Section 420-G:4-b New Hampshire HealthFirst; Standard Wellness Plan for Small Employers.
I. The purpose of this section is to:
(a) Promote the availability of more affordable health coverage in the small employer market by engaging consumers, health care providers, insurers, and small employers to address the underlying costs of health care through better care management and more efficient utilization of health care services without increasing overall cost sharing requirements or reducing coverage for services essential to health and wellness.
(b) Enhance competition among health carriers in the small employer market by facilitating comparison of a standard plan.
II. If a health carrier offers coverage in the small employer market in this state and had at least 1,000 covered lives in this market at the end of the prior calendar year, such carrier shall be required to offer the standard wellness plan to small employers. The standard wellness plan shall be offered on a guaranteed issue basis to all small employers in the state. If a health carrier is part of an insurance holding company system, as defined in RSA 401-B:1, IV, in which 2 or more affiliates, as defined in RSA 401-B:1, I, are licensed health carriers in the state with a combined New Hampshire small group membership of at least 1,000 covered lives at the end of the prior calendar year, the requirement in this paragraph to offer the standard wellness plan to all small employers shall apply. However, only one such health carrier affiliate in the holding company group shall be subject to the requirement.
III. The commissioner shall adopt rules, pursuant to RSA 541-A, relative to the requirements for the standard wellness plan. Before adopting rules, the commissioner shall convene a standing advisory committee to include representatives of small employers, business groups and associations of small employers, consumers who obtain their coverage through the small employer market, one representative, appointed by the speaker of the house of representatives and one member of the senate, appointed by the president of the senate. The advisory committee shall, at least once every 3 years, make recommendations to the insurance commissioner on the requirements for the standard wellness plan. The standard wellness plan requirements shall be established so that small employer health insurance carriers would be reasonably expected to set the plan's health coverage plan rate, as defined in RSA 420-G:4, I(c), at or below the target rate of 10 percent of the prior year's median statewide wage as reported by the United States Department of Labor. In order to assist the advisory committee in making its recommendations, the commissioner shall engage an actuarial expert at the expense of the small employer carriers that are subject to RSA 420-G:4-b, II to confirm that the proposed standard wellness plan requirements are reasonable in relation to the target health plan coverage rate. The plan shall include benefit structure, cost sharing requirements, and provider payment initiatives consistent with the incentive required in RSA 420-G:46, IV. The committee shall recommend an out-of-pocket maximum for the standard wellness plan. Throughout the process of developing its recommendations, the advisory committee shall consult with interested health carriers, health insurance producers, health care providers, the actuarial expert retained by the commissioner, and, as necessary and appropriate, other available experts.
IV. The commissioner shall ensure that the standard wellness plan creates incentives for consumers, health care providers, employers, and/or health carriers to:
(a) Promote wellness.
(b) Promote primary care, preventive care, and a medical home model.
(c) Manage and coordinate care for persons with chronic health conditions or acute illness.
(d) Promote the use of cost effective care.
(e) Promote quality of care by the use of evidence-based, best practice standards and patient-centered care.
V. To the extent practicable, health carriers shall be permitted to utilize existing programs to meet the requirements for the standard wellness plan.
VI. The plan shall be made available in accordance with this section on October 1, 2009, or as soon thereafter as practicable and shall be reviewed and revised as necessary, but no less frequently than once every 3 years after the date of initial offer.
VII. (a) Small employer carriers shall be required to file their standard wellness plan rates 60 days prior to the date on which the plan is to be made available. If at least one small employer carrier files a health coverage plan rate at or below the stated target, then each carrier subject to RSA 420-G:4-b, II shall offer the standard wellness plan at its own filed and approved rate. If no small employer carrier files a health coverage plan rate at or below the stated target, then the commissioner shall hold a hearing on the reasonableness of the proposed standard wellness plan benefits in relation to the target health plan coverage rate to determine whether small employer carriers subject to RSA 420-G:4-b, II shall be required to offer the standard wellness plan at a health coverage plan rate equal to the target rate or whether changes should be made to the standard wellness plan requirements to adjust benefits or cost sharing requirements.
(b) Between plan revisions, carriers may request rate adjustments with appropriate supporting documentation. However, the commissioner shall not grant any rate adjustment in excess of the carrier's overall small group trend.
(c) All small employer carrier filings made in accordance with this section shall be subject to approval under RSA 420-G:4, I(h).
VIII. In establishing the requirements for the standard wellness plan, the commissioner:
(a) May require the use of qualified wellness or disease management programs and the use of rating factors for such programs as provided in RSA 420-G:4-a.
(b) Shall prohibit small employer carriers from offering nonconforming products with similar benefit designs with the intent or likely effect of undermining the purposes of this section.
(c) Shall require small employer carriers to illustrate or quote the standard wellness plan together with any proposal or quote provided to any small employer.
IX. Except as specifically provided in this section, all statutory and regulatory requirements applicable to small employer health benefit plans shall apply to the standard wellness plan.
Source. 2008, 56:1, eff. July 18, 2008.