Ins 6100

CHAPTER Ins 6100 DISCONTINUANCE AND REPLACEMENT OF ANCILLARY HEALTH AND BLANKET COVERAGE

Statutory Authority: RSA 400-A:15, I; RSA 415:18, I; RSA 415-A:2, I

REVISION NOTE #1:

Document #12471, effective 1-31-18, adopted Chapter Ins 6100 titled “Discontinuance and Replacement of Group Ancillary Health and Blanket Coverage” containing Part Ins 6101 titled the same.

Chapter Ins 6100 had formerly been numbered as Part Ins 1906 titled “Discontinuance and Replacement of Group Accident and Health Coverage” in Chapter Ins 1900 titled “Accident and Health Insurance.” Former Part Ins 1906 expired 6-12-14. The filing affecting the former Ins 1906 was Document #8646, effective 6-12-06.

REVISION NOTE #2:

Document #12560, effective 6-25-18, adopted Part Ins 6102 titled “Replacement of Ancillary Health Coverage”.

Part Ins 6102 had been based on the former rule Ins 1901.08 titled “Requirements for Replacement of Individual Accident and Health Insurance”, which had expired 4-17-14. The former Ins 1901.08 had been in Part Ins 1901 titled “Minimum Standards for Accident and Health Insurance”, which in turn had been in Chapter Ins 1900 titled “Accident and Health Insurance.” Part Ins 6102 replaces the provisions in the former Ins 1901.08. The filings affecting the former Ins 1901.08 include the following documents:

#1900, effective 1-1-82

#4287, effective 7-1-87

#5656, effective 7-1-93

#7017, INTERIM, effective 7-1-99, EXPIRED 10-29-99

#8609, effective 4-17-06, EXPIRED 4-17-14

PART Ins 6101 DISCONTINUANCE AND REPLACEMENT OF GROUP ANCILLARY HEALTH AND BLANKET COVERAGE

Ins 6101.01 Scope and Applicability. This chapter is applicable to all ancillary health insurance policies and certificates issued or provided by a carrier on a group basis.

Source. (See Revision Note #1 at chapter heading for Ins 6100) #12471, eff 1-31-18

Ins 6101.02 Effective Date of Discontinuance for Nonpayment of Premium.

(a) If a policy or contract subject to this part provides for automatic discontinuance of the policy or contract after a premium has remained unpaid through the grace period allowed for such payment, pursuant to RSA 415:18, the carrier shall be liable for valid claims for covered losses incurred prior to the end of the grace period.

(b) If the actions of the carrier after the end of the grace period indicate that it considers the policy or contract as continuing in force beyond the end of the grace period, such as by continuing to recognize claims subsequently incurred, the carrier shall be liable for valid claims for losses beginning prior to the effective date of written notice of discontinuance to the policyholder or other entity responsible for making payments to the carrier. The effective date of discontinuance shall not be prior to midnight at the end of the third scheduled business day after the date upon which the notice is delivered.

Source. (See Revision Note #1 at chapter heading for Ins 6100) #12471, eff 1-31-18

Ins 6101.03 Requirements for Notice of Discontinuance. Any notice of discontinuance shall comply with the provisions of RSA 415:18.

Source. (See Revision Note #1 at chapter heading for Ins 6100) #12471, eff 1-31-18

Ins 6101.04 Extension of Benefits. Every group policy, contract, or certificate subject to this part, except dental expense coverage, issued on or after the effective date of this part, or under which the level of benefits is altered, modified, or amended on or after the effective date of this part, shall provide a provision for a period of no less than 90 days extension of benefits in the event of total disability at the date of discontinuance of the group policy, contract, or certificate as required by the following paragraphs of this section.

(a) In the case of a group plan that contains a disability benefit extension of any type (e.g., premium waiver extension, extended death benefit in event of total disability, or payment of income for a specified period during total disability), the discontinuance of the group policy, contract, or certificate shall not operate to terminate the extension.

(b) In the case of a group plan providing benefits for loss of time from work or specific indemnity during hospital confinement, discontinuance of the group policy, contract, or certificate during a disability shall have no effect on benefits payable for that disability or confinement.

