TITLE XXXVII
INSURANCE

Chapter 417-D
WOMEN'S HEALTH CARE

Section 417-D:1

417-D:1 Definitions. –
In this chapter:
I. "Commissioner" means the insurance commissioner.
II. "Insurer" means any entity issuing accident or health insurance or accident and health insurance policies, contracts, certificates, or other evidence of coverage pursuant to RSA 415, 415-A, 420-A, or 420-B.
III. "Low-dose mammography" means the X-ray examination of the breast using equipment dedicated specifically for mammography, including the X-ray tube, filter, compression device, screens, films, and cassettes, with a radiation exposure which is diagnostically valuable and in keeping with the recommended "Average Patient Exposure Guides" as published by the Conference of Radiation Control Program Directors, Inc. "Low-dose mammography" shall also include 3-D tomosynthesis mammography.

Source. 1988, 267:2. 1997, 190:12, eff. Jan. 1, 1998. 2018, 208:1, eff. Aug. 7, 2018.

Section 417-D:2

417-D:2 Low-Dose Mammography Coverage. –
I. Each insurer that issues or renews any policy of accident and health insurance providing benefits for hospital expense, medical-surgical expense, or major medical expense shall provide in each group or individual policy, contract, or certificate of insurance issued or renewed for persons who are residents of this state, coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer within the provisions of the policy, contract, or certificate. The coverage shall be as follows:
(a) A baseline mammogram for women 35 to 39 years of age.
(b) A mammogram every 1 to 2 years, even if no symptoms are present, for women 40 to 49 years of age.
(c) An annual mammogram for women 50 years of age or older.
II. Such benefits shall be at least as favorable as for other radiological examinations and subject to the same dollar limits, deductibles, and co-insurance factors.

Source. 1988, 267:2. 1996, 75:3, eff. Jan. 1, 1997.

Section 417-D:2-a

417-D:2-a Pregnancy, Delivery, and Postpartum Coverage. –
Each insurer that issues or renews any policy of accident and health insurance providing maternity benefits for hospital expense, medical-surgical expense, or major medical expense shall provide in each group or individual policy, contract, or certificate of insurance issued or renewed for persons who are residents of this state the following in providing coverage during pregnancy and delivery and the postpartum period:
I. The length of hospital stay and the number of postpartum visits shall be determined by the attending health care provider based on clinical information that demonstrates that the mother and infant are clinically stable based on nationally accepted guidelines pursuant to paragraph IV and that appropriate care for the mother and newborn can be provided for upon discharge. The length of stay shall not be determined by the health insurer or the hospital based on economic criteria.
II. Upon notification of the pregnancy by the insured to the insurer, the insurer shall inform the pregnant woman in writing regarding the insurer's prenatal, maternity, and postpartum benefits, including but not limited to prenatal visits, diagnostic tests, prenatal education, hospital length of stay, postpartum care, homemaker services, and contraceptive counseling and referrals.
III. The insurer shall pay for medically necessary prenatal homemaker services when a woman is confined to bedrest or her activities of daily living are otherwise restricted on the recommendation of her attending health care provider who shall consult with the applicable case manager.
IV. Any length of hospital stay shorter than the current minimum nationally accepted guidelines for perinatal care, such as Guidelines for Perinatal Care prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, shall be at the recommendation of the attending health care provider in consultation with the mother. In such cases the insurer shall pay for at least 2 postpartum visits. During one such visit, the collection of an adequate sample from the newborn for screening for genetic and metabolic diseases shall take place in accordance with RSA 132 and applicable rules.
V. Postpartum visits shall include a physical assessment of mother and infant. The assessment shall include but not be limited to: infant nutrition and feeding, infant behavior, family interactions, safety and injury prevention, infant and maternal health promotion, and community resources. Providers of postpartum visits shall be licensed health care providers experienced in perinatal care.
VI. The insurer shall pay for appropriate medically necessary postpartum homemaker services as determined by the attending health care provider who shall consult with the applicable case manager.
VII. No attending health care provider shall be penalized by an insurer for following the provisions of this section. Insurers shall not deny payment for services that are within standards of good and generally accepted medical practice as reflected by scientific and peer medical literature and recognized within the organized medical community in the state of New Hampshire.

Source. 1996, 75:4, eff. Jan. 1, 1997.

Section 417-D:2-b

417-D:2-b Reconstructive Surgery. – Every insurer subject to this chapter that provides individual or group coverage for mastectomy surgery shall provide coverage for reconstruction of the breast on which surgery has been performed and surgery and reconstruction of the other breast to produce a symmetrical appearance if the patient elects reconstruction and in the manner chosen by the patient and the physician.

Source. 1997, 311:1, eff. Jan. 1, 1998.

Section 417-D:3

417-D:3 Rulemaking. – The commissioner may adopt rules, under RSA 541-A, relative to the administration of this chapter.

Source. 1988, 267:2, eff. Jan. 1, 1989.

Section 417-D:4

417-D:4 Penalty. – Any insurer that violates any provision of this chapter or any rule adopted pursuant to it, may, at the discretion of the commissioner, have its certificate of authority indefinitely suspended or revoked.