N.H. Admin. Code § Ins 4005.02 - Exclusions from Filing Requirements
(a) Carriers
and third-party administrators shall not be required to submit health care
claims data files, Health Care Effectiveness Data and Information Set
(HEDIS®) data, or Consumer Assessment of Health Plans Survey (CAHPS) survey
data if they meet the following criteria:
(1)
For carriers that do not offer any products on the health insurance exchange
for residents of New Hampshire and that did not cover more than 9,999 members
in New Hampshire at any point in any medical, pharmacy, or dental coverage
class during the prior calendar year; or
(2) For third-party administrators that did
not cover more than 9,999 members in New Hampshire at any point in any medical,
pharmacy, or dental coverage class during the prior calendar
year.
(b) Carriers and
third-party administrators shall perform the calculation for (a) above at the
entity level, meaning the level at which major governance decisions are made
under a senior leadership team, regardless of the number of companies operating
under separate corporate divisions. Carriers or third-party administrators
experiencing a drop in membership below the de minimis threshold shall submit
claims data and any corrections to membership files for a period of 180 days
from the point the carrier or third-party administrator meets the de minimis
exemption.
(c) Carriers and
third-party administrators shall not be required to submit health care claims
data about coverage that is not part of a comprehensive medical insurance
policy, including the following:
(1) Specific
disease;
(2) Accident;
(3) Injury;
(4) Hospital indemnity;
(5) Disability;
(6) Long-term care;
(7) Vision coverage;
(8) Durable medical equipment; or
(9) Blanket health insurance.
Notes
#8279, eff 2-3-05; ss by #9500, eff 7-6-09
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