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Subchapter I. Group Health Insurance
§ 3501. Group policies must meet group requirements. - Except as provided in § 3509 of this title, no...
§ 3502. Employee groups. - A policy may be issued to an employer, or to...
§ 3503. Debtor groups. - A policy may be issued to a creditor or its...
§ 3504. Labor union or employee organization groups. - A policy may be issued to a labor union, or...
§ 3505. Trustee groups. - A policy may be issued to a trust, or to...
§ 3506. Association groups. - (a) “Bona fide association” means, with respect to health insurance...
§ 3507. Credit union groups. - A policy may be issued to a credit union or...
§ 3508. Discretionary groups. - A policy may be issued to any other substantially similar...
§ 3509. Requirements for other groups; out-of-state groups. - (a) Group health insurance offered to a resident of this...
§ 3510. Disclosure requirements for other groups. - (a) With respect to a program of insurance which if...
§ 3511. Dependents' coverage. - Except for a policy issued under § 3503 of this...
§ 3512. Group health insurance standard provisions generally. - No policy of group health insurance shall be delivered in...
§ 3513. Grace period. - A group health insurance policy shall contain a provision that...
§ 3514. Incontestability. - A group health insurance policy shall contain a provision that...
§ 3515. Application; statements deemed representations. - A group health insurance policy shall contain a provision that...
§ 3516. Insurability. - A group health insurance policy shall contain a provision setting...
§ 3517. Preexisting conditions; limits [For application of this section, see 79 Del. Laws, c. 99, § 19]. - (a) A group health insurance policy shall not include a...
§ 3518. Misstatement of age. - If the premiums or benefits vary by age, there shall...
§ 3519. Certificate. - A group health insurance policy shall contain a provision that...
§ 3520. Notice of claim. - A group health insurance policy shall contain a provision that...
§ 3521. Claim forms. - A group health insurance policy shall contain a provision that...
§ 3522. Proofs of loss; disability. - When applicable, a group health insurance policy shall contain a...
§ 3523. Time for payment of benefits. - A group health insurance policy shall contain a provision that...
§ 3524. Payment of benefits. - A group health insurance policy shall contain a provision that...
§ 3525. Physical examinations. - A group health insurance policy shall contain a provision that...
§ 3526. Legal actions. - A group health insurance policy shall contain a provision that...
§ 3527. Information to debtors. - In the case of a policy insuring debtors, a group...
§ 3528. Direct payment of hospital or medical services. - Any group health policy may provide that all or any...
§ 3529. Readjustment of premiums; dividends. - Any contract of group health insurance may provide for the...
Subchapter II. Blanket Health Insurance
§ 3540. “Blanket health insurance” defined. - Blanket health insurance is hereby declared to be that form...
§ 3541. Filing and required provisions in blanket policies. - Any insurer authorized to write health insurance in this State...
§ 3542. Application and certificates not required. - An individual application need not be required from a person...
§ 3543. Payment of benefits under blanket policy. - All benefits under any blanket health policy or contract shall...
Subchapter III. Provisions Applicable to Group and Blanket Health Insurance
§ 3550. Newborn children. - All group and blanket health insurance policies providing coverage for...
§ 3551. Filing of rates. - Except for credit health insurance, the rates of group health...
§ 3552. Cancer screening tests. - (a) All group and blanket health insurance policies, which are...
§ 3553. Midwife services reimbursement. - (a) This section shall apply to every group or blanket...
§ 3554. Lead poison screening reimbursement [For application of this section, see 83 Del. Laws, c. 75, § 9]. - (a) All group and blanket insurance policies, which are delivered...
§ 3555. Coverage of cancer monitoring tests. - (a) All group and blanket health insurance policies, which are...
§ 3555A. Equal reimbursement for oral and intravenous anticancer medication. - (a) Every group or blanket policy or contract of health...
§ 3555B. Coverage of drugs approved for treatment of certain cancers [For application of this section, see 81 Del. Laws, c. 180, §§ 3 and 4]. - No group or blanket policy or contract of health insurance,...
§ 3556. Obstetrical and gynecological coverage. - (a) This section applies to every group or blanket policy...
§ 3556A. Primary care coverage [For application of this section, see 81 Del. Laws, c. 392, § 12] [Effective until Jan. 1, 2027]. - (a) For purposes of this section: (1) a. “Carrier” means...
§ 3556A. Primary care coverage [For application of this section, see 81 Del. Laws, c. 392, § 12] [Effective Jan. 1, 2027]. - (a) For purposes of this section: (1) a. “Carrier” means...
§ 3557. Child abuse or neglect — Group coverage. - No group or blanket policy, contract or certificate issued thereunder,...
§ 3558. Immunizations and preventive services. - (a) This section applies to any health carrier providing coverage...
§ 3559. Contraceptive coverage. - (a) For purposes of this section: (1) “Carrier” means any...
§ 3559A-3559C. Insurance coverage for diabetes; annual pap smear coverage reimbursement; colorectal cancer screening. - Transferred to present §§ 3560 to 3562 by 73 Del....
§ 3560. Insurance coverage for diabetes. - (a) Every individual or group hospital service corporation contract, individual...
§ 3560A. Cost sharing in prescription insulin drugs. - (a) For purposes of this section, “prescription insulin drug” means...
§ 3560B. Coverage for insulin pumps. - (a) For purposes of this section, “insulin pump” means a...
§ 3561. Annual pap smear coverage reimbursement. - All group and blanket health insurance policies which are delivered...
§ 3562. Colorectal cancer screening. - (a) All group and blanket health insurance policies which are...
