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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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| Mandatory Coverage |
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New Hampshire mandates that insurers provide coverage for certain conditions and/or services, depending on the category of the insurance plan.
H.M.O, Group plans and fully insured plans must cover:
- non-prescription enteral formulas for gastro-intestinal track anomalies;
non-prescription enteral formulas and food products for inherited - absorption diseases;
necessary hospital or surgical day care and administration of general anesthesia for dental procedures for children under age 4 or a person who has exceptional medical circumstances or developmental disability;
- non-prescription enteral formulas and food products for inherited treatment and diagnosis of mental illnesses including:
schizophrenia, major depressive disorders, bipolar disorder, anorexia and bulimia nervosa, obsessive-compulsive disorder, panic disorder, pervasive developmental disorder or autism, and chronic post-traumatic stress
disorder;
- non-prescription enteral formulas and food products for inherited continued coverage of family member with developmental disability after eligible status would normally end;
- non-prescription enteral formulas and food products for inherited
Employer funded, employer administered, and ERISA (Employee Retirement Income Security Act) plans cover:
expenses according to the policy and the employer's discretion. There is generally no mandated coverage for this type of health benefit. The employer is required by federal law to provide a detailed copy of the policy to each covered employee. Contact your employer's human resources office to find out what is covered on your policy. |
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| Categories of Insurance |
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State regulated plans are referred to as fully insured and include:
- Health Maintenance Organizations
- Group health insurance plans
- Individual health insurance plans
Plans that are not regulated by the state include:
- Self-administered - plans that are contracted out to a health insurance company
- Self-funded - plans in which expenses are paid by the employer directly
- Government employee plans
- Church sponsored plans
- Union sponsored plans
- Employee Retirement Income Security Act (ERISA) plans
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| Resources for Health Insurance Questions |
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National Association of Insurance Commissioners
2301 McGee St.
Suite 800
Kansas City. MO 64108
(816) 842-3600
(816) 783-8175 fax
www.naic.org website
For information on your health insurance company including consumer complaints in each state.
For group, H.M.O. and other fully insured plans:
State of New Hampshire Insurance Department
56 Old Suncook Road
Concord, NH 03301-7317
(603) 271-2261
800-852-3416 for consumer questions only
(603) 271-0248 fax
request@ins.state.nh.us email
www.state.nh.us/insurance website
N.H. Department of Labor
95 Pleasant St.
Concord, NH 03301
(603) 271-3176
For employer funded and employer administered plans:
U.S Department of Labor
Employee Benefits and Security Administration
Regional Office
JFK Federal Building Room 575
Boston, MA 02203
(617) 565-9600
(617) 565-9666 fax
U.S. Department of Labor
Employee Benefits Security Administration
Frances Perkins Building
200 Constitution Ave, NW
Washington, DC 20210
866-444-3272
TTY 877-889-5627
www.dol.gov/ebsa website
U.S. Department of Justice
Americans with Disabilities Act Division
950 Pennsylvania Ave., NW
Washington, DV 20530-0001
800-949-4232
800-514-0383 TDD
www.usdoj.gov/crt/ada website |
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