N.H. Code Admin. R. Ins 1902.05 - Prohibited Policy Provisions

(a) No medicare supplement policy shall limit or exclude coverage by type of illness, accident, treatment, or medical condition, except as follows:

(1) Foot care in connection with corns, calluses, flat feet, fallen arches, weak feet, chronic foot strain, or symptomatic complaints of the feet;

(2) Alcoholism, drug addiction, and mental or emotional disorders except as provided in RSA 415:18-a; RSA 419:5-a; and RSA 420:5-a;

(3) Illness, treatment, or medical condition arising out of:

a. War or act of war, whether declared or undeclared;

b. Participation in a felony, riot or insurrection;

c. Service in the armed forces or units auxiliary thereto;

d. Suicide, sane or insane, attempted suicide or intentionally self-inflicted injury;

e. Aviation;

(4) Cosmetic surgery, except that "cosmetic surgery" shall not include reconstructive surgery when such service is incidental to or follows surgery resulting from trauma, infection, other diseases or disorders of the involved part;

(5) Care in connection with the detection and correction by manual or mechanical means of structural imbalance, distortion, or subluxation in the human body for purposes of removing nerve interference and the effects thereof, where such interference is the result of or related to distortion, misalignment or subluxation of, or in the vertebral column;

(6) Treatment provided in a governmental hospital, benefits provided under governmental program, except Medicaid, any state or federal workers' compensation, employers' liability or occupational disease law or any motor vehicle no-fault law, services rendered by employees of hospitals, laboratories or other institutions, services performed by a member of the covered person's immediate family and services for which no charge is normally made in the absence of insurance;

(7) Dental care or treatment;

(8) Eyeglasses, hearing aids, and examinations for the prescription or fitting thereof;

(9) Rest cures, custodial care, transportation, and routine physical examinations; or

(10) Territorial limitations outside the United States provided, however, medicare supplement policies may not contain, when issued, limitations or exclusions of the type enumerated in this paragraph that are more restrictive than those of medicare. Medicare supplement policies may exclude coverage for any expense to the extent of any benefit available to the insured under medicare.

(b) No medicare supplement policy may use waivers to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.

(c) No medicare supplement policy shall include terms which provide that the policy may be cancelled or nonrenewed by the insurer solely on the grounds of deteriorated health.

(d) The terms "medicare supplement," "medigap", and words of similar import shall not be used unless the policy is issued in compliance with this part.

(e) No medicare supplement insurance policy, contract, or certificate in force in this state shall contain benefits which duplicate benefits provided by medicare.

Notes

N.H. Code Admin. R. Ins 1902.05

#1900, eff 1-1-82; ss by #4287, eff 7-1-87; ss by #5119, eff 4-25-91; amd by #5421, eff 7-1-92; ss by #5656, eff 7-1-93; ss by #7017, INTERIM, eff 7-1-99, EXPIRED: 10-29-99

New. #8555, eff 2-1-06

Amended by Volume XXXVI Number 06, Filed February 11, 2016, Proposed by #11014, Effective 1/8/2016, Expires 1/8/2026.