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Volume 16, Issue 3
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Spring 2004 |
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| published quarterly by: The New Hampshire Challenge, Inc. P.O. Box 579, Dover, NH 03821-0579 |
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| In This Issue |
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From our archives:
By: Jamie Stephenson |
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(Editor's note: This article is reprinted from our Summer, 1995 issue. This is the legislation that was repealed when SB 110 was passed by the NH Legislature in the 2003 session. A look at the history of the original legislation provides an understanding of the problems leading to its passage in 1994, as well as the likelihood of the re-emergence of those same problems as a result of the present legislation.)
In the last issue of the New Hampshire Challenge, the article on health insurance raised several questions about who sets the rules for insurance in New Hampshire.
Do the insurance companies have too much influence on the lawmakers who regulate the industry? Are consumers protected from discrimination and unfair insurance rates? Do persons with disabilities have access to health insurance or do pre-existing conditions exclude them from commercial insurance? Some of these issues are critical for the disability community and yet persons with disabilities are not always involved with legislation which would protect their interests in health insurance.
During the 1994 session of the New Hampshire legislature, Senator C. Jeanne Shaheen introduced a bill which addressed the problem of accessibility to health insurance in New Hampshire. Named SB 711, it proposed basic changes in the way health insurance is sold to small employers (less than 100 employees) and individuals in New Hampshire and in the way premium rates are set for those groups.
SB 711 survived numerous committees and votes in the Legislature and Senate. According to Robert Warren, Director, Life, Accident, and Health Division of the New Hampshire Insurance Department, there were numerous changes to the original bill proposed by Senator Shaheen. The final version was signed by the governor and took effect on January 1, 1995.
Many organizations had input during the revisions of SB 711. The list includes some obvious players like the New Hampshire Insurance Department, New Hampshire Blue Cross/Blue Shield, the Division of Health and Human Services and health insurance industry representatives.
There were also some grassroots consumer groups involved including the New Hampshire Citizen Action Committee, the American Association of Retired Persons (AARP), various small business organizations and chambers of commerce, the New Hampshire Women's Lobby, the National Organization of Women (NOW), and the National Education Association (NEA).
Clark Dumont of N.H. Blue Cross said, it was the "largest, most varied group of collaborators that I have ever seen in New Hampshire." The result of that collaboration is a health insurance law which will protect the rights of persons with disabilities and ensure all New Hampshire residents access to health insurance. However, although it does not guarantee affordability only access, SB 711 prohibits health insurers from charging discriminatory premium rates to persons with pre-existing conditions or who are at higher than normal risk for illness.
SB 711 states that premiums must be based on a community rating. This means that all small businesses could be considered a "community" and the premium rates charged to each policy holder would be the same "with no modification for gender, geographic location, occupation, health status, individual and /or group claims experience or duration of coverage." (RSA 420-G:4 I (a) (1)
The shift to community rating also means that the young, healthy people the insurance companies have traditionally preferred to insure will probably see their premiums go up during the next five years but there are provisions in the law to keep the increase gradual. By the year 2000, the premium rates are expected to have leveled off and further increases will be the result of normal carrier cost and utilization trends. Whatever their premium rate, a company must gain approval from the New Hampshire Insurance Commissioner before issuing a policy.
High risk pools are no longer allowed which means that "low risk" individuals will be grouped with "high risk" individuals and pay more than they use to in order to cover the costs of individuals in the community who need more than average health care. That is what insurance is all about, the cost of everyone's health care is shared among the group. Therefore, if you are in a car accident and need expensive hospital care, the bills will be paid because all of the other members of the community have paid their premiums. Even healthy people have accidents or get sick unexpectedly.
In addition to the problem of higher premiums, the practice of "medical underwriting" can create a multitude of problems for persons with chronic disease, disability, or genetic conditions. Health insurance companies use health questionnaires and physician's statements to select healthy people and exclude those with potential health problems. Even healthy people with conditions which the underwriters imagined would cause future health problems (for example, Fragile X Syndrome) are excluded.
SB 711 prohibits medical underwriting for small employers and individual policy holders in New Hampshire. Beginning in January 1995, an insurer cannot ask any questions about your medical history, your family's medical history, genetic test results, or even about your hobbies. You cannot be required to submit any physician's statements or medical information either to the insurance carrier or to your employer for the purpose of medical underwriting. And "Carriers shall not deny coverage to any person nor any eligible dependant" [RSA 420-G: I (c) (2)]. This new law eliminates the problem which persons with disabilities are very familiar with: being turned down by health insurance companies because of pre-existing conditions.
Each company which sells insurance in New Hampshire must inform its potential customers about the method used for setting and changing premium rates and about coverage renewal. We must read the information materials carefully and be informed consumers. The companies are answerable to the Insurance Department for compliance with SB 711 but consumers must take an active part in this process.
If you work for a small employer and you are asked medical questions for the health insurance policy, ask them why and if you are not satisfied with the answer, call the New Hampshire Insurance Department. Also call the department if you are denied health insurance because of a pre-existing condition. The protection is there now but consumers must be the watchdogs.
New Hampshire Department of Insurance 271-2261 |
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