State and Territory Updates

New Hampshire

November 08, 2022

NH PFML Website Launched

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New Hampshire’s Paid Family and Medical Leave (NH PFML) program will be available beginning January 1, 2023. Open enrollment for employer plans begins on December 1, 2022, and open enrollment for individuals runs from January 1, 2023, through March 2, 2023. NH PFML provides 60% wage replacement (up to the Social Security wage cap) for either six or twelve weeks per year for absences related to the following life events:

  • A worker’s own serious health condition when disability coverage does not apply, including childbirth
  • For a worker to bond with a child during the first year of birth, including placement for adoption or fostering
  • For a worker to care for a family member with a serious health condition
  • Any qualifying urgent demand or need arising out of the fact that the worker’s spouse, child or parent is a covered military member on covered active duty
  • For a worker to care for a covered service member with a serious injury or illness if the eligible worker is the service member’s spouse, child, parent or next of kin

An unpaid period of up to seven days must be exhausted once per benefit period, after which a claim may be paid. Leave can be taken all at once or in partial days in a minimum of four-hour increments.

The program is voluntary for private employers, but New Hampshire employees may still purchase a NH PFML individual plan if their employer does not offer an equivalent plan. Employers who choose to participate qualify for a Business Enterprise Tax (BET) credit equal to 50% of their NH PFML insurance premium payments on the six-week plan.

Nonparticipating large employers (50 or more employees) must still collect premium payments through payroll deductions for any employees who have elected individual NH PFML coverage. All employers must assist with the claims process for any employees who have elected individual coverage. The state has launched a website to provide employers guidance with the NH PFML program, available at Employer Responsibilities | NH Paid Family Medical Leave and Employers | NH Paid Family Medical Leave.

Employers with employees in New Hampshire should review the new guidance. The state is also developing an Employer Toolkit said to be available soon.

October 26, 2021

Open Enrollment in the Individual Market Extended

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On October 18, 2021, the Insurance Department issued INS 21-097-AB, providing that health insurers selling off-exchange plans in the individual market must allow individuals to purchase health insurance coverage during the annual open enrollment period aligned with the federal exchange between November 1, 2021, and January 15, 2022.

As background, CMS announced in September 2021 that the enrollment period for plans offered on the federal exchange is extended by 30 days, running November 1, 2021, through January 15, 2022. Because of the extension provided for the federal exchange open enrollment window, insurers selling off-exchange individual plans must at minimum allow enrollment between November 1, 2021, and January 15, 2022, with flexibility to exceed the federal open enrollment period.

While this guidance does not impact employer-sponsored group health plans, employers should be aware of these developments.

INS 21-097-AB »

July 20, 2021

New Paid Leave Program Adopted

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On June 25, 2021, Gov. Sununu signed into law House Bill 2, a state budget bill that includes the Granite State Paid Family Leave Plan (among other matters). This new law requires paid family leave for state employees and provides a voluntary opt-in by both non-state employers and individual non-state employees. 

The program requires payroll deductions and certain employment protections, including health insurance coverage while on leave (among other protections). In addition, there is a tax credit provided to employers who opt-in to the program and the ability for individuals whose employers choose not to opt-in (or not required to participate) to participate through an individual pool.

As an overview, the benefit provides 60% wage replacement for up to six weeks per year. The qualifying reasons for leave appear to depend on whether the individual is a state employee, employed by an employer who chose to opt-in or an individual who chose to opt-in. As with many new laws, further guidance is anticipated for clarification. 

The effective date of this new law is July 1, 2021, with coverage required by January 1, 2023. Employers with employees in New Hampshire should be aware of these developments. 

House Bill 2 »

July 07, 2021

Coverage of Ultrasounds Required to Determine Gestational Age

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On July 1, 2021, the Insurance Department issued INS 21-042-AB explaining that insurers must cover all necessary medical examinations, imaging studies and tests required to determine gestational age. This includes coverage of ultrasounds for purposes of determining gestational age. 

