N.H. State Continuation

State Continuation is not insurance; State Continuation is a right of N.H. residents, under N.H. law, to temporarily continue their FULLY INSURED group health and dental benefit plan (see below for an explanation of fully insured) for themselves and their dependents after the date the insurance would have otherwise ended due to a change in eligibility. For laws governing general requirements for State Continuation, refer to RSA 415:18, XVI). 

A Fully insured plan is when your employer has a contract with an insurance company for an insurance policy and pays a fee (i.e., the premium) for coverage vs. an employee benefit plan which is the employer offering a health benefit plan that is funded by the employer and only administered by the insurance company (these plans are also known as self-funded and employer benefit plans).  The N.H. Insurance Department only has jurisdiction over the fully insured plans.  Self-insured/self-funded Employee benefit plans fall under federal jurisdiction (U.S. D.O.L.).  Your benefits manager or human resource administrator should be able to clarify which type of plan you have. 

Under N.H. State Law, any insured individual whose employer has a fully insured group plan and is no longer eligible due to a “qualifying event,” i.e.,                 

           Termination (Except For Gross Misconduct), Quit, Laid Off, Divorce, Legal Separation, Change In Dependent Status, Declared Totally Disabled,                Death Of Covered Employee, Employer Declares Bankruptcy

See chart for the length of coverage, which is based on the “qualifying” event.

In the event the covered employee becomes divorced, legally separated, declared disabled (under the Social Security Act), or has substantial losses due to the employer declaring bankruptcy, the employee must notify the employer, who will then notify the insurance company/carrier. 

In the event of the termination, laid off, or death of the covered employee, then the employer should notify the carrier/insurance company.

The insurance carrier is responsible, under NH Law, to notify eligible individuals of their continuation rights.  Once the carrier is notified the carrier has 30 days from notification of eligibility for State Continuation to provide the individual with an election notice which offers the option and directions to sign up for State Continuation.  The individual then has 45 days to decide.

• Coverage is retroactive. Example: An employee has 45 days from the notification letter from the carrier to make a decision and communicate their acceptance to the employer. Once State Continuation begins, the coverage will be retroactive to the last day of the coverage.
• Other individuals on the health plan can elect State Continuation even if the covered employee does not.
• No pre-existing conditions apply to the extent an individual met any pre-existing requirements under their terminating group plan.

The benefits of the plan shall be made available to all eligible for the plan at the full group rate charged by the insurance carrier plus an allowable administrative fee not to exceed 2% (percent) of the monthly premium. Full payment shall be made to the employer who then will forward the premium with the group’s premium to the insurance carrier.

When Insured Fails to Pay

• The insurance can be terminated for failure of the insured to make timely payments.
• There is a 30 day grace period allowed for payments. 

When Insured Pays Employer But Employer Fails to Pay Carrier /  Insurance Company

• If an employer fails to make the payments to the insurer and this results in coverage termination, the employer will be liable for the benefits to the same extent as the insurer would have been had coverage not been terminated.

When a fully insured group plan terminates its benefits, the plan shall be available at the same group rate to all participants who are N.H. residents and for an extension period of 39 weeks or until coverage is available under another group plan, whichever occurs first. The full cost of the insurance as charged to the employer plus an allowable 2% administrative charge is due by the individual, and the premium is paid directly to the health insurance carrier.

Upon termination of the continuation period, individuals should consider purchasing insurance.  At the N.H. Insurance Department’s website at www.nh.gov/insurance under the Consumer’s Health page (or under Quick Links on the first page) there is a listing of companies offering individual health insurance. 

Please note that if you are denied individual health coverage for any medical reason, you may qualify for the New Hampshire Health Plan. For further details, please visit their website at www.nhhealthplan.org or call 877-888-6447.