SB 70-FN – AS AMENDED BY THE SENATE
03/08/07 0329s
03/08/07 0391s
2007 SESSION
01/05
SENATE BILL 70-FN
COMMITTEE: Commerce, Labor and Consumer Protection
This bill establishes a right to external review for individual and group disability income insurance policies.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
03/08/07 0329s
03/08/07 0391s
07-0004
01/05
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Seven
AN ACT relative to external review for disability income policies.
Be it Enacted by the Senate and House of Representatives in General Court convened:
1 New Section; Right to External Review for Individual and Group Disability Income Policies. Amend RSA 415-A by inserting after section 4-b the following new section:
415-A:4-c Right to External Review for Individual and Group Disability Income Policies. A covered person shall have the right to independent external review in accordance with RSA 420-J:5-b through RSA 420-J:5-e of a determination by a health carrier or its designee utilization review entity under an individual or group disability income policy when all of the following conditions apply:
I. The subject of the request for external review is a determination denying, in whole or in part, a claim for benefits based on a finding that the claimant’s condition does not meet the carrier’s definition of disability as set forth in the policy.
II. If the covered person has a right to internal review, the covered person has completed the internal review procedures provided by the carrier or other licensed entity pursuant to RSA 415-A:4-b, or rules adopted by the commissioner, or the carrier or other entity has agreed to submit the determination to independent external review prior to completion of internal review, or the covered person has requested first or second level, standard or expedited review and has not received a decision from the carrier or other licensed entity within the required time frames.
III.(a) The covered person or the covered person’s authorized representative has submitted the request for external review in writing to the commissioner within 180 days of the date of the carrier or other licensed entity’s denial decision provided pursuant to RSA 415-A:4-b, or if the carrier or other licensed entity has failed to make a first or second level, standard or expedited review decision that is past due, within 180 days of the date the decision was due.
(b) The covered person’s or the covered person’s authorized representative’s participation in any voluntary level of appeal offered by a carrier or other licensed entity pursuant to RSA 415-A:4-b shall not affect a covered person’s ability to submit a request for external review. In the event that a covered person or a covered person’s authorized representative elects to proceed with a voluntary appeal, that person shall have 180 days from the date the decision is rendered on the voluntary appeal to submit a request for external review.
IV. The covered person’s disputed claim is anticipated in a 12-month period to be equal to or in excess of $400.
2 Effective Date. This act shall take effect January 1, 2008.
LBAO
07-0004
01/30/07
SB 70-FN - FISCAL NOTE
AN ACT relative to external review for disability income policies.
FISCAL IMPACT:
The Insurance Department states this bill may increase state revenue by an indeterminable amount in FY 2008 and each year thereafter. There is no fiscal impact on county and local revenue or state, county, and local expenditures.
METHODOLOGY:
The Insurance Department states this bill requires carriers provide a right of external review in individual and group disability insurance policies. The Department assumes carriers will pay the cost for external reviews and these reviews could result in more claims being paid. It is anticipated carriers will increase premiums to cover the costs associated with the external reviews. If carriers do increase premiums, the premium tax collected by the state will increase resulting in an increase in state revenue.