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2020 New Hampshire Revised Statutes
Title XXXVII - Insurance
Title 404-G - Individual Health Insurance Market
Section 404-G:3 - Association's Powers and Duties.
Universal Citation: NH Rev Stat § 404-G:3 (2020)
404-G:3 Association's Powers and Duties. –
I. The association shall be a not-for-profit, voluntary corporation under RSA 292 and shall possess all general powers as derive from that status and such additional powers and duties as are approved by the commissioner or as specified below.
II. The board of directors of the association shall have the following powers:
(a) Enter into contracts as necessary or proper to administer the plan of operation.
(b) Sue or be sued, including taking any legal action necessary or proper for the recovery of any assessments for, on behalf of, or against members of the association or other participating person.
(c) Take legal action as necessary to avoid the payment of improper claims against the plan or to defend the coverage provided by or through the pool.
(d) Oversee the issuance of policies of insurance and certificates or evidences of coverage.
(e) Retain appropriate legal, actuarial, and other persons as necessary to provide technical assistance in the operation of the plan, policy development, and other contract design and in any other function within the authority of the plan.
(f) Borrow money to carry out the plan of operation.
(g) Provide for reinsurance of risks incurred.
(h) Perform any other functions within the authority of the association as may be necessary or proper to carry out the plan of operation.
(i) Perform additional powers as set forth in RSA 404-G:5-g.
III. The board of directors of the association shall have the following duties:
(a) Fulfill the plan of operation as approved by the commissioner.
(b) Issue policies of insurance to persons eligible for the high risk pool.
(c) Prepare certificate of eligibility forms and enrollment instruction forms.
(d) Determine and collect assessments for the risk sharing mechanism and for the high risk pool.
(e) Disburse assessment payments, as provided in the plan of operation for the high risk pool.
(f) Establish appropriate rates, rate schedules, rate adjustments, expense allowances, agent referral fees, claim reserve formulas and any other actuarial functions appropriate to the plan of operation for the high risk pool.
(g) Provide for and employ cost-containment measures and requirements, which shall include but not be limited to, preadmission screening, second surgical opinion, concurrent utilization review, and individual case management for the purpose of making the benefit plan more cost effective.
(h) Develop a list of medical or health conditions the existence or history of which makes an individual eligible for participation in the high risk pool without first requiring application to a carrier for health coverage.
(i) In connection with the managed care or network based coverage options required pursuant to RSA 404-G:5-b, III, design, utilize, contract or otherwise arrange for the delivery of cost-effective health care services, including establishing or contracting for administration and operation of the pool with a carrier, a preferred provider organization, a health maintenance organization, or any other network provider arrangement.
IV. Neither the association nor its employees shall be liable for any obligations of the plan. No member or employee of the association shall be liable, and no cause of action of any nature may arise against them, for any act or omission related to the performance of their powers and duties under this chapter unless such act or omission constitutes willful or wanton misconduct. The association may provide in its bylaws or rules for indemnification of, and legal representation for, its members and employees.
I. The association shall be a not-for-profit, voluntary corporation under RSA 292 and shall possess all general powers as derive from that status and such additional powers and duties as are approved by the commissioner or as specified below.
II. The board of directors of the association shall have the following powers:
(a) Enter into contracts as necessary or proper to administer the plan of operation.
(b) Sue or be sued, including taking any legal action necessary or proper for the recovery of any assessments for, on behalf of, or against members of the association or other participating person.
(c) Take legal action as necessary to avoid the payment of improper claims against the plan or to defend the coverage provided by or through the pool.
(d) Oversee the issuance of policies of insurance and certificates or evidences of coverage.
(e) Retain appropriate legal, actuarial, and other persons as necessary to provide technical assistance in the operation of the plan, policy development, and other contract design and in any other function within the authority of the plan.
(f) Borrow money to carry out the plan of operation.
(g) Provide for reinsurance of risks incurred.
(h) Perform any other functions within the authority of the association as may be necessary or proper to carry out the plan of operation.
(i) Perform additional powers as set forth in RSA 404-G:5-g.
III. The board of directors of the association shall have the following duties:
(a) Fulfill the plan of operation as approved by the commissioner.
(b) Issue policies of insurance to persons eligible for the high risk pool.
(c) Prepare certificate of eligibility forms and enrollment instruction forms.
(d) Determine and collect assessments for the risk sharing mechanism and for the high risk pool.
(e) Disburse assessment payments, as provided in the plan of operation for the high risk pool.
(f) Establish appropriate rates, rate schedules, rate adjustments, expense allowances, agent referral fees, claim reserve formulas and any other actuarial functions appropriate to the plan of operation for the high risk pool.
(g) Provide for and employ cost-containment measures and requirements, which shall include but not be limited to, preadmission screening, second surgical opinion, concurrent utilization review, and individual case management for the purpose of making the benefit plan more cost effective.
(h) Develop a list of medical or health conditions the existence or history of which makes an individual eligible for participation in the high risk pool without first requiring application to a carrier for health coverage.
(i) In connection with the managed care or network based coverage options required pursuant to RSA 404-G:5-b, III, design, utilize, contract or otherwise arrange for the delivery of cost-effective health care services, including establishing or contracting for administration and operation of the pool with a carrier, a preferred provider organization, a health maintenance organization, or any other network provider arrangement.
IV. Neither the association nor its employees shall be liable for any obligations of the plan. No member or employee of the association shall be liable, and no cause of action of any nature may arise against them, for any act or omission related to the performance of their powers and duties under this chapter unless such act or omission constitutes willful or wanton misconduct. The association may provide in its bylaws or rules for indemnification of, and legal representation for, its members and employees.
Source. 1998, 340:6. 2001, 295:7. 2010, 243:5, eff. July 1, 2010.
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