Title 18, Insurance Code

§ 3347. Required coverage for reconstructive surgery following mastectomies. (a) All individual health insurance policies, contracts or certificates that are delivered or issued for delivery in this State by any health insurer, health service corporation or managed care organizat…

§ 3348. Referrals. (a) This section applies to every policy or contract of health insurance which is delivered or issued for delivery in this State, including each policy or contract issued by a health service corporation, and which designates network physicians or providers or p…

§ 3349. Emergency care. (a) This section applies to every policy or contract of health insurance, including each policy or contract issued by a health service corporation, which is delivered or issued for delivery in this State, and which designates network physicians or provider…

§ 3349A. Required coverage for volunteer ambulance company services. (a) For the purpose of this section: (1) “Ambulance run” means a volunteer ambulance company response to dispatched calls for service. (2) “Basic life support (BLS)” shall have the same meaning as set forth in §…

§ 3350. Prescription medication. (a) This section applies to every policy or contract of health insurance, including each policy or contract issued by a health service corporation, which is delivered or issued for delivery in this State and which provides coverage for outpatient …

§ 3350B. Copayment or coinsurance for prescription drugs limited [For application of this section, see 82 Del. Laws, c. 57, § 3 and 83 Del. Laws, c. 522, § 4]. (a) Definitions. — (1) “Carrier” means any entity that provides health insurance in this State. “Carrier” includes an in…

§ 3351. Clinical trials. (a) This section applies to every policy or contract of health insurance, including each policy or contract issued by a health service corporation, which is delivered or issued for delivery in this State. (b) Definitions. — (1) “Clinical trials,” for purp…

§ 3351B. Experimental treatment coverage. (a) No individual policy or contract of health insurance, or certificate issued thereunder, which is delivered, issued for delivery, or renewed in this State by any health insurer, health service corporation, or health maintenance organiz…

§ 3352. Newborn and infant hearing screening; coverage and reimbursement. (a) Any individual health insurance policy which is delivered, issued for delivery, renewed, extended, or modified in this State by any health-care insurer and which provides coverage for a child shall be d…

§ 3353. Use of social security numbers on insurance cards. (a) As used in this section, “insurance card” means a card that a person or entity provides to an individual so that the individual may present the card to establish the eligibility of the individual or the individual’s d…

§ 3354. Supplemental coverage for children of insureds [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) Definitions. — As used in this section: (1) “Carrier” means any entity that provides health insurance in this State. For the purposes of this section, “car…

§ 3355. Phenylketonuria (PKU) and other inherited metabolic diseases. (a) Definitions. — In this section the following words shall have the meanings indicated: (1) “Inherited metabolic diseases” shall mean diseases caused by an inherited abnormality of biochemistry. The words “in…

§ 3356. Required coverage for scalp hair prosthesis. (a) Every individual health insurance policy, contract or certificate that is delivered or issued for delivery in this State by any health insurer, health service corporation or managed care organization which provide for medic…

§ 3357. Hearing aid coverage. (a) For purposes of this section, the term “hearing aid” means any nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but excluding batteries, cords, a…

§ 3358. Dental services for children with a severe disability. (a) Definitions. — As used in this section: (1) “Child with a severe disability” means a person under the age of 21 who, due to a significant mental or physical condition, illness, or disease, is likely to require spe…

§ 3359. Health insurance; pharmacies; electronic reimbursement. (a) This section shall apply to: (1) Insurers and nonprofit health service plans that provide, directly or through a pharmacy benefit manager, coverage for prescription drugs under health insurance policies or contra…

§ 3359B. Electronic medical (non-pharmaceutical) claims. (a) This section shall apply to all claims for healthcare services that are submitted and are not covered by § 3359 of this title. (b) For purposes of this section: (1) “Carrier” means any entity that provides health insura…

§ 3360. Screening of infants and toddlers for developmental delays. (a) Definitions. — As used in this section: (1) “Carrier” means any entity that provides health insurance in this State. For the purposes of this section, “carrier” includes an insurance company, health service c…

§ 3361. Limitations on preexisting condition limitations for minor children [Repealed].78 Del. Laws, c. 141, § 1; 80 Del. Laws, c. 310, § 1; repealed by 82 Del. Laws, c. 186, § 1, effective Aug. 6, 2019.;

§ 3362. Reimbursement for orthotic and prosthetic services. (a) Definitions. — For purposes of this section: (1) “Federal reimbursement rates” means the current listed fee schedule from the Centers for Medicare and Medicaid Services, listing the current Healthcare Common Procedur…

§ 3363. Recommended immunizations and preventive services. (a) This section applies to any health carrier providing coverage under an individual or group health benefit plan. (1) This section does not apply to grandfathered plan coverage. (2) For purposes of this section, “grandf…

§ 3364. Specialty tier prescription coverage. (a) Unless otherwise specifically provided, the definitions herein apply throughout this section. (1) “Class of drugs” means a group of medications having similar actions designed to treat a particular disease process. (2) “Coinsuranc…

§ 3365. School-based health centers. (a) For purposes of this section, a school-based health center (SBHC) is a health clinic that: (1) Is located in or near a school facility; (2) Is organized through school and health provider relationships; (3) Except as provided by subsection…

