TITLE XXXVII
INSURANCE
Chapter 417-D
WOMEN'S HEALTH CARE
Section 417-D:1
417-D:1 Definitions. –
In this chapter:
I. "Commissioner" means the insurance commissioner.
II. "Insurer" means any entity issuing accident or health insurance or accident and health insurance policies, contracts, certificates, or other evidence of coverage pursuant to RSA 415, 415-A, 420-A, or 420-B.
III. "Low-dose mammography" means the X-ray examination of the breast using equipment dedicated specifically for mammography, including the X-ray tube, filter, compression device, screens, films, and cassettes, with a radiation exposure which is diagnostically valuable and in keeping with the recommended "Average Patient Exposure Guides" as published by the Conference of Radiation Control Program Directors, Inc. "Low-dose mammography" shall also include 3-D tomosynthesis mammography.
Source. 1988, 267:2. 1997, 190:12, eff. Jan. 1, 1998. 2018, 208:1, eff. Aug. 7, 2018.
Section 417-D:2
417-D:2 Low-Dose Mammography Coverage. –
I. Each insurer that issues or renews any policy of accident and health insurance providing benefits for hospital expense, medical-surgical expense, or major medical expense shall provide in each group or individual policy, contract, or certificate of insurance issued or renewed for persons who are residents of this state, coverage for screening by low-dose mammography for all women 35 years of age or older for the presence of occult breast cancer within the provisions of the policy, contract, or certificate. The coverage shall be as follows:
(a) A baseline mammogram for women 35 to 39 years of age.
(b) A mammogram every 1 to 2 years, even if no symptoms are present, for women 40 to 49 years of age.
(c) An annual mammogram for women 50 years of age or older.
II. Such benefits shall be at least as favorable as for other radiological examinations and subject to the same dollar limits, deductibles, and co-insurance factors.
Source. 1988, 267:2. 1996, 75:3, eff. Jan. 1, 1997.
Section 417-D:2-a
417-D:2-a Pregnancy, Delivery, and Postpartum Coverage. –
Each insurer that issues or renews any policy of accident and health insurance providing maternity benefits for hospital expense, medical-surgical expense, or major medical expense shall provide in each group or individual policy, contract, or certificate of insurance issued or renewed for persons who are residents of this state the following in providing coverage during pregnancy and delivery and the postpartum period:
I. The length of hospital stay and the number of postpartum visits shall be determined by the attending health care provider based on clinical information that demonstrates that the mother and infant are clinically stable based on nationally accepted guidelines pursuant to paragraph IV and that appropriate care for the mother and newborn can be provided for upon discharge. The length of stay shall not be determined by the health insurer or the hospital based on economic criteria.
II. Upon notification of the pregnancy by the insured to the insurer, the insurer shall inform the pregnant woman in writing regarding the insurer's prenatal, maternity, and postpartum benefits, including but not limited to prenatal visits, diagnostic tests, prenatal education, hospital length of stay, postpartum care, homemaker services, and contraceptive counseling and referrals.
III. The insurer shall pay for medically necessary prenatal homemaker services when a woman is confined to bedrest or her activities of daily living are otherwise restricted on the recommendation of her attending health care provider who shall consult with the applicable case manager.
IV. Any length of hospital stay shorter than the current minimum nationally accepted guidelines for perinatal care, such as Guidelines for Perinatal Care prepared by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, shall be at the recommendation of the attending health care provider in consultation with the mother. In such cases the insurer shall pay for at least 2 postpartum visits. During one such visit, the collection of an adequate sample from the newborn for screening for genetic and metabolic diseases shall take place in accordance with RSA 132 and applicable rules.
V. Postpartum visits shall include a physical assessment of mother and infant. The assessment shall include but not be limited to: infant nutrition and feeding, infant behavior, family interactions, safety and injury prevention, infant and maternal health promotion, and community resources. Providers of postpartum visits shall be licensed health care providers experienced in perinatal care.
VI. The insurer shall pay for appropriate medically necessary postpartum homemaker services as determined by the attending health care provider who shall consult with the applicable case manager.
VII. No attending health care provider shall be penalized by an insurer for following the provisions of this section. Insurers shall not deny payment for services that are within standards of good and generally accepted medical practice as reflected by scientific and peer medical literature and recognized within the organized medical community in the state of New Hampshire.
Source. 1996, 75:4, eff. Jan. 1, 1997.
Section 417-D:2-b
417-D:2-b Reconstructive Surgery. –
Every insurer subject to this chapter that provides individual or group coverage for mastectomy surgery shall provide coverage for reconstruction of the breast on which surgery has been performed and surgery and reconstruction of the other breast to produce a symmetrical appearance if the patient elects reconstruction and in the manner chosen by the patient and the physician.
Source. 1997, 311:1, eff. Jan. 1, 1998.
Section 417-D:2-c
417-D:2-c Coverage for Diagnostic and Supplemental Breast Examinations. –
I. No group health plan, or a health insurance issuer offering group or individual health insurance coverage, that provides benefits with respect to screening and diagnostic and supplemental breast examinations furnished to an individual enrolled under such plan or coverage, shall impose any cost-sharing requirements for such services.
