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Applications
Rates

Policy Forms
Other Forms

Application

Application (includes: NHHP ResAff 2002-a NHHP TobAff 2002-a)	PDF	This is a comprehensive application form which consists of the application with a Residency Affidavit and a Non-Tabocco User Affidavit.
Supplemental Family Application	PDF	Supplemental Family Coverage for Managed Care Option H
Notice of Privacy Practices	PDF	NH Health Plan's Privacy Policy
Applicant’s Checklist	PDF	Helpful checklist of items needed to complete the application
How to File a Claim	PDF	Helpful steps for Insureds on how to file a claim.

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Current Policy Forms

NHHP Indemnity A	PDF
NHHP Indemnity B	PDF
NHHP Outline of Coverage Indemnity	PDF
NHHP Managed Care A	PDF
NHHP Managed Care B	PDF
NHHP Outline of Coverage Managed Care A & B	PDF
NHHP Managed Care C	PDF
NHHP Outline of Coverage Managed Care C	PDF
NHHP Managed Care D	PDF
NHHP Outline of Coverage Managed Care D	PDF
NHHP Managed Care H	PDF
NHHP Outline of Coverage Managed Care H	PDF
Maternity Benefit Rider	PDF
NHHP Prescription Drug Standard	PDF
NHHP Prescription Drug HSA	PDF

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Rates

Note: Rates are guaranteed for 6 months and will be reset every 6 months to the new levels then in effect for these plans. At each renewal, rates for the insured's age at that time will apply.

Rates 2008 Jan - Jun	PDF
Rates 2007 Jul - Dec	PDF
Rates 2007 Jan - Jun	PDF
Rates 2006 Jul - Dec	PDF
Rates 2006 Jan - Jun	PDF
Rates 2005 Jul - Dec	PDF
Rates 2005 Jan - Jun	PDF
Rates 2004 Jul - Dec	PDF
Rates 2004 Jan - Jun	PDF
Rates 2003 Jul - Dec	PDF
Rates 2003 Apr - Jun	PDF

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Other Forms

Safe Harbor Notice	PDF	This form is approved for use by licensed insurance companies only.
Plan Comparison Summary	PDF
Plan Brochure	PDF
Privacy Notice	PDF
Appeals Process Notice	PDF

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