N.H. Code Admin. R. Ins 6201.05 - Required Disclosure Provisions

The following disclosure provisions shall apply to all ancillary health policies and certificates which are subject to Ins 6201:

(a) All policies and certificates of ancillary health insurance, except for disability income protection, shall contain the following statement:

"This policy does not provide comprehensive health insurance coverage. It is not intended to satisfy the individual mandate of the Affordable Care Act (ACA) or provide the minimum essential coverage required by the ACA (often referred to as "Major Medical Coverage"). It does not provide coverage for hospital, medical, surgical, or major medical expenses.";

(b) All applications for coverages specified in RSA 415-A:3, I(d), (h), (i), (j), and (k) shall contain a prominent statement by type, stamp, or other appropriate means in either contrasting color or in boldface type at least equal to the size type used for the headings or captions of sections of the application and in close conjunction with the applicant's signature block on the application as follows:

"This [policy] [certificate] provides limited benefits. Review your [policy] [certificate] carefully.";

(c) All applications for dental plans shall contain a prominent statement by type, stamp, or other appropriate means in either contrasting color or in boldface type at least equal to the size type used for the headings or captions of sections of the application and in close conjunction with the applicant's signature block on the application as follows:

"This [policy] [certificate] provides dental benefits only. Review your [policy] [certificate] carefully.";

(d) All applications for vision plans shall contain a prominent statement by type, stamp, or other appropriate means in either contrasting color or in boldface type at least equal to the size type used for the headings or captions of sections of the application and in close conjunction with the applicant's signature block on the application as follows:

"This [policy] [certificate] provides vision benefits only. Review your [policy] [certificate] carefully.";

(e) Except for amendments or riders by which the insurer effectuates a request made in writing by the policyholder or exercises a specifically reserved right under the policy, all amendments or riders added to a policy after the date of issue, or at reinstatement or renewal, that reduce or eliminate benefits or coverage in the policy shall require signed acceptance by the policyholder. After the date of policy issue, any amendment or rider that increases benefits or coverage with a concomitant increase in premium during the policy term shall be agreed to in writing signed by the policyholder, unless the increased benefits or coverage is required by law. The signature requirements in this paragraph apply to group ancillary health insurance certificates only where the certificateholder also pays the insurance premiums;
(f) Where a separate additional premium is charged for benefits provided in connection with amendments or riders, the premium charge shall be set forth in the policy;
(g) A policy or certificate that provides for the payment of benefits based on standards described as "usual and customary", "reasonable and customary", or words of similar import shall include a definition of the terms and an explanation of the terms in its accompanying outline of coverage;
(h) If a policy or certificate contains any limitations with respect to preexisting conditions, the limitations shall appear as a separate paragraph of the policy or certificate and be labeled as "Preexisting Condition Limitations";
(i) All accident-only policies and certificates shall contain a prominent statement on the cover page of the policy or certificate, in either contrasting color or in boldface type at least equal to the size of type used for headings or captions of sections in the policy or certificate, a prominent statement as follows:

"Notice to Buyer: This is an accident-only [policy] [certificate] and it does not pay benefits for loss from sickness. Review your [policy] [certificate] carefully.";

(j) Accident-only policies and certificates that provide coverage for hospital or medical care shall contain the following statement on the cover page, in addition to the Notice to Buyer in (i) above:

"This [policy] [certificate] provides limited benefits. Benefits provided are not intended to cover all medical expenses.";

