CHAPTER 235
HB 330 – FINAL VERSION
04Mar2009… 0364h
06/03/09 1861s
24Jun2009… 2337eba
2009 SESSION
01/04
HOUSE BILL 330
AN ACT relative to life, accident, and health insurance.
COMMITTEE: Commerce and Consumer Affairs
This bill makes technical changes in the insurance laws and clarifies the definition of “dependent” for purposes of dependent care coverage.
This bill is a request of the insurance department.
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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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.
04Mar2009… 0364h
06/03/09 1861s
24Jun2009… 2337eba
09-0731
01/04
STATE OF NEW HAMPSHIRE
In the Year of Our Lord Two Thousand Nine
AN ACT relative to life, accident, and health insurance.
Be it Enacted by the Senate and House of Representatives in General Court convened:
235:1 Insurance; Dependent Children. Amend RSA 415:5, I(3)(a) to read as follows:
(3)(a) It purports to insure only one person, except that a policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon the application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children [or any dependent under age 26. In this section “dependent child” means a subscriber’s child by blood or by law, who:], or any other person dependent on the policyholder. In the event a carrier elects to provide coverage for dependent children, the term “dependent child” shall include a subscriber’s child by blood or by law, who is unmarried and one of the following:
[(1) Is less than 26 years of age;
(2) Is unmarried;
(3) Is a resident of New Hampshire or is enrolled as a student at a public or private institution of higher education; and
(4) Is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. 1395 et seq. ]
(1) Under age 19.
(2) Under age 25 if the child is a full-time enrolled student at an educational institution.
(3) Under age 26, a resident of New Hampshire, and is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq.
235:2 Insurance; Dependent Coverage. Amend RSA 415:5, I(3-a)(a) to read as follows:
(3-a)(a) The coverage of any family member insured by such policy, pursuant to subparagraph (3), who is mentally or physically incapable of earning his or her own living on the date as of which such dependent’s status as a covered family member would otherwise expire because of age, shall continue under such policy while such policy remains in force or is replaced by another policy as long as such incapacity continues and as long as said dependent remains chiefly financially dependent on the policyholder or the employee or his or her estate is chargeable for the care of said dependent, provided that due proof of such incapacity is received by the insurer within 31 days of such expiration date. If such coverage is continued in accordance with this subparagraph, such dependent shall be entitled upon the termination of such incapacity to [a converted policy in accordance with and subject to the terms and conditions of the conversion privilege clause if such privilege is afforded by the policy, provided that such dependent has not attained the limiting age, if any, for coverage of adults specified in the policy] coverage offered by the New Hampshire high risk pool under RSA 404-G;
235:3 Individual Insurance; Prompt Payment. Amend RSA 415:6-h, V to read as follows:
V. The commissioner may assess an administrative fine against any insurer or may suspend or revoke the license or certificate of authority of any insurer after determining that the insurer has established a pattern of overdue payments and that the contemplated enforcement action would not promote the deterioration of the financial condition of an at-risk insurer. Such fine shall [be up to $5,000 per violation,] not [to] exceed[ $100,000] $300,000 per calendar year examined. Nothing in this paragraph shall be construed to alter the commissioner’s authority to investigate or take action, including, but not limited to, action pursuant to RSA 415:20, in response to individual instances of noncompliance.
235:4 Group Policy Provisions. Amend RSA 415:18, VII-a(e) to read as follows:
(e) After the 6-month period, the employee shall have the right to continue the benefits being continued under this paragraph for an additional 12 months as if the employee originally had elected the extension period provided by RSA 415:18, VII(g)(1) and subject to the same conditions. At the end of the additional 12 months, the employee shall have the right, if the group insurance coverage is no longer available, to [convert to an individual policy in accordance with the provisions of RSA 415:18, VII] obtain coverage from the high risk pool.
235:5 Group Policy Provisions. Amend RSA 415:18, XVI(h)(5) to read as follows:
(5) The date on which the group plan terminates subject to the continuation rights set forth in [this paragraph] RSA 415:18, XVII.
235:6 New Paragraph; Coverage for Mental and Nervous Conditions. Amend RSA 415:18-a by inserting after paragraph VII the following new paragraph:
VIII. The commissioner may adopt rules, under RSA 541-A, as may be necessary to effectuate any provisions of the Mental Health Parity Act of 2008 that relate to the business of insurance.
