Open Enrollment in the Individual Market Extended
October 26, 2021
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 »
New Paid Leave Program Adopted
July 20, 2021
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 »
Coverage of Ultrasounds Required to Determine Gestational Age
July 07, 2021
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 »
Coordination of Group Health Benefits with Medicare
May 25, 2021
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 »
Gender Identity Discrimination Prohibited
June 23, 2020
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 »
Expanding Access to COVID-19 Testing
June 09, 2020
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 »
Employer Guidelines During COVID-19
May 27, 2020
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 »
Additional Guidance on Health Coverage and COVID-19
May 12, 2020
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 »
Additional Telehealth Guidance
April 28, 2020
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 »
Alternative Care Setting Services Covered as In-Network
April 28, 2020
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 »