Medicare, the standardized Medigap plans, Medicaid and long-term care design are covered in the national Senior and Special Needs guide. This guide covers New Hampshire's Medicare supplement law (RSA 415-F; Ins 1905) and its long-term care law (RSA 415-D; Ins 3601 and 3602), plus the rule against misleading senior designations.

Medicare supplement

Open enrollment (Ins 1905.13)

• For the six months starting with the first month a person is enrolled in Part B, an issuer can't deny, condition or price a policy based on health.
• Every currently available policy must be offered to qualifying applicants without regard to age.
• An open enrollment applicant with at least six months of creditable coverage can't have benefits excluded for a preexisting condition.

At the sale

• Free look. 30 days from delivery, with a full premium refund (RSA 415-F:6).
• Medicare guide. The issuer provides the Guide to Health Insurance for People with Medicare in at least 12-point type (Ins 1905.19).
• Application (Ins 1905.20):
  • The agent lists policies sold to the applicant that are still in force, plus those sold in the past five years that aren't.
  • The application explains that Medigap may be suspended for up to 24 months while on Medicaid, if requested within 90 days.

Prohibited sales (Ins 1905.23)

• Any sale that gives a person more than one Medigap policy.
• A policy for a Part C (Medicare Advantage) enrollee unless it takes effect after the Part C coverage ends.

Marketing (Ins 1905.22)

• The first page carries the notice "This policy may not cover all of your medical expenses."
• High-pressure tactics using force, fright, threat or undue pressure are prohibited.

Compensation (Ins 1905.18). First-year commission may be no more than 200% of the second-year amount. Renewal commission must equal the second-year amount for at least five renewal years.

Premiums and claims

• When a member on Medicare because of disability turns 65, the issuer can't keep charging the under-65 premium (415-F:9).
• Proof of loss on Medigap claims is due within one year after the loss. Other A&H policies allow 90 days (415:6).

Long-term care insurance (RSA 415-D)

Selling the policy

• Outline of coverage. It goes to the applicant before an application is presented (415-D:8).
• Delivery. The policy is delivered within 30 days after approval.
• Free look. 30 days from delivery. Any refund is made within 30 days of the return (415-D:7).
• Marketing (Ins 3601.22):
  • Buyers must be told the policy may not cover all long-term care costs.
  • Cold lead advertising is prohibited: marketing that hides its insurance purpose or that a producer will make contact.

Policy standards (415-D:5, 415-D:6)

• No prior hospitalization may be required for any benefit.
• A policy can't cover only skilled nursing care, or give significantly more coverage for skilled care than for lower levels.
• Preexisting conditions. The look-back is limited to six months before the effective date. Exclusions can last no more than six months.
• Renewal. A policy may be canceled or nonrenewed only for nonpayment, never because of age or declining health.

Group coverage ending. Group certificate holders whose coverage ends may get an individual policy or replacement group certificate by applying and paying within 30 days after written notice (415-D:6).

Partnership inflation protection (Ins 3602.07)

Senior designations (Ins 311.04)

Misleading use of a senior-specific certification or designation is an unfair and deceptive practice. That includes designations that don't exist, are self-conferred, or weren't earned. It implies special training in advising seniors that the producer doesn't have.

Common exam traps

• Medigap and LTC free looks are 30 days. The life free look in New Hampshire is 10 days.
• New Hampshire's Medigap open enrollment runs six months from the first month of Part B enrollment, and it's available regardless of age.
• Medigap first-year commission can't exceed 200% of the second-year rate.
• An LTC policy can be canceled only for nonpayment, and it can't require a prior hospital stay.