2027 Plan Year Issuer Guidance

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 26-019-AB TO: All New Hampshire Licensed Health and Dental Insurers FROM: Commissioner David J. Bettencourt DATE: April 6, 2026 RE: 2027 Plan Year Issuer Guidance This Bulletin applies to all medical and dental issuers that will submit plan applications to the New Hampshire Insurance Department for Plan Year 2027. This includes plans seeking certification as Qualified Health Plans (QHP) both on and off the federal exchange and non-QHP. NHID’s focus remains on ensuring stability and predictability in these markets and we are dedicated to working collaboratively to address any issues or concerns. QHP Issuers should note the Bulletin reflects the guidance set forth in the proposed Notice of Benefit and Payment Parameters for 2027 (NBPP) and the draft 2027 Letter to Issuers in the federally facilitated exchanges (Letter) and is subject to revision for further state and federal guidance. Issuers planning to introduce a new product or network as well as those that will discontinue an existing plan in Plan Year 2027 or are planning to submit a Non- Network Plan for QHP certification are strongly urged to contact the Department as soon as possible, but no later than the initial filing deadline of May 1, 2026. Issuers should provide notice to Quincy Gunn at the New Hampshire Insurance Department (NHID) by email at Quincy.B.Gunn@ins.nh.gov or by phone at 603-271-3944. Telephone 603-271-2261 • Fax 603-271-1406 • TDD Access: Relay NH 1-800-735-2964 insurance.nh.gov Contents I. Legal Authority............................................................................................................................... 3 II. PY 2027 Guidance to all Major Medical Issuers (QHP & Non-QHP) on Select Requirements ........................................................................................................................ 4 a. Cost-Sharing................................................................................................................................... 4 b. Network Adequacy ....................................................................................................................... 4 c. Mental Health Parity Quantitative Treatment Limits (QTL) Reporting Tool............. 5 d. Treatment at In-Network facilities and Emergency Services including Ground Ambulance............................................................................................................................................ 6 e. Substance Use Disorder Attestation...................................................................................... 6 III. QHP Issuer Procedures, Timeline, and Guidance on Select Requirements ....................................................................................................................................... 6 a. Form Filing Deadlines.................................................................................................................. 6 b. Rate Filing Deadlines................................................................................................................... 6 c. Rate Filing Procedures (Individual Market)......................................................................... 7 d. Drug Tools........................................................................................................................................ 7 Page 2 of 8 I. Legal Authority The New Hampshire Insurance Commissioner “is charged with the rights, powers, and duties pertaining to the enforcement and execution of the insurance laws” of New Hampshire under NH RSA 400-A:3. The Commissioner has general rulemaking and enforcement authority with respect to regulation of the business of insurance in New Hampshire under NH RSA 400-A:15. Under New Hampshire law, the Insurance Department regulates licensing of health insurance related entities (NH RSA 400­ A:15-h; NH RSA 402; NH RSA 420-A and NH RSA 420-B) and solvency of health insurers (NH RSA 400-A:36 and 37); reviews health insurance policy forms and benefit design (NH RSA 415, NH RSA 420-G); exercises prior approval authority over rates (NH RSA 415:1); monitors network adequacy and treatment of consumer claims (NH RSA 420-J); apply the standards, and enforce the consumer protections and market reforms set forth in the Affordable Care Act (ACA) (NH RSA 420-N:5) and has authority to take enforcement action with respect to violations of health insurance regulatory standards (NH RSA 415:20, NH RSA 420-G:16, NH RSA 420-J:14) and unfair trade practices (NH RSA 417), including health insurance marketing practices. The federal ACA establishes the legal authority for qualified health plan (QHP) certification as well as other operational standards, codified in 45 CFR 155 and 156. To ensure full compliance with the ACA, issuers shall consult and comply with all applicable federal regulations, including, but not limited to, 45 CFR Subtitle A, Subchapter B, the NBPP, and the Letter. Page 