As background, House Bill 2 was signed into law on June 25, 2021, and requires healthcare providers to use an ultrasound to determine the gestational age of a fetus (in addition to performing other medical examinations considered reasonably necessary to accurately determine gestational age), among other requirements. Because determining the gestational age of a fetus is included as routine prenatal care, it is a covered service. 

While this guidance applies to insurers, employers should be aware of these developments and confirm with carriers (as applicable) that ultrasounds for purposes of determining gestational age are a covered service.

INS 21-042-AB »
House Bill 2 »

May 25, 2021

Coordination of Group Health Benefits with Medicare

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On May 7, 2021, Insurance Commissioner Nicolopoulos issued Bulletin INS 21-028-AB which provides additional guidance to health carriers regarding the coordination of benefits (COB) with Medicare for group health plans.

New Hampshire law prohibits the use of a COB provision to reduce benefits provided under the plan when “a person is or could have been covered under another plan, except with respect to Part B of Medicare.” The Insurance Department interprets the state’s benchmark plan to permit an insurer to reduce group health plan benefits regarding Medicare Part B only. The bulletin further explains that a group health plan may only coordinate benefits with Medicare when Medicare is the primary payer according to federal rules.

While this bulletin is directed at health carriers, employers should be aware of this guidance.

INS 21-028-AB »

June 23, 2020

Gender Identity Discrimination Prohibited

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On June 8, 2020, the Insurance Department issued Bulletin INS 20-033-AB which explains that effective January 1, 2020, gender identity discrimination is prohibited.

As background, New Hampshire enacted HB 608 in the 2019 legislative session, which prohibits discrimination based on gender identity or sexual orientation. As such, gender identity is added to other protected classes (that also includes race, religion, color, national origin, age, sex and marital status). More specifically, HB 608 prohibits discrimination “on the basis of gender identity with respect to availability of any covered services, medications, supplies or durable medical equipment” in health insurance policies and contracts. As of January 1, 2020, insurers are prohibited from denying, excluding or otherwise limiting coverage for services deemed medically necessary, based on gender identity. Importantly, insurers should base coverage decisions on medical necessity rather than a person’s gender identity.

While the bulletin applies to insurers, employers should be aware that gender identity discrimination is prohibited and conform their policies are compliant with this guidance.

INS 20-033-AB »
HB 608 »

June 09, 2020

Expanding Access to COVID-19 Testing

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On May 21, 2020, Gov. Sununu issued Executive Order #47, expanding access to COVID-19 testing via licensed pharmacists in light of the continued COVID-19 public health emergency. More specifically, licensed pharmacists may initiate, order, administer and analyze COVID-19 tests if certain requirements are satisfied. This expanded access to COVID-19 testing via licensed pharmacists is effective until the state of emergency is terminated, or the order is rescinded, whichever occurs first.

While the order does not directly impact benefits administration, employers should be aware of these developments.

Executive Order #47 »

May 27, 2020

Employer Guidelines During COVID-19

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On May 1, 2020, Gov. Sununu issued Emergency Order #40 (extending a previous closure of non-essential businesses and stay-at-home order), which includes Exhibit B that provides guidelines in light of the COVID-19 public health crisis to New Hampshire employers who remain open (or who are reopening) and their employees. While the guidelines largely provide guidance on employment law matters – such as developing screening processes, allowing employees to telework as appropriate, updating illness policies – employers are reminded of the requirements under the FFCRA to provide paid sick leave as applicable. In addition, the guidelines include requirements for employees, such as practicing social distancing, staying home when ill and wearing a face mask (among other requirements).

New Hampshire employers should be aware of these guidelines and communicate with employees accordingly.

