reglab/housing_qa huggingface dataset:
18 DE Code § 3566. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3566. Prescription medication.

§ 3566. Prescription medication. (a) This section applies to every group or blanket policy or contract of health insurance, including each policy or contract issued by a health service corporation, which is delivered or issued for delivery in this State and which provides coverage for outpatient prescription drugs. (b) Every group or blanket policy or contract of health insurance described in subsection (a) of this section shall provide coverage for any outpatient drug prescribed to treat a covered person for a covered chronic, disabling or life-threatening illness if the drug:  (1) Has been approved by the Food and Drug administration for at least 1 indication; and (2) Is recognized for treatment of the indication for which the drug is prescribed in:  a. A prescription drug reference compendium approved by the Insurance Commissioner for purposes of this section; or b. Substantially accepted peer reviewed medical literature. (c) Coverage of a drug required by this section shall include coverage of medically necessary services associated with administration of the drug. (d) This section does not require coverage for:  (1) Medication that may be obtained without a physician's prescription; (2) Experimental drugs not otherwise approved for the proposed use or indication by the Food and Drug Administration; or (3) Any disease, condition, service or treatment that is excluded from coverage under the policy. (e) Nothing in this section shall prevent the operation of policy provisions involving deductibles, coinsurance, allowable charge limitations, maximum dollar policy limitations or coordination of benefits. 73 Del. Laws, c. 96, §  10;  73 Del. Laws, c. 315, §  5;
18 DE Code § 3566A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3566A. Copayment or coinsurance for prescription drugs limited [For application of this section, see 82 Del. Laws, c. 57, § 3].

§ 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 provides health insurance in this State. “Carrier” includes an insurance company, health service corporation, health maintenance organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation. (2) “Contract price” — means the lowest price a pharmacy is paid for the acquisition of a prescription drug based on a contract that a pharmacy has with a carrier or pharmacy benefits manager. “Contract price” includes a dispensing fee set by a contract between a pharmacy and a carrier or pharmacy benefits manager. (3) “Pharmacy” — means as defined in § 2502 of Title 24. (4) “Pharmacy benefit manager” — means as defined under § 3302A of this title. (b) Application. — This section applies to a carrier that provides coverage, either directly or through a pharmacy benefits manager, for prescription drugs under a health insurance policy or contract that is issued or delivered in this State. (c) A carrier subject to this section may not impose a copayment or coinsurance requirement for a covered prescription drug that exceeds the lesser of one of the following:  (1) The applicable copayment or coinsurance that would apply for the prescription drug in the absence of this section. (2) The amount an individual would pay for the prescription drug if the individual were paying the usual and customary price. (3) The contract price for the prescription drug.82 Del. Laws, c. 57, § 2;
18 DE Code § 3567B. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3567B. Experimental treatment coverage.

§ 3567B. Experimental treatment coverage. (a) No group or blanket policy or contract of health insurance or certificate issued thereunder which is delivered, issued for deliver, or renewed in this State shall deny coverage, payment, or reimbursement for a National Coverage Determination Service on the basis that the service, item, test, or treatment is experimental or investigational. (b) “National Coverage Determination Service” as used in this section shall mean a service, item, test, or treatment which has been determined to be covered nationally by the Secretary of the U.S. Department of Health and Human Services pursuant to the Social Security Act, § 1869 (f) [42 U.S.C. § 1395ff]. 81 Del. Laws, c. 266, § 2;
18 DE Code § 3568. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3568. Newborn and infant hearing screening; coverage and reimbursement.

§ 3568. Newborn and infant hearing screening; coverage and reimbursement. (a) Any group or blanket insurance health insurance policy which is delivered, issued for delivery, renewed, extended, or modified in this State by any health-care insurer and which provides coverage for a child shall be deemed to provide coverage for hearing loss screening tests of newborns and infants provided by a hospital before discharge. (b) The amount of reimbursement for newborn or infant hearing screening provided under such a policy shall be consistent with reimbursement of other medical expenses under the policy, including the imposition of co-payment, coinsurance, deductible, or any dollar limit or other cost-sharing provisions otherwise applicable under the policy. 75 Del. Laws, c. 116, §  3;
18 DE Code § 3569. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3569. Use of Social Security numbers on insurance cards.

