The New Hampshire Health Plan (NHHP) is a state high risk pool established to provide health insurance to NH residents who are declined coverage through the private market, have a pre-qualifying condition or are otherwise eligible. The NHHP is intended generally to be the insurer of last resort for New Hampshire residents. Applicants are encouraged to first seek coverage from private insurance companies before contacting NHHP.

NHHP also provides health insurance for individuals who are entitled for certain Trade Adjustment Act or Pension Benefit Guaranty Corporation benefits. For these individuals, premiums may be payable through the federal health care tax credit program.

The Plan benefits are administered by BMI. See the Welcome Page for more information.

Information:

Rack Card

Pre-qualifying Conditions

Provider Network

Preferred Drug Listing

Rules For Precertification Review

1. For a Nonemergency Confinement or Medical Procedure -- the insured and/or the attending Physician must notify and give the appropriate admission or medical information to the Utilization Review Panel (Panel) by phone (see your policyowner identification card) at least seven days before the Confinement or medical procedure. Within one day after the Panel receives the required information, the Panel will notify the insured, the Physician and, if applicable, the facility of any Confinement or medical procedure which is certified as Medically Necessary.

   If the Panel does not receive the notice within seven days prior to the Confinement or medical procedure, coverage will be provided as explained in the Effect on Benefits paragraph located at the end of this Managed Care Techniques provision.

2. For an Emergency Confinement or Medical Procedure -- If the insured is confined or receives a medical procedure as a result of a Medical Emergency, then the insured and/or the attending Physician must notify and give the appropriate admission or medical information to the Panel by phone (see the policyowner identification card): (a) within 48 hours after a weekday Confinement or medical procedure; (b) within 72 hours after a weekend Confinement or medical procedure; or (c) as soon as reasonably possible after that. On the same business day that the Panel receives the required information, the Panel will notify the insured, the Physician and, if applicable, the facility of any Confinement or medical procedure which is certified as Medically Necessary.

3. For Continued Confinement -- Before the approved period of Confinement ends, the Panel will phone the attending Physician to determine whether the insured requires further Hospital Confinement. On the same business day, the insured, the Physician and the Hospital will be notified of any additional days of Confinement which are recommended as Medically Necessary, if any.

Case Management

Definition
"Case Management Program" means a written alternate treatment plan endorsed by the attending Physician and accepted by us to provide Medically Necessary and appropriate care in a cost-effective setting. It is the insured's final decision to participate in the program. There is no penalty for not participating in the program or for leaving during its course. In either case, any further benefits will be paid in accordance with the other provisions, limits and exceptions of this policy.

Eligible for the Case Management Program

Acquired Immune Deficiency Syndrome Amputations Burns Chemotherapy Chronic infections Chronic liver disease Chronic pulmonary diseases and conditions Coagulation defects Coma Conditions related to diabetes mellitus Demyelinating diseases of the central nervous system Diseases related to intracranial hemorrhage or occlusion

Disorders of the immune system Inflammatory diseases of the central nervous system Intestinal disorders Multiple fractures, with or without other system involvement Myoneural disorders Organ and tissue transplants Paralytic disorders Radical surgeries Renal diseases Spinal cord injuries Tumors, malignant or unspecified