sb 0041

CHAPTER 276

SB 41 - FINAL VERSION

AN ACT relative to technical corrections for life, accident and health insurance.

SPONSORS: Sen. Wheeler, Dist 21; Rep. Francoeur, Rock 22

This bill makes certain technical corrections to the laws regarding life, accident and health insurance.

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Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

AN ACT relative to technical corrections for life, accident and health insurance.

Be it Enacted by the Senate and House of Representatives in General Court convened:

276:1 Extension of Coverage. Amend RSA 415:18, VII(g)(1)(C) (iii) - (v) to read as follows:

(iii) the covered employee's becoming entitled to benefits under Title XVIII of the Social Security Act or the covered employee's becoming entitled to benefits under Title XVIII of the Social Security Act within the 18-month continuation in subparagraph (g)(1)(A); or

(~~v) coverage reduction or termination that takes place within one year of the date the employer files for protection under the bankruptcy provisions of Title 11 of the United States Code~~].

276:2 Group Health Insurance; Certain Retirees and Dependents. Amend RSA 415:18, VII(g)(1)(E) and (F) to read as follows:

(E) 36 months, for retirees and dependents who have a substantial loss of coverage within one year of the employer filing for protection under the bankruptcy provisions of Title 11 of the United States Code.

(i) the first day of the month following the date the individual becomes eligible for benefits under another group plan;

(ii) the date of the first medicare open enrollment period following the date the individual became ineligible for continued participation under the group plan;

(iii) the date on which the group plan terminates subject to RSA 415:18, VII(g)(4); or

(iv) the date on which coverage ceases because of a failure to make timely payment of premium as required; however, the payment of any premium shall be considered to be timely if made within 30 days after the date due or within such longer period as applies to the plan.

[~~(F)~~] (G) The individual, surviving spouse, divorced spouse, legally separated spouse, or dependent shall elect to continue the participation in the group plan according to rules adopted by the commissioner under RSA 541-A. The individual, surviving spouse, or dependent shall be responsible for payment of premiums which may include an administrative fee not to exceed 2 percent of the monthly premium to the employer or policyholder throughout the extension period. Any divorced spouse or legally separated spouse who is responsible for making a portion of or full payment to the employer shall notify the employer and the insurance company, in writing within 30 days of the decree of divorce or separation, that coverage under this subparagraph is requested. Any employee who is responsible for making a portion of or full payment to the employer shall likewise notify the employer and the insurance company, in writing within 30 days of the decree of divorce or separation, that coverage under this subparagraph is requested. The employer shall have the right to terminate coverage for a former dependent spouse who is receiving coverage under this subparagraph if any payment for the coverage is not received from the former dependent spouse within 30 days of the date the premium payments are due. If any payment for the coverage for which the employee is responsible is not received from the employee within 30 days of the date the premium payments are due, the employer shall have the right to terminate coverage for a former dependent spouse; however, no such termination shall occur without 30 days' prior notice to the former dependent spouse, during which time the former dependent spouse shall be given an opportunity to make the payments due or to secure payment from the employee. Upon termination of the extension period, the member, surviving spouse, divorced spouse, legally separated spouse, or dependent shall be entitled to exercise any option which is provided in the group plan to elect a converted policy. After timely receipt of the premium payment from the individual, surviving spouse, divorced spouse, legally separated spouse, or dependent, if the employer fails to make payments to the insurer or health service corporation or health maintenance organization, with the result that coverage is terminated, the employer shall be liable for benefits to the same extent as the insurer or health service corporation or health maintenance organization would have been liable if coverage had not been terminated.

276:3 Coverage for Scalp Hair Prostheses. Amend RSA 415:18-d, I to read as follows:

I. Each insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses and which also provides coverage for other prostheses, shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state and whose principal place of employment is in this state, coverage for expenses for scalp hair prostheses worn for hair loss suffered as a result of alopecia areata, alopecia totalis, alopecia medicamentosa resulting from the treatment from any form of cancer or leukemia, or permanent loss of scalp hair due to injury. Such coverage, however, shall be subject to a written recommendation by the treating physician stating that the hair prosthesis is a medical necessity. Such coverage shall be subject to the same limitations and guidelines as other prostheses, provided, that such coverage for alopecia medicamentosa shall not exceed $350 per year.

276:4 Coverage for Scalp Hair Prostheses. Amend RSA 420-A:14, I to read as follows:

I. Every health service corporation and every other similar corporation licensed under the laws of another state, which provides coverage for other prostheses, shall provide to each group, or to the portion of each group comprised of certificate holders of such insurance who are residents of this state and whose principal place of employment is in this state, coverage for expenses for scalp hair prostheses worn for hair loss suffered as a result of alopecia areata, alopecia totalis, alopecia medicamentosa resulting from the treatment from any form of cancer or leukemia, or permanent loss of scalp hair due to injury. Such coverage, however, shall be subject to a written recommendation by the treating physician stating that the hair prosthesis is a medical necessity. Such coverage shall be subject to the same limitations and guidelines as other prostheses, provided, that such coverage for alopecia medicamentosa shall not exceed $350 per year.

276:5 Benefits for Scalp Hair Prostheses. Amend RSA 420-B:8-f, I to read as follows:

I. Benefits for scalp hair prostheses shall conform to the requirements of RSA [~~415:18-c~~] 415:18-d. Such benefits shall not be subject to any greater deductible than any other prostheses benefits provided by the health maintenance organization. The coinsurance required by the enrolled participant shall not exceed the amount allowed under the contract for the reasonable and customary charge for the services provided. Such coverage, however, shall be subject to a written recommendation by the treating physician stating that the hair prosthesis is a medical necessity. Such coverage shall be subject to the same limitations and guidelines as other prostheses.