Chapter 420-F

Section 420-F:1

    420-F:1 Definitions; Scope of Chapter. –
I. In this chapter:
(a) "Commissioner" means the New Hampshire insurance commissioner.
(b) "Contract holder" means any individual, proprietorship, partnership, corporation, association, union or other organization which contracts or may contract for dental care for oneself, employees, members, and their dependents.
(c) "Delta" means Delta Dental Plan of New Hampshire, Inc., formerly known as New Hampshire Dental Service Corporation.
(d) "Dental care" means dental services ordinarily provided by licensed dentists in accordance with accepted standards of the dental practice of the community at the time the service is rendered.
(e) "Participating dentist" means a provider who has entered into a contract with Delta to provide dental care.
(f) "Provider" means any person duly authorized and licensed to practice dentistry under the laws of the state in which the dental care is provided.
(g) "Public member" means a member of the general public who may or may not be eligible for benefits under a Delta service plan, who shall not be in a position to make the dental plan purchasing decision for a group or be associated with the dental profession. Family members of persons in a position to make group dental plan purchasing decisions and family members of persons associated with the dental profession may not serve as public members.
(gg) "Purchaser member" means an employer, association, union, or other entity which is a current Delta group contract holder.
(h) "Subscriber" means an individual entitled to receive dental care pursuant to a written agreement between Delta and a contract holder.
II. In accordance with 1961, 345, Delta was incorporated as New Hampshire Dental Service Corporation on July 26, 1966, and has operated since the date of its incorporation, as a voluntary corporation under RSA 292. Delta received recognition from the Internal Revenue Service as a section 501(c)(4) tax-exempt organization on February 21, 1973, and has operated as a tax-exempt organization since that date. The articles of agreement, by-laws and all contracts between Delta and its participating dentists and contract holders in effect on or before January 1, 1993, shall survive and be in full force and effect, except as modified by this chapter. Delta's principal place of business shall be in Concord, New Hampshire.
III. Delta shall be governed by this chapter and shall be exempt from this title, except for the provisions of RSA 400-A:16, RSA 400-A:37, RSA 400-A:39, RSA 402-C, RSA 404-F, RSA 415:18, XVI, relative to continuation of coverage, RSA 420-G:11, II, II-a and III, and 1961, 345; provided, however, if any of the provisions of 1961, 345 are inconsistent with this chapter the provisions of this chapter shall prevail. Delta and its agents shall be subject to the fees prescribed for health service corporations under RSA 400-A:29, VII.
IV. Every organization doing business pursuant to this chapter shall be subject to the premium tax requirements of RSA 400-A:31 and RSA 400-A:32. Except for payments made by the state of New Hampshire, no tax shall be levied on any premiums, fees-for-service and other payments for dental benefit coverages from political subdivisions of the state of New Hampshire or from employees or retirees of such political subdivisions, either directly or indirectly. Nor shall any tax be levied on any revenues of such an organization that are derived from any business of the organization where the organization has assumed no insurance risk and is providing administrative services, only.

Source. 1992, 252:1. 1995, 256:4. 1997, 54:2. 1998, 85:2; 180:1, 2. 2000, 207:8. 2007, 289:37. 2010, 91:1, eff. July 24, 2010. 2018, 36:3, eff. May 15, 2018.

Section 420-F:2

    420-F:2 Directors. –
I. The board of directors who shall manage the business and affairs of Delta shall be composed of 7 participating dentists, 4 public members, and 4 purchaser members.
II. A nominating committee composed of 2 participating dentists, one member of the general public, and 2 purchasers, none of whom are members of the board, selected by a majority vote of the entire board, shall develop recommendations for board nominees, as board vacancies occur, which nominees shall be approved to serve on the board by a majority vote of the entire board. The nominating committee may use an outside consultant in selecting new board members as vacancies occur.

Source. 1992, 252:1. 1998, 180:3, eff. July 1, 1998.

