2015 New Hampshire Revised Statutes
Title XXXVII - INSURANCE
Chapter 415 - ACCIDENT AND HEALTH INSURANCE
Section 415:5 - Form of Policy.
415:5 Form of Policy.
I. No policy of accident and sickness insurance shall be delivered or issued for delivery to any person in this state unless:
(1) The entire money and other considerations therefor are expressed therein; and
(2) The time at which the insurance takes effect and terminates is expressed therein; and
(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 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 under age 26.
(b) Nothing in this subparagraph shall be construed to require:
(1) Coverage for services provided to a dependent before the effective date of this section; or
(2) That an employer pay all or part of the cost of family coverage that includes a dependent as provided pursuant to this subparagraph.
(c) A subscriber that elects family coverage during any applicable open enrollment period may enroll any dependent eligible pursuant to this subparagraph.
(d) Coverage for a dependent provided pursuant to this subparagraph shall be provided until the earlier of the following:
(1) The dependent is disqualified for dependent status as set forth in subparagraph I(3)(a); or
(2) The date upon which the employer under whose contract coverage is provided to a dependent ceases to provide coverage to the subscriber.
(e) Nothing in this subparagraph shall be construed to permit a health insurance carrier to refuse an election for coverage by a dependent pursuant to subparagraph (c), based upon the dependent's prior disqualification pursuant to subparagraph (d)(1).
(f) Notice regarding coverage for a dependent as provided pursuant to this subparagraph shall be provided to a subscriber:
(1) In the certificate of coverage prepared for subscribers on or about the date of commencement of coverage; and
(2) Within 30 days following the effective date of this subparagraph. Such notice shall include information regarding the required special open enrollment period.
(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 coverage offered by the New Hampshire high risk pool under RSA 404-G;
(b) If the coverage for dependent children under subparagraph (3) includes coverage for dependent children who are full-time students, as defined by the appropriate educational institution, beyond the age of 18, such dependent coverage shall include coverage for a dependent's medically necessary leave of absence from school for a period not to exceed 12 months or the date on which coverage would otherwise end pursuant to the terms and conditions of the policy, whichever comes first. Any breaks in the school semester shall not disqualify the dependent child from coverage under this subparagraph. Documentation and certification of the medical necessity of a leave of absence shall be submitted to the insurer by the student's attending physician and shall be considered prima facie evidence of entitlement to coverage under this subparagraph. The date of the documentation and certification of the medical necessity of a leave of absence shall be the date the insurance coverage under this subparagraph commences; and
(4) The style, arrangement and over-all appearance of the policy give no undue prominence to any portion of the text, and unless every printed portion of the text of the policy and of any indorsements or attached papers is plainly printed in light-faced type of a style in general use, the size of which shall be uniform and not less than 10-point with a lower-case unspaced alphabet length not less than 120-point (the "text'' shall include all printed matter except the name and address of the insurer, name or title of the policy, the brief description if any, and captions and subcaptions); and
(5) The exceptions and reductions of indemnity are set forth in the policy, and, except those which are set forth in RSA 415:6, are printed, at the insurer's option, either included with the benefit provision to which they apply, or under an appropriate caption such as "Exceptions,'' or "Exceptions and Reductions,'' provided that if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of such exception or reduction shall be included with the benefit provision to which it applies; and
(6) Each such form, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of the first page thereof; and
(7) It contains no provision purporting to make any portion of the charter, rules, constitution, or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks, or short-rate table filed with the commissioner; and
(8) Wherever such policy provides for reimbursement for any service which may be legally performed by a person licensed in this state for the practice of osteopathy, chiropractic, podiatry, optometry, or licensed as an advanced practice registered nurse, said policy contains a provision for reimbursement for such service when performed by a person so licensed.
(9) Notwithstanding any provisions in any such policy or contract for the provision of health care services or benefits provided by any health, medical or other service corporation licensed by the state, whenever the terms "physician'' or "doctor'' are used in any such policy or contract, said terms shall include within their meaning those persons licensed under RSA 317-A in respect to any care, services, procedures or benefits covered by said policy or contract which the persons so licensed are authorized to perform.
(10) It also conforms to the relevant provisions of RSA 420-G.
II. If any policy is issued by an insurer domiciled in this state for delivery to a person residing in another state, and if the official having responsibility for the administration of the insurance laws of such other state shall have advised the commissioner that any such policy is not subject to approval or disapproval by such official, the commissioner may by ruling require that such policy meet the standards set forth in paragraph I of this section and in RSA 415:6.
III. Nonrenewable, individual health insurance policies which provide medical, hospital, or major medical expense benefits for a specified term may be delivered or issued for delivery to any person in this state for purposes of providing short-term, interim coverage only and no such policy shall provide coverage for a specified term in excess of 6 months, nor shall any such policy be issued in this state to a person who was previously covered under short-term medical policies providing in total more than 540 days of coverage within the preceding 24-month period.
Source. 1913, 226:2. PL 281:4. RL 331:4. 1951, 207:1, par. 4. RSA 415:5. 1969, 163:2; 271:1. 1973, 72:71. 1975, 111:1. 1985, 239:1. 1995, 112:5. 1997, 344:2. 2001, 112:1. 2006, 321:2. 2007, 352:1. 2009, 54:5; 177:1; 235:1, 2. 2010, 243:8, eff. Sept. 23, 2010.
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