N.H. Code Admin. R. Ins 1906.05 - Extension of Benefits

(a) Every group policy, contract or certificate subject to this rule issued on or after the effective date of this rule, or under which the level of benefits is altered, modified or amended on or after the effective date of this rule, shall provide a reasonable provision for extension of benefits in the event of total disability at the date of discontinuance of the group policy, contract or certificate as required by the following paragraphs of this section.

(b) In the case of a group life plan that contains a disability benefit extension of any type (e.g., premium waiver extension, extended death benefit in event of total disability, or payment of income for a specified period during total disability), the discontinuance of the group policy, contract or certificate shall not operate to terminate the extension.

(c) In the case of a group plan providing benefits for loss of time from work or specific indemnity during hospital confinement, discontinuance of the group policy, contract or certificate during a disability shall have no effect on benefits payable for that disability or confinement;

(d) In the case of hospital or medical expense coverages other than dental and maternity expense, a reasonable extension of benefits or accrued liability provision is required.

(1) An extension of benefits or accrued liability provision will be considered "reasonable" if:

a. It provides an extension of at least 12 months under "major medical" and "comprehensive medical" type coverages; and

b. Under other types of hospital and medical expense coverages, it provides:

1. An extension of at least 90 days; or

2. An accrued liability for expenses incurred during a period of disability or during a period of at least 90 days starting with a specific event that occurred while coverage was in force, e.g., an accident;

(e) An applicable extension of benefits or accrued liability shall be described in any policy or contract involved as well as in group insurance certificates as follows:

(1) The benefits payable during any period of extension of benefits or accrued liability may be subject to the policy's, contract's or certificate's regular benefit limits, such as benefits ceasing at exhaustion of a benefit period or of maximum benefits.

(2) The benefit payments for hospital or medical expense coverages may be limited to payments applicable to the disability condition only.

Notes

N.H. Code Admin. R. Ins 1906.05

#8646, eff 6-12-06