New Hampshire: HealthFirst Plan

In May, Governor John Lynch signed legislation to enact HealthFirst, a health insurance plan designed to make coverage more affordable by emphasizing wellness programs and prevention. The law requires that plan designs address wellness, prevention, and chronic disease management and be made available to consumers by October 1, 2009.^[i] The insurance department has convened an advisory group to make recommendations on the benefit design. The general requirements of the program include the following:

• The base rate of the plan, calculated on a per member per month basis, may not exceed 10 percent of the previous year’s median wage, which is approximately $310. The benefit plan must also include limits on out-of-pocket spending.
• If one carrier files rates for the HealthFirst plan that meet the target rate, then all carriers with at least 1,000 members in the small group market must also offer the HealthFirst plan. If no carrier files a rate that meets the target rate, the commissioner will hold a hearing to determine the reasonableness of the target rate for the HealthFirst plan. Depending on the outcome of the hearing, all carriers may be required to offer the product at the target premium.
• The Insurance Commissioner must certify that the HealthFirst wellness benefit design creates incentives for consumers, health care providers, employers and health carriers to:
  • Encourage wellness strategies;
  • Promote primary care, preventive care, and a medical home model;
  • Manage and coordinate care for persons with chronic health conditions or acute illness;
  • Advance the use of cost effective care; and
  • Promote quality of care by the use of evidence-based, best practice standards and patient-centered care.^[ii]