Title 18 — Insurance Code

§ 5725. Merger or conversion. (a) A domestic reciprocal insurer upon affirmative vote of not less than 2/3 of its subscribers who vote on such merger, pursuant to due notice and the approval of the Commissioner of the terms therefor, may merge with another reciprocal insurer or b…

§ 5726. Impaired reciprocals. (a) If the assets of a domestic reciprocal insurer are at any time insufficient to discharge its liabilities, other than any liability on account of funds contributed by the attorney or others, and to maintain the required surplus, its attorney shall…

§ 6101. Rescissions based upon post-claims underwriting barred. Unless approval is granted pursuant to § 6102 of this title, no insurer may rescind, cancel or limit any health insurance policy, contract, evidence of coverage or certificate that provides coverage of the types spec…

§ 6102. Approval of rescission. An insurer shall apply for approval of such rescission, cancellation or limitation by submitting such written information to the Insurance Commissioner on an application in such appropriate form as the Commissioner prescribes. Such insurer shall pr…

§ 6103. Affected health insurance policies. As used in this chapter, “health insurance policy, contract, evidence of coverage or certificate” means insurance providing benefits due to illness or injury, resulting in loss of life, loss of earnings, or expenses incurred, and includ…

§ 6104. Authority of Insurance Commissioner to promulgate regulations. The Insurance Commissioner may promulgate regulations to implement the provisions of this chapter.77 Del. Laws, c. 471, § 1;

§ 6301. Provisions exclusive. Health service corporations now or hereafter incorporated in this State shall be governed by this chapter, shall be exempt from all other provisions of this title, except as herein expressly provided, and no insurance law hereafter enacted shall be d…

§ 6302. Health service corporation defined. “Health service corporation” means a nonprofit corporation, without capital stock, organized under the laws of this State for the purpose of establishing, maintaining and operating plans to provide hospital, physicians’ or related healt…

§ 6303. Limited application. This chapter, other than § 6301 of this title, shall not apply to any corporation operating or maintaining a hospital service plan or medical service plan, participation in which is limited to its employees and the employees of other persons or corpor…

§ 6304. Certificate of authority; when required; application. (a) No corporation shall engage in the business of a health service corporation without first obtaining a certificate of authority therefor from the Commissioner, except that this provision shall not apply to corporati…

§ 6305. Issuance of certificate of authority. The Commissioner shall issue a certificate of authority to the applicant when it is shown to the Commissioner’s satisfaction that: (1) The applicant is established as a bona fide nonprofit health service corporation; (2) Arrangements …

§ 6306. Filing required for contract or rate changes. No new or changed contract or rider shall be offered to the public and no new or changed rate or rating formula shall be charged or employed, unless documentation with respect thereto as specified in § 6304(b) of this title is…

§ 6307. Annual report; examination. (a) Not later than March 1 of each year every such corporation shall file with the Commissioner a statement sworn to by at least 2 of its principal officers, showing its financial condition on the last day of the next preceding calendar year. S…

§ 6308. Suspension or revocation of authority to do business. The Commissioner may, after hearing, suspend or revoke the right to do business or the certificate of authority for any of the following causes: (1) If the corporation is no longer qualified therefor under this chapter…

§ 6309. Other provisions applicable. (a) Such corporations shall be subject to this chapter and to the following chapters of this title, to the extent applicable and not in conflict with the express provisions of this chapter: (1) Chapter 1 (General Definitions and Provisions). (…

§ 6310. Affiliations involving health service corporations. (a) (1) With respect to any proposed change of control affiliation or transaction between: a. A health service corporation licensed under this chapter; and b. Any insurer that administers a Children’s Health Insurance Pr…

§ 6311. Reserves and surplus; holding company standards. (a) Any approval by the Commissioner of a change of control of a health service corporation shall be governed under the provisions of Chapter 50 of this title and shall be subject to conditions that ensure compliance with t…

§ 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…

§ 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;

§ 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:…

§ 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…

§ 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…

§ 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…

§ 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…

§ 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 …

§ 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;

§ 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…

§ 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…

§ 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…

§ 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…

§ 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, …

§ 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…

§ 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…

§ 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…

§ 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 …

§ 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…

§ 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…

§ 6601. Definitions [For application of this section, see 79 Del. Laws, c. 434, § 3]. As used in this chapter: (1) “College or university” shall mean any nonprofit college in the State which is accredited by the appropriate regional accrediting agency. (2) “Covered person” is def…

§ 6602. Payment for beneficiaries; tuition payments; burial expenses. (a) Upon certification by the Insurance Commissioner that a claim under this chapter has been approved, the State Treasurer shall: (1) For claims submitted prior to July 1, 1997, pay to the beneficiary or benef…

§ 6603. Designation or determination of beneficiary [For application of this section, see 79 Del. Laws, c. 434, § 3]. (a) Each covered person under this chapter shall submit to the person’s employing state, county or municipal agency, volunteer fire department or ambulance operat…

§ 6604. Records of agencies. Every county and local police agency, volunteer and municipal fire department, the Department of Health and Social Services, the National Guard, the Department of Safety and Homeland Security and every organization providing voluntary ambulance servic…

§ 6605. Administration of Fund; adjudication of claims. (a) The Insurance Commissioner must receive claims against the Fund under this chapter. The Commissioner must determine the validity of all such claims and determine whether a death resulting in any such claim was in the lin…

§ 6606. Appeals. Any aggrieved claimant may appeal a decision of the Insurance Commissioner to Superior Court, which shall have final appellate jurisdiction under this chapter. Such appeal shall be an appeal on the record. Superior Court may, by rule, set forth the procedure for …

§ 6607. Payments to be diminished by amounts of other benefits. Repealed by 65 Del. Laws, c. 273, § 1, effective May 28, 1986.

§ 6608. Source of payments under this chapter. Payments made pursuant to this chapter shall be made from the State Self-Insurance Fund, as provided in Chapter 65 of this title. The General Assembly shall, when necessary, from time to time, provide for the adequate funding to the …

§ 6609. Tax exemption for payments. Payments made under this chapter to a beneficiary shall not be subject to Delaware income taxes or Delaware estate taxes.18 Del. C. 1953, § 6609; 58 Del. Laws, c. 504, § 1;

§ 6701. Definitions. As used in this chapter, the following words and terms have the following meanings: (1) “Covered firefighters” shall mean enrolled firefighters, ladies auxiliary members, and volunteer ambulance and rescue company members in good standing either according to …

§ 6701A. Funeral expenses for deceased volunteer firefighters. (a) The funeral expenses of a deceased member of a volunteer fire company, volunteer fire company ladies auxiliary, or volunteer ambulance and rescue company must be paid in the amount of $7,000. (b) (1) An individual…

§ 6701B. Definitions [For application of this section, see 84 Del. Laws, c. 419, § 6]. For purposes of this chapter: (1) “Active” means either of the following: a. A paid service member who has worked at least 1,250 hours within the previous 12-month period. b. A volunteer member…

§ 6702. Payment of benefits. Upon certification by the Commissioner that a claim under this chapter has been approved, the State Treasurer shall pay to a covered firefighter who has been permanently disabled in the line of duty, a benefit of $500 per month, plus $50 per month for…