Section 420-F:2-a

    420-F:2-a Bylaws. – Any bylaw developed by the board of directors or developed by the members shall require approval of both 2/3 of the members of the board and a simple majority of all the members of Delta.

Source. 1998, 180:4, eff. July 1, 1998.

Section 420-F:3

    420-F:3 Agent License. –
I. No person, for himself or in behalf of any person, shall sell or offer to sell any Delta benefit plan, as is provided for in this chapter, without being licensed by the commissioner pursuant to the provisions of RSA 402-J.
II. Upon written notice by Delta of its appointment of a person to act as its agent, the commissioner shall issue, if he is first satisfied that the appointee is a suitable person and intends to hold himself out in good faith as an agent and upon payment of the proper fee by the applicant, to the appointee a license to act as such agent.
III. A license previously issued may be renewed upon the application of Delta upon payment of the proper fee.
IV. The commissioner, at any time after granting such license, for cause shown and after notice and hearing, may determine such licensee to be unsuitable to act as such agent, and shall thereupon revoke such license and notify both Delta and the agent of such revocation.
V. Unless revoked by the commissioner, or unless Delta by written notice to the commissioner cancels the agent's authority to act for it, such license issued to an agent, or any renewal thereof, shall expire on June 14 of the second year after its issue.
VI. If a person acts or aids in any manner in the negotiation of Delta contracts, or solicits or receives any application for such contracts, without a license from the commissioner, or if the license granted to him or her or Delta for whom he or she acts as agent has been revoked, he or she shall be guilty of a class A misdemeanor if a natural person, or guilty of a felony if any other person; but any contract issued on an application thus procured shall bind Delta if otherwise valid. This paragraph shall not apply to any clerical employee of Delta, or to any persons rendering their services without compensation.

Source. 1992, 252:1. 2000, 315:24. 2005, 206:9, eff. Jan. 1, 2006.

Section 420-F:4

    420-F:4 Filing and Approval of Contracts. – Delta shall not revise or modify any contract or issue a new contract to a contract holder until it shall have filed with the commissioner a copy of the form of such amendment, modification or contract, including all riders and endorsements, and until the commissioner's approval shall have been obtained. Any form of amendment, modification or contract not disapproved by the commissioner within 90 days after the filing, shall be deemed to have been approved as filed.

Source. 1992, 252:1, eff. Jan. 1, 1993.

Section 420-F:5

    420-F:5 Contracts With Contract Holders. –
Every contract between Delta and a contract holder shall be in writing, a copy of which shall be furnished to the contract holder and shall contain the following provisions:
I. A statement of the amount payable to Delta by the contract holder and the manner in which such amount is payable.
II. A statement of the nature and extent of the benefits to be provided, and if any benefits are to be limited or excepted, an enumeration of such limitations or exceptions shall be printed with the same prominence as the statement of benefits conferred.
III. A statement of the terms and conditions upon which the contract may be cancelled or otherwise terminated at the option of either party.
IV. A statement that the contract includes endorsements and attached papers, if any, and that it comprises the entire contract.
V. A provision that no statement by the contract holder in its application for a contract shall void the contract or be used in any legal proceeding on the contract unless an exact copy of the application is included or attached to the contract.
VI. A statement of the grace period which will be allowed the contract holder for making any payment due under the contract. Such period shall be not less than 10 days.
VII. If the coverage for dependent children includes coverage for dependent children who are full-time students, as defined by the appropriate educational institution, beyond the age of 18, such dependent coverage shall include coverage for a dependent's medically necessary leave of absence from school for a period not to exceed 12 months or the date on which coverage would otherwise end pursuant to the terms and conditions of the policy, whichever comes first. Any breaks in the school semester shall not disqualify the dependent child from coverage under this paragraph. Documentation and certification of the medical necessity of a leave of absence shall be submitted to the insurer by the student's attending physician and shall be considered prima facie evidence of entitlement to coverage under this paragraph. The date of the documentation and certification of the medical necessity of a leave of absence shall be the date the insurance coverage under this paragraph commences.

Source. 1992, 252:1. 2007, 289:20, eff. Jan. 1, 2008.

