(a) Coverage for essential health benefits package. —
A health insurer that offers health insurance coverage in the small group market shall ensure that such coverage includes the essential health benefits package in conformity with § 1302 of the Patient Protection and Affordable Care Act [42 U.S.C. § 18022], as the law and its implementing regulations were in effect on January 1, 2018, and state law. The Commissioner shall issue a regulation setting forth what constitutes “essential health benefits” for purposes of this section.
(b) Cost-sharing under group health plans. —
A group health plan shall ensure that any annual cost-sharing imposed under the plan does not exceed the limitations provided for under § 1302(c)(1) and (2) of the Patient Protection and Affordable Care Act [42 U.S.C. § 18022(c)(1) and (2)], as the law and its implementing regulations were in effect on January 1, 2018, and state law.
(c) Child-only plans. —
If a health insurer offers health insurance coverage in any level of coverage specified under § 1302(d) of the Patient Protection and Affordable Care Act [42 U.S.C. § 18022(d)], as the law and its implementing regulations were in effect on January 1, 2018, or state law, the health insurer shall also offer such coverage in that level as a plan in which the only enrollees are individuals who, as of the beginning of the plan year, are under the age of 21.
(d) Dental only. —
This section shall not apply to a plan described in § 1311(d)(2)(B)(ii) of the Patient Protection and Affordable Care Act [42 U.S.C. § 18031(d)(2)(B)(ii)], as the law and its implementing regulations were in effect on January 1, 2018.
Structure Delaware Code
Chapter 35. GROUP AND BLANKET HEALTH INSURANCE
Subchapter III. Provisions Applicable to Group and Blanket Health Insurance
§ 3552. Cancer screening tests.
§ 3553. Midwife services reimbursement.
§ 3555. Coverage of cancer monitoring tests.
§ 3555A. Equal reimbursement for oral and intravenous anticancer medication.
§ 3556. Obstetrical and gynecological coverage.
§ 3557. Child abuse or neglect — Group coverage.
§ 3558. Immunizations and preventive services.
§ 3559. Contraceptive coverage.
§ 3560. Insurance coverage for diabetes.
§ 3560A. Cost sharing in prescription insulin drugs.
§ 3560B. Coverage for insulin pumps.
§ 3561. Annual pap smear coverage reimbursement.
§ 3562. Colorectal cancer screening.
§ 3563. Required coverage for reconstructive surgery following mastectomy.
§ 3565A. Required coverage for volunteer ambulance company services.
§ 3566. Prescription medication.
§ 3567B. Experimental treatment coverage.
§ 3568. Newborn and infant hearing screening; coverage and reimbursement.
§ 3569. Use of Social Security numbers on insurance cards.
§ 3570A. Autism spectrum disorders coverage.
§ 3571. Phenylketonuria (PKU) and other inherited metabolic diseases.
§ 3571A. Hearing aid coverage.
§ 3571B. Required coverage for scalp hair prosthesis.
§ 3571C. Dental services for children with a severe disability.
§ 3571D. Screening of infants and toddlers for developmental delays.
§ 3571E. Reimbursement for orthotic and prosthetic services.
§ 3571G. School-based health centers.
§ 3571H. Payment for emergency medical services.
§ 3571P. Rating factors [For application of this section, see 79 Del. Laws, c. 99, § 19].
§ 3571R. Telehealth and telemedicine.
§ 3571S. Network disclosure and transparency.
§ 3571U. Mental Health Parity and Addiction Equity Act reporting requirements.
§ 3571V. Time of submitting claim for reimbursement.
§ 3571W. Electronic medical claims.
§ 3571X. Medication assisted treatment for drug and alcohol dependencies.
§ 3571Y. Coverage for epinephrine autoinjectors.
§ 3571Z. Annual behavioral health well check [Effective Jan. 1, 2024].