What You'll Lose in New Hampshire

New Hampshire has consumer protections that: Comparable Federal Rule for AHPs?

Ensure fair insurance premiums for small groups. There are limits on:

  • How much insurers can charge sicker groups
  • Premiums for similar employers can only vary +/- 15 percent for health status, experience or duration

  • Limits on other rating factors: 4:1 for age; 15% for area; 20% for group size; 20% for industry; use of gender is prohibited
  • How much insurers can increase an employer's premiums when an employee gets sick

    15% annual limit on increases for health status, duration, claims experience
    How often rates can increase (every 12 months)

  • How often rates can increase (evert 12 months)

 


No

 

 

 

 


No

 

No

 

No

Ensure access to independent review:

  • Consumers can demand independent external review of claims denials

 

No

Ensure appropriate access to care. Insurers must:

  • Cover emergency services that a “prudent layperson” thought necessary

  • Cover transitional care from a provider who leaves a network

  • Cover non-formulary prescription drugs in certain situations

  • Allow direct access to OB-GYNs

  • Cover clinical trials

 

No

 

No

 

No

 

No

Ensure marketing protections:

  • Insurers must follow detailed requirements for marketing materials

 

No

Ensure health plans cover important benefits, such as:

  • Mental health parity that goes beyond federal requirements

  • Mammography screening

  • Diabetes supplies and education


  • Prompt payment rules

 

No

No

No

No

 

 

Ensure appropriate oversight of insurers:

  • State handles complaints from consumers & providers

  • State investigates, oversees, enforces rules (including financial penalties)

 

No

 

No$

Prevent failures and ensure payment of claims:

  • Insurers must maintain financial surpluses that grow with size of insurer

  • State oversees corrective action once insurer nears minimum standards

  • State acts quickly to seize assets to pay claims

 

No ($2M cap)

 

No

 

No

Promote access for the uninsured:

  • Mini-COBRA rules for small employers with fewer than 20 employees

  • Insurers must help fund state high-risk pool



 

No


No