N.H. Admin. Code § Ins 8001.04

Current through Register No. 52, December 26, 2024

Section Ins 8001.04 - Required Policy Provisions

(a) Every policy or certificate shall contain a provision for the payment of any benefits due to an insured that are unpaid at the time of the insured's death to be payable to the beneficiary designated, or if none are designated, to the estate of the individual. The provision shall state that the insured has the right to change the beneficiary and the consent of the beneficiary shall not be required to terminate or assign the policy, change the beneficiary, or make any other changes in the policy.

(b) Every policy or certificate shall contain a severability provision and a clause instructing that the policy or certificate shall be interpreted or applied so as to avoid a conflict with federal and state law.

(c) The policy or certificate shall provide for payment of benefits to insureds weekly, biweekly, or at such intervals as the employee is customarily paid wages.

(d) The policy or certificate shall provide notice of the insured's right to commence legal action relating to coverage or other contractual disputes.

(e) Each policy of individual insurance or group insurance shall include a renewal, continuation, or nonrenewal provision. The language or specification of the provision shall be consistent with the type of contract to be issued. The provision shall be appropriately captioned, appear on the first page of the policy, and clearly state the duration, where limited, of renewability and the duration of the term of coverage for which the policy is issued and for which it may be renewed.

(f) Declination of renewal or termination of group insurance provisions shall be as follows:

(1) No insurer shall decline to renew a group policy unless the cause of its action is based on one or more of the reasons for declination of renewal stated in the policy;

(2) Any reason to decline renewal shall be stated in a group policy and shall be objective in nature;

(3) Declination of renewal shall be defined so as to include any termination of a group policy by the insurer for any reason except for nonpayment of premiums; and

(4) Notice of nonrenewal or termination of a group policy by the insurer shall provide for at least 45 days prior notice to the policyholder.

(g) "Group" policies shall only be issued, as specified below:

(1) A policy issued to an employer, or to the trustees of a fund established by an employer, for which the employer or trustees shall be deemed the policyholder, to insure employees of the employer for the benefit of persons other than the employer, subject to the following requirements:

a. The employees eligible for insurance under the policy shall be all of the employees of the employer, or all of any class or classes thereof determined by conditions pertaining to their employment, regardless of the wages paid such employees;

b. The policy may provide that the term "employees'' shall include the employees of one or more subsidiary corporations and the employees, individual proprietors, and partners of one or more affiliated corporations, proprietors, or partnerships if the business of the employer and of such affiliated corporations, proprietors, or partnerships is under common control through stock ownership, contract, or otherwise;

c. The policy may provide that the term "employees'' shall include the individual proprietor or partners if the employer is an individual proprietor or a partnership;

d. The premium for the policy shall be remitted by the policyholder or by some other designated person acting on behalf of the policyholder, either from the employer's funds, or from funds contributed by the insured employees, or from both; and

e. A policy on which no part of the premium is to be derived from funds contributed by the insured employees shall insure all eligible employees;

(2) A policy issued to a labor union or Taft-Hartley Trust, or to the trustees of a fund established by one or more unions, for the benefit of the members of the labor union, which shall be deemed the policyholder, to insure members of such union for the benefit of persons other than the union or any of its officials, representatives, or agents, is subject to the following requirements:

a. The members eligible for insurance under the policy shall be all of the members of the union, or all of any class or classes thereof determined by conditions pertaining to their employment, or to membership in the union, or both;

b. The premium for the policy shall be remitted by the policyholder by some other designated person acting on behalf of the policyholder, either wholly from the union's funds or from funds contributed by the insured members specifically for the insurance, or from both; and

c. A policy on which no part of the premium is to be derived from funds contributed by the insured members specifically for their insurance shall insure all eligible members;

(3) A policy issued to a professional employer leasing company that is authorized under RSA 277-B:2(V) and RSA 277-B:9-11. The premium for the policy shall be remitted by the policyholder;

(4) A policy issued to a bona fide professional association which is legally obligated to regulate the professional requirements and licensure of a regulated profession and satisfies all of the following:

a. Has been in existence for more than 5 years;

b. Was formed for purposes other than providing insurance;

c. The policy is issued to the association and the insurer or properly licensed third party administrator administers the plan and issues the certificates to the insureds; and

d. The association does not receive any compensation, fees, royalties, or other consideration in connection with the provision of insurance; and

(5) A policy issued to a group that is expressly authorized in applicable statutes.

N.H. Admin. Code § Ins 8001.04

Derived from Number 2, Filed January 12, 2023, Proposed by #13499, Effective 11/30/2022, Expires 11/30/2032