Emergency Order #40 Exhibit B »
Emergency Order #40 »

May 12, 2020

Additional Guidance on Health Coverage and COVID-19

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On April 24, 2020, Gov. Sununu issued Emergency Order #34, providing additional guidance on temporary requirements regarding health coverage related to COVID-19. Highlights include:

  • Requiring carriers and pharmacy benefit managers (PBMs) to remove signature requirements for in-person prescriptions receipts or in-home prescription deliveries (except where federal signature requirements exists).
  • Prohibiting carriers and PBMs from performing certain audits.
  • Requiring carriers to allow employers to continue group health plan coverage eligibility regardless of any “hours worked” provisions.

While the above impacts carriers and PBMs, employers should be aware of these updates.

Emergency Order #34 »

April 28, 2020

Additional Telehealth Guidance

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On April 8, 2020, the Insurance Department (NHID) released Bulletin 20-24-AB providing guidance to carriers and providers regarding Emergency Order #8 (see the Compliance Corner article from March 31, 2020, for more information on Emergency Order #8). More specifically, the bulletin highlights the following:

  • Emergency Order #8 allows providers to perform health care services through all means of telehealth. Further, the department requires coverage of telehealth services when covered under the policy and appropriate through telehealth.
  • First dollar coverage is required for services provided via telehealth related to COVID-19. In other words, no cost sharing is required for the COVID-19 test and the health care visit that results in being tested for COVID-19 when the patient meets the testing criteria. In addition, this requirement for no cost sharing includes all the services during the visit (regardless of test results).

While this guidance pertains to carriers and providers, employers should be aware of these updates.

Bulletin 20-24-AB »

April 28, 2020

Alternative Care Setting Services Covered as In-Network

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On April 9, 2020, Gov. Sununu issued Emergency Order #30 which establishes temporary requirements for health care provided in alternative care settings (ACS). Such settings include schools, auditoriums, convention centers, ambulatory surgical centers, nursing facilities or rehabilitation hospitals. Further, the order requires all insurers to treat all medically necessary, covered ACS services as in-network (and reimburse at the in-network rate) and explains that out-of-network providers who are reimbursed as in-network under this order are prohibited from balance billing the member.

Employers should be aware of these updates.

Emergency Order #30 »

March 31, 2020

Emergency Orders in Response to COVID-19: Expanding Telehealth and Access to Out-of-State Providers

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Gov. Sununu has released several emergency orders impacting health and welfare benefits administration during the public health COVID-19 crisis. Highlights include:

  • Emergency Order 8: All health insurance carriers are required to allow all in-network providers to deliver clinically appropriate, medically necessary covered services to members via telehealth effective March 17, 2020 (and remaining in effect until the emergency order is rescinded or the State of Emergency is terminated, whichever is first). While telehealth is generally required to be provided by live video and audio, during the state of emergency period related to COVID-19 in New Hampshire, audio-only telehealth is permitted. Further, carriers shall cover COVID-19 treatment delivered via telehealth by in-network providers without cost sharing (and shall make sure that costs for services to in-network providers for services delivered via telehealth are not less than the rates of payment established by the carrier for services delivered via in-person methods).
  • Emergency Order 14: Out-of-state pharmacies have temporary authorization (subject to certain conditions) to act as a licensed mail-order facility within New Hampshire, effective March 23, 2020, and until the emergency order is rescinded or the State of Emergency is terminated, whichever is first.
  • Emergency Order 15: Out-of-state medical providers have temporary authorization (subject to certain conditions) to provide medically necessary services, and provide services via telemedicine, effective March 23, 2020, and until the emergency order is rescinded or the State of Emergency is terminated, whichever is first.

Employers should be aware of these developments.

Emergency Order 8 »
New Hampshire Telehealth Fact Sheet »
Emergency Order 14 »
Emergency Order 15 »

March 17, 2020

Health Insurers Ordered to Cover COVID Testing

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On March 10, 2020, the New Hampshire Insurance Department ordered health insurers in New Hampshire to cover the costs of testing for COVID-19 for insureds who meet the CDC criteria for testing (including in-network provider office visits, urgent care visits or emergency services). This also includes out-of-network testing if in-network providers are unavailable.