Section 420-F:5-a

    420-F:5-a Dependent Coverage. –
I. A policy may, at the election of the carrier, insure, originally or by subsequent amendment, upon application of an adult member of a family who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children, or any other person dependent upon the policyholder. In the event a carrier elects to provide coverage for dependent children, the term "dependent child" shall include a subscriber's child by blood or by law, who is under age 26.
I-a. The coverage of any family member insured by such policy, pursuant to paragraph I, who is mentally or physically incapable of earning his or her own living as of the date on which such dependent's status as a covered family member would otherwise expire because of age, shall continue under such policy while such policy remains in force or is replaced by another policy as long as such incapacity continues and as long as such dependent remains chiefly financially dependent on the policyholder or the employee or his or her estate is chargeable for the care of such dependent; provided, that due proof of such incapacity is received by the insurer within 31 days of such expiration date. If such coverage is continued in accordance with this paragraph, such dependent shall be entitled upon the termination of such incapacity to coverage offered by the New Hampshire high risk pool under RSA 404-G.
II. Nothing in this section shall be construed to require:
(a) Coverage for services provided to a dependent before the effective date of this section; or
(b) That an employer pay all or part of the cost of family coverage that includes a dependent as provided pursuant to this section.
III. A subscriber that elects family coverage during any applicable open enrollment period may enroll any dependent eligible pursuant to this section.
IV. Coverage for a dependent provided pursuant to this section shall be provided until the earlier of the following:
(a) The dependent is disqualified for dependent status as set forth in paragraph I of this section; or
(b) The date upon which the employer under whose contract coverage is provided to a dependent ceases to provide coverage to the subscriber.
V. Nothing in this section shall be construed to permit a health insurance carrier to refuse an election for coverage by a dependent pursuant to paragraph III, based upon the dependent's prior disqualification pursuant to subparagraph IV(a).
VI. (a) Notice regarding coverage for a dependent as provided pursuant to this section shall be provided to a subscriber:
(1) In the certificate of coverage prepared for subscribers on or about the date of commencement of coverage; and
(2) Within 30 days following the effective date of this section.
(b) Such notice shall include information regarding the required special open enrollment period.

Source. 2007, 352:5. 2009, 235:14. 2010, 243:12, eff. Sept. 23, 2010.

Section 420-F:6

    420-F:6 Rates and Contracts to be Approved. – Delta shall file with the insurance commissioner a full schedule of the rates to be paid by contract holders and shall obtain the commissioner's approval prior to implementing any rate changes. The commissioner may refuse such approval if he finds the rates are excessive, inadequate, or discriminatory.

Source. 1992, 252:1, eff. Jan. 1, 1993.

Section 420-F:7

    420-F:7 Cancellation or Nonrenewal. –
I. No contract with a contract holder authorized under this chapter shall be cancelled by Delta, except for nonpayment of premium, unless the contract holder receives a notice of cancellation in accordance with this section. Notice of cancellation for breach of the contract by the contract holder shall be delivered to the contract holder or mailed to the contract holder's last address as shown in the records of Delta at least 10 days prior to the effective date of the cancellation. Notice of cancellation for lack of participation shall be delivered to the contract holder or mailed to the contract holder's last address as shown in the records of Delta, at least 30 days prior to the effective date of the cancellation.
II. No contract with a contract holder authorized under this chapter shall be nonrenewed by Delta, except for nonpayment of premium, unless the contract holder receives either a notice of nonrenewal or an offer of renewal in accordance with this section. The notice of nonrenewal or offer of renewal shall be delivered to the contract holder or mailed to the contract holder's last address as shown in the records of Delta at least 30 days prior to the renewal date of the contract.

Source. 1992, 252:1, eff. Jan. 1, 1993.

Section 420-F:8

    420-F:8 Investments. – Delta shall invest its funds as provided for in RSA 411-A.

Source. 1992, 252:1, eff. Jan. 1, 1993.

