(a) The commissioner, upon the commissioner’s own initiative or upon request by an insurer, shall waive any requirement of this part if such waiver does not contradict the objective or intent of the rule and:

1. (1) Applying the rule provision would cause confusion or would be misleading to consumers;
2. (2) The rule provision is in whole or in part inapplicable to the given circumstances;
3. (3) There are specific circumstances unique to the situation such that strict compliance with the rule would be onerous without promoting the objective or intent of the rule provision; or
4. (4) Any other similar extenuating circumstances exist such that application of an alternative standard or procedure better promotes the objective or intent of the rule provision.

(d) A request for a waiver shall specify the basis for the waiver and proposed alternative, if any.

Source. #12770, eff 5-5-19

APPENDIX A

STATE OF NEW HAMPSHIRE

INSURANCE DEPARTMENT

INDIVIDUAL RISK FORM FILING

NAMED INSURED AND MAILING ADDRESS

INSURANCE COMPANY AND

MAILING ADDRESS

Policy Number_____________________

Policy Term_______________________

REASON FOR INDIVIDUAL RISK FORM

Describe exposure(s) or any other circumstances which would necessitate the use of a form which is not filed by the insurer.

Attach revised form(s) and copy of original form indicating what revisions were made.

I HEREBY CERTIFY THAT I UNDERSTAND THAT THE COVERAGE PROVIDED FOR THIS POLICY IS NOT STANDARD.

I HEREBY CERTIFY AND I UNDERSTAND THAT THE PREMIUM CHARGE FOR THIS POLICY (ENDORSEMENT) IS NOT STANDARD.

____________________________ ______________________________

Policyholder Signature Date

____________________________

Title

The signature by the policyholder or an authorized representative of the policyholder (NOT the insurance agent) must be made after this form has been completed.

Available at https://www.nh.gov/insurance/pc/documents/individualrisk.pdf

APPENDIX B

STATE OF NEW HAMPSHIRE

INSURANCE DEPARTMENT

CONSENT TO RATE FORM

(Must be accompanied by declarations page showing name, location and address.)

NAMED INSURED AND MAILING

ADDRESS

INSURANCE COMPANY AND MAILING ADDRESS

Policy Number_____________________

Policy Term______________________

REASON(S) FOR EXCEPTION TO FILED RATE(S) - RSA 412:16X:

Describe exposure(s) or any substandard, unusual or hazardous conditions which necessitates the use of a rate or premium not filed with the Department. Include any underwriting information in support of the proposed rating. Reasons that merely refer to a policyholder’s inability to obtain coverage at standard rates, or comments that essentially equate to “class of risk” are not acceptable.

_____Unusual hazard involved

_______Unfavorable loss experience

______Other

Explanation of above reason(s)

Premium at filed rate(s)______________

Premium at Consent Rate(s)_____________

I HEREBY CERTIFY AND I UNDERSTAND THAT THE PREMIUM CHARGE FOR THIS POLICY (ENDORSEMENT) IS NOT STANDARD.

____________________________ ______________________________

Policyholder Signature Date

____________________________

Title

The signature by the policyholder or an authorized representative of the policyholder (NOT the insurance agent) must be made after this form has been completed.

Available at https://www.nh.gov/insurance/pc/documents/consenttorate.pdf

APPENDIX C

Rule

Specific State Statute the Rule Implements

Ins 5001.01

RSA 400-A:15, I; RSA 412:1-5; RSA 412:43, I

Ins 5001.02

RSA 400-A:15; RSA 412:43, I

Ins 5001.03

RSA 400-A:15, I; RSA 412:5, I; RSA 412:19; RSA 412:43, I;

RSA 417-C:1, I(c); RSA 417-B:3, IV

Ins 5001.04

RSA 400-A:15, I; RSA 412:5, I; RSA 412:19; RSA 412:43, I

Ins 5001.05

RSA 400-A:15, I; RSA 412:5, I; RSA 412:43, I

Ins 5001.06

RSA 400-A:15, I; RSA 412:5, I; RSA 412:43, I

Ins 5001.07

RSA 400-A:15, I; RSA 412:5, I; RSA 412:43, I

Ins 5001.08

RSA 400-A:15, I; RSA 541-A:22, IV