Title 18 — Insurance Code

§ 7201. Purpose. The purpose and intent of this chapter are to promote the availability of health insurance coverage to small employers regardless of their health status or claims experience, to prevent abusive rating practices, to require disclosure of rating practices to purcha…

§ 7202. Definitions [For application of this section, see 79 Del. Laws, c. 99, § 19]. As used in this chapter: (1) “Actuarial certification” means a written statement by a member of the American Academy of Actuaries, or other individual acceptable to the Commissioner, that a smal…

§ 7203. Applicability and scope. This chapter shall apply to any health benefit plan provided by a small employer which provides coverage to the employees of such small employer in this State.68 Del. Laws, c. 175, §§ 1, 3; 68 Del. Laws, c. 340, § 1;

§ 7204. Establishment of classes of business. (a) A small employer carrier may establish more than 1 class of business only to reflect substantial differences in expected claims experience or administrative costs related to the following reasons: (1) The small employer carrier us…

§ 7205. Restrictions relating to premium rates. Premium rates for health benefit plans subject to this chapter shall be subject to the following provisions: (1) The index rate for any class of business shall not exceed the index rate for similar coverage for any other class of bu…

§ 7206. Renewability of coverage. (a) A health benefit plan subject to this chapter shall be renewable with respect to all eligible employees or dependents, at the option of the small employer, except in any of the following cases: (1) Nonpayment of the required premiums; (2) Fra…

§ 7207. Availability of coverage; preexisting conditions; minimum participation [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) (1) Subject to paragraph (a)(4) of this section, every small employer carrier shall, as a condition of transacting business in thi…

§ 7208. Notice of intent to operate as a risk-assuming carrier. (a) (1) Each small employer carrier desiring to operate as a risk-assuming carrier shall make application to the Commissioner within 30 days of January 4, 1993 to operate as a risk-assuming carrier, pursuant to § 720…

§ 7209. Application to become a risk-assuming carrier. (a) A small employer carrier may apply to become a risk-assuming carrier by filing an application with the Commissioner in a form and manner prescribed by the Commissioner. (b) The Commissioner shall consider the following fa…

§ 7210. Small Employer Health Reinsurance Program [Repealed]. Repealed by 77 Del. Laws, c. 106, § 3, effective July 6, 2009.

§ 7211. Health benefit plan committee. (a) The Commissioner shall appoint a Health Benefit Plan Committee. The Committee shall be composed of representatives of carriers, small employers and employees, health-care providers and producers. (b) The Committee shall recommend the for…

§ 7212. Periodic market evaluation. The board, in consultation with the Committee, shall study and report at least every 3 years to the Commissioner on the effectiveness of this chapter. The report shall analyze the effectiveness of the chapter in promoting rate stability, produc…

§ 7213. Waiver of certain state laws. No law requiring the coverage of a health-care service or benefit, or requiring the reimbursement, utilization or inclusion of a specific category of licensed health-care practitioner, shall apply to a basic health benefit plan delivered or i…

§ 7214. Administrative procedures. The Commissioner shall issue regulations in accordance with § 314 of this title and Chapter 101 of Title 29, for the implementation and administration of this chapter.68 Del. Laws, c. 340, § 1;

§ 7215. Standards to assure fair marketing. (a) Each small employer carrier shall actively market health benefit plan coverage, including the basic and standard health benefit plans, to eligible small employers in the State. If a small employer carrier denies coverage to a small …

§ 7216. Regulations; exceptions. (a) The Commissioner may establish regulations to implement the provisions of this section and to assure that rating practices used by small employer carriers are consistent with the purposes of this chapter, including regulations that: (1) Assure…

§ 7217. Disclosure of rating practices; certification of compliance. (a) In connection with the offering for sale of any health benefit plan to a small employer, a small employer carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of all o…

§ 7218. Factors for premium rates; premium rate variations; premium rate adjustments; “stop-loss” policies prohibited. (a) The only factors, other than plan design and family composition, that may be considered by a small employer carrier in setting premium rates for small employ…