Section 420-F:9

    420-F:9 Financial Report and Examination. –
I. Delta shall file with the commissioner, on March 1, a report verified by an appropriate official of Delta, showing its financial condition on the last day of the preceding fiscal year.
II. Such report shall include:
(a) Delta's financial statements, including its balance sheet and statement of income and expenditures for the preceding year, certified by an independent public accountant;
(b) Such other financial information relating to Delta's performance as the commissioner may require.

Source. 1992, 252:1. 2001, 224:9, eff. Jan. 1, 2002.

Section 420-F:10

    420-F:10 Contingency Reserve Fund. – Delta shall collect reasonable rates as described in RSA 420-F:6, designed to permit it to accumulate and maintain a contingency reserve fund which shall not be less than 8 percent of Delta's annual premium risk income.

Source. 1992, 252:1, eff. Jan. 1, 1993.

Section 420-F:11

    420-F:11 Examination. –
I. The commissioner shall make an examination of Delta as often as he or she deems it necessary, but not less frequently than once in every 5 years. All examinations shall be conducted at the expense of Delta.
II. Delta shall submit its books and records relating to its operations to such examinations and in every way facilitate them. For the purpose of examinations, the commissioner may issue subpoenas, administer oaths to, and examine the officers and agents of Delta.

Source. 1992, 252:1, eff. Jan. 1, 1993. 2018, 36:4, eff. May 15, 2018.

Section 420-F:12

    420-F:12 Appeals. – All orders and decisions of the commissioner concerning matters within his jurisdiction under this chapter shall be subject to rehearing and appeal as provided in RSA 541. RSA 541:18 and 19 shall apply to orders and decisions of the insurance commissioner affecting the rates of Delta.

Source. 1992, 252:1, eff. Jan. 1, 1993.

Section 420-F:13

    420-F:13 Administrative Services. – Delta may contract to furnish administrative, marketing, and managerial services to any health related organization, agency, entity or plan.

Source. 1992, 252:1, eff. Jan. 1, 1993.

Section 420-F:14

    420-F:14 Nonliability of Corporation. – Delta, its officers or employees, shall not be liable for injuries resulting from negligence, malfeasance, nonfeasance or malpractice on the part of any provider in the course of rendering any dental care.

Source. 1992, 252:1, eff. Jan. 1, 1993.

Section 420-F:15

    420-F:15 Not-for-Profit-Status. – Delta is not organized and shall not be maintained or operated for private profit or benefit. The income or property of Delta from whatever source derived shall be applied solely toward the promotion of the purposes of Delta and no portion of such income or property shall be transferred to or inure to the profit or benefit of any provider, officer, director or employee of Delta or any individual, provided that nothing in this section shall prevent the payment in good faith of reasonable remuneration to any officer, director or employee of Delta, or to any other person, or to any participating dentist who has entered into contracts with Delta to furnish dental care, for any services rendered to Delta or to individuals pursuant to contracts with Delta for dental care.

Source. 1992, 252:1, eff. Jan. 1, 1993.

Section 420-F:16

    420-F:16 Relationship of Provider and Patient. – Nothing in this chapter shall be deemed to alter the relationship of provider and patient. Delta shall not in any way influence the subscriber in the free choice of provider. Nothing in this chapter shall be deemed to abridge the right of any provider to decline patients in accordance with lawful standards and practices of such provider.

Source. 1992, 252:1, eff. Jan. 1, 1993.

Section 420-F:17

    420-F:17 Rulemaking Authority. – The commissioner may adopt rules in accordance with RSA 541-A, which are reasonable and necessary to administer and enforce the provisions of this chapter.

Source. 1992, 252:1. 2002, 207:49, eff. July 15, 2002.

Section 420-F:18

    420-F:18 Prohibited Practices. – RSA 417 shall be construed to apply to Delta and the contracts which Delta issues, except to the extent that the commissioner determines that the nature of Delta, and the contracts which Delta issues, renders such provisions inappropriate.

Source. 1992, 252:1. 1997, 190:16, eff. Jan. 1, 1998.