Producers

• Rates are individual rates. (Family coverage is available for Managed Care Option H only.)
• If one person in a family is eligible for coverage then the entire family is eligible.
• Rates for a family are calculated on a person-by-person basis based on each individual´s age.
• Premiums are accepted through pre-authorized checking or monthly billing.
• If the monthly billing option is selected an additional $10 administrative fee must be included with each monthly payment.
• Rates are guaranteed for 12 months and will be reset upon the anniversary date.

Benefit Summaries

• Plan Comparison Summary

Pre-qualifying Conditions

Applicant’s Checklist

• PROOF OF NH RESIDENCY
  • Residency Affidavit (page 3 of the application form)
    
  
  
• ELIGIBILITY CERTIFICATION
  (only one requirement must be met)
  • Rejection letter from another carrier, or;
  • Offered coverage but at premium rate exceeding NHHP, or;
  • Have one of the pre-qualifying diseases, or;
  • Not eligible, not offered or have exhausted COBRA coverage, or;
  • Am a resident dependent or a resident family member who is covered by NH Health Plan, or;
  • Eligible for federal trade act assistance or pension benefit guaranty corporation assistance, or;
  • Offered coverage with a rider or endorsement excluding coverage for a specific condition
  
  
• PREMIUM PAYMENT OPTIONS
  All premiums are payable to the New Hampshire Health Plan
  • Check
    If this option is chosen, an additional $10 monthly fee must be included.
  • Debit (Automatic monthly withdrawal)
    • The first premium must be paid by check or money order.
    • A voided check must be included.
      
  Please note: Only one month's payment, for the exact amount due, is allowed. Any checks with multiple payments or wrong amounts will be returned.

• HIPAA CERTIFICATE OR OTHER EVIDENCE OF PREVIOUS COVERAGE(S)