3 of 8 - II. PY 2027 Guidance to all Major Medical Issuers (QHP & Non-QHP) on Select Requirements a. Cost-Sharing Issuers are expected to comply with the final cost sharing and maximum annual limits as set forth annually by HHS/CMS. Below are the updated maximum annual limits for PY 2027 (as of February 2026). Eligibility Category Description Plan Year 2027 Maximum Annual Limitation Self Only Family Maximum Annual Limit on Cost-Sharing $12,000 $24,000 Silver 94% AV* CSR Plan Variant Individuals eligible for CSRs under § 155.305(g)(2)(i) (household income greater than or equal to 100 and less than or equal to 150 percent of FPL). $4,000 $8,000 Silver 87% AV* CSR Plan Variant Individuals eligible for CSRs under § 155.305(g)(2)(ii) (household income greater than 150 and less than or equal to 200 percent of FPL). $4,000 $8,000 Silver 73% AV* CSR Plan Variant Individuals eligible for CSRs under § 155.305(g)(2)(iii) (household income greater than 200 and less than or equal to 250 percent of FPL) $9,600 $19,200 *Under section 1402(d) of the ACA, American Indian/Alaska Native (AI/AN) enrollees with incomes under 300 percent of FPL are eligible for Zero Cost Sharing plan variants. Additionally, all AI/AN QHP enrollees are eligible for no cost sharing for items and services provided by the Indian Health Service, an Indian Tribe, Tribal Organization, or Urban Indian Organization or through referral under contract health services. Under 45 CFR 155.305(g)(1)(ii), all other enrollees must be enrolled in a silver plan variant to be eligible for CSRs. b. Network Adequacy For PY2027, all medical and dental issuers shall complete and submit via SERFF the NHID Network Adequacy template. The template can be found on the NHID website at https://www.insurance.nh.gov/about-us/life-health-division. A webinar discussing the NHID’s Network Adequacy Review Process and Tool will be held on Thursday, April 9, 2026. Attendees may register at Page 4 of 8 https://events.gcc.teams.microsoft.com/event/5e2473e3-37f4-461c-8a54­ c628ea2561bc@992deae9-1c4c-42c8-a310-5088af55ba74. Carriers are reminded that CMS defers to NHID to enforce network adequacy requirements. The NHID continues to use our claims data approach to focus on actual access to care for our consumers. Our approach to evaluating network adequacy differs from other jurisdictions in that it is a service-centric review rather than a provider-based review, which NHID feels is the better approach to ensure consumers have access to necessary care in our state. c. Mental Health Parity Quantitative Treatment Limits (QTL) Reporting Tool Beginning with PY 2027 applications, all health plan issuers (including non-QHP issuers) will be required to complete and submit the NHID QTL Reporting tool. This tool is used to demonstrate compliance with MHPAEA (Federal Mental Health Parity and Addiction Equity Act of 2008). Individual and Small Group Plans must submit a separate template for each plan. Large Group Plans should submit a separate template for at least one HMO, one PPO, one EPO, and one POS sample plan design, as applicable to their products. Please note that to comply with MHPAEA, separate QTL analysis must be completed and documented for all plans, providing classifications and limitations for ALL covered benefits listed in each plan as sold. Large group plans should have a completed QTL analysis for each plan available to submit to the Department upon request. Carriers are reminded that they are required to verify compliance with the financial requirements as outlined in 42 USC sec. 300gg-26 for each plan and retain documentation demonstrating such compliance. Detailed instructions as to how to complete the NHID QTL template are located on the first tab of the tool. Results are automatically populated based on what information is provided for each covered service. When completing the template, all covered services must be listed and should include all services that are listed in the Certificate of Coverage. Projected claims should be reported as a total dollar amount and not on a “PMPM” basis. Projected claims should be based on plan level, but a product may be used if there is insufficient experience. The methodology used to estimate claims must be reasonable and in compliance with applicable Actuarial Standards of Practice and documented in writing. If a plan has a tiered network, all tiered information must be included, as well as an explanation about what qualifies as a tier (see 45 CFR 146.136 and Fact Sheet & FAQ, multiple network tiers at https://www.cms.gov/marketplace/resources/fact-sheets­ faqs#Mental_Health_Parity). Each completed template should be submitted under the Supporting Documentation Tab of the Form Filing in SERFF. QHP issuers should note that this is a change from previous years where QTL Templates were submitted under the Binder in SERFF. QTL Submissions are due along with the initial application. Page 5 of 8 The QTL Reporting Tool and Instructions for completing the template can be found