AN ACT TO AMEND TITLE 18, TITLE 29, AND TITLE 31 OF THE DELAWARE CODE RELATING TO INSURANCE COVERAGE FOR TREATMENT TO PREVENT HIV INFECTION.

Lower HIV prevention costs for Delaware enrollees

Starting January 1, 2028, the law requires covered Delaware health plans to cover medically needed HIV prevention medicines. These include PrEP, taken before exposure, and PEP, taken after exposure. Coverage includes prescriptions for people at increased risk of getting HIV. The law covers applicable individual and group insurance, state employee health plans, and Medicaid. It applies to policies renewed, modified, altered, amended, or reissued after December 31, 2027. Plans must cover these medicines without deductibles, copays, coinsurance, or other out-of-pocket costs, as federal law allows. Plans also cannot require prior approval, require trying another treatment first, or unreasonably delay coverage, as federal law allows. Medicaid requirements apply only as federal law permits. Limited policies are excluded, including accident-only, specified-disease, hospital-indemnity, Medicare-supplement, long-term-care, disability-income, and other limited health policies. Existing cost-sharing can remain when needed to preserve a catastrophic plan's federal status. Qualified high-deductible plans can require meeting the deductible first when earlier no-cost coverage would prevent health savings account eligibility.