CHAPTER 420-O SELF-FUNDED STUDENT HEALTH BENEFIT PLANS
Section 420-O:3
420-O:3 Certificate of Authority. –
I. An institution of higher education shall not establish, maintain, or otherwise participate in a student health plan in this state unless the institution obtains and maintains a certificate of authority from the commissioner pursuant to this chapter.
II. To obtain a certificate of authority, an institution shall file an application on such form as the commissioner may prescribe, and shall provide to the satisfaction of the commissioner the following:
(a) A copy of the student contract, including a table of the premium rates charged or proposed to be charged.
(b) A report indicating the benefit provisions, premium rates or premium equivalents, and incurred medical losses associated with the institution's students under the insurance policy or self-funded plan insuring the institution's students, for the 3 years prior to the date of the application.
(c) The most recent certified independently-audited financial statement for the institution.
(d) A report prepared by a qualified actuary that supports the proposed premiums for the plan.
(e) A copy of all agreements between the institution and any plan administrator, with regard to the student health plan.
(f) A balance sheet, including actuarially determined claims liabilities, and statement of revenue and expenses, including reasonably projected expenses, medical losses, and premiums to be charged to students for the plan during the first 3 years.
(g) A narrative description of the:
(1) Accounting methodology that the institution will utilize, including a description of the separate accounts for revenues and expenses, including medical and hospital expenses and administration expenses, reserves for claims and expenses thereon, including incurred-but-not-reported, unearned premium reserves, contingent reserves, and any asset accounts, including cash, premiums receivable, and investments, relevant to the plan. The accounts may be established within the institution's general accounting ledger system; provided the general ledger accounts are clearly identifiable as pertaining to the plan, including any such accounts allocated to the plan;
(2) Billing and claim payment procedures, including the names and contact information for those persons charged with handling accounting and claims issues; and
(3) Any compensation the institution will receive in connection with the plan.
(h) A copy of any stop-loss insurance policy issued or proposed to be issued by an insurer authorized to do the business of accident and health insurance in this state.
(i) Evidence of the student health plan's recognition as minimum essential coverage by the United States Department of Health and Human Services pursuant to 45 C.F.R. section 156.604.
(j) Such other information as the commissioner may require.
III. To maintain a certificate of authority, an institution shall:
(a) Have on a continuous basis within its own organization adequate resources and competent personnel to administer the student health plan or, in order to provide such administrative services, in whole or part, have contracted with a person or entity to serve as a plan administrator; provided that any such contracted plan administrator shall be in good standing under RSA 402-H or any other requirements of Title XXXVII applicable to administration of the plan.
(b) Establish and maintain premium equivalents sufficient to meet its contractual obligations and to satisfy the reserve requirements set forth in RSA 420-O:5.
(c) Comply with consumer protection requirements under Title XXXVII, including, but not limited to, RSA 420-J, and rules adopted thereunder, RSA 417, and the department's claims processing rules, including the requirements for claims review, network adequacy, dispute resolution, and appeal procedures.
(d) Provide covered students with a copy of the plan document annually.
(e) Maintain recognition of the student health plan as minimum essential coverage in accordance with 45 C.F.R. section 156.604.
(f) File all plan documents, including the plan document, premium equivalents, and any changes in contracts or stop-loss coverage with the commissioner annually at least 60 days prior to the start of the plan year, and receive the commissioner's approval in accordance with Title XXXVII prior to the coverage start date.
(g) File an annual report with the commissioner in accordance with RSA 420-O:6.
IV. Upon compliance by the institution with the requirements under paragraph II, and demonstration of capacity to comply with the requirements of paragraph III, the commissioner may issue a certificate of authority to an applicant. Every certificate of authority shall contain the name of the certified entity and its home office address. The commissioner shall refuse to grant a certificate of authority to an applicant that fails to meet the requirements of this section. The commissioner may refuse to issue any certificate of authority if, in the commissioner's judgment, the refusal will best promote the interests of the people of this state.