In addition, the Department directs all health insurance carriers to:

  • Keep consumers informed by providing members with information and timely access to all medically necessary covered health care services.
  • Provide coverage for testing services regardless of any site of service (in the event of labs or specialized testing sites), provided such site has all necessary public health approvals.
  • Ensure all telehealth programs are robust to meet any increase in demand. Health carriers may not deny coverage because it was provided through telemedicine.

The above requirements are not exhaustive. Employers with employees in New Hampshire should consult their carriers, as applicable, and be aware of the Insurance Commissioner’s directives when addressing questions regarding health insurance coverage and COVID-19.

INS No. 20-016-AP »

August 06, 2019

New Bulletin on Coverage/Reimbursement for Emergency Room Boarding

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On July 25, 2019, the Insurance Department published Bulletin Docket No. INS No. 19-106-AB. The new bulletin relates to SB 11, a new law enacted in 2019 (which takes effect July 1 2019), which requires certain coverage and reimbursement for emergency room boarding. The law and bulletin expands required coverage and provider reimbursements for individuals who are in an acute care hospital, awaiting admission on a voluntary basis for services to treat a mental health condition as a result of mental illness, or when the individual is waiting to be admitted to a NH hospital (or community-based designed receiving facility to treat a mental health condition), the hospital has completed an involuntary admission certificate that meets certain criteria.

The law and bulletin require carriers to pay the acute care hospital a per diem rate required to board and care for the patient. The law prohibits the per diem rate from being all inclusive, and the bulletin interprets the law to mean that a hospital may bill for services not included in the per diem rate and that the hospital shall receive payment for these additional services insofar as they are medically necessary from the perspective of the treating provider. The per diem rate is distinct from inpatient reimbursement, and the per diem rate for the hospital stay may include member cost sharing liabilities consistent with the IRS requirements for HDHPs. The bulletin also includes additional guidance on provider reimbursement rates and consecutive days of coverage.

The bulletin contains no new employer compliance obligations. But employers with fully insured plans in NH should be aware of the coverage requirements under the new law and bulletin.

Bulletin Docket No. INS. No. 19-016-AB »
SB 11 »

August 06, 2019

New Bulletin on Balance Billing and Network Adequacy

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On July 25, 2019, the Insurance Department published Bulletin Docket No. INS. No. 19-015-AB. The new bulletin relates to a 2018 law (HB 1809) that is aimed at protecting patients from surprise medical bills (sometimes referred to as “balance billing”) by certain hospital based providers, which became effective July 1, 2018. The 2018 law expands NH’s balance protections by prohibiting anesthesiologists, radiologists, pathologists, and emergency medicine providers from billing patients for more than regular cost sharing when a patient is treated at an in-network hospital or ambulatory surgery center, even if the provider is out-of-network. When the providers listed above are not participating in the carrier network, the carrier must provide for a commercially reasonable amount to be paid to the provider, provider group, or provider employer. This will help provide balance in the dispute between providers and carriers, and will help curb the surprise medical bill issue in NH.

The law also requires the Department’s network adequacy rules to include standards for addressing in-network access to hospital-based providers such as those listed above. In response, the Department amended its network adequacy rule to require that carriers assure that providers whose services are integral to care in a hospital or similar facility either be included in their networks or provided without additional cost sharing.

None of the above rules apply specifically to an employer. So, the bulletin does not create any new employer compliance obligations. But NH employers will want to be aware of the application of the new law and bulletin guidance on surprise medical billing and network adequacy.

Bulletin Docket No. INS. No. 19-015-AB »

November 28, 2018

New Hampshire Provides Guidance for Short-Term Limited Duration Insurance

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On Nov. 13, 2018, Commissioner Elias issued Bulletin INS-18-055-AB to provide guidance for New Hampshire’s fully insured short-term limited-duration insurance (STLDI). The guidance is in response to the final rules regarding short-term limited duration health plans that were issued by the US Department of the Treasury, IRS, EBSA, and HHS on Oct. 2, 2018. In short, this bulletin reminds insurance carriers that the final rule does not preempt state laws regarding STLDI coverage.