§ 3569. Use of Social Security numbers on insurance cards. (a) As used in this section, “insurance card” means a card that a person or entity provides to an individual so that the individual may present the card to establish the eligibility of the individual or the individual's dependents to receive health, dental, optical, or accident insurance benefits, prescription drug benefits, or benefits under a managed care plan or a plan provided by a health maintenance organization, a health services plan corporation, or a similar entity. (b) No person or entity which provides an insurance card shall use an individual's Social Security number as the identification number on that insurance card. 75 Del. Laws, c. 179, §  2;  70 Del. Laws, c. 186, §  1;
18 DE Code § 3571. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3571. Phenylketonuria (PKU) and other inherited metabolic diseases.

§ 3571. Phenylketonuria (PKU) and other inherited metabolic diseases. (a) Definitions. — In this section the following words shall have the meanings indicated:  (1) “Inherited metabolic diseases” shall mean diseases caused by an inherited abnormality of biochemistry. The words “inherited metabolic diseases” shall also include any diseases for which the State screens newborn babies. (2) a. “Low protein modified formula or food product” means a formula or food product that is:  1. Specially formulated to have less than 1 gram of protein per serving; and 2. Intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease. b. “Low protein modified food product” does not include a natural food that is naturally low in protein. (3) “Medical formula or food” means a formula or food that is:  a. Intended for the dietary treatment of an inherited metabolic disease for which nutritional requirements and restrictions have been established by medical research; and b. Formulated to be consumed or administrated enterally under the direction of a physician. (b) Application of this section. — The provisions of this section shall apply to any health insurance contract that:  (1) Provides coverage for a family member of the insured; and (2) Is delivered or issued for delivery in the State. (c) A health insurance contract shall, under the family member coverage, include coverage for medical formulas and foods and low protein modified formulas and modified food products for the treatment of inherited metabolic diseases, if such medical formulas and foods or low protein modified formulas and food products are:  (1) Prescribed as medically necessary for the therapeutic treatment of inherited metabolic diseases, and (2) Administered under the direction of a physician.76 Del. Laws, c. 176, §  2;
18 DE Code § 3571A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3571A. Hearing aid coverage.

§ 3571A. Hearing aid coverage. (a) For purposes of this section, the term “hearing aid” means any nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but excluding batteries, cords, and other assistive listening devices such as FM systems. (b) Every group and blanket health insurance contract, including each policy or contract issued by a health service corporation, which is delivered, issued for delivery, or renewed in this State on or after January 1, 2009, shall provide coverage of up to $1000 per individual hearing aid, per ear, every 3 years, for children less than 24 years of age, covered as a dependent by the policy holder. (c) The insured may choose a hearing aid exceeding $1,000 and pay the difference in cost above the amount of coverage required by this section. Reimbursement shall be provided according to the respective principles and policies of the insurer. The insurer may require the policyholder to provide a prescription or show proof through other suitable documentation of the need for a hearing aid and nothing contained in this section shall preclude the insurer from conducting managed care, medical necessity, or utilization review or prevent the operation of such policy provisions as deductibles, coinsurance, allowable charge limitations, coordination of benefits or provisions restricting coverage to services by licensed, certified or carrier-approved providers or facilities. (d) This section does not apply to insurance coverage providing benefits for:  (1) Hospital confinement indemnity;  (2) Disability income;  (3) Accident only; (4) Long-term care; (5) Medicare supplement; (6) Limited benefit health; (7) Specified diseased indemnity; (8) Sickness or bodily injury or death by accident or both; and (9) Other limited benefit policies.76 Del. Laws, c. 244, §  2;
18 DE Code § 3571B. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3571B. Required coverage for scalp hair prosthesis.