(c) An applicable extension of benefits or accrued liability shall be described in any policy or contract involved as well as in group insurance certificates as follows:

(1) The benefits payable during any period of extension of benefits or accrued liability may be subject to the policy’s, contract’s, or certificate’s regular benefit limits, such as benefits ceasing at exhaustion of a benefit period or of maximum benefits; and

(2) The benefit payments for hospital or medical expense coverages may be limited to payments applicable to the disability condition only.

(d) Every group policy, contract, or certificate subject to this part, including dental expense coverage, must provide for continuation of coverage for confinement or courses of treatment that commenced prior to termination of coverage.

Source. (See Revision Note #1 at chapter heading for Ins 6100) #12471, eff 1-31-18

Ins 6101.05 Continuance of Coverage in Situations Involving Replacement of One Carrier by Another. This section shall indicate the carrier responsible for liability in those instances in which one carrier’s policy or certificate replaces a plan of similar benefits of another carrier.

(a) After discontinuance of the policy or certificate, the prior carrier remains liable only to the extent of its accrued liabilities and extensions of benefits. The position of the prior carrier shall be the same whether the group policyholder or other entity secures replacement coverage from a new carrier, self-insures, or foregoes the provision of coverage.

(b) If the individual was validly covered under the prior plan on the date of discontinuance, each individual who is eligible for coverage in accordance with the succeeding carrier’s plan of benefits with respect to the class or classes of individuals eligible for coverage under the succeeding carrier’s plan shall be enrolled and covered by the succeeding carrier’s plan of benefits as follows:

(1) Each person not covered under the succeeding carrier’s plan of benefits in accordance with the above shall nevertheless be covered by the succeeding carrier in accordance with the following rules if the individual was validly covered, including benefit extension, under the prior plan on the date of discontinuance and if the individual is a member of the class or classes of individuals eligible for coverage under the succeeding carrier’s plan. Any reference in the following rules to an individual who was or was not totally disabled is a reference to the individual’s status immediately prior to the date the succeeding carrier’s coverage becomes effective, and:

a. The minimum level of benefits to be provided by the succeeding carrier shall be the applicable level of benefits of the prior carrier’s plan reduced by any benefits payable by the prior plan;

b. Coverage shall be provided by the succeeding carrier on the earliest of the following dates:

1. The date the individual becomes eligible under the succeeding carrier’s plan as

described in Ins 6101.05(b);

2. For each type of coverage, the date the individual’s coverage would terminate in accordance with the succeeding carrier’s plan provisions applicable to individual termination of coverage such as at termination of employment or ceasing to be an eligible dependent; or

3. In the case of an individual who was totally disabled, and in the case of a type of coverage for which Ins 6101.04 requires an extension of benefits or accrued liability, the end of any period of extension or accrued liability that is required of the prior carrier by Ins 6101.04 or, if the prior carrier’s policy, contract, or certificate is not subject to that section but would have been required of the prior carrier had the policy, contract, or certificate been subject to Ins 6101.04 at the time the prior carrier’s plan was discontinued and replaced by the succeeding carrier’s plan;

(2) In the case of a preexisting conditions limitation included in the succeeding carrier’s plan, the level of benefits applicable to preexisting conditions of individuals becoming covered by the succeeding carrier’s plan in accordance with this paragraph during the period of time this limitation applies under the new plan shall be the lesser of:

a. The benefits of the new plan determined without application of the preexisting conditions limitations; or

b. The benefits of the prior plan;

(3) The succeeding carrier, in applying any deductibles or coinsurance amounts applicable to the out-of-pocket maximum or waiting periods in its plan, shall give credit for the satisfaction or partial satisfaction of the same or similar provisions under a prior plan providing similar benefits. In the case of deductible provisions or coinsurance amounts applicable to the out-of-pocket maximums, the credit shall apply for the same or overlapping benefit periods and shall be given for expenses actually incurred and applied against the deductible or coinsurance provisions of the prior carrier’s plan during the 90 days preceding the effective date of the succeeding carrier’s plan but only to the extent these expenses are recognized under the terms of the succeeding carrier’s plan and are subject to a similar deductible or coinsurance provision; and

(4) In any situation where a determination of the prior carrier’s benefit is required by the

succeeding carrier, at the succeeding carrier’s request, the prior carrier shall furnish a statement

of the benefits available or pertinent information sufficient to permit verification of the benefit determination or the determination itself by the succeeding carrier. For the purposes of this subparagraph, benefits of the prior plan shall be determined in accordance with all of the definitions, conditions, and covered expense provisions of the prior plan rather than those of the succeeding plan. The benefit determination shall be made as if coverage had not been replaced by the succeeding carrier.

