04/03/03 0992s

5jun03... 1707h

2003 SESSION

03-0603

01/09

SENATE BILL 21

COMMITTEE: Insurance

ANALYSIS

This bill authorizes insurers to place health insurance riders on individual policies if certain conditions are met.

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Explanation: Matter added to current law appears in bold italics.

Matter removed from current law appears [in brackets and struckthrough.]

Matter which is either (a) all new or (b) repealed and reenacted appears in regular type.

04/03/03 0992s

5jun03... 1707h

03-0603

01/09

STATE OF NEW HAMPSHIRE

In the Year of Our Lord Two Thousand Three

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

201:1 Medical Underwriting; Individual Policies. Amend RSA 420-G:5, II to read as follows:

II. Health carriers providing health coverage for individuals may perform medical underwriting, including the use of individual health statements or screenings or the use of prior individual claims history, to the extent necessary to establish or modify premium rates, only as provided in RSA 420-G:4. Such underwriting may be limited to the use of a standardized health statement for use in adjustments to rating pursuant to RSA 420-G:4. The commissioner may, by rule, require carriers to use a standardized health statement. Health carriers providing health coverage for individuals may issue policies containing riders or endorsements that exclude coverage for a specified condition that existed prior to the issuance of coverage and complications that arise from the specified condition if all of the following standards are met:

(a) The coverage exclusion shall be for a specific medical condition and complications arising from the condition.

(b) The coverage exclusion shall not apply to any other medical condition not related directly to the specific medical condition being excluded.

(c) The health carrier shall provide to the applicant before issuance of the policy a written notice explaining the coverage exclusion for the specified condition and complications arising from the condition.

(d) The health carrier's offer of coverage and policy shall clearly indicate in bold print as a separate section of the policy or on a separate form that the applicant is being offered coverage with a coverage exclusion and specifying the excluded medical condition and related complications that will be considered as arising from the excluded condition.

(e) The health carrier's offer of coverage and policy shall not include riders or endorsements that exclude coverage for more than 2 specified conditions.

(f) The health carrier shall notify the applicant that it will review the underwriting basis for the coverage exclusion upon request one time per year, and remove the coverage exclusion, no later than the next policy renewal date, if the health carrier determines that evidence of insurability is satisfactory.

(g) The health carrier shall notify the applicant in writing that the applicant may decline the offer of coverage with a coverage exclusion and obtain coverage through the New Hampshire health insurance high risk pool, under RSA 404-G.

(h) The coverage exclusion period shall be concurrent with any other applicable preexisting condition limitation or exclusion period.

(i) The health carrier shall provide to covered persons who may be subject to coverage exclusions a means by which coverage for specific services can be verified in advance.

(j) Riders or endorsements containing coverage exclusions shall not apply to services, benefits, or options required by state or federal law to be included in the coverage.

(k) Any rider or endorsement used to reduce or deny payment for coverage otherwise included in the policy, shall include the name or specific description of the sickness or physical condition that is to be reduced or denied.

201:2 Medical Underwriting; Exception Added. Amend RSA 420-G:5, III(b) to read as follows:

(b) Except as provided in RSA 420-G:5, II, offer riders or endorsements to exclude certain illnesses or health conditions in order to avoid the purpose of this chapter.

201:3 High Risk Pool Eligibility. Amend RSA 404-G:5-e, I(c) and (d) to read as follows:

(c) The individual has a history of any medical or health condition that is on a list adopted by the association; [or]

(d) The individual is an "eligible individual" as defined in section 2741(b) of the Public Health Service Act[.]; or

(e) The individual has received an offer of coverage from a carrier of individual health insurance that contains a rider or endorsement excluding coverage for a specified condition pursuant to RSA 420-G:5, II.

201:4 Effective Date. This act shall take effect 60 days after its passage.

(Approved: June 30, 2003)

(Effective Date: August 29, 2003)