1 New Section; Coverage Purchased Through a Qualified Purchasing Alliance. Amend RSA 415 by inserting after section 19-c the following new section:

415:19-d Coverage Purchased Through a Qualified Purchasing Alliance. Health coverage purchased through a qualified purchasing alliance, as defined in RSA 420-M:2, X, shall be considered by the department of insurance to be large group coverage subject to all applicable laws and rules that generally apply to large group accident and health insurance coverage, notwithstanding the size of any individual member employer.

2 Purchasing Alliances; Qualified Purchasing Alliance. Amend the introductory paragraph and paragraph I of RSA 420-M:13 to read as follows:

A purchasing alliance that has a minimum of 3,000 250 enrollees may elect to obtain certification from the commissioner as a qualified purchasing alliance. To obtain certification, a purchasing alliance shall demonstrate:

I. Either that membership in the alliance is open to all employers without discrimination or that the alliance has established membership criteria that limit membership in the alliance to employers that are members of or affiliated with an association, trade group, or other entity that has been in existence for at least 10 years and was established and maintained for purposes other than the provision of health coverage; and

3 Powers and Duties of Purchasing Alliances; Restrictions on Purchasing Alliances. Amend RSA 420-M:7, II(s) to read as follows:

(s) Negotiate the premium rates charged for coverage offered through the alliance and, for small employer members, ensure that rates are consistent with the rating restrictions contained in RSA 420-G;

4 Purchasing Alliances; Powers and Duties of Purchasing Alliances; Restrictions on Purchasing Alliances. Amend RSA 420-M:7, III(a)-(e) to read as follows:

(a) *Purchase health care services directly, assume risk for the cost or provision of health care services, or otherwise contract with health care providers for the provision of health care services to enrollees.

(b)* Exclude from membership in the alliance an employer, eligible employee, or eligible dependent of an eligible employee who meets the alliance's membership criteria and who agrees to pay fees for membership and the premium for health coverage through the alliance and who abides by the bylaws and rules of the alliance.

(c) (b) As a condition of membership, require an employer, eligible employee, or eligible dependent to subscribe to limited health coverage or non-health coverage related products or services.

(d) (c) Engage in any act or practice that results in the selection of member employers and enrollees based on industry type, experience, gender, family status, education, health status, income, employer size, or other factors related to the risk profile of the group.

(e) (d) Require or take any action inconsistent or in conflict with state laws or regulations.

5 Portability, Availability, and Renewability of Health Coverage. Amend RSA 420-G:10, I(a)-(e) to read as follows:

(a) *Comply with the rating restrictions outlined in RSA 420-G:4 for all small employer members with 50 or fewer employees based upon the association's or alliance's group experience, except that for a qualified association trust, no rating factor shall be utilized without the express written consent of the association.

(b)* Offer all eligible members, as defined under the applicable trust or other documents, coverage and rates on a guaranteed issue and renewable basis.

(c) (b) Comply with the regulations concerning medical underwriting in RSA 420-G:5.

(d) (c) Comply with the preexisting conditions provision of RSA 420-G:7.

(e) (d) Prohibit any employer that voluntarily discontinues participation in either a qualified association trust or a qualified purchasing alliance from rejoining for a period of at least 24 months.

6 Repeal. RSA 420-M:12, relative to purchasing alliance distinguished from multiple employer welfare arrangement, is repealed.

7 Effective Date. This act shall take effect upon its passage.

1 New Section; Coverage Purchased Through a Qualified Purchasing Alliance. Amend RSA 415 by inserting after section 19-c the following new section:

415:19-d Coverage Purchased Through a Qualified Purchasing Alliance. Health coverage purchased through a qualified purchasing alliance, as defined in RSA 420-M:2, X, shall be considered by the department of insurance to be large group coverage subject to all applicable laws and rules that generally apply to large group accident and health insurance coverage, notwithstanding the size of any individual member employer.

2 Purchasing Alliances; Qualified Purchasing Alliance. Amend the introductory paragraph and paragraph I of RSA 420-M:13 to read as follows:

A purchasing alliance that has a minimum of 250 enrollees may elect to obtain certification from the commissioner as a qualified purchasing alliance. To obtain certification, a purchasing alliance shall demonstrate:

I. Either that membership in the alliance is open to all employers without discrimination or that the alliance has established membership criteria that limit membership in the alliance to members of an association, trade group, or other entity that has been in existence for at least 10 years and was established and maintained for purposes other than the provision of health coverage; and

3 Powers and Duties of Purchasing Alliances; Restrictions on Purchasing Alliances. Amend RSA 420-M:7, II(s) to read as follows:

(s) Negotiate the premium rates charged for coverage offered through the alliance ;

4 Purchasing Alliances; Powers and Duties of Purchasing Alliances; Restrictions on Purchasing Alliances. Amend RSA 420-M:7, III(a)-(e) to read as follows:

(a) Exclude from membership in the alliance an employer, eligible employee, or eligible dependent of an eligible employee who meets the alliance's membership criteria and who agrees to pay fees for membership and the premium for health coverage through the alliance and who abides by the bylaws and rules of the alliance.

(b) As a condition of membership, require an employer, eligible employee, or eligible dependent to subscribe to limited health coverage or non-health coverage related products or services.

(c) Engage in any act or practice that results in the selection of member employers and enrollees based on industry type, experience, gender, family status, education, health status, income, employer size, or other factors related to the risk profile of the group.

(d) Require or take any action inconsistent or in conflict with state laws or regulations.

5 Portability, Availability, and Renewability of Health Coverage. Amend RSA 420-G:10, I(a)-(e) to read as follows:

(a) Offer all eligible members, as defined under the applicable trust or other documents, coverage and rates on a guaranteed issue and renewable basis.

(b) Comply with the regulations concerning medical underwriting in RSA 420-G:5.

(c) Comply with the preexisting conditions provision of RSA 420-G:7.

(d) Prohibit any employer that voluntarily discontinues participation in either a qualified association trust or a qualified purchasing alliance from rejoining for a period of at least 24 months.

6 Repeal. RSA 420-M:12, relative to purchasing alliance distinguished from multiple employer welfare arrangement, is repealed.

7 Effective Date. This act shall take effect upon its passage.