This past year, the New Hampshire General Court passed laws that expanded coverage for benefits under your fully insured, New Hampshire-based health plan. Below is a description of the new coverage requirements:
Medical Prior Authorizations:
House Bill 1639, effective immediately, prohibits insurers from requiring prior authorizations for emergency services necessary to screen and stabilize an individual. Additionally, the law prohibits insurers from requiring a prior authorization for medically necessary interfacility transports for services related to the treatment and diagnosis of certain serious mental illnesses.
Insulin Cost Sharing:
House Bill 1280, effective September 14, 2020, places a cap on the total amount that a covered person is required to pay for each covered insulin drug prescription. The maximum a covered person will be required to pay is $30 for up to a 30-day supply of each covered insulin prescription.
House Bill 1162, effective September 18, 2020, requires coverage of in-network early intervention services with no member cost sharing (deductibles, copayments or coinsurance) for members enrolled in non-HSA plans. For members enrolled in HSA plans, the law requires plans to cover in-network early intervention services in full only after their in-network deductible has been met. Coverage is subject to the benefit limits and age requirements listed on your Schedule of Benefits.
House Bill 1623, effective September 19, 2020, requires plans to provide coverage and reimbursement for telemedicine health care services on the same basis as in-person health care services. Additionally, this law prohibits plans from imposing any additional benefit limitations on telemedicine services that are not equally imposed on similar in-person visits. Lastly, this law adds “audio-only telephone” as a covered service to the telemedicine benefit.
Perfluoroalkyls (PFAS) and Perfluorinated Compound (PCF) Blood Testing:
House Bill 1264, effective September 21, 2020, requires coverage for perfluoroalkyls (PFAS) and perfluorinated compound (PFC) blood testing. While the state of New Hampshire is now requiring coverage of PFAS/PFC, your Harvard Pilgrim plan has already been providing this coverage.
House Bill 1280, effective January 1, 2021, requires coverage of epinephrine auto injectors. While the state of New Hampshire is now requiring coverage of epinephrine auto-injectors, your Harvard Pilgrim plan has already been providing this coverage.
Pharmacy Prior Authorizations:
House Bill 1280, effective January 1, 2021, requires insurers to respond to a prescription drug prior authorization request within two business days from the time a completed request is received from the prescribing provider. A prescription drug that requires prior authorization for coverage will be considered approved if the prior authorization process exceeds two business days.
Long-Term Antibiotic Therapy for Tick-Borne Illness:
House Bill 1639, effective June 30, 2021, requires that plans cover long-term antibiotic therapy for tick-borne illnesses and defines long-term antibiotic therapy as the administration of oral, intramuscular or intravenous antibiotics for periods of time in excess of four weeks. Coverage will be provided when medically necessary and ordered by a licensed infectious disease physician after a thorough evaluation.
To obtain additional information about your benefits and applicable cost sharing under your plan, please refer to your Evidence of Coverage.