Source. (See Revision Note #1 at chapter heading for Ins 6100) #12471, eff 1-31-18

PART Ins 6102 REPLACEMENT OF INDIVIDUAL ANCILLARY HEALTH COVERAGE

Statutory Authority: RSA 400-A:15, I; RSA 415-A:2, I

Ins 6102.01 Scope and Applicability. This section is applicable to all ancillary health insurance policies issued or provided by a carrier on an individual basis.

Source. (See Revision Note #2 at chapter heading for Ins 6100) #12560, eff 6-25-18

Ins 6102.02 Requirements for Replacement of Individual Ancillary Health Insurance.

(a) An application form shall include a question designed to elicit information as to whether the

insurance to be issued is intended to replace any other ancillary health insurance subject to this part and presently in force. A supplementary application or other form to be signed by the applicant containing the question may be used.

(b) Upon determining that a sale will involve replacement, an insurer, other than a direct response

insurer, or its agent shall furnish the applicant, prior to issuance or delivery of the policy, the notice described in paragraph (c) below. The insurer shall retain a copy of the notice. A direct response insurer shall deliver to the applicant, upon issuance of the policy, the notice described in paragraph (d) below. In no event, however, will the notices be required in solicitation of accident-only and single-premium nonrenewable policies.

(c) The notice required by paragraph (b) above for an insurer, other than a direct response insurer, shall provide, in substantially the following form:

NOTICE TO APPLICANT REGARDING REPLACEMENT

OF ANCILLARY HEALTH INSURANCE

According to [your application] [information you have furnished], you intend to lapse or otherwise terminate existing ancillary health insurance and replace it with a policy to be issued by [insert company name] Insurance Company. For your own information and protection, you should be aware of and seriously consider certain factors that may affect the insurance protection available to you under the new policy.

(1) Health conditions which you may presently have, such as preexisting conditions, may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits present under the new policy, whereas a similar claim might have been payable under your present policy.

(2) You may wish to secure the advice of your present insurer or its agent regarding the proposed replacement of your present policy. This is not only your right, but it is also in your best interests to make sure you understand all the relevant factors involved in replacing your present coverage.

(3) If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your medical/health history. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed and before you sign it, reread it carefully to be certain that all information has been properly recorded.

The above “Notice to Applicant” was delivered to me on:

______________________________

(Date)

______________________________

(Applicant’s Signature)

(d) The notice required by paragraph (b) above for a direct response insurer shall be as follows:

NOTICE TO APPLICANT REGARDING REPLACEMENT

OF ANCILLARY HEALTH INSURANCE

According to [your application] [information you have furnished] you intend to lapse or otherwise terminate existing ancillary health insurance and replace it with the policy delivered herewith issued by [insert company name] Insurance Company. At any time within 30 days after your receipt of your new policy, you may decide, without cost, whether you desire to keep the policy. For your own information and protection you should be aware of and seriously consider certain factors that may affect the insurance protection available to you under the new policy.

(1) Health conditions that you may presently have, such as preexisting conditions, may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.

(3) [To be included only if the application is attached to the policy.] If, after due consideration, you still wish to terminate your present policy and replace it with new coverage, read the copy of the application attached to your new policy and be sure that all questions are answered fully and correctly. Omissions or misstatements in the application could cause an otherwise valid claim to be denied. Carefully check the application and write to [insert company name and address] within 10 days if any information is not correct and complete, or if any past medical history has been left out of the application.

[COMPANY NAME]

Source. (See Revision Note #2 at chapter heading for Ins 6100) #12560, eff 6-25-18

Ins 6102.03 Waiver of Rules.