§ 3571B. Required coverage for scalp hair prosthesis. (a) All group and blanket health insurance policies, contracts or certificates that are delivered or issued for delivery in this State by any health insurer, health service corporation or managed care organization which provide for medical or hospital expenses and also provide coverage for other prostheses, shall provide coverage for expenses for a scalp hair prosthesis worn for hair loss suffered as a result of alopecia areata, resulting from an autoimmune disease. Such coverage shall be subject to the same limitations and guidelines as other prostheses, provided that such coverage for alopecia areata shall not exceed $500 per year. (b) For purposes of this section:  (1) “Prostheses” means artificial appliances used to replace lost natural structures. Prostheses include, but are not limited to, artificial arms, legs, breasts, or glass eyes. (2) “Scalp hair prosthesis” means artificial substitutes for scalp hair that are made specifically for a specific individual. (c) Such coverage may be subject to annual deductibles and co-insurance provisions as may be deemed appropriate and as are consistent with those established for other benefits under the plan of coverage. Written notice of the availability of such coverage shall be delivered to the insured, participant, policyholder, subscriber and beneficiary upon enrollment and annually thereafter. (d) All group and blanket health benefit plans shall provide notice to each insured, participant, policyholder, subscriber and beneficiary under such plan regarding the coverage required by this section in accordance herewith. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan and shall be transmitted as part of any yearly informational packet sent to the insured, participant, policyholder, subscriber and beneficiary. 76 Del. Laws, c. 314, §  2;
18 DE Code § 3571C. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3571C. Dental services for children with a severe disability.

§ 3571C. Dental services for children with a severe disability. (a) Definitions. — As used in this section:  (1) “Child with a severe disability” means a person under the age of 21 who, due to a significant mental or physical condition, illness, or disease, is likely to require specialized treatment or supports to secure effective access to dental care. The written certification of a child's treating physician, advance practice nurse, or licensed psychologist shall be sufficient to qualify a person as a “child with a severe disability.” (2) “Dental services” means the full range of diagnostic and treatment services within the scope of benefits available under the health insurance contract or policy. (b) Application of section. — This section applies to every group or blanket health insurance contract, including each policy or contract issued by a health service corporation, which is delivered, issued for delivery, or renewed in this State which provides coverage for dental services for a child. (c) Payment authorization. — Every contract or policy described in subsection (b) of this section shall authorize payment to a licensed practitioner for dental services to a child with a severe disability irrespective of lack of contractual or network status. Unless otherwise negotiated with the practitioner in advance, such payment shall be in an amount at least equal to the insurer's reasonable and customary compensation for the same or similar services in the same geographical area. A nonnetwork practitioner accepting payment under this section may not balance bill the insured. (d) Preservation of contract limits. — Nothing in this section shall prevent the application of contract or policy provisions involving deductibles, coinsurance, maximum dollar limitations or coordination of benefits, provided that such limits shall be applied using in-network standards. (e) Waiver. — The Commissioner may establish, by regulation, standards authorizing the issuance of a waiver to an insurer from application of this section. At a minimum, such waiver standards shall only permit a time-limited, renewable waiver upon submission of clear and convincing documentation of the numerical and geographical availability of in-network practitioners willing and able to effectively treat a child with a severe disability. 77 Del. Laws, c. 54, §  2;
18 DE Code § 3571D. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3571D. Screening of infants and toddlers for developmental delays.

§ 3571D. Screening of infants and toddlers for developmental delays. (a) Definitions. — As used in this section:  (1) “Carrier” means any entity that provides health insurance in this State. For the purposes of this section, “carrier” includes an insurance company, health service corporation, health maintenance organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation. “Carrier” also includes any third-party administrator or other entity that adjusts, administers, or settles claims in connection with health benefit plans.  (2) “Developmental screening” shall mean any developmental screening tool favorably mentioned by the American Academy of Pediatrics Committee on Children with Disabilities in its position paper on “Developmental Surveillance and Screening of Infants and Young Children,” or any program judged by the Department of Health and Social Services to be an equivalent program. (b) This section shall apply to any health insurance contract that provides coverage for a family member of the insured and is delivered by a carrier or issued by a carrier for delivery in the State. (c) This section shall not apply to policies that exclusively cover:  (1) Hospital confinement indemnity;  (2) Disability income;  (3) Accident only;  (4) Long-term care;  (5) Medicare supplement;  (6) Specified disease indemnity; or (7) Sickness or bodily injury or death by accident, or both. (