[RSA 415:18-ff effective until Jan. 1, 2028; see also RSA 415:18-ff set out below.]
415:18-ff Coverage for Prosthetic Devices for Children. –
Each insurer that issues or renews a policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses shall provide coverage for prosthetic devices, including activity-specific prosthetic devices, for children under 19 years of age, who are residents of this state and covered by such insurance. The insurer may limit coverage for activity-specific prosthetic devices to one activity-specific prosthetic device per plan year. Medically necessary prosthetic devices shall not be subject to any annual limits. Coverage under this section shall be subject to such other terms and conditions of the policy that may apply.
I. Covered benefits shall include:
(a) All materials and components necessary to use the device;
(b) Instruction to the enrollee on using the device; and
(c) The repair or replacement of a prosthetic device that is determined medically necessary or is necessary for maximizing the enrollee's ability to engage in the specific activity.
II. In this section:
(a) "Prosthetic" means an artificial substitute for a body part for functional or therapeutic purposes.
(b) "Activity-specific prosthetic device" means a prosthetic device designed to allow an individual to participate in a specific activity that could damage the residual limb or everyday prosthesis, or when the everyday prosthesis would not function effectively to perform that specified activity.
III. This section shall not apply to plans available through the Small Business Health Options Program (SHOP).
[RSA 415:18-ff effective Jan. 1, 2028; see also RSA 415:18-ff above.]
415:18-ff Coverage for Prosthetic Devices. –
I. Each insurer that issues or renews a policy of group health insurance providing benefits for medical or hospital expenses shall provide coverage for prosthetic devices, including activity-specific prosthetic devices, for children under 19 years of age, who are residents of this state and covered by such insurance. The insurer may limit coverage for activity-specific prosthetic devices to one activity-specific prosthetic device per plan year. Medically necessary prosthetic devices shall not be subject to any annual limits. Coverage under this section shall be subject to such other terms and conditions of the policy that may apply.
II. Each insurer that issues or renews a policy of group health insurance providing benefits for medical or hospital expenses shall provide coverage for prosthetic devices, including activity-specific prosthetic devices, for individuals over 19 years of age who are residents of this state and covered by such insurance. The insurer may limit coverage for activity-specific prosthetic devices to one activity-specific prosthetic device every 5 years and may apply utilization management, including limiting or excluding coverage if the covered person has received an activity-specific device in the last 5 years. Medically necessary prosthetic devices shall not be subject to any annual limits. Coverage under this section shall be subject to such other terms and conditions of the policy that may apply, including any applicable cost sharing. This section shall also apply to the state of New Hampshire's employee health benefit plan under RSA 21-I.
III. Covered benefits shall include:
(a) All materials and components necessary to use the device;
(b) Instruction to the enrollee on using the device; and
(c) The repair or replacement of a prosthetic device that is determined medically necessary or is necessary for maximizing the enrollee's ability to engage in the specific activity.
IV. In this section:
(a) "Prosthetic" means an artificial substitute for a body part for functional or therapeutic purposes.
(b) "Activity-specific prosthetic device" means a prosthetic device designed to allow an individual to participate in a specific activity that could damage the residual limb or everyday prosthesis, or when the everyday prosthesis would not function effectively to perform that specified activity.
V. This section shall not apply to plans available through the Small Business Health Options Program (SHOP).