Title 18, Insurance Code

§ 3571I. No lifetime or annual limits [For application of this section, see 79 Del. Laws, c. 9, § 19]. (a) (1) Except as provided in subsection (b) of this section, a group health plan, or a health insurance issuer offering group or individual health insurance coverage, may not e…

§ 3571J. Guaranteed availability of coverage [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) Guaranteed availability of coverage in the group market. — Subject to subsections (b)-(d) of this section, a health insurer that offers health insurance coverage in …

§ 3571K. Prohibition on excessive waiting periods [For application of this section, see 79 Del. Laws, c. 99, § 19]. A group health plan and a health insurer offering group health insurance coverage shall not apply any waiting period that exceeds 90 days. As used in this section, …

§ 3571L. Nondiscrimination in health care [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) Providers. — A group health plan and a health insurer offering group health insurance coverage shall not discriminate with respect to participation under the plan or co…

§ 3571M. Comprehensive health insurance coverage [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) Coverage for essential health benefits package. — A health insurer that offers health insurance coverage in the small group market shall ensure that such coverag…

§ 3571N. Prohibiting discrimination against individual participants and beneficiaries based on health status [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) In general. — A group health plan and a health insurer offering group health insurance coverage may n…

§ 3571O. Insurance offered through the state health insurance exchange [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) A health insurer that offers health insurance coverage in the small group market through the state health insurance exchange program establ…

§ 3571P. Rating factors [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) In establishing rates for health insurance coverage offered in the small group market, the rate may vary with respect to the particular plan or coverage involved only by determining the …

§ 3571Q. 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 group health insurance coverage by an insurer due to nonpayment of premiums shall be in writing, shall be d…

§ 3571R. 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…

§ 3571S. 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 …

§ 3571T. Coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. (a) All group and blanket health insurance policies, contracts, or certificates that are delivered, iss…

§ 3571U. Mental Health Parity and Addiction Equity Act reporting requirements [Effective until Jan. 1, 2028]. Each health insurer offering group health insurance coverage that provides mental illness and drug and alcohol dependencies benefits must submit a report to the Delaware …

§ 3571V. 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 …

§ 3571W. Electronic medical claims. (a) This section shall apply to all claims for healthcare services that are submitted as part of group or blanket health insurance contracts. (b) For purposes of this section: (1) “Carrier” means any entity that provides health insurance in thi…

§ 3571X. Medication assisted treatment for drug and alcohol dependencies [Effective until Jan. 1, 2028]. (a) For purposes of this section, “medication-assisted treatment” means the use of U.S. Food and Drug Administration-approved medications, in combination with counseling and b…

§ 3571Y. 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 group and blanket health insurance policies, …

§ 3571Z. 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…

§ 3572. Definitions. As used in this subchapter: (1) “Affiliation period” means a period of time not to exceed 2 months (3 months for late enrollees) during which a health maintenance organization does not collect premium and coverage issued is not effective. (2) “Bona fide assoc…

§ 3573. Limitations on preexisting condition limitations [For application of this section, see 79 Del. Laws, c. 99, § 19]. A health benefit plan that covers a large group in this State: (1) Shall not deny, exclude or limit benefits for a covered individual because of a preexistin…

§ 3574. Renewability of coverage. (a) A health benefit plan shall be renewable with respect to an enrollee or dependents at the option of the enrollee, except in any of the following cases: (1) The policyholder fails to comply with participation or contribution rules; (2) With re…

§ 3575. Rate regulation. A carrier offering a large group health benefit plan may not require any individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution that is greater than such premium or contribution for a similarly si…

§ 3576. Mental health parity. A carrier offering a large group health plan shall comply with the provisions of 42 U.S.C. § 300gg-5, Public Law 104-204 and any subsequent changes in federal law.71 Del. Laws, c. 143, § 14; 73 Del. Laws, c. 89, § 1; 76 Del. Laws, c. 176, § 3;

§ 3577. Newborns and mothers health protection. A carrier offering a health benefit plan shall comply with the provisions of 42 U.S.C. § 300gg-4 and any subsequent changes in federal law.71 Del. Laws, c. 143, § 14; 73 Del. Laws, c. 89, § 1; 76 Del. Laws, c. 176, § 3;

§ 3578. Insurance coverage for serious mental illness [For application of this section, see 81 Del. Laws, c. 29, § 3] [Effective until Jan. 1, 2028]. (a) Definitions. — For the purposes of this section, the following words and phrases shall have the following meanings: (1) “ASAM …

