State Law

New Hampshire Admin. Code-Chapter Ins 2700-Part Ins 2701. Health and Dental Benefit Plan Network Adequacy

08/15/2023 New Hampshire Section 2701.08


Network Adequacy

(a) The department shall grant a carrier an exception to the standards for geographic accessibility in Ins 2701.06 where:

(1) A health carrier demonstrates that an insufficient number of qualified providers or facilities are available in the county to meet the geographic accessibility standards contained in Ins 2701.06;

(2) A health carrier demonstrates that the carrier’s failure to develop a provider network in a given county that is sufficient in number and type of providers to meet all of the standards in Ins 2701.06 is due to the refusal of a local provider to accept a commercially reasonable rate, fee, term, or condition and that the health carrier has taken steps to effectively mitigate the detrimental impact on covered persons;

(3) A health carrier demonstrates that the required service can be obtained through the use of telemedicine or telehealth from an in-network participating provider;

(4) A health carrier arranges to pay for the required service from an out-of-network provider, and the member is informed prior to the treatment that they can access services from the provider with no additional cost sharing beyond the benefit patient responsibility to an in-network provider; or

(5) A health carrier has requested and been granted a waiver under Ins 2701.14 with respect to another component of the geographic accessibility standard.

(b) The department shall grant a carrier an exception excluding one or more of the services listed in Ins 2701.07 from the network adequacy analysis where a health carrier can establish that the service in question is not a covered service for the health benefit plan to which the network applies and that exclusion of the service is appropriate for that coverage.