§ 3563. Required coverage for reconstructive surgery following mastectomy. - (a) All group and blanket health insurance policies, contracts or...
§ 3564. Referrals. - (a) This section applies to every group or blanket policy...
§ 3565. Emergency care. - (a) This section applies to every group or blanket policy...
§ 3565A. Required coverage for volunteer ambulance company services. - (a) For the purpose of this section: (1) “Ambulance run”...
§ 3566. Prescription medication. - (a) This section applies to every group or blanket policy...
§ 3566A. Copayment or coinsurance for prescription drugs limited [For application of this section, see 82 Del. Laws, c. 57, § 3]. - (a) Definitions. — (1) “Carrier” — means any entity that...
§ 3567. Clinical trials. - (a) Definitions. — (1) “Clinical trials” for purposes of this...
§ 3567B. Experimental treatment coverage. - (a) No group or blanket policy or contract of health...
§ 3568. Newborn and infant hearing screening; coverage and reimbursement. - (a) Any group or blanket insurance health insurance policy which...
§ 3569. Use of Social Security numbers on insurance cards. - (a) As used in this section, “insurance card” means a...
§ 3570. Supplemental coverage for children of insureds [For application of this section, see 79 Del. Laws, c. 99, § 19]. - (a) Definitions. — As used in this section: (1) “Carrier”...
§ 3570A. Autism spectrum disorders coverage. - (a) All group and blanket health benefit plans as defined...
§ 3571. Phenylketonuria (PKU) and other inherited metabolic diseases. - (a) Definitions. — In this section the following words shall...
§ 3571A. Hearing aid coverage. - (a) For purposes of this section, the term “hearing aid”...
§ 3571B. Required coverage for scalp hair prosthesis. - (a) All group and blanket health insurance policies, contracts or...
§ 3571C. Dental services for children with a severe disability. - (a) Definitions. — As used in this section: (1) “Child...
§ 3571D. Screening of infants and toddlers for developmental delays. - (a) Definitions. — As used in this section: (1) “Carrier”...
§ 3571E. Reimbursement for orthotic and prosthetic services. - (a) Definitions. — For purposes of this section: (1) “Federal...
§ 3571F. Mini-COBRA small employer group health policies [For application of this section, see 79 Del. Laws, c. 99, § 19]. - A group policy renewed or delivered or issued for delivery...
§ 3571G. School-based health centers. - (a) For purposes of this section, a school-based health center...
§ 3571H. Payment for emergency medical services. - (a) As used in this section: (1) “Ambulance” shall have...
§ 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...
§ 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. —...
§ 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...
§ 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...
§ 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...
§ 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...
§ 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...
§ 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...
§ 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...
§ 3571R. Telehealth and telemedicine. - (a) For purposes of this section: (1) “Distant site” means...
§ 3571S. Network disclosure and transparency. - (a) This section applies to every policy or contract of...
§ 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...
§ 3571U. Mental Health Parity and Addiction Equity Act reporting requirements. - Each health insurer offering group health insurance coverage that provides...
§ 3571V. Time of submitting claim for reimbursement. - (a) For purposes of this section: (1) “Carrier” means any...
§ 3571W. Electronic medical claims. - (a) This section shall apply to all claims for healthcare...
§ 3571X. Medication assisted treatment for drug and alcohol dependencies. - (a) For purposes of this section, “medication-assisted treatment” means the...
§ 3571Y. Coverage for epinephrine autoinjectors. - (a) For purposes of this section, “epinephrine autoinjector” means a...
§ 3571Z. Annual behavioral health well check [Effective Jan. 1, 2024]. - (a) As used in this section: (1) “Behavioral health well...
Subchapter IV. Large Employer Health Insurance Standards
§ 3572. Definitions. - As used in this subchapter: (1) “Affiliation period” means a...
§ 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...
§ 3574. Renewability of coverage. - (a) A health benefit plan shall be renewable with respect...
§ 3575. Rate regulation. - A carrier offering a large group health benefit plan may...
§ 3576. Mental health parity. - A carrier offering a large group health plan shall comply...
§ 3577. Newborns and mothers health protection. - A carrier offering a health benefit plan shall comply with...
§ 3578. Insurance coverage for serious mental illness [For application of this section, see 81 Del. Laws, c. 29, § 3]. - (a) Definitions. — For the purposes of this section, the...
§ 3579. Health insurance; pharmacies; electronic reimbursement. - (a) This section shall apply to: (1) Insurers and nonprofit...
§ 3580. Specialty tier prescription coverage. - (a) Unless otherwise specifically provided, the definitions herein apply throughout...
Subchapter V. Pre-Authorization Transparency
§ 3581. Definitions [For application of this section, see 82 Del. Laws, c. 44, § 3]. - For purposes of this subchapter, the following definitions apply: (1)...
§ 3582 . Disclosure and review of pre-authorization requirements. - (a) A utilization review entity shall make any current pre-authorization...
§ 3583 . Utilization review entity's obligations with respect to pre-authorizations in nonemergency circumstances. - (a) If a utilization review entity requires pre-authorization of a...
§ 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...
§ 3585. Retrospective denial. - The utilization review entity may not revoke, limit, condition or...
§ 3586. Length of pre-authorization. - (a) A pre-authorization for pharmaceuticals shall be valid for 1...
§ 3587. Electronic standards for pharmaceutical pre-authorization. - No later than January 1, 2018, the insurer must accept...
§ 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...
§ 3589. Waiver prohibited. - The provisions of this subchapter cannot be waived by contract...
§ 3590. Exemptions. - This subchapter shall not apply to policies or contracts designed...
§ 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...