Revision: Jan. 1, 2008, midnight
HB 1599-FN – AS INTRODUCED
2008 SESSION
01/09
HOUSE BILL 1599-FN
AN ACT relative to allowable deductibles in the individual insurance market.
This bill authorizes insurers to place condition deductibles on individual policies for a specific medical condition that existed prior to the issuance of the policy 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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
08-2128
01/09
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Eight
AN ACT relative to allowable deductibles in the individual insurance market.
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.(a) 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.
(b) Health carriers providing health coverage for individuals may issue policies containing specified condition deductibles for a specific medical condition that existed prior to the issuance of coverage and complications that arise from the specific medical condition if all of the following standards are met:
(1) The specified condition deductible shall be for a specific medical condition and complications arising from the condition.
(2) The specified condition deductible shall not apply to any other medical condition not related directly to the specific medical condition for which the specified condition deductible is applied.
(3) The health carrier shall provide to the applicant before issuance of the policy a written notice explaining and listing all of the specified condition deductibles with the corresponding associated specific medical condition and the complications arising from the condition.
(4) The health carrier’s offer of coverage and the 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 specified condition deductible and specifying the specific medical condition and related complications that will be considered as arising from the condition to which the specified condition deductible is applied.
(c) The health carrier’s offer of coverage and the policy shall not include specified condition deductibles for more than 2 specific conditions.
(d) The health carrier shall notify the applicant that it will review the underwriting basis for the specified condition deductible, upon request, one time per year, and remove the specified condition deductible, no later than the next policy renewal date, if the health carrier determines that evidence of insurability is satisfactory.
(e) The health carrier shall notify the applicant in writing that the applicant may decline the offer of coverage with a specified condition deductible and may be eligible for full coverage from another carrier or through the New Hampshire health insurance high risk pool, under RSA 404-G.
(f) The specified condition deductible shall not be concurrent with or applied with any other applicable preexisting condition limitation or exclusion period.
(g) The health carrier shall provide to covered persons who may be subject to specified condition deductibles a means by which coverage for specific services can be verified in advance.
(h) Specified condition deductibles shall not apply to services, benefits, or options required by state or federal law to be included in the coverage.
(i) Any specified condition deductible used to reduce 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.
(j) 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 this subparagraph. 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 Specified Condition Deductible Included Herein.”
(2) “Notice! See Exception Specified Condition Deductible Included Herein.”
(3) “Notice! See Exclusion Specified Condition Deductible Included Herein.”
(4) “Notice! See Limitation Specified Condition Deductible Included Herein.”
(5) “Notice! See Reduction Specified Condition Deductible Included Herein.”
2 Medical Underwriting; Individual Policies. Amend RSA 420-G:5, IV to read as follows:
IV. Health carriers shall not offer riders or endorsements to exclude certain illnesses or health conditions in order to avoid the purpose of this chapter. However, health carriers may offer policies with specified condition deductibles pursuant to RSA 420-G:5, I.
3 Health Insurance; High Risk Pool. 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] containing a specified condition deductible pursuant to RSA420-G:5, I.
4 Penalties. Amend RSA 420-G:16 to read as follows:
420-G:16 Penalties for Violations.
I. Any health carrier who proposes, advertises, solicits, issues or delivers to any person or entity in this state any form which does not comply with this chapter or who shall in any way violate this chapter may:
[I.] (a) Be prohibited from marketing, selling, or otherwise administering to the individual or small employer market if the commissioner finds a health carrier to be in violation of RSA 420-G.
[II.] (b) Be subject to an administrative fine not to exceed $2,500 for each violation. Repeated violations of the same chapter shall constitute separate fineable offenses.
[III.] (c) Have its certificate of authority indefinitely suspended or revoked at the discretion of the commissioner.
II. In addition to the penalties included in paragraph I, any violation of the provisions of RSA 420-G:5, I(b)-(j) shall be considered an unfair insurance trade practice under RSA 417.
5 Effective Date. This act shall take effect January 1, 2009.
LBAO
08-2128
Revised 01/16/08
HB 1599 FISCAL NOTE
AN ACT relative to allowable deductibles in the individual insurance market.
FISCAL IMPACT:
The Insurance Department states this bill will have an indeterminable fiscal impact on state general fund revenue in FY 2009 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 allows carriers writing individual health insurance policies to write policies with condition of specific deductibles for medical conditions that existed prior to the issuance of the policy. The Department indicates this bill may impact the aggregate premiums collected from the individual health insurance policies market. The individual health insurance policy market accounts for approximately 1 percent of the premium tax base. The Department states the fiscal impact on premium tax revenue is indeterminable but negligible.