N.H. Code Admin. R. Ins 1907.03 - Prohibited Discrimination in Rules for Eligibility

(a) A carrier subject to this chapter shall not establish a rule for eligibility, including continued eligibility, of an individual to enroll for benefits under the plan that discriminates based on any health factor that relates to the individual or dependent of the individual.

(b) For purposes of this section, rules of eligibility includes rules relating to:

(1) Enrollment;

(2) The effective date of coverage;

(3) Waiting or affiliation periods;

(4) Late and special enrollment;

(5) Eligibility for benefit packages, including rules for individuals to change their selection among benefit packages;

(6) Benefits, including rules relating to covered benefits, benefit restrictions, and cost-sharing mechanisms, such as coinsurance, copayments and deductibles as described in Ins 1907.05(a) and (b) of this chapter;

(7) Continued eligibility; and

(8) Terminating coverage, including disenrollment, of an individual under the plan.

(c) Nothing in this section prohibits a carrier subject to this chapter from:

(1) Establishing more favorable rules of eligibility for individuals with an adverse health factor, such as disability, than for individuals without the adverse health factor; or

(2) Subject to state law, charging a higher premium or contribution with respect to an individual with an adverse health factor if the individual would not be eligible for coverage, but for the adverse health factor.

Notes

N.H. Code Admin. R. Ins 1907.03

#8607, eff 4-17-06