New Hampshire Revised Statutes 420-H:4 – Requirements
Current as of: 2023 | Check for updates
|
Other versions
Enrollees, subscribers, certificate holders, and individual insureds shall receive in simple and concise written language at least the following information:
I. An explanation of benefits provided.
II. Any benefit limitations, reductions, exclusions or exceptions to covered services, including an explanation of any restrictions on a subscriber’s access to network practitioners based upon the subscriber’s choice of primary care physician. The explanation of restrictions shall include a section regarding “referrals to other providers or other medical specialists” that shall urge enrollees, subscribers, certificate holders, and individual insureds to inquire about their primary care provider’s referral group within the insurer‘s network. Such explanation shall include a general statement regarding the existence of physician hospital organizations within the insurer’s network, to which primary care providers may be associated.
III. The nature of any payments required of the beneficiary, enrollee or subscriber such as copayments or deductibles.
IV. The nature of any limitations on payment by the insurer, including limitations based on the use of network or out-of-network health care providers.
V. The credentials of any health care provider the health care plan holds out as a specialist denoting board eligibility or board certification for such specialty.
VI. For companies or insurers providing health insurance through a managed care system of health care delivery or reimbursement, a description of the grievance procedures as required pursuant to N.H. Rev. Stat. § 420-J:5.
VII. For enrollees, subscribers, certificate holders, or individual insureds whose health insurance is provided through a managed care system of health care delivery and reimbursement, an explanation of a covered person‘s option to receive direct access to certain obstetrical-gynecological care, pursuant to N.H. Rev. Stat. § 420-J:6-a.
I. An explanation of benefits provided.
Terms Used In New Hampshire Revised Statutes 420-H:4
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- Certificate: means a document received by an insured, enrollee, or subscriber from an insurer in lieu of a policy or contract which evidences the coverage to which the insured, enrollee or subscriber is entitled. See New Hampshire Revised Statutes 420-H:2
- following: when used by way of reference to any section of these laws, shall mean the section next preceding or following that in which such reference is made, unless some other is expressly designated. See New Hampshire Revised Statutes 21:13
- insurer: means any life or health insurance company, fraternal benefit society, nonprofit health service corporation, nonprofit hospital service corporation, nonprofit medical service corporation, prepaid health plan, dental care plan, vision care plan, pharmaceutical plan, health maintenance organization, and all similar type organizations. See New Hampshire Revised Statutes 420-H:2
- person: may extend and be applied to bodies corporate and politic as well as to individuals. See New Hampshire Revised Statutes 21:9
II. Any benefit limitations, reductions, exclusions or exceptions to covered services, including an explanation of any restrictions on a subscriber’s access to network practitioners based upon the subscriber’s choice of primary care physician. The explanation of restrictions shall include a section regarding “referrals to other providers or other medical specialists” that shall urge enrollees, subscribers, certificate holders, and individual insureds to inquire about their primary care provider’s referral group within the insurer‘s network. Such explanation shall include a general statement regarding the existence of physician hospital organizations within the insurer’s network, to which primary care providers may be associated.
III. The nature of any payments required of the beneficiary, enrollee or subscriber such as copayments or deductibles.
IV. The nature of any limitations on payment by the insurer, including limitations based on the use of network or out-of-network health care providers.
V. The credentials of any health care provider the health care plan holds out as a specialist denoting board eligibility or board certification for such specialty.
VI. For companies or insurers providing health insurance through a managed care system of health care delivery or reimbursement, a description of the grievance procedures as required pursuant to N.H. Rev. Stat. § 420-J:5.
VII. For enrollees, subscribers, certificate holders, or individual insureds whose health insurance is provided through a managed care system of health care delivery and reimbursement, an explanation of a covered person‘s option to receive direct access to certain obstetrical-gynecological care, pursuant to N.H. Rev. Stat. § 420-J:6-a.