N.H. Admin. Code § Ins 4103.03 - Definitions

For the purposes of this part:

(a) "Actuarial certification" means a written statement signed by a member of the American Academy of Actuaries;

(b) "Actuarial memorandum" means the document describing the basis on which rates were determined and that includes other supporting documentation as required;

(c) "Anticipated loss ratio" means the calculation of the medical loss ratio over the 12 month period that begins on the rate effective date;

(d) "Case characteristics" means demographic or other relevant characteristics of a small employer that are considered by the small employer carrier in the determination of premium rates for the small employer;

(e) "Earned premium" means premium revenue pursuant to 45 CFR Part 158.130;

(f) "Earned premium adjustments" means federal and state taxes and licensing and regulatory fees pursuant to 45 CFR Part 158.161(a) and 158.162(a)(1) and (b)(1);

(g) "Eligible employee" means any employee who is eligible for the employer's sponsored health benefit plan and who regularly works at least 15 hours per week, or at least half the weekly hours full-time employees work, whichever is greater. The term includes a sole proprietor, a partner of a partnership, and an independent contractor, if these individuals are included as employees under the small employer's health benefit plan;

(h) "Employee" means employee under Section 3(6) of Title I of the Employee Retirement Income Security Act of 1974 (ERISA);

(i) "Enrolled employee" means an eligible employee who has elected coverage in the employer's sponsored health benefit plan;

(j) "Health coverage" means "health coverage" as defined in RSA 420-G:2, IX;

(k) "Incurred claims" means reimbursements for clinical services provided to enrollees, pursuant to 45 CFR Part 158.140;

(l) "List bill" means a method for computing premium rates that are based on each enrolled employee's attained age;

(m) "Medical loss ratio" means "medical loss ratio" as defined in 45 CFR Part 158.221(a);

(n) "Member" means "covered person" as defined in Ins 4101.04(c);

(o) "Premium" means the total amount due from a small employer policyholder to a small employer carrier for the provision of health coverage;

(p) "Premium rate" means an amount per covered person or an amount per enrolled employee used to calculate premium;

(q) "Quality improvement expenses" means amounts expended for activities that improve health care quality pursuant to 45 CFR 158.150 and 45 CFR 158.151;

(r) "Small employer" means any person, firm, corporation, partnership or group of affiliated companies that are eligible to file a combined tax return and that is actively engaged in business that, on at least 50 percent of the working days during the preceding calendar year, employed at least one employee and no more than 50 eligible employees, the majority of whom are employed within this state;

(s) "Small employer carrier" means a carrier that offers health insurance to one or more small employers in this state;

(t) "Small employer health insurance plan" means all policies or plans sold or marketed by a carrier that meet the definition of health coverage under RSA 420-G:2, IX;

(u) "Subscriber" means an enrolled employee as defined in (i) above;

(v) "Tier" means a category of enrollment to which enrolled employees can elect coverage, and includes at a minimum, "single employee," "couple," and "family" tiers.

Notes

N.H. Admin. Code § Ins 4103.03

#9690, eff 4-9-10; ss by #9938, eff 6-10-11; ss by #10212, eff 11-1-12

The amended version of this section by New Hampshire Register Volume 39, Number 24, eff.6/10/2019 is not yet available.