Waiver of Ins 6001.05(h)(4) Pertaining to Coordination of Benefits for Retiree Health

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 25-083-AB TO: All Insurance Companies Issuing Limited Benefit Retiree Health Plans FROM: Commissioner David J. Bettencourt DATE: November 19, 2025 RE: for Retiree Health Waiver of Ins 6001.05(h)(4) Pertaining to Coordination of Benefits The New Hampshire Insurance Department (NHID) has recently reviewed the ancillary health administrative rule prohibiting coordination of benefits (COB) in limited benefit plans. The scope of limited benefit coverage includes retiree health plans, and as such, the rule prohibiting COB currently applies to those products. NHID has considered the impact of an unrestricted prohibition of COB, as is currently the case, for these products and the resulting unintended consequences. Currently as applied, retiree health plans are not permitted to coordinate with Medicare or Medicare Advantage coverage, leading to an unworkable result. Retiree health plans are intended to pay secondary to Medicare coverage when retirees become eligible for those benefits, and sometimes also paying supplemental benefits that aren’t covered under the program. Such a strict application of the rule operates as a barrier to the essential operation of the product. The commissioner, upon the commissioner’s own initiative, may waive any rule requirement in Ins 6001 if such waiver does not contradict the objective or intent of the rule, and the rule is not applicable under the circumstances. See Ins 6001.071. 1 Ins 6001.07 Waiver or Suspension of Rules. a. The commissioner, upon the commissioner’s own initiate or upon request by an insurer, shall waive any requirement of this chapter if such waiver does not contradict the objective or intent of the rule and; 1. Applying the rule provision would cause confusion or would be misleading to consumers; 2. The rule provision is in whole or in part inapplicable to the given circumstances; 3. There are specific circumstances unique to the situation such that strict compliance with the rule would be onerous without promoting the objective or intent of the rule provision; or 4. Any other similar extenuating circumstances exist such that application of an alternative standard or procedure better promotes the objective or intent of the rule provision. b. No requirement prescribed by statute shall be waived unless expressly authorized by law. c. Any person or entity seeking a waiver shall make a request in writing. d. A request for a waiver shall specify the basis for the waiver and proposed alternative, if any #12478, eff 2-12-18 Telephone 603-271-2261 • Fax 603-271-1406 • TDD Access: Relay NH 1-800-735-2964 insurance.nh.gov Here, considering the foregoing regarding retiree health plans, the prohibition against COB should be waived to restore the intended coordination mechanism. It is appropriate to waive the requirement of Ins 6001.05(h)(4) under the following conditions: the retiree health plan shall be limited to retired members only, and COB is permitted only with Medicare, Medicare Advantage, and Medicare supplemental coverage. A retiree health plan shall not coordinate benefits with any other type of ancillary or limited benefit coverage. This waiver is inapplicable to retiree health plans that include current employees as that coverage does not fall under the scope of Ins 6001.05. Rather, those plans are subject to the provisions of the ACA and NH RSA 420-G which already permit COB. This waiver is also not applicable to other types of ancillary health coverage such as hospital indemnity, accident-only, and specified disease. Such an application to those products would be outside the limited purpose of restoring normal market coordination with retiree health plans and run contrary to the federal and state excepted benefit structure. Until the rule can be amended, this waiver shall apply to all pending and future filings, consistent with this Bulletin. This limited waiver of Ins 6001.05(h)(4) is effective immediately and will remain in effect until such time as NHID undertakes formal rulemaking. Questions concerning this bulletin may be directed via email to Victoria Fowler, Administrator of Life and Health Compliance, at victoria.w.fowler@ins.nh.gov. Page 2 of 2