§ 3366. Autism spectrum disorders coverage. (a) All individual health benefit plans as defined in § 3343(a) of this title shall provide coverage for the screening and diagnosis of autism spectrum disorders and the treatment of autism spectrum disorders in individuals less than 21…

§ 3367. Payment for emergency medical services. (a) As used in this section: (1) “Ambulance” shall have the same definition set forth in § 9702 of Title 16. (2) “Basic life support” shall have the same definition set forth in § 9702 of Title 16. (3) “Emergency medical services pr…

§ 3368. No lifetime or annual limits [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) (1) Except as provided in subsection (b) of this section, a health insurance issuer offering group or individual health insurance coverage may not establish any lifetime lim…

§ 3369. Notification and reasons for cancellation or nonrenewal [For application of this section, see 79 Del. Laws, c. 390, § 8]. A notice of cancellation or nonrenewal of health insurance coverage by an insurer due to nonpayment of premiums shall be in writing, shall be delivere…

§ 3370. Telehealth and telemedicine. (a) For purposes of this section: (1) “Distant site” means a site at which a health-care provider legally allowed to practice in Delaware is located while providing health-care services by means of telemedicine or telehealth. (2) “Originating …

§ 3370A. Network disclosure and transparency. (a) This section applies to every policy or contract of health insurance which is delivered or issued for delivery in this State, including each policy or contract issued by a health-service corporation, which provides medical, major …

§ 3370B. Coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. (a) All individual health insurance policies, contracts, or certificates that are delivered, issued for…

§ 3370C. Time of submitting claim for reimbursement. (a) For purposes of this section: (1) “Carrier” means any entity that provides health insurance in this State. “Carrier” includes an insurance company, health service corporation, health maintenance organization, and any other …

§ 3370D. Coverage for epinephrine autoinjectors. (a) For purposes of this section, “epinephrine autoinjector” means a single-use device used for the automatic injection of a premeasured dose of epinephrine into the human body. (b) All individual health insurance policies, contrac…

§ 3370E. Annual behavioral health well check. (a) As used in this section: (1) “Behavioral health well check” means a predeductible annual visit with a licensed mental health clinician with at minimum a masters level degree. The well check must include but is not limited to a rev…

§ 3370F. Supplemental and diagnostic breast examinations [For application of this section, see 84 Del. Laws, c. 121, § 5]. (a) As used in this section: (1) “Breast magnetic resonance imaging” or “breast MRI” means a diagnostic tool, including standard and abbreviated breast MRI, …

§ 3370G. Coverage for allergenic protein dietary supplements [For application of this section, see 84 Del. Laws, c. 376, § 5]. (a) For purposes of this section: (1) “Dietary supplement” means as defined in the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. § 321. (2) “Early egg …

§ 3370H. Services related to termination of pregnancy. (a) As used in this section: (1) “Carrier” means any entity that provides health insurance in this State that is subject to the provisions of this chapter. “Carrier” includes an insurance company, health service corporation, …

§ 3370I. Coverage for doula services. (a) “Doula services” means services provided by a trained doula and designed to provide physical, emotional, and educational support to pregnant and birthing persons, before, during, and after childbirth. “Doula services” include the followin…

§ 3370J. Pharmacist services reimbursement [For application of this section, see 85 Del. Laws, c. 253, § 23]. (a) For purposes of this section, “carrier” means any entity that provides health insurance in this State. “Carrier” includes any insurance company, managed care organiza…

§ 3370K. Annual mammograms. (a) As used in this section, “Carrier” means any entity that provides health insurance in this State that is subject to the provisions of this chapter. “Carrier” includes an insurance company, health service corporation, health maintenance organization…

§ 3370L. Developmentally-delayed speech coverage [For application of this section, see 84 Del. Laws, c. 520, § 3]. (a) For the purpose of this section “child” means a child from birth to age 18. (b) Every individual health insurance contract, including each policy or contract del…

§ 3370M. Coverage for removal of excess skin and subcutaneous tissue [For application of this section, see 85 Del. Laws, c. 88, § 5]. (a) For purposes of this section: (1) “Medically necessary” means as defined in § 3371 of this title. (2) “Panniculectomy” means an operative proc…

§ 3370N. Coverage for pre-exposure prophylaxis treatment and post-exposure prophylaxis treatment [For application of this section, see 85 Del. Laws, c. 452, § 5]. (a) As used in this section: (1) “Cost-sharing requirement” includes a deductible, coinsurance, copayment, and out-of…

§ 3370O. Coverage for diagnostic services and treatment for menopause and perimenopause [For application of this section, see 85 Del. Laws, c. 482, § 5]. (a) As used in this section: (1) “Hormone replacement therapy” means medical treatment, approved by the United States Food and…

§ 3370P. Biomarker testing [For application of this section, see 85 Del. Laws, c. 484, § 5]. (a) For purposes of this section: (1) “Biomarker” means a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, o…

§ 3371. Definitions [For application of this section, see 82 Del. Laws, c. 44, § 3; 85 Del. Laws, c. 176, § 4]. For purposes of this subchapter: (1) “Adverse determination” means a benefit denial, reduction, or termination, or determination that an admission or continued stay, or…

§ 3372. Disclosure and review of pre-authorization requirements; adverse determinations [For application of this section, see 85 Del. Laws, c. 176, § 4]. (a) A utilization review entity shall make any current pre-authorization requirements and restrictions readily accessible on i…