(k) All policies and certificates, except single-premium nonrenewable policies and as otherwise provided in this section, shall have a notice prominently printed on the cover page of the policy or certificate stating in substance that the policyholder or certificate holder shall have the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the policyholder or certificate holder is not satisfied for any reason;
(l) If age is to be used as a determining factor for reducing the maximum aggregate benefits made available in the policy or certificate as originally issued, that fact shall be prominently set forth in the outline of coverage;
(m) If a policy or certificate contains a conversion privilege, it shall comply, in substance, with the following:
(1) The caption of the provision shall be "Conversion Privilege" or words of similar import;
(2) The provision shall indicate the persons eligible for conversion, the circumstances applicable to the conversion privilege, including any limitations on the conversion, and the person by whom the conversion privilege may be exercised; and
(3) The provision shall specify the benefits to be provided on conversion or shall state that the converted coverage shall be as provided on a policy form then being used by the insurer for that purpose;
(n) Insurers, except direct response insurers, shall give a person applying for cancer insurance the National Association of Insurance Commissioners' (NAIC) "A Shopper's Guide to Cancer Insurance" (2006), available as referenced in Appendix B, at the time of application enrollment and shall obtain all recipients' written acknowledgement of the guide's delivery. Direct response insurers shall provide the NAIC's "A Shopper's Guide to Cancer Insurance" upon request but not later than the time that the policy or certificate is delivered;
(o) All specified disease policies and certificates shall contain on the cover page in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the policy orcertificate, a prominent statement as follows:

"Notice to Buyer: This is a specified disease [policy] [certificate]. This [policy] [certificate] provides limited benefits. Benefits provided are supplemental and are not intended to cover all medical expenses. Read your [policy] [certificate] carefully with the outline of coverage and the Buyer's Guide.";

(p) Hospital confinement indemnity and other indemnity policies:
(1) All hospital confinement indemnity policies and certificates shall display prominently by type, stamp, or other appropriate means on the cover page of the policy or certificate, in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the policy or certificate the following:

"Notice to Buyer: This is a hospital confinement indemnity [policy] [certificate]. This [policy] [certificate] provides limited benefits. Benefits provided are supplemental and are not intended to cover all medical expenses."; and

(2) In addition to the "Notice to Buyer" required by (1) above, all "hospital confinement indemnity" and "other indemnity" policies sold in the individual market shall display prominently on the cover page in at least 14 point type the following language:

"THIS IS A SUPPLEMENT TO HEALTH INSURANCE AND IS NOT A SUBSTITUTE FOR MAJOR MEDICAL COVERAGE.";

(q) Unless a specific disclosure for the coverage type is provided as described in paragraphs (i), (j), (o), and (p) above, an ancillary health policy or certificate shall display prominently by type, stamp, or other appropriate means on the cover page of the policy or certificate, in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the policy or certificate the following:

"Notice to Buyer: This is an ancillary health [policy] [certificate]. This [policy] [certificate] provides limited benefits. Benefits provided are supplemental and are not intended to cover all medical expenses.";

(r) All dental plan policies and certificates shall display prominently by type, stamp, or other appropriate means on the cover page of the policy or certificate, in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the policy or certificate the following:

"Notice to Buyer: This [policy] [certificate] provides dental benefits only.";

(s) All vision plan policies and certificates shall display prominently by type, stamp, or other appropriate means on the cover page of the policy or certificate, in either contrasting color or in boldface type at least equal to the size type used for headings or captions of sections in the policy or certificate the following:

"Notice to Buyer: This [policy] [certificate] provides vision benefits only."; and

(t) Any policy or certificate that contains exclusions, limitations, reductions, or conditions of such a restrictive nature that the payment of benefits under such policies is limited in frequency or in amounts shall carry the legend "This is a Limited Benefit Policy - Read it Carefully" imprinted across the face and filing back, if any, of the policy, in not less than 18-point outline type of contrasting color, not less than 24-point outline type of non-contrasting color diagonally, or not less than 24-point bold within a black border.

Notes

N.H. Code Admin. R. Ins 6201.05
Derived From Volume XXXVIII Number 32, Filed August 9, 2018, Proposed by #12600, Effective 8/3/2018, Expires 8/3/2028. Amended by Volume XL Number 50, Filed December 10, 2020, Proposed by #13137, Effective 11/24/2020, Expires 11/24/2030.

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