The final rule provides that the initial contract term of a short-term limited-duration health policy must be no less than 12 months and limited a carrier’s ability to renew or extend the policy for no more than 36 months. While NH law does allow for short-term, interim coverage solutions, such policy periods may not exceed six months and are nonrenewable. Further, a carrier cannot issue a short-term policy to a person who was previously covered by a short-term medical policy that results in more than 540 days of coverage within the preceding twenty-four month period. NH’s intent for this short-term coverage is to fill a gap for individuals that are in transition between coverage.

The STLDI is not subject to the ACA’s guaranteed issue and individual market rating rule requirements, but is subject to NH’s insurance mandates applicable to the individual market coverage and, to the extent the STLDI policy is network-based, it is subject to state requirements, such as external review, network adequacy, and balance billing.

This main purpose of this bulletin is to remind insurers doing business in NH that the state retains the right to regulate STLDI coverage. Employers do not need to take any action but may want to be familiar with the state’s individual insurance market requirements.

Bulletin INS-18-055-AB »

September 05, 2018

Association Health Plan Guidance

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On Aug. 31, 2018, Insurance Commissioner Elias issued Bulletin 18-045-AB regarding the association health plan (AHP) rule. The bulletin provides guidance on the current NH law applying to AHP coverage and explains the department’s intention to convene a stakeholder group to develop legislation for consideration in early 2019. The goal of the group would be to update the current law with respect to AHP coverage and create clear standards that will enable NH employers to benefit from the availability of new coverage options, while minimizing negative impacts to other health insurance markets.

As background, on June 21, 2018, the DOL issued final regulations regarding association health plans (AHPs). Under the regulations, a group or association of employers may act as a single employer sponsor of an AHP under ERISA. The federal regulations attempted to encourage the creation of these associations but emphasized that the states retain their authority to regulate AHPs. This bulletin clarifies the coordination with NH law.

In NH, AHPs are currently subject to the same statutory and regulatory requirements as any other MEWA or group health insurance plan — all group policies or certificates must have the prior written approval of the commissioner, including association coverage. Regardless of the new flexibility offered by the DOL, fully insured AHP coverage under current NH law must be rated in accordance with small group rating rules, if issued to a small employer (generally defined as an employer with at least one and up to 50 employees, including owners and self-employed persons, during the previous calendar year). Both the fully insured and self-insured rules for MEWAs apply equally to out-of-state association coverage, to the extent it’s issued to an employer with a “brick and mortar” workplace in NH that employs one or more NH resident.

Self-funded MEWAs are permissible in NH. To qualify, they must be: 1) nonprofit; 2) established by a trade association, political subdivision, religious organization or professional association organized and maintained for at least one year for a purpose other than providing health insurance; 3) operated pursuant to a trust by a board of trustees; 4) not offered or advertised to the public generally; and 5) operated in accordance with sound actuarial principles.

NH employers interested in MEWAs (either fully insured or self-insured) should be mindful of the current NH law limitations. This bulletin clarifies these limits within existing legislation, but also indicates that the department will work to convene a working group in September and October of 2018 to discuss options for legislative changes in 2019 that may further increase the ability for small employers to have access to AHP coverage.

John Elias. “Bulletin INS NO. 18-045-AB.” 2018 Bulletins, »

July 24, 2018

Change to Treatment of FDA-Approved Prescription Contraceptive Drugs and Devices

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On July 5, 2018, Gov. Sununu signed SB 421 to require plans that provide coverage for hospital and medical expenses and prescription drug coverage to also provide coverage for all FDA-approved prescription contraceptive drugs and devices under the same terms and conditions that apply to other prescription drugs. Specifically, employers can’t impose utilization review requirements or other limitations to control the prescribing or dispensing of contraceptives to amounts that are less than a 12-month supply, if that quantity is prescribed. Insurers aren’t required to provide coverage for more than a 12-month supply of a contraception prescription in a single dispensing per plan year.

