New rules for insurance networks

The New Hampshire Insurance Department is in the process of changing its rules for health insurance networks.

The Department faced criticism after approving a "narrow network" for Anthem Blue Cross Blue Shield, the only insurer to offer plans on the Affordable Care Act health insurance exchange in 2014. The network excluded 10 of the state's 26 hospitals, but allowed Anthem to offer lower premiums.

Anthem’s narrow network was approved under a set of rules that focused on patients’ travel times to a provider. For example, there had to be at least two primary care providers within 40 minutes driving time of 90% of insured patients.

The Insurance Department is working on new rules that instead requires certain "core" services to be offered within each insured patient’s "community." "Core" services include routine services, from contraception to pediatric oral health. A "community" is defined as a Hospital Service Area that contains one to two dozen municipalities.

"Common" services, such as chemotherapy or delivery of a newborn, must be offered in a patient’s community or adjacent community.

"Specialized" services, such as a hysterectomy or radiation therapy, must be offered somewhere in New Hampshire.

Supporters of the new rules argue that an update is due, considering how much health care has changed since the rules were first drafted in 2001.

On the other hand, some argue that the problem is not how Anthem’s narrow network was approved, but rather the fact that Anthem’s narrow network was the only choice available on the health insurance exchange. The state might increase consumer choice by actually loosening insurance regulations, allowing more insurance plans to be offered.

Several other insurers joined Anthem Blue Cross Blue Shield to offer plans on New Hampshire’s health insurance exchange in 2015.

The Insurance Department working group on networks will meet again on September 10.