II. For a health care contract that meets the definition of a "high deductible plan" set forth in 26 U.S.C. section 223(c)(2), this requirement shall apply only after the enrollee has satisfied the minimum deductible under section 223 for the year, except with respect to items or services that are preventive care pursuant to section 223(c)(2)(C) of the federal Internal Revenue Code, in which case paragraph I shall apply regardless of whether the minimum deductible under section 223 has been satisfied.
III. In this section:
(a) "Cost-sharing requirements" mean a deductible, coinsurance, copayment, and any maximum limitation on the application of such a deductible, coinsurance, copayment or similar out-of-pocket expense.
(b) "Diagnostic breast examination" means a medically necessary and appropriate examination of the breast, including such an examination using diagnostic mammography, breast magnetic resonance imaging, or breast ultrasound, that is:
(1) Used to evaluate an abnormality seen or suspected from a screening examination for breast cancer; or
(2) Used to evaluate an abnormality detected by another means of examination.
(c) "Supplemental breast examination" means a medically necessary and appropriate examination of the breast, including such an examination using breast magnetic resonance imaging, or breast ultrasound, that is:
(1) Used to screen for breast cancer when there is no abnormality seen or suspected; and
(2) Based on personal or family medical history, or additional factors that may increase the individual's risk of breast cancer.
Source. 2024, 32:1, eff. Jan. 1, 2025.
Section 417-D:2-d
417-D:2-d Maternal Depression Screening Coverage. –
I. Each health carrier that issues or renews any group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide to certificate holders of such insurance coverage for maternal depression screening.
II. Covered benefits shall include:
(a) Periodic prenatal and postpartum depression screening of the pregnant and postpartum patient under the patient's plan.
(b) Periodic maternal depression screening for the mother of a child at the child's one month, 2 month, 4 month, and 6 month well-child visits under the child's plan.
(c) Instruction to the mother on the results of screening and referral to mental health and/or community based resources.
III. In this section:
(a) "Maternal depression screening" means any and all screening tools for maternal mental health that is consistent with current standard of care and under the supervision of a certified health care provider.
(b) "Pregnant or postpartum patient" is defined as an individual who:
(1) Is pregnant or within 12 months of giving birth; or
(2) Has lost a pregnancy or relinquished an infant for adoption within the previous 12 months.
IV. This section shall not apply to plans available through the Small Business Health Options Program (SHOP).
Source. 2025, 141:259, eff. Jan. 1, 2026.
Section 417-D:2-e
417-D:2-e Coverage of Perinatal Mental Health and Substance Use Disorder Treatment. –
I. Any group health plan or health insurance issuer offering group health insurance coverage, that provides benefits with respect to mental health and substance use disorders treatment furnished to a perinatal individual enrolled under such plan or coverage, may choose to waive copayment for such services.
II. For a health care contract that meets the definition of a "high deductible plan" set forth in 26 U.S.C. section 223(c)(2), this requirement shall apply only after the enrollee has satisfied the minimum deductible under section 223 for the year, except with respect to items or services that are preventive care pursuant to section 223(c)(2)(C) of the federal Internal Revenue Code, in which case paragraph I shall apply regardless of whether the minimum deductible under section 223 has been satisfied.
III. In this section:
(a) "Perinatal individual" shall refer to an individual who:
(1) Is pregnant or is within 12 months of giving birth;
(2) Is a biological parent or an adoptive or foster parent who is within 12 months from assuming custodial care of a child; or
(3) Has lost a pregnancy or relinquished an infant for adoption within the previous 12 months.
(b) "Substance use treatment" and "substance use disorder services" mean health care services that are provided to a covered person as treatment for an addictive substance-related condition, not including treatment for any condition related to tobacco use.
Source. 2025, 141:262, eff. Jan. 1, 2026.
Section 417-D:2-f
417-D:2-f Coverage of Perinatal Home Visiting Services. –
I. Each health carrier that issues or renews any group policy, plan, or contract of accident or health insurance providing benefits for medical or hospital expenses, shall provide certificate holders of such insurance coverage for home visiting services for pregnant and postpartum women who do not otherwise qualify.
II. Covered benefits shall include:
(a) Home visiting services for pregnant and postpartum women up to 12 months post birth of a child provided by a qualified health professional with maternal and pediatric health training.
(b) Instruction, resource referral, and materials necessary to home visiting care.
III. In this section, "home visiting services" includes evidence-based, voluntary home, or community-based services for mothers and caregivers with newborns aimed at improving maternal and child health, including but limited to:
(a) Screenings for unmet health needs;
(b) Maternal and infant nutritional needs;
(c) Emotional health supports, including postpartum depression supports; and
(d) Resource and referral.
Source. 2025, 141:262, eff. Jan. 1, 2026.
Section 417-D:3
417-D:3 Rulemaking. –
The commissioner may adopt rules, under RSA 541-A, relative to the administration of this chapter.
Source. 1988, 267:2, eff. Jan. 1, 1989.
Section 417-D:4
417-D:4 Penalty. –
Any insurer that violates any provision of this chapter or any rule adopted pursuant to it, may, at the discretion of the commissioner, have its certificate of authority indefinitely suspended or revoked.
Source. 1988, 267:2, eff. Jan. 1, 1989.