This bill becomes effective on and after Jan. 1, 2019. This bill contains no new employer obligations, but employers with fully insured plans in New Hampshire should review the new law to better understand the required changes.

SB 421 »

July 24, 2018

Initial Screening Provided Through Pharmacies Included as Outpatient Contraceptive Services

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On June 8, 2018, Gov. Sununu signed HB 1822 into law. This legislation requires initial screening provided through pharmacies to be regarded as outpatient contraceptive services. Outpatient services include consultations, examinations and medical services provided on an outpatient basis, including the initial screening provided though pharmacies (as required by law at rates established by contracts between pharmacies and insurers or their PBM), and related to the use of FDA-approved contraceptive methods to prevent pregnancy.

This new law allows pharmacists with a standing order authored by one or more licensed physicians or advanced practice registered nurses to dispense hormonal contraceptives without a prior prescription and with specific dispensing guidelines.

This bill becomes effective on and after Jan. 1, 2019. This bill contains no new employer obligations, but employers with fully insured plans in New Hampshire should review the new laws to better understand the required changes.

HB 1822 »

July 10, 2018

General Anesthesia for Dental Procedures

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On June 8, 2018, Gov. Sununu signed HB 1577 into law. This law requires plans that provide coverage for hospital or medical expenses or oral surgery to provide coverage for general anesthesia and medically necessary hospital or surgical day care facility charges and in-office dental procedures related to dental procedures performed for plan participants who are younger than age 13 and determined by a licensed dentist, in conjunction with a licensed physician, to have a condition of significant dental complexity or have exceptional medical circumstances or developmental disabilities as determined by a licensed physician.

This bill is effective Aug. 7, 2018. This bill contains no new employer obligations, but employers with fully insured plans in New Hampshire should review the new laws to better understand the required coverages.

HB 1577 »

July 10, 2018

Telemedicine Services Must Be Provided

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On June 18, 2018, Gov. Sununu signed HB 1471 into law. This law provides that plans cannot exclude health-care services from coverage solely because they are provided through telemedicine if such services are covered when provided through in-person consultation between health-care providers and plan participants. Telemedicine includes delivery of health-care services through audio, video, or other electronic medical for the purpose of diagnosis, consultation, or treatment. Telemedicine doesn’t include audio-only telephone conversations or fax transmissions.

This bill becomes effective Aug. 17, 2018. This bill contains no new employer obligations, but employers with fully insured plans in New Hampshire should review the new laws to better understand the required coverages.

HB 1471 »

May 15, 2018

New Hampshire Expands Anti-Discrimination Law to Include Transgender People

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On May 2, 2018, the New Hampshire Senate passed bill HB 1319, which updates the state’s anti-discrimination laws to prohibit discrimination against the state’s transgender residents. Gov. Sununu has indicated his intention to sign the bill into law.

The state’s anti-discrimination law bans discrimination in housing, employment and public accommodations and already prohibits discrimination based on “age, sex, race, creed, color, marital status, familial status, physical or mental disability, or national origin.” Once the bill is signed by the governor, New Hampshire will become the 21st state to extend the protected class designation to include gender identity.

NH employers shouldn’t treat transgender people differently with regard to health plan offerings and other benefits, and should work with outside counsel on overall compliance with the new law.

HB 1319 »

May 01, 2018

Extension of Renewal for Grandmothered Plans

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On April 16, 2018, the New Hampshire Insurance Department issued Bulletin INS-18-018-AB, which provides guidance related to transitional small group policies.

As background, on April 9, 2018, CMS announced that states would have the option to further extend renewal of transitional small group and individual policies for policy years beginning on or before Oct. 1, 2019, provided all policies end by Dec. 31, 2019. The non-grandfathered policies had to be in place prior to 2014. If the policy meets requirements, it’s exempt from certain coverage mandates, including community rating, coverage of clinical trials and essential health benefits. Bulletin INS-18-018-AB represents New Hampshire’s approval for the extension through 2019.

