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If you are a NH resident and have been denied health insurance, you may be eligible for NH Health Plan. |
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NHHP-Fed Brochure
Eligibility
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Pre-Qualifying Conditions
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FAQs
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Are you eligible for NHHP-Fed coverage?
NHHP-Fed coverages are available to any New Hampshire residents who meets all of the requirements below:
- is a citizen or national of the United States or lawfully present in the United States;
- has not been covered under creditable coverage for a continuous six (6) month period of time prior to the date on which they are applying for coverage under the NHHP-Fed program;
- has a pre-existing condition as established by the following:
- evidence of denial of coverage by a health insurer; or
- evidence that coverage was offered with an exclusionary rider or endorsement; or
- letter from an insurance agent/producer licensed in New Hampshire stating that the applicant would be denied individual insurance coverage and/or coverage for his/her medical condition by a health insurer licensed in New Hampshire if s/he applied and the insurance agent/producer is appointed to write policies for the identified health insurer; or
- has one of the pre-qualifying conditions listed below:
How can a child who is under age 19 qualify for NHHP-Fed?
Provided that a child applying for NHHP-Fed coverage is a US citizen or US national or is otherwise lawfully present in the U.S. and has been without creditable coverage for at least 6 months, he or she is able to satisfy the pre-existing condition requirement for NHHP-Fed in one of two ways. First, NHHP-Fed will accept evidence that the child had been offered individual insurance coverage by a licensed health insurance company during the 12 months prior to applying for enrollment in NHHP-Fed for a premium that is at least twice as much as the premium for the NHHP-Fed Standard Option. Second, the child may qualify for NHHP-Fed on the basis of having a condition that was present before the date of enrollment for such coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before such date. “Pre-existing condition” is defined in the sameway for the purpose of the rules limiting pre-existing condition exclusions under the Public Health Service Act.
What eligibility documentation will NHHP-Fed require to determine whether a child has a pre-existing condition?
To document the presence of a pre-existing condition for a child under age 19, NHHP-Fed will accept a document dated within the past 12 months from a doctor of medicine, doctor of osteopathy, physician assistant, or nurse practitioner who is licensed to practice stating that such child used to have, or presently has a condition. The document will be reviewed to verify that:
- it is dated within 12 months of the date of application;
- it identifies the child and his or her condition; and
- includes the name, license number, and signature of a doctor of medicine, doctor of osteopathy, physician assistant, or nurse practitioner for purposes of validating whether he or she is licensed to practice.
Pre-qualifying conditions:
Behavioral Health (Psychiatric)
- Bipolar Disorder
- Bulimia/Anorexia
- Chemical Dependency
- Creutzfeldt-Jakob Disease
- Dementia
- Disorders From Organic Brain Syndrome
- Pick’s Disease
- Psychotic Disorders
- Wernicke-Kosakoff Syndrome
- Any other behavioral health inpatient treatment within the last 12 months
Blood/Blood Forming
- Aplastic Anemia
- Hemochromatosis
- Hemophilia
- Sickle Cell Disease
Cardiovascular
- Angina Pectoris
- Cardiomyopathy
- Congestive Heart Failure
- Coronary Artery Disease
- Coronary Insufficiency
- Coronary Occlusion
- Pacemaker
Endocrine (Hormonal)
- Addison’s Disease
- Cystic Fibrosis
- Diabetes (Type I or II)
- Porphyria
- Wilson’s Disease
Gastrointestinal
- Ascites
- Banti’s Disease or Syndrome
- Cirrhosis of the Liver
- Crohn’s Disease
- Esophageal Varices
- Hepatitis B or C
- Ulcerative Colitis
Infectious
Musculoskeletal/Connective
- Ankylosing Spondylitis
- Lupus Erythematosus - Systemic
- Rheumatoid Arthritis
- Scleroderma
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Neoplasm (Cancers)
- Cancer (except skin cancer) treated or diagnosed within the past 5 years
- Melanoma
- Hodgkin’s Disease
- Leukemia
- Multiple Myeloma
- Non-Hodgkin’s Lymphoma
- Wilm’s Tumor
Neurologic
- Alzheimer’s Disease
- Amyotrophic Lateral Sclerosis (ALS) (Lou Gehrig’s Disease)
- Friederich’s Ataxia
- Guillain Barre Syndrome
- Huntington’s Chorea
- Hydrocephalus
- Multiple Sclerosis
- Muscular Dystrophy
- Myasthenia Gravis
- Myotonia
- Palsy
- Paraplegia
- Parkinson’s Disease
- Quadraplegia
- Stroke
- Syringomyelia
- Tay-Sachs Disease
Pulmonary (Lung)
- Chronic Obstructive Pulmonary Disease (COPD)
- Emphysema
Other
- Kidney Disease requiring Dialysis
- Major Organ Transplant
- Pregnancy
- Spina Bifida
- Physician order for a medically necessary surgical procedure
- Prescription for ongoing maintenance medications, e.g. treatment for blood pressure, high cholesterol, thyroid problems, etc.
- Physician order for ongoing therapies to treat a medical condition, such as physical therapy, occupational therapy, speech therapy, cardiac rehabilitation therapy
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If you produce evidence of one of the pre-qualifying conditions, you do not have to first apply to another insurance company before applying for NHHP-Fed coverage. This list maybe amended from time to time.
Pre-Existing Conditions
NHHP-Fed does not have any pre-existing condition limitations.
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