Current as of: 2009 In this chapter:
I. "Actuarial certification'' means a written statement by a member of the American Academy of Actuaries or other individual acceptable to the commissioner that a small employer health carrier is in compliance with the provisions of and the rules adopted by the commissioner, based upon the person's examination, including a review of the appropriate records and of the actuarial assumptions and methods used by the small employer health carrier in establishing premium rates for applicable health benefit plans.
I-a. "Case characteristics'' means demographic or other relevant characteristics of a small employer group that may be considered by the health carrier in the determination of premium rates for that group.
II. "Commissioner'' means the commissioner of insurance.
II-a. "Composite billing'' means a method of calculating premium rates for small employer groups in which each enrolled employee's rate varies only by the enrolled employee's family composition.
III. "Creditable coverage'' means any public or private health insurance or health benefit plan, whether insured or self-insured, unless that coverage consists solely of benefits excluded from the definitions of "health coverage'' in paragraph IX or "individual health coverage'' in paragraph XI. Notwithstanding the exclusion in paragraph IX, short-term, nonrenewable individual policies for medical, hospital, or major medical coverage issued pursuant to RSA 415:5, III or other law shall be considered "creditable coverage.''
III-a. "Date of enrollment'' means the first day of coverage under the plan, or, if there is a waiting period, the first day of the waiting period, which is typically the first day of work.
IV. "Department'' means the department of insurance.
V. "Eligible dependents'' means those persons who may be included under a covered person's health coverage by the terms of the policy or plan and in accordance with this chapter.
VI. "Eligible employee'' means an employee who meets the requirements for eligibility set forth by the employer, the health coverage plan and state law.
VII. "Exclusion period'' means the length of time that must expire before a health carrier will cover medical treatment expense relating to a preexisting condition.
VII-a. "Family composition'' means health plan membership type, including: enrollee only; enrollee and spouse; enrollee and children; enrollee, spouse, and children; and other similar membership types.
VIII. "Health carrier'' means any entity subject to the insurance laws and rules of this state, or subject to the jurisdiction of the commissioner, that contracts or offers to provide, deliver, arrange for, pay for or reimburse any of the costs of health services; including an insurance company, a health maintenance organization, a nonprofit health services corporation, or any other entity providing health coverage.
IX. "Health coverage'' means any hospital or medical expense incurred policy or certificate, nonprofit health services corporation subscriber contract, or health maintenance organization subscriber contract and any other health insurance plan or health benefit plan. For the purposes of this chapter, health coverage does not include:
(a) Accident-only or disability income insurance.
(b) Coverage issued as a supplement to liability insurance.
(c) Liability insurance, including general liability insurance and automobile liability insurance.
(d) Workers' compensation or similar insurance.
(e) Automobile medical-payment insurance.
(f) Credit only insurance.
(g) Coverage for on-site medical clinics.
(h) Short-term, individual, nonrenewable medical, hospital, or major medical policies.
(i) Other similar insurance coverage, specified in rules, under which benefits for medical care are secondary or incidental to other insurance benefits.
(j) If offered separately:
(1) Limited scope dental or vision benefits.
(2) Long-term care, nursing home care, home health care, community-based care, or any combination thereof.
(3) Prescription drug benefits.
(4) Other similar, limited benefits as are specified in rules.
(k) If offered as independent, noncoordinated benefits:
(1) Specified disease or illness benefits.
(2) Hospital or surgical indemnity benefits.
(l) If offered as a separate insurance policy, Medicare supplemental health insurance, coverage supplemental to the coverage provided under chapter 55 of Title 10, United States Code, and similar supplemental coverage as specified in regulations.
IX-a. "Health coverage plan rate'' means a rate that is uniquely determined for each of the coverages or health benefit plans a health carrier writes and that is derived from the market rate through the application of plan factors that reflect actuarially demonstrated differences in expected utilization and health care costs attr ________________________________________________________________________
Questions & Answers: Health InsuranceNew Hampshire Laws: Health InsuranceU.S. Code Provisions: Health InsuranceFederal Regulations: Health Insurance
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