Key Takeaways
- New Hampshire uses the federal HealthCare.gov marketplace for ACA coverage
- The New Hampshire Insurance Department (NHID) regulates health insurance
- Pre-existing condition exclusions are prohibited under ACA-compliant plans
- New Hampshire has mental health parity requirements under RSA 417-E
- New Hampshire is a "community rating" state for individual and small group markets
New Hampshire Health Insurance Policy Requirements
New Hampshire has health insurance regulations that work alongside federal requirements under Title XXXVII of the New Hampshire Revised Statutes Annotated.
Regulatory Structure
New Hampshire health coverage is regulated by the New Hampshire Insurance Department (NHID):
| Agency | Role |
|---|---|
| New Hampshire Insurance Department (NHID) | Regulates all health insurance, reviews rates and forms |
| Federal CMS | Operates the HealthCare.gov marketplace for New Hampshire |
Health Insurance Marketplace
New Hampshire uses the federal HealthCare.gov marketplace:
- Federally facilitated marketplace
- Provides access to qualified health plans (QHPs)
- Premium tax credits available for eligible residents
- Open enrollment and special enrollment periods apply
Metal Tier Plans
| Tier | Actuarial Value | Cost Sharing |
|---|---|---|
| Bronze | 60% | Higher out-of-pocket costs |
| Silver | 70% | Moderate cost sharing |
| Gold | 80% | Lower out-of-pocket costs |
| Platinum | 90% | Lowest out-of-pocket costs |
Community Rating
New Hampshire is a community rating state:
- Insurers cannot vary rates based on health status
- Limited rating factors allowed (age, tobacco use, family size, geography)
- Promotes equal access to coverage
Pre-Existing Condition Protections
New Hampshire prohibits pre-existing condition exclusions in ACA-compliant plans:
| Market Segment | Pre-Existing Condition Exclusions |
|---|---|
| Individual | Prohibited |
| Small Group | Prohibited |
| Large Group | Limited by federal law |
Guaranteed Issue and Renewal
New Hampshire requires:
Guaranteed Issue
- Insurers must accept all applicants for ACA-compliant plans
- Cannot deny coverage based on health status
- Applies to individual and small group markets
Guaranteed Renewal
- Insurers cannot cancel coverage except for:
- Non-payment of premium
- Fraud or misrepresentation
- Plan discontinuation (with proper notice)
Mental Health Parity
New Hampshire has its own mental health parity law under RSA 417-E:
Coverage Requirements
New Hampshire law requires health plans to cover:
- Mental health conditions
- Nervous conditions
- Emotional disorders
- Substance use disorders
Parity Requirements
Under RSA 417-E, insurers must provide:
- Mental health benefits at parity with medical/surgical
- No more restrictive financial requirements
- No more restrictive treatment limitations
- Comparable prior authorization requirements
Federal MHPAEA Compliance
New Hampshire also requires compliance with the federal Mental Health Parity and Addiction Equity Act (MHPAEA):
- Financial requirements must be comparable
- Treatment limitations must be comparable
- Out-of-pocket costs must be comparable
Exam Tip: New Hampshire has its own state mental health parity law (RSA 417-E) in addition to federal MHPAEA requirements.
Essential Health Benefits
All individual and small group plans must cover:
- Ambulatory patient services
- Emergency services
- Hospitalization
- Maternity and newborn care
- Mental health and substance use disorders
- Prescription drugs
- Rehabilitative services
- Laboratory services
- Preventive and wellness services
- Pediatric services (including dental and vision)
External Review
New Hampshire provides external review rights:
- Consumers can appeal denied claims
- Independent external review available
- Binding decision on insurer
Which marketplace does New Hampshire use for individual health insurance under the ACA?
What is New Hampshire's rating system for health insurance?
Under which law does New Hampshire require mental health parity?
Can New Hampshire health insurers deny coverage based on pre-existing conditions?
What rights do New Hampshire consumers have when a health insurance claim is denied?