Title 29 — State Government

§ 5201. Definitions. For purposes of this chapter: (1) “Chronic care management” means the services in the Chronic Care Management Services Program, as administered by the Centers for Medicare and Medicaid Services, and includes Current Procedural Terminology (“CPT”) codes 99487,…

§ 5202. Payment of premium; maximum state share; proration ratio. (a) (1) The maximum state share for a regular officer or employee and for an eligible spouse and child dependents who are not eligible for Medicare is as follows: a. Ninety-six percent of the premium for the basic …

§ 5203. Specifications of the coverage. (a) The basic health care insurance plan for state employees shall be equivalent to the “minimum creditable coverage” as defined by applicable federal law and include coverage for contraceptive methods under § 5203A of this title. (b) (1) T…

§ 5203A. Insurance coverage for contraceptive methods. (a) The plan shall provide coverage for contraceptive methods that includes all of the following: (1) All FDA-approved contraceptive drugs, devices, and other products as follows: a. If the FDA has approved 1 or more therapeu…

§ 5204. Selection of the group insurance carrier. (a) The health-care insurance coverage shall be provided through a carrier incorporated under the laws of this State or legally authorized to transact business within this State, having adequate servicing facilities to carry out t…

§ 5205. Duties of State Insurance Commissioner [Repealed]. Repealed by 69 Del. Laws, c. 64, § 68, effective July 1, 1993.

§ 5206. Duties of State Treasurer. Upon written authorization the State Treasurer shall withhold from the employee’s salary or eligible pensioner’s benefits such sums as are necessary for the payment of premium or subscription charges for the optional supplemental or extended ben…

§ 5207. Temporary employees. Any person not a “regular officer or employee” but employed by a state agency and who works the regularly scheduled full-time hours of the employing agency or at least 30 or more hours per week or 130 hours per month (with allowable interruptions) sha…

§ 5208. Employees of labor organizations. Any labor organization representing the state employees may elect to participate in the health-care insurance plans provided by the provisions of this chapter for their regularly scheduled full-time regular employees who work in the State…

§ 5209. Employees of Delaware authorities or commissions. (a) Any Delaware authority or commission may elect to participate in the health-care insurance plans provided by the provisions of this chapter for regularly scheduled full-time employees. The full cost of such coverage sh…

§ 5210. Authority and duties of the State Employee Benefits Committee [For application of this section, see 85 Del. Laws, c. 176, § 4]. The State Employee Benefits Committee established by § 9602 of this title shall have the following powers, duties and functions under this chapt…

§ 5211. Coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. The plan shall provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associa…

§ 5212. Cost sharing in prescription insulin drugs. (a) For purposes of this section, “prescription insulin drug” means a drug containing insulin that is dispensed under Chapter 47 of Title 16 for the treatment of diabetes. (b) The plan must provide coverage for prescription insu…

§ 5213. 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) The plan shall provide coverage for medically-nece…

§ 5214. Coverage for insulin pumps. (a) For purposes of this section, “insulin pump” means a small, portable medical device that is approved by the U.S. Food and Drug Administration to provide continuous subcutaneous insulin infusion. (b) The plan shall provide coverage for a med…

§ 5215. Annual behavioral health well check. (a) As used in this section “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 review of…

§ 5216. Cost sharing in diabetes equipment and supplies. (a) For purposes of this section, “diabetes equipment and supplies” means blood glucose meters and strips, urine testing strips, syringes, continuous glucose monitors and supplies, and insulin pump supplies. (b) The plan fo…

§ 5217. 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, t…

§ 5218. 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 a…

§ 5219. Services related to the termination of pregnancy. The plan shall provide coverage for services related to the termination of pregnancy. Such coverage may not be subject to any deductible, coinsurance, copayment, or any other cost-sharing requirement and must cover the ful…

§ 5220. Pharmacist services reimbursement [For application of this section, see 85 Del. Laws, c. 253, § 23]. (a) The plan must provide reimbursement to a pharmacist for a service or procedure at a rate not less than that provided to other nonphysician practitioners if the service…

§ 5221. Mammogram coverage. The plan shall provide coverage for annual mammograms for the purpose of early detection for a woman 40 years of age or older, with or without referral from the woman’s health-care provider. 84 Del. Laws, c. 483, § 3;

§ 5222. Ovarian cancer screening and monitoring tests [For application of this section, see 84 Del. Laws, c. 488, § 3]. (a) For purposes of this section: (1) “At risk for ovarian cancer” means any of the following: a. Having a family history of any of the following: 1. One or mor…

§ 5223. 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 § 3581 of Title 18. (2) “Panniculectomy” means an operative procedu…