HB 263-FN – AS AMENDED BY THE HOUSE
27Mar2007… 0784h
2007 SESSION
01/03
HOUSE BILL 263-FN
AN ACT relative to health insurance riders.
This bill authorizes insurers to place health insurance riders on individual policies if certain conditions are met.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
27Mar2007… 0784h
07-0148
01/03
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Seven
AN ACT relative to health insurance riders.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 Medical Underwriting; Individual Policies. Amend RSA 420-G:5, I to read as follows:
I. Health carriers providing health coverage for individuals may perform medical underwriting, including the use of health statements or screenings or the use of prior claims history, to the extent necessary to establish or modify premium rates as provided in RSA 420-G:4. Small group carriers shall use the standard reinsurance underwriting form for their reinsurance ceding decisions to the New Hampshire small employer health reinsurance pool, established in RSA 420-K:2, after premium prices have been agreed upon by the carrier and the small employer. Health carriers providing health coverage for individuals may issue policies containing riders or endorsements that exclude coverage for a specified condition that existed prior to the issuance of coverage and complications that arise from the specified condition if all of the following standards are met:
(a) The coverage exclusion shall be for a specific medical condition and complications arising from the condition.
(b) The coverage exclusion shall not apply to any other medical condition not related directly to the specific medical condition being excluded.
(c) The health carrier shall provide to the applicant before issuance of the policy a written notice explaining the coverage exclusion for the specified condition and complications arising from the condition.
(d) The health carrier’s offer of coverage and policy shall clearly indicate in bold print as a separate section of the policy or on a separate form that the applicant is being offered coverage with a coverage exclusion and specifying the excluded medical condition and related complications that will be considered as arising from the excluded condition.
(e) The health carrier’s offer of coverage and policy shall not include riders or endorsements that exclude coverage for more than 2 specified conditions.
(f) The health carrier shall notify the applicant that it will review the underwriting basis for the coverage exclusion upon request one time per year, and remove the coverage exclusion, no later than the next policy renewal date, if the health carrier determines that evidence of insurability is satisfactory.
(g) The health carrier shall notify the applicant in writing that the applicant may decline the offer of coverage with a coverage exclusion and obtain coverage through the New Hampshire health insurance high risk pool, under RSA 404-G.
(h) The coverage exclusion period shall be concurrent with any other applicable preexisting condition limitation or exclusion period.
(i) The health carrier shall provide to covered persons who may be subject to coverage exclusions a means by which coverage for specific services can be verified in advance.
(j) Riders or endorsements containing coverage exclusions shall not apply to services, benefits, or options required by state or federal law to be included in the coverage.
(k) Any rider or endorsement used to reduce or deny payment for coverage otherwise included in the policy, shall include the name or specific description of the sickness or physical condition that is to be reduced or denied.
(l) Prior to providing coverage under this section, the health carrier shall obtain an acceptance form signed by the member that contains all of the information required by subparagraphs (c), (d), (g) and (i). Unless approved by the commissioner, the acceptance form shall use not less than 12-point type, and shall employ one of the following titles:
(1) “Notice! See Elimination Rider Endorsement Included Herein.”
(2) “Notice! See Exclusion Rider Included Herein.”
(3) “Notice! See Exception Rider Included Herein.”
(4) “Notice! See Limitation Rider Included Herein.”
(5) “Notice! See Reduction Rider Included Herein.”
(6) “Notice! See Elimination Endorsement Included Herein.”
(7) “Notice! See Exclusion Endorsement Included Herein.”
(8) “Notice! See Exception Endorsement Included Herein.”
(9) “Notice! See Limitation Endorsement Included Herein.”
(10) “Notice! See Reduction Rider Included Herein.”
2 Medical Underwriting; Individual Policies. Amend RSA 420-G:5, IV to read as follows:
IV. Except as provided in RSA 420-G:5, I, health carriers shall not offer riders or endorsements to exclude certain illnesses or health conditions in order to avoid the purpose of this chapter.
3 High Risk Pool Eligibility. Amend RSA 404-G:5-e, I(f) to read as follows:
(f) The individual has received an offer of coverage from a carrier of individual health insurance that contains a rider or endorsement excluding coverage for a specified condition pursuant to RSA 420-G:5, [II] I.
4 Applicability. Any policies containing riders issued after January 1, 2004 shall continue to be in effect.
5 Effective Date. This act shall take effect 60 days after its passage.
LBAO
07-0148
1/9/07
HB 263-FN - FISCAL NOTE
AN ACT relative to health insurance riders.
FISCAL IMPACT:
The Insurance Department has determined this bill may increase state general fund revenue by an indeterminable amount in FY 2007 and each fiscal year thereafter. There will be no fiscal impact on county and local revenue or state, county, and local expenditures.
METHODOLOGY:
The Insurance Department states this bill allows individual health insurance carriers to write coverage with condition specific exclusions, giving carriers another marketing option. Currently, a carrier’s only option might be to decline a coverage offer; under this bill, the carrier might decide to offer coverage that excludes a specified condition. Regardless, the applicant would be eligible for high risk pool coverage. The Department states some applicants would opt for the coverage that excludes the specified condition rather than purchase coverage through the high risk insurance pool. The high risk pool does not pay insurance premium tax, and individual carriers do pay insurance premium tax. To the extent more coverage is purchased in the private market under this bill than before, state insurance premium tax revenue will increase by an indeterminable amount. The Department states the high risk pool currently insures less than 1,000 people, and a fraction of these people might have been offered coverage with a condition specific exclusion.
The Department of Administrative Services states this bill will have no fiscal impact on the internal service fund that supports the State’s self-funded employee and retiree health benefit program.