Section 420-G:11 Disclosure.
I. Health carriers operating in the small employer and/or individual markets shall make reasonable disclosure in solicitation and sales materials provided to individuals and small employers of the following:
(a) The methodology by which premium rates for an individual or specific small employer are established. Each health carrier shall state that rates and practices are in full compliance with this chapter.
(b) The provisions concerning the health carrier's right to change premium rates and the factors which affect changes in premium rates.
(c) The provisions relating to renewability of health coverage.
(d) The provisions relating to any preexisting condition exclusions.
(e) The benefits and premiums available under all health insurance coverage for which the employer is qualified.
II. (a) All health carriers, licensed third party administrators, and any entity required to be registered with the commissioner pursuant to RSA 402-H, shall electronically provide:
(1) Their encrypted claims data to the department and to the department of health and human services in accordance with rules approved by the commissioner of health and humans services and adopted under RSA 420-G:14.
(2) To the department of health and human services, cross-matched claims data on requested policyholders, and subscriber information necessary for third party liability for benefits provided under RSA 167, filed in accordance with rules adopted under RSA 167:3-c.
(b) Notwithstanding RSA 91-A:10, the collection storage and release of health care data and statistical information that is subject to the federal requirements of the Health Information Privacy and Accountability Act (HIPAA) shall be governed exclusively by the rules adopted thereunder in 45 CFR Parts 160 and 164.
II-a. All health carriers and other health plans that collect the Health Employer Data and Information Set (HEDIS) shall annually submit the HEDIS information to the department.
III. All health carriers shall accept electronic claims submitted in Centers for Medicare and Medicaid Services (CMS) format for UB-92 or HCFA-1500 records, or as amended by CMS.
Source. 1997, 344:1. 1999, 318:4. 2003, 145:3, 4, eff. Aug. 16, 2003; 292:3, 4, eff. July 18, 2003; 292:7, eff. Aug. 16, 2003 at 12:01 a.m. 2006, 271:13, eff. Aug. 8, 2006.