(a) The commissioner, upon the commissioner’s own initiative or upon request by an insurer, shall waive any requirement of this part if such waiver does not contradict the objective or intent of the rule and:

(1) Applying the rule provision would cause confusion or would be misleading to consumers;

(2) The rule provision is in whole or in part inapplicable to the given circumstances;

(3) There are specific circumstances unique to the situation such that strict compliance with the rule would be onerous without promoting the objective or intent of the rule provision; or

(4) Any other similar extenuating circumstances exist such that application of an alternative standard or procedure better promotes the objective or intent of the rule provision.

(b) No requirement prescribed by statute shall be waived unless expressly authorized by law.

(d) A request for a waiver shall specify the basis for the waiver and proposed alternative, if any.

Source. (See Revision Note #2 at chapter heading for Ins 6100) #12560, eff 6-25-18

PART Ins 6103 DISCONTINUANCE OF INDIVIDUAL ANCILLARY HEALTH COVERAGE

Statutory Authority: RSA 400-A:15, I; RSA 415:6, VII; RSA 415-A:2, I

Ins 6103.01 Applicability and Scope. This part shall be applicable to all ancillary health insurance policies issued or provided by a carrier on an individual basis, except dental and vision expense policies.

Source. #12630, eff 9-28-18

Ins 6103.02 Definitions.

(a) “Block of business” means the total number of policies written by one insurance company using the same policy forms.

Source. #12630, eff 9-28-18

Ins 6103.03 Requirements for Discontinuance of Individual Ancillary Health Coverage.

(a) In order to discontinue a block of business, the insurer shall make such request in writing and through the System for Electronic Rate and Form Filings (SERFF) at https://www.serff.com/ to the commissioner 60 days prior to the date of discontinuance and include in such request:

(1) The number of New Hampshire policies currently in force;

(2) The total number of covered lives;

(3) The total annual premium of the policies in force;

(4) An explanation of the classification of risk involved therein to indicate that such classification is reasonable and nondiscriminatory; and

(5) Statistical data sufficient to indicate that the cancellation or nonrenewal requested is reasonable and nondiscriminatory.

(b) Where the insurer reserves the right to cancel, the provisions of RSA 415:6, II(8) shall be delineated in the policy.

Source. #12630, eff 9-28-18

Ins 6103.04 Notification requirements.

(a) Notice shall be provided to policyholders at least 30 days prior to the date of discontinuance and include:

(1) The policy number and coverage type;

(2) The date of discontinuance of such policy; and

(3) Company contact information, including a toll-free telephone number.

Source. #12630, eff 9-28-18

Ins 6103.05 Waiver of Rules.

(1) Applying the rule provision would cause confusion or would be misleading to consumers;

(2) The rule provision is in whole or in part inapplicable to the given circumstances;

(3) There are specific circumstances unique to the situation such that strict compliance with the rule would be onerous without promoting the objective or intent of the rule provision; or

(4) Any other similar extenuating circumstances exist such that application of an alternative standard or procedure better promotes the objective or intent of the rule provision.

(b) No requirement prescribed by statute shall be waived unless expressly authorized by law.

(d) A request for a waiver shall specify the basis for the waiver and proposed alternative, if any.

Source. #12630, eff 9-28-18

APPENDIX

Rule	Specific State Statute the Rule Implements

Ins 6101.01	RSA 400-A:15, I; RSA 415:18, I; RSA 415-A:2, I
Ins 6101.02	RSA 400-A:15, I; RSA 415:18; RSA 415-A:2, I
Ins 6101.03	RSA 400-A:15, I; RSA 415:18; RSA 415-A:2, I
Ins 6101.04	RSA 400-A:15, I; RSA 415:18; RSA 415-A:2, I
Ins 6101.05	RSA 400-A:15, I; RSA 415:18; RSA 415-A:2, I

Ins 6102.01	RSA 400-A:15, I; RSA 415-A:2, I
Ins 6102.02	RSA 400-A:15, I; RSA 415-A:2, I(l)
Ins 6102.03	RSA 400-A:15, I; RSA 541-A:22, IV

Ins 6103.01	RSA 400-A:15, I; RSA 415-A:2, I
Ins 6103.02	RSA 400-A:15, I; RSA 415:6
Ins 6103.03	RSA 400-A:15, I; RSA 415:6
Ins 6103.04	RSA 400-A:15, I; RSA 415:6
Ins 6103.05	RSA 400-A:15, I; RSA 541-A:22, IV