Benefits for such services shall be subject to the same dollar limits, deductibles, co-payments and co-insurance factors and to the terms and conditions of the policy or certificate, including any managed care provisions. However, the claimant or claimant’s representative shall have 48 hours from the commencement of a court-ordered service to seek any pre-authorization, pre-certification, or referral required under the terms of the policy. The determination of these preservice claims for court-ordered services shall be made as soon as possible, taking into account the medical exigencies, but in no event later than 48 hours after receipt of the request and sufficient information, unless the claimant or claimant’s representative fails to provide sufficient information to determine whether, or to what extent, benefits are covered or payable. In the case of such failure, the insurer shall notify the claimant or claimant’s representative within 24 hours of receipt of the request and shall advise the claimant or claimant’s representative of the specific information necessary to determine to what extent benefits are covered or payable. The claimant or claimant’s representative shall be afforded a reasonable amount of time, taking into account the circumstances, but not less than 48 hours, to provide the specified information. Thereafter, notification of the claim determination shall be made as soon as possible, but in no case later than 48 hours after the earlier of:
I. The insurer’s receipt of the specified additional information; or
II. The end of the period afforded the claimant or claimant’s representative to provide the specified additional information.
2 New Section; Coverage for Court-Ordered Counseling; Group. Amend RSA 415 by inserting after section 18-p the following new section:
415:18-q Coverage for Court-Ordered Counseling. No insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for mental health services shall consider the existence of a court order for counseling or a psychological evaluation in a divorce or child custody proceeding under RSA 458 in determining whether such services are covered under the relevant portion of the policy. Benefits for such services shall be subject to the same dollar limits, deductibles, co-payments, and co-insurance factors and to the terms and conditions of the policy or certificate, including any managed care provisions. However, the claimant or claimant’s representative shall have 48 hours from the commencement of a court-ordered service to seek any pre-authorization, pre-certification, or referral required under the terms of the policy. The determination of these preservice claims for court-ordered services shall be made as soon as possible, taking into account the medical exigencies, but in no event later than 48 hours after receipt of the request and sufficient information, unless the claimant or claimant’s representative fails to provide sufficient information to determine whether, or to what extent, benefits are covered or payable. In the case of such failure, the insurer shall notify the claimant or claimant’s representative within 24 hours of receipt of the request and shall advise the claimant or claimant’s representative of the specific information necessary to determine to what extent benefits are covered or payable. The claimant or claimant’s representative shall be afforded a reasonable amount of time, taking into account the circumstances, but not less than 48 hours, to provide the specified information. Thereafter, notification of the claim determination shall be made as soon as possible, but in no case later than 48 hours after the earlier of:
I. The insurer’s receipt of the specified additional information; or
II. The end of the period afforded the claimant or claimant’s representative to provide the specified additional information.
3 Coverage for Court-Ordered Counseling by Health Service Corporations. Amend RSA 420-A:2 to read as follows:
420-A:2 Applicable Statutes. Every health service corporation shall be governed by this chapter and the relevant provisions of RSA 161-H, and shall be exempt from this title except for the provisions of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415-A, RSA 415-F, RSA 415:6, II(4), RSA 415:6-g, RSA 415:6-k, RSA 415:6-l, RSA 415:18, V, RSA 415:18, VII(g), RSA 415:18, VII-a, RSA 415:18-a, RSA 415:18-j, RSA 415:18-o, RSA 415:18-q, RSA 415:22, RSA 417, RSA 417-E, RSA 420-J, and all applicable provisions of title XXXVII wherein such corporations are specifically included. Every health service corporation and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.
4 Coverage for Court-Ordered Counseling by Health Maintenance Organizations. Amend RSA 420-B:20, III to read as follows:
III. The requirements of RSA 400-A:39, RSA 401-B, RSA 402-C, RSA 404-F, RSA 415:6-g, RSA 415:6-l, RSA 415:18, VII(g), RSA 415:18, VII-a, RSA 415:18-j, RSA 415:18-q, RSA 415-A, RSA 415-F, RSA 420-G, and RSA 420-J shall apply to health maintenance organizations.
5 Effective Date. This act shall take effect January 1, 2006.
LBAO
05-0525
Revised 3/3/05
HB 615 FISCAL NOTE
AN ACT relative to insurance coverage for court-ordered counseling services.
FISCAL IMPACT:
The Insurance Department has determined this bill may increase state revenue and county and local expenditures by an indeterminable amount in FY 2006 and each year thereafter. There will be no fiscal impact on state expenditures or county and local revenue.
METHODOLOGY:
The Insurance Department stated this bill mandates that insurers provide coverage for court-ordered counseling services. Mandated benefits increase the cost of insurance coverage. The Department stated it cannot estimate the premium impact of the mandate. Currently, health benefits for state employees are provided through a self-insured program; therefore, there would be no fiscal impact on state expenditures. The counties and locals are affected by increases in premiums for healthcare benefits as employers. Since premium revenue is taxed, such increases should cause an increase in premium tax revenue to the state general fund. Since the relative increase in premium is indeterminable, the relative increase in county and local expenditures and state revenue is indeterminable.
The Administrative Office of the Courts stated this bill should have no fiscal impact on the Judicial Branch.