§ 3579. 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…

§ 3580. 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…

§ 3581. Definitions [For application of this section, see 82 Del. Laws, c. 44, § 3; 85 Del. Laws, c. 176, § 4]. For purposes of this subchapter, the following definitions apply: (1) “Adverse determination” means a benefit denial, reduction or termination, or determination that an…

§ 3582. 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 …

§ 3583. Utilization review entity’s obligations with respect to pre-authorizations [For application of this section, see 85 Del. Laws, c. 176, § 4]. (a) If a utilization review entity requires pre-authorization of a pharmaceutical, the utilization review entity must complete its …

§ 3584. Utilization review entity’s obligations with respect to pre-authorization concerning emergency health-care services. A utilization review entity must follow all emergency procedures and mandates as delineated in §§ 3349 and 3565 of this title.80 Del. Laws, c. 310, § 2;

§ 3585. Retrospective denial. The utilization review entity may not revoke, limit, condition or restrict a pre-authorization on ground of medical necessity after the date the health-care provider received the pre-authorization. Any language attempting to disclaim payment for serv…

§ 3586. Effect and length of pre-authorization; limitation per episode of care [For application of this section, see 85 Del. Laws, c. 176, § 4]. (a) A pre-authorization for pharmaceuticals shall be valid for 1 year from the date the health-care provider receives the pre-authoriza…

§ 3587. Electronic standards for pre-authorization [For application of this section, see 85 Del. Laws, c. 176, § 4]. (a) No later than January 1, 2018, the insurer must accept and respond to pre-authorization requests under the pharmacy benefit through a secure electronic transmi…

§ 3588. Health-care services deemed preauthorized if a utilization review entity fails to comply with the requirements of this subchapter. Any failure by a utilization review entity to comply with the deadlines and other requirements specified in this subchapter will result in an…

§ 3589. Waiver prohibited. The provisions of this subchapter cannot be waived by contract issued or renewed after January 1, 2017. Any contractual arrangement in conflict with the provisions of this subchapter or that purports to waive any requirements of this subchapter is null …

§ 3590. Exemptions. This subchapter shall not apply to policies or contracts designed for issuance to persons eligible for coverage under Titles XVIII, XIX, and XXI of the Social Security Act [42 U.S.C. § 1395 et seq., § 1396 et seq. and § 1397aa. et seq.], known as Medicare, Med…

§ 3591. Step therapy exception process [For application of this section, see 82 Del. Laws, c. 44, § 3]. (a) When coverage of a prescription drug for the treatment of any medical condition is restricted for use by an insurer, health plan, or utilization review entity through the u…

§ 3601. Purpose and scope. (a) The purpose of this chapter shall be to provide reasonable standardization and simplification of terms and coverages of individual health insurance policies and subscriber contracts of health service corporations to facilitate public understanding a…

§ 3602. Definitions [For application of this section, see 79 Del. Laws, c. 99, § 19]. As used in this chapter: (1) “Affiliation period” means a period of time not to exceed 2 months (3 months for late enrollees) during which a health maintenance organization does not collect prem…

§ 3603. Standards for policy provisions. (a) The Commissioner shall issue reasonable regulations to establish specific standards, including standards of full and fair disclosure, that set forth the manner, content and required disclosure for the sale of individual policies of hea…

§ 3604. Minimum standards for benefits. (a) The Commissioner may issue regulations to establish minimum standards for benefits under each of the following categories of coverage in individual policies, other than conversion policies issued pursuant to a contractual conversion pri…

§ 3605. Disclosure requirements. (a) In order to provide for full and fair disclosure in the sale of individual health insurance policies or subscriber contracts of a health service corporation, no such policy or contract shall be delivered or issued for delivery in this State un…

§ 3606. Preexisting conditions [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) Notwithstanding § 3306 of this title, a policy or contract must not deny, exclude, or limit benefits for a covered individual for losses due to a preexisting condition, and the po…

§ 3607. Guaranteed availability of coverage [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) Guaranteed availability of coverage in the individual market. — Subject to subsections (b)-(d) of this section, a carrier that offers health insurance coverage in the…

§ 3608. Renewability of coverage. (a) An individual health benefit plan shall be renewable with respect to an enrollee or dependents at the option of the enrollee, except in any of the following cases: (1) The individual has failed to pay premiums or contributions in accordance w…