Delay of Enforcement of Certain Filing Requirements

The State of New Hampshire Insurance Department 21 South Fruit Street, Suite 14 Concord, NH 03301 David J. Bettencourt Keith E. Nyhan Commissioner Deputy Commissioner BULLETIN Docket #INS 25-024-AB TO: All New Hampshire Health Carriers, Licensed Entities Offering Group Health Plans and Employee Benefit Plans, and Medical Utilization Review Entities FROM: Commissioner David J. Bettencourt DATE: March 17, 2025 RE: Delay of Enforcement of Certain Filing Requirements The purpose of this bulletin is to provide guidance regarding the postponement of enforcement of compliance with certain regulatory requirements. The Department plans to issue rules and further guidance on these requirements and will not penalize carriers for non-compliance until such guidance is available. This forthcoming rule and guidance will be based on an assessment of the utility of these requirements to ensure the Department upholds the highest standards and commitment to consumer protection while avoiding imposing unnecessary paperwork requirements that could lead to higher premiums for consumers due to increased costs in staff time and resources. Utilization Review Filings Starting January 1, 2025, every health carrier conducting utilization reviews— whether directly or through a contracted entity—must have written procedures for these reviews and file them with the Department by April 1 annually, in accordance with RSA 420-J:6,I. RSA 420-E:3 mandates that entities licensed for medical utilization review provide the Department with details of their review processes at both initial licensure, and annually by April 1. However, non-compliance will not be enforced after the initial submission unless specifically requested by the Department. The Department will not enforce compliance with the annual filing requirements for utilization reviews for the deadlines of April 1, 2025, and April 1, 2026. Additional guidance on filing procedures due April 1, 2027, and later will be provided. Health carriers must still maintain their review procedures in writing and make them available upon request. Telephone 603-271-2261 • Fax 603-271-1406 • TDD Access: Relay NH 1-800-735-2964 nh.gov/insurance Market Conduct Annual Report Requirements Annual reports on plan complaints, claim denials, and prior authorization statistics must be submitted to the Department in the prescribed format. Each carrier or other licensed entity providing group health insurance or employee benefit plans must file this information by April 1 each year and maintain an appeal procedure for claim denials. The Department is not enforcing compliance with the requirements for annual report filings due on April 1, 2025, according to 415-A:4-b,V(f) and RSA 420-J:5 V(f). Further guidance for submitting the April 1, 2026 report and subsequent filings will be provided, including a template Per RSA 415-A:4-a,III, entities must file their annual claim determination procedures and member information with the Department, ensuring compliance with confidentiality laws. Additionally, carriers must maintain appeal procedures for a fair review of denied claims, to be filed with the Department by April 1 annually. Compliance with these filing requirements, due April 1, 2025, will not be enforced. The Department will offer guidance for reports due April 1, 2026, and later, including a template where necessary. However, all health carriers are expected to maintain and produce all applicable reports and procedures upon the Department’s request. Non-compliance with such requests will be enforced, but the filing requirements themselves will not be enforced. Enforcement of compliance with the requirement that an insurer file a certificate of compliance regarding advertisements with an its annual statement per Ins 2601.18 (b) and Ins 2602.09 (c) will likewise be suspended. Contact Information For any questions or concerns regarding this bulletin, please contact the Consumer Services unit of the New Hampshire Insurance Department by email at consumerservices@ins.nh.gov or by telephone at 603-271-2261. 2