Title 18 — Insurance Code
83 chapters · 1,008 sections in this title.
18 Del. C. § 6401. Legislative intent.
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§ 6401. Legislative intent. It is the intent of the General Assembly in enacting this chapter to provide that the Insurance Commissioner regulate managed care organizations, including financial solvency, established or operated in this State. It is the intent of the General Assem…
18 Del. C. § 6402. Short title.
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§ 6402. Short title. This chapter shall be known and may be cited as the “Delaware Managed Care Organization Act” or the “Delaware MCO Act.”63 Del. Laws, c. 382, § 1; 66 Del. Laws, c. 124, § 7; 71 Del. Laws, c. 229, § 8; 75 Del. Laws, c. 362, § 2;
18 Del. C. § 6403. Definitions.
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§ 6403. Definitions. As used in this chapter, unless the context clearly indicates a different meaning, the following words and phrases shall have the meaning ascribed to them in this section: (1) “Basic health services” means a range of services including at least the following:…
18 Del. C. § 6404. Certificate of authority; when required; application and issuance.
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§ 6404. Certificate of authority; when required; application and issuance. (a) No person shall establish, operate or engage in the business of a managed care organization or enter this State for the purpose of enrolling persons in a managed care organization without first obtaini…
18 Del. C. § 6405. Suspension or revocation of certificate of authority.
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§ 6405. Suspension or revocation of certificate of authority. (a) The Commissioner may, after a hearing, suspend or revoke the certificate of authority of a managed care organization for any of the following causes: (1) If the managed care organization is no longer qualified ther…
18 Del. C. § 6406. Annual report.
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§ 6406. Annual report. (a) Every managed care organization shall annually, on or before June 1, file with the Department a report covering the preceding fiscal year. (b) Such report shall include: (1) A financial statement of the organization, including its balance sheet and rece…
18 Del. C. § 6407. Prohibited practices.
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§ 6407. Prohibited practices. (a) No managed care organization or representative thereof may cause or knowingly permit the use of advertising or solicitation which is untrue or misleading. (b) No managed care organization may cancel or refuse to renew the enrollment of an enrolle…
18 Del. C. § 6408. Rules and regulations.
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§ 6408. Rules and regulations. The Department shall have authority to promulgate such reasonable rules and regulations as are necessary to carry out this chapter. Such rules or regulations shall conform to and be promulgated pursuant to the Administrative Procedures Act, Chapter …
18 Del. C. § 6409. Fees.
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§ 6409. Fees. Every managed care organization subject to this chapter shall pay the fees set forth in § 701 of this title for filing an application for a certificate of authority and for filing an annual report.75 Del. Laws, c. 362, § 2; 84 Del. Laws, c. 336, § 6;
18 Del. C. § 6410. Provision of professional services.
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§ 6410. Provision of professional services. (a) A managed care organization shall have a medical director. The medical director shall be licensed to practice medicine in Delaware in accordance with § 1702 of Title 24. The medical director’s duties shall include, at a minimum, tho…
18 Del. C. § 6411. Relationship to other laws.
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§ 6411. Relationship to other laws. (a) Managed care organizations shall be subject to this chapter and to the following chapters of this title, as amended from time to time, to the extent applicable and not in conflict with the express provisions of this chapter. For purposes of…
18 Del. C. § 6412. Confidentiality of health information.
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§ 6412. Confidentiality of health information. Any data or information pertaining to the diagnosis, treatment or health of any enrollee or applicant obtained from such person or from any health-care provider by any managed care organization shall be held in confidence and shall n…
18 Del. C. § 6413. Freedom of choice.
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§ 6413. Freedom of choice. In order to promote freedom of choice by employers and others in Delaware who purchase group health-care coverage, it shall be unlawful for any insurer, health service corporation or other person in the business of providing or insuring health-care serv…
18 Del. C. § 6414. Nondisclosure clause.
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§ 6414. Nondisclosure clause. A managed care organization contract shall contain no provision or nondisclosure clause prohibiting physicians or other health-care providers from giving patients information regarding diagnoses, prognoses and treatment options.63 Del. Laws, c. 382, …
18 Del. C. § 6415. Refusal to contract.
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§ 6415. Refusal to contract. A managed care organization shall not refuse to contract with or compensate for covered services an otherwise eligible health-care provider solely because that provider has in good faith communicated with 1 or more of the provider’s current, former or…
18 Del. C. § 6416. Independent health care appeals program.
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§ 6416. Independent health care appeals program. (a) There is established the Independent Health Care Appeals Program in the Department of Insurance. The program will include, at a minimum, a final step in the grievance process which provides for a review by an Independent Utiliz…
18 Del. C. § 6417. Appeal reviews; independent utilization review organizations.
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§ 6417. Appeal reviews; independent utilization review organizations. (a) The Insurance Commissioner or designee shall certify such organizations that meet the requirements of this section or regulations to be promulgated pursuant to it or shall deem certified any independent rev…
18 Del. C. § 6418. Indemnification and immunity of employees.
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§ 6418. Indemnification and immunity of employees. (a) An employee of the Department who participates in the program shall not be liable in any action for damages to any person for any action taken within the scope of that employee’s function in the program. The Attorney General …
18 Del. C. § 6419. Violations; penalties.
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§ 6419. Violations; penalties. (a) A carrier that violates any provision of this chapter shall be liable to a civil penalty of not less than $250 and not greater than $10,000 for each day that the carrier is in violation of the chapter if 10-days notice in writing is given of the…
18 Del. C. § 6420. Enforcement; adoption of rules and regulations.
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§ 6420. Enforcement; adoption of rules and regulations. The Insurance Commissioner shall enforce the provisions of this chapter. The Insurance Commissioner shall adopt rules and regulations, pursuant to the Administrative Procedure Act (Chapter 101 of Title 29), necessary to carr…