New Hampshire Health Study Guide

New Hampshire’s health law is a study in numbers that are almost the national ones. The grace period is not a single figure. The continuation election window is not sixty days. One continuation period is measured in weeks rather than months. Each difference is small enough to look like a misprint and large enough to cost you the item.

The standard provisions — RSA 415:6, and the tiered grace period

Individual accident and health policies in New Hampshire carry the required provisions at RSA 415:6, and the first one that matters is the grace period, because it is not one number. The statute prints the blank and the instruction to fill it: “A grace period of ______ (insert a number not less than ‘7’ for weekly premium policies, ‘10’ for monthly premium policies and ‘31’ for all other policies) days.”

Seven, ten, thirty-one — by premium mode. When a question bothers to tell you how the premium is paid, the premium mode is the question.

Defenses, claims and proofs

New Hampshire uses the time limit on certain defenses framing rather than a life-style incontestability clause. After 2 years from issue, “no misstatements, except fraudulent misstatements, made by the applicant … shall be used to void the policy or to deny a claim.” Fraud is carved out permanently.

Reinstatement can happen by conduct alone: where the insurer subsequently accepts premium without requiring a reinstatement application, that acceptance reinstates the policy (RSA 415:6, I(4)).

The claim clocks are 20 days to give notice of claim after the occurrence or commencement of loss, and 90 days to furnish proof of loss. The proof-of-loss rule then splits: where the policy pays periodically for a continuing loss, proof is due 90 days after the end of the period the insurer is liable for, and Medicare supplement gets no extension there. For any other loss, Medicare supplement stretches the 90 days to a full year. Learn the carve-out with its limit attached — it is narrower than it is usually taught.

The free look — 30 days, and not in the statute

Individual accident and health policies carry a 30-day right to return under Department rule Ins 401.06(b)(10), in prescribed words: the policy “may, at any time within 30 days after its receipt by the policyholder, be returned,” whereupon it is void from the beginning and premium is refunded. Nothing in RSA 415:6 grants it — as with life, the free look lives in the form rules.

Health’s thirty days is the ordinary figure across New Hampshire: long-term care is 30 (RSA 415-D:7), Medicare supplement is 30 (RSA 415-F:6), a replacement is 30 (Ins 302.06(a)(4)). Individual life, at 10 days, is the exception.

State continuation — where New Hampshire diverges hardest

New Hampshire’s mini-COBRA is RSA 415:18, XVI, and candidates import three federal numbers into it that do not belong.

First, scope. There is no federal-style twenty-employee floor — but do not overstate it as “no threshold at all,” because RSA 415:18, XVI(i) excludes group policies issued to small employers of size one. Above that single-employee carve-out, continuation reaches any group health policy covering a New Hampshire resident, expressly including a policy “delivered or issued for delivery in this state or any other state.” It attaches to the individual, not to the employer’s size.

Second, the election window is 45 days from the date of notice, not the 60 that federal COBRA teaches. On a divorce or legal separation, the employee or spouse notifies the employer within 30 days, and the former spouse then gets its own 45.

Third, the durations, which are five rather than two: 18 months base; 39 WEEKS — not months — where the entire group policy terminates; 29 months where the individual is determined disabled within the first 60 days; 36 months for certain dependent events; and an open-ended period for a surviving, divorced or legally separated spouse aged 55 or older, running until that spouse is eligible for another employer group plan or for Medicare. Premium is capped at 102 percent of the group amount.

Appeals, external review and prompt pay

External review under RSA 420-J is requested within 180 days of the final adverse determination. The independent review organization decides within 20 days — or no more than 72 hours expedited — and the decision is binding on the health carrier. Internal appeals run 30 days standard and 72 hours urgent.

New Hampshire splits its prompt-pay deadline where many states use one number: 15 calendar days for a clean electronic claim, 30 calendar days for a clean paper claim, under RSA 420-J:8-a. Overdue claims carry 1.5 percent per month interest, and a judicial finding of bad faith can add attorney’s fees.

Medicare supplement and long-term care

Beyond the 30-day free look and the one-year proof of loss, New Hampshire added a rule effective January 1, 2022: an issuer may not keep charging a disabled under-65 Medicare beneficiary the under-65 premium rate once that person reaches age 65 (RSA 415-F:9).

Long-term care inflation protection is an opt-out, not an opt-in. Ins 3601.12 requires it to be “included in a long-term care insurance policy unless an insurer obtains a rejection of inflation protection signed by the policyholder,” and the offer must include 5% annual compounded increases. A Long-Term Care Insurance Personal Worksheet is required at or before application.

One thing to not carry in: New Hampshire imposes no producer training hour count for long-term care. The rules put the training duty on the insurer, not on the state.