235:7 Group Insurance; Prompt Payment. Amend RSA 415:18-k, V to read as follows:
V. The commissioner may assess an administrative fine against any insurer or may suspend or revoke the license or certificate of authority of any insurer after determining that the insurer has established a pattern of overdue payments and that the contemplated enforcement action would not promote the deterioration of the financial condition of an at-risk insurer. Such fine shall [be up to $5,000 per violation,] not [to] exceed [$100,000] $300,000 per calendar year examined. Nothing in this paragraph shall be construed to alter the commissioner’s authority to investigate or take action, including, but not limited to, action pursuant to RSA 415:20, in response to individual instances of noncompliance.
235:8 New Paragraph; Coverage for Certain Biologically-Based Mental Illness; Mental Health Parity. Amend RSA 417-E:1 by inserting after paragraph IV the following new paragraph:
V. The commissioner may adopt rules, under RSA 541-A, as may be necessary to effectuate any provisions of the Mental Health Parity Act of 2008 that relate to the business of insurance.
235:9 Health Service Corporations; Dependent Coverage. RSA 420-A:10-a, I is repealed and reenacted to read as follows:
I. A policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any other person dependent upon the policyholder. In the event a carrier elects to provide coverage for dependent children, the term “dependent child” shall include a subscriber’s child by blood or by law, who is unmarried and one of the following:
(a) Under age 19.
(b) Under age 25 if the child is a full-time enrolled student at an educational institution.
(c) Under age 26, a resident of New Hampshire, and is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq.
I-a. The coverage of any family member insured by such policy, pursuant to paragraph I, who is mentally or physically incapable of earning his or her own living as of the date on which such dependent’s status as a covered family member would otherwise expire because of age, shall continue under such policy while such policy remains in force or is replaced by another policy as long as such incapacity continues and as long as such dependent remains chiefly financially dependent on the policyholder or the employee or his or her estate is chargeable for the care of such dependent; provided, that due proof of such incapacity is received by the insurer within 31 days of such expiration date. If such coverage is continued in accordance with this paragraph, such dependent shall be entitled upon the termination of such incapacity to coverage offered by the New Hampshire high risk pool under RSA 404-G.
235:10 Health Maintenance Organizations; Dependent Coverage. RSA 420-B:8, III-b is repealed and reenacted to read as follows:
III-b. The coverage of any family member insured by such policy, pursuant to RSA 420-B:8-aa, I, who is mentally or physically incapable of earning his or her own living as of the date on which such dependent’s status as a covered family member would otherwise expire because of age, shall continue under such policy while such policy remains in force or is replaced by another policy as long as such incapacity continues and as long as such dependent remains chiefly financially dependent on the policyholder or the employee or his or her estate is chargeable for the care of such dependent; provided, that due proof of such incapacity is received by the insurer within 31 days of such expiration date. If such coverage is continued in accordance with this paragraph, such dependent shall be entitled upon the termination of such incapacity to coverage offered by the New Hampshire high risk pool under RSA 404-G.
235:11 Health Maintenance Organizations; Dependent Coverage. RSA 420-B:8-aa, I is repealed and reenacted to read as follows:
I. A policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any other person dependent upon the policyholder. In the event a carrier elects to provide coverage for dependent children, the term “dependent child” shall include a subscriber’s child by blood or by law, who is unmarried and one of the following:
(a) Under age 19.
(b) Under age 25 if the child is a full-time enrolled student at an educational institution.
(c) Under age 26, a resident of New Hampshire, and is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq.
235:12 New Paragraph; Coverage for Mental and Nervous Conditions. Amend RSA 420-B:8-b by inserting after paragraph IV the following new paragraph:
V. The commissioner may adopt rules, under RSA 541-A, as may be necessary to effectuate any provisions of the Mental Health Parity Act of 2008 that relate to the business of insurance.
235:13 Preferred Provider Agreements; Dependent Coverage. RSA 420-C:4-a, I is repealed and reenacted to read as follows:
I. A policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any other person dependent upon the policyholder. In the event a carrier elects to provide coverage for dependent children, the term “dependent child” shall include a subscriber’s child by blood or by law, who is unmarried and one of the following:
(a) Under age 19.
(b) Under age 25 if the child is a full-time enrolled student at an educational institution.