The bulletin explains that insurers in New Hampshire have the option of renewing such policies. However, state law requires that premium rates charged by an insurer be guaranteed for at least 12 months. Because federal law prohibits the extension of a policy period beyond 12 months, a policy in New Hampshire can only be renewed for a period of 12 months.

As was the case in 2017, the New Hampshire Insurance Department didn’t fully adopt the extended transitional policy as contemplated by CMS. Rather, the transition period is only extended to policies that are renewed on or before Jan. 1, 2019. Policies renewing after Jan. 1, 2019 are required to be ACA compliant.

New Hampshire small employers that have non-ACA-compliant plans and are interested in renewing should work with their advisors and insurers.

Bulletin INS-18-018-AB »

August 08, 2017

Managed Care Plans and Substance Abuse Coverage

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On June 29, 2017, Gov. Sununu signed SB 158 into law. The new law applies to managed care plans. Specifically, managed care plans that provide coverage for substance use disorder services and have authorized or otherwise approved medication-assisted treatment for such services cannot require plan participants to renew those authorizations more frequently than once every 12 months. The law is effective Aug. 28, 2017.

SB 158 »

June 13, 2017

Insurer to Employer Notification Requirements for Product Discontinuance Versus Market Withdrawal

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On June 2, 2017, the New Hampshire (NH) Insurance Department published Bulletin Docket No.: INS-17-027-AB. The purpose of the bulletin is to clarify consumer protections and to provide health insurance carriers guidance relating to the product discontinuance and full market withdrawal under NH law. Some of that guidance relates to the notice requirements insurers must give employers when discontinuing a product or withdrawing from the market altogether.

The bulletin reminds insurers that coverage in NH is guaranteed to be renewable, with a few exceptions, including where an insurer discontinues a product or withdraws from the market entirely. For product discontinuance, the insurer must provide the employer (in both the small and large employer market) with a notice at least 90 days in advance of the discontinuance and must offer the employer the option to purchase any other health coverage being offered by the carrier in the relevant market (and that coverage may not discriminate on the basis of claims experience or health status). For market withdrawal (i.e., where a carrier discontinues all of its health coverage in a particular market), the carrier must provide the employer (and all covered persons) with notice at least 180 days in advance of the withdrawal. The carrier may not renew any plans in that market and is barred from reentering the market for five years from the date of the withdrawal (although the state can waive or reduce the five-year period for good cause shown).

Although the bulletin contains no new employer obligations, employers with fully insured plans in NH will want to be aware of the insurer notices and requirements that could potentially relate to their plan. Employers should work closely with their carriers and advisors should discontinuance or withdrawal arise.

Bulletin Docket No.: INS-17-027-AB »

March 21, 2017

Conditional Extension of Renewal for Non-PPACA-Compliant Plans

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On March 10, 2017, the New Hampshire Department of Insurance published Bulletin Docket No.: INS-17-014-AB. The bulletin outlines the Department’s position on renewal of non-PPACA-compliant plans in New Hampshire. As background, on Feb. 23, 2017, CMS issued guidance allowing extension of non-PPACA-compliant plans that have been continued since 2014, subject to state and carrier approval. This bulletin is New Hampshire’s approval for such an extension (but with an exception). According to the bulletin, transitional policies can be renewed until Oct. 1, 2018, but no such policy may extend past Dec. 31, 2018. While the CMS guidance allows policy years that are shorter than 12 months, the bulletin reminds insurers that New Hampshire law does not allow renewal for less than a 12-month period. Therefore, the Department will not fully adopt the extended transition allowed by CMS, but will allow only 12-month renewals that occur on or before Jan. 1, 2018. Policies renewing after Jan. 1, 2018, are required to be PPACA compliant.

Employers with non-PPACA-compliant plans should work with their carrier in determining whether their plan can be extended.

