Section Ins 1901.05 - Prohibited Policy Provisions(a) Except as provided in Ins 1901.04(k), an individual policy shall not contain provisions establishing a probationary or waiting period during which no coverage is provided under the policy, subject to the further exception that a policy may specify a probationary or waiting period not to exceed 6 months for the following specified diseases or conditions and losses resulting from diseases or conditions related to hernia disorder of reproduction organs, varicose veins, adenoids, appendix and tonsils. However, the permissible 6 month exception shall not be applicable where the specified diseases or conditions are treated on an emergency basis. Accident policies shall not contain probationary or waiting periods.(b) A policy or rider for additional coverage may not be issued as a dividend unless an equivalent cash payment is offered as an alternative to the dividend policy or rider. A dividend policy or rider for additional coverage shall not be issued for an initial term of less than 6 months.(1) The initial renewal subsequent to the issuance of a policy or rider as a dividend shall clearly disclose that the policyholder is renewing the coverage that was provided as a dividend for the previous term and that the renewal is optional.(c) A policy or certificate shall not exclude coverage for a loss due to a preexisting condition for a period greater than 12 months following the issuance of the policy or certificate where the application or enrollment form for the insurance does not seek disclosure of prior illness, disease or physical conditions or prior medical care and treatment of the preexisting condition and is not specifically excluded by the terms of the policy or certificate. This provision shall not apply to policies or certificates issued pursuant to RSA 420-G.(d) A disability income policy may contain a "return of premium" or "cash value benefit" so long as the return of premium or cash value benefit is not reduced by an amount greater than the aggregate of claims paid under the policy; and the insurer demonstrates that the reserve basis for the policies is adequate. No other policy subject to RSA 415-A and this part shall provide a return of premium or cash value benefit, except return of unearned premium upon termination or suspension of coverage, retroactive waiver of premium paid during disability, payment of dividends on participating policies, or experience rating refunds.(e) Policies providing hospital confinement indemnity coverage shall not contain provisions excluding coverage because of confinement in a hospital operated by the federal government.(f) A policy shall not limit or exclude coverage by type of illness, accident, treatment or medical condition, except as follows:(1) Preexisting conditions or diseases, except for congenital anomalies of a covered dependent child;(2) Mental or emotional disorders, alcoholism and drug addiction;(3) Pregnancy, except for complications of pregnancy, other than for policies defined in Ins 1901.06(h) of this part;(4) Illness, treatment or medical condition arising out of: a. War or act of war (whether declared or undeclared); participation in a felony, riot or insurrections; service in the armed forces or units auxiliary to it;b. Suicide (sane or insane), attempted suicide or intentionally self-inflicted injury;c. Aviation, except as a fare-paying passenger;d. With respect to short-term nonrenewable policies, interscholastic sports; ande. With respect to disability income protection policies, incarceration.(5) Cosmetic surgery, except that "cosmetic surgery" shall not include reconstructive surgery when the service is incidental to or follows surgery resulting from trauma, infection or other diseases of the involved part, and reconstructive surgery because of congenital disease or anomaly of a covered dependent child that has resulted in a functional defect;(6) Foot care in connection with corns, calluses, flat feet, fallen arches, weak feet, chronic foot strain or symptomatic complaints of the feet;(7) Care in connection with the detection and correction by manual or mechanical means of structural imbalance, distortion, or subluxation in the human body for purposes of removing nerve interference and the effects of it, where the interference is the result of or related to distortion, misalignment or subluxation of, or in the vertebral column.(8) Treatment provided in a government hospital; benefits provided under Medicare or other governmental program (except Medicaid), a state or federal workers' compensation, employer's liability or occupational disease law, or motor vehicle no-fault law; services rendered by employees of hospitals, laboratories or other institutions; services performed by a member of the covered person's immediate family; and services for which no charge is normally made in the absence of insurance.(9) Dental care or treatment;(10) Eye glasses, hearing aids and examination for the prescription or fitting of them;(11) Rest cures, custodial care, transportation and routine physical examinations; and(12) Territorial limitations.(g) This part shall not impair or limit the use of waivers to exclude, limit or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions except that the provisions of RSA 420-G shall control for policies issued pursuant to that chapter. Where waivers are required as a condition of issuance, renewal or reinstatement, signed acceptance by the insured is required unless on initial issuance the full text of the waiver is contained either on the first page or specification page.(h) Policy provisions precluded in this section shall not be construed as a limitation on the authority of the commissioner to disapprove other policy provisions in accordance with RSA 415-A, RSA 420-A and RSA 420-B that in the opinion of the commissioner are unjust, unfair or unfairly discriminatory to the policyholder, beneficiary or a person insured under the policy.N.H. Admin. Code § Ins 1901.05
#1900, eff 1-1-82; ss by #4287, eff 7-1-87; amd by #4811, eff 5-4-90; ss by #5656, eff 7-1-93; amd by #5943, eff 1-1-95; amd by #7017, INTERIM, eff 7-1-99, EXPIRED: 10-29-99 except for paragraph (e) which EXPIRED: 1-1-03
New. #8609, eff 4-17-06