(c) Under age 26, a resident of New Hampshire, and is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq.
I-a. The coverage of any family member insured by such policy, pursuant to paragraph I, who is mentally or physically incapable of earning his or her own living as of the date on which such dependent’s status as a covered family member would otherwise expire because of age, shall continue under such policy while such policy remains in force or is replaced by another policy as long as such incapacity continues and as long as such dependent remains chiefly financially dependent on the policyholder or the employee or his or her estate is chargeable for the care of such dependent; provided, that due proof of such incapacity is received by the insurer within 31 days of such expiration date. If such coverage is continued in accordance with this paragraph, such dependent shall be entitled upon the termination of such incapacity to coverage offered by the New Hampshire high risk pool under RSA 404-G.
235:14 Delta Dental Plan; Dependent Coverage. RSA 420-F:5-a, I is repealed and reenacted to read as follows:
I. A policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any other person dependent upon the policyholder. In the event a carrier elects to provide coverage for dependent children, the term “dependent child” shall include a subscriber’s child by blood or by law, who is unmarried and one of the following:
(a) Under age 19.
(b) Under age 25 if the child is a full-time enrolled student at an educational institution.
(c) Under age 26, a resident of New Hampshire, and is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq.
I-a. The coverage of any family member insured by such policy, pursuant to paragraph I, who is mentally or physically incapable of earning his or her own living as of the date on which such dependent’s status as a covered family member would otherwise expire because of age, shall continue under such policy while such policy remains in force or is replaced by another policy as long as such incapacity continues and as long as such dependent remains chiefly financially dependent on the policyholder or the employee or his or her estate is chargeable for the care of such dependent; provided, that due proof of such incapacity is received by the insurer within 31 days of such expiration date. If such coverage is continued in accordance with this paragraph, such dependent shall be entitled upon the termination of such incapacity to coverage offered by the New Hampshire high risk pool under RSA 404-G.
235:15 Small Group Insurance. 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.]
235:16 New Paragraph; Small Group Insurance. Amend RSA 420-G:6 by inserting after paragraph V the following new paragraph:
V-a. Health carriers shall not underwrite insureds at time of renewal unless an insured has applied for an increase in his or her coverage.
235:17 Managed Care; Prompt Payment. Amend RSA 420-J:8-a, V to read as follows:
V. The commissioner may assess an administrative fine against any health carrier or may suspend or revoke the license or certificate of authority of any health carrier after determining that the health carrier has established a pattern of overdue payments and that the contemplated enforcement action would not promote the deterioration of the financial condition of an at-risk insurer. Such fine shall [be up to $5,000 per violation,] not [to] exceed [$100,000] $300,000 per calendar year examined. Nothing in this paragraph shall be construed to alter the commissioner’s authority to investigate or take action, including, but not limited to, action pursuant to RSA 415:20, in response to individual instances of noncompliance.
235:18 Managed Care; Dependent Coverage. RSA 420-J:8-d, I is repealed and reenacted to read as follows:
I. A policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any other person dependent upon the policyholder. In the event a carrier elects to provide coverage for dependent children, the term “dependent child” shall include a subscriber’s child by blood or by law, who is unmarried and one of the following:
(a) Under age 19.
(b) Under age 25 if the child is a full-time enrolled student at an educational institution.
(c) Under age 26, a resident of New Hampshire, and is not provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, church plan, or health benefits plan, or entitled to benefits under Title XVIII of the Social Security Act, Public Law 89-97, 42 U.S.C. section 1395 et seq.
I-a. The coverage of any family member insured by such policy, pursuant to paragraph I, who is mentally or physically incapable of earning his or her own living as of the date on which such dependent’s status as a covered family member would otherwise expire because of age, shall continue under such policy while such policy remains in force or is replaced by another policy as long as such incapacity continues and as long as such dependent remains chiefly financially dependent on the policyholder or the employee or his or her estate is chargeable for the care of such dependent; provided, that due proof of such incapacity is received by the insurer within 31 days of such expiration date. If such coverage is continued in accordance with this paragraph, such dependent shall be entitled upon the termination of such incapacity to coverage offered by the New Hampshire high risk pool under RSA 404-G.
235:19 Effective Date. This act shall take effect 60 days after its passage.
Approved: July 16, 2009
Effective Date: September 14, 2009