on the NHID website at https://www.insurance.nh.gov/about-us/life-health­ division. d. Treatment at In-Network facilities and Emergency Services including Ground Ambulance Effective January 1, 2022, the No Surprises Act prohibited balance billing of covered person for emergency services, air ambulance, and services rendered at in-network facilities. Moving forward, New Hampshire will assume responsibility for reviewing all plan language to ensure compliance with the federal No Surprises. Recent legislative changes have clarified that NHID has the authority to review plans documents to ensure compliance with all aspects of the No Surprises Act. As such, reviews of plan documents have been streamlined by having NHID conduct this review and there will no longer be a need to submit plan documents to CMS for a separate review. Issuers should note that Senate Bill 245, codified at RSA 420-J:21 and effective January 1, 2026, prohibits ground ambulance providers from balance billing fully insured consumers for covered services. e. Substance Use Disorder Attestation All plans providing coverage for substance use disorder services shall file with the commissioner an annual attestation of compliance in accordance with RSA 420­ J:16. Such attestations shall now be submitted under the Supporting Documentation Tab of the Form Filing in SERFF. Any attestations submitted in SERFF for the upcoming plan year will be considered to meet the filing deadline required in the statute. III. QHP Issuer Procedures, Timeline, and Guidance on Select Requirements a. Form Filing Deadlines Health insurance issuers, as well as stand-alone dental issuers, requesting certification from the Centers for Medicare & Medicaid Services (CMS) must submit their initial applications (including all state-required templates, submissions, and form filings) with initial binder submissions no later than May 1, 2026. b. Rate Filing Deadlines Issuers are permitted to file a rate template as a placeholder on or by May 1, 2026, and will be allowed to update the template prior to the initial rate filing deadline. Initial rate submissions must be finalized and submitted by June 8, 2026. Off-exchange-only form and rate filings are due by June 22, 2026. Rate revisions for on-exchange plans are due on July 8, 2026. Final rate revisions are due by July 30, 2026. The NHID will complete all reviews and make recommendations for certification by August 12, 2026. Any plan that is not certified under the timeline (see Figure 1) Page 6 of 8 will be ineligible to be offered in the Marketplace during Plan Year 2027. Petition to CMS is required for changes to service area after initial submission. Please contact Jennifer Li: Chief Life, Accident & Health Actuary (HsiuChen.Li@ins.nh.gov) with questions or for further guidance regarding the PY2027 rate submission. c. Rate Filing Procedures (Individual Market) New Hampshire’s Reinsurance Program (Program) is supported by a Section 1332 State Innovation Waiver. For all years that the Program is in place and for federal pass-through funding calculation purposes, individual market issuers are required to file two sets of rates to include explanation of such rate assumptions in the actuarial memorandum for all plans eligible for participation in the Program. Issuers should submit the following: a “with waiver” rate template that factors in the estimated impact of Program payments on rates and a “without waiver” rate template (into the Supporting Documentation tab) that shows the anticipated rates if there were no Program or Program payments. The “with waiver” rates must be reflective of the issuer’s estimate of the actuarial impact that the Program will have on the issuer’s plan(s) for the upcoming benefit year. The “without waiver” rates should consider the cumulative impact of the Program payments and should not allocate the Program impact to any particular services. As such, there should only be one URRT template submitted for each “with waiver” and “without waiver” scenario. Additional information regarding the Program and its annual parameters can be found on the New Hampshire Health Plan (NHHP) website at https://nhhp.org/nh-reinsurance-program/. d. Drug Tools The NHID will continue to review formularies for compliance using data submitted via the federal Plan & Benefits and Prescription Drug templates. We will submit inquiries to the carrier should this review show any deficiencies or issues. There are no additional formulary template or tool requirements for the QHP Binder submission. While issuers are required to run the following CMS tools: Essential Health Benefit (EHB) Category and class Drug Count Tool, the Adverse Tiering Tool, and the Non- Discrimination Clinical Appropriateness Tool, NHID no longer requires carriers to submit these results as part of their QHP application. The NHID may verify the results of these tools and request further justifications only if warranted. Page 7 of 8 Figure 1: NHID QHP Application and Certification Timeline Page 8 of 8