Bulletin Docket No.: INS-17-014-AB »

February 07, 2017

Guidance on Newborn Child Coverage

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On Jan. 3, 2017, the New Hampshire (NH) Insurance Department published Bulletin INS-17-001-AB. The new bulletin is directed towards health insurers and addresses the period of time for which coverage of a newborn child is required without the payment of additional premium. As background, NH law requires coverage for children “from the moment of birth,” but requires notification of birth of a newborn within 31 days only if payment of a specific premium is required in order to have the coverage continue beyond such 31-day period.

Based on that, and according to the bulletin, individual and group plans issued in NH must provide coverage of a newborn child for the first 31 days without payment of additional premium or enrollment of the newborn. However, in order for coverage to extend beyond 31 days, the insurer may require the insured member to enroll the newborn within the first 31 days and to pay any required premium for coverage beginning on day 32.

The bulletin brings no new employer compliance obligations, but employers with fully insured plans in NH should work with their insurers in better understanding and applying the concepts around newborn coverage in NH.

Bulletin INS-17-001-AB »

November 03, 2015

NH State Updates - 2015 Jan 03 No.01

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On Oct. 27, 2015, Insurance Commissioner Sevigny issued Bulletin INS-15-065-AB related to the definition of “small group” under state law. New Hampshire insurance statutes define a small group as an employer with up to 50 employees. Since the federal provision mandating the change of the definition of small group to 100 employees is no longer in effect as a result of the PACE Act, New Hampshire will keep its definition of small group at 1 - 50 employees. Thus, groups with 51 to 100 employees will continue to be rated as large groups and will not be required to switch to the small group market in 2016.

Bulletin INS-15-065-AB »

October 20, 2015

NH State Updates - 2015 Jan 20 No.01

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On Oct. 8, 2015, Insurance Commissioner Sevigny issued Bulletin INS-15-061-AB related to the definition of small group under state law. New Hampshire insurance statutes define a small group as an employer with 1 to 50 employees. Because the federal provision mandating the change of small group to 100 employees is no longer in effect as a result of the PACE Act, New Hampshire will keep the definition of small group at 50 employees. Thus, groups with 51 to 100 employees will continue to be rated as large groups and will not be required to switch to the small group market in 2016.

Bulletin INS-15-061-AB »

August 11, 2015

NH State Updates - 2015 Jan 11 No.01

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On July 21, 2016, Gov. Hassan signed HB 508 into law. The new law applies to group health policies that provide coverage for anti-cancer medications. Insurers are prohibited from imposing a higher deductible, copayment or coinsurance amount for patient-administered medications than for injected or intravenously administered medications. This applies regardless of the plan’s drug formulary or benefit category determination. The law is effective for plan years starting on or after Jan. 1, 2017.

HB 508 »

May 05, 2015

NH State Updates - 2015 Jan 05 No.01

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On April 20, 2015, the New Hampshire Insurance Department issued Bulletin INS-15-014-AB, which explains how the transitional policy rules apply to employers groups with 51 to 100 employees. As a reminder, such groups are currently treated as large groups and are experience rated. Effective Jan. 1, 2016, the definition of small group is expanded to employers with up to 100 employees, meaning that groups with 51 to 100 employees would be changed to a small group policy with modified community rating.

The bulletin provides that a carrier may renew a large group policy for employers with 51 to 100 employees if the policy is in place on Dec. 31, 2015 and no significant changes are made at renewal. Thus, a group with 51 to 100 employees may be able, at the discretion of the carrier, to continue its large group policy and delay the small group rating for plan years starting between Jan. 1, 2016 and Sept. 30, 2016.

With regard to counting employees to determine market size, effective July 1, 2015 New Hampshire adopts the federal counting method with the full-time equivalent employee calculation used for employer mandate purposes. It also applies the employer aggregation rules, which means that employers under common ownership would be counted as a single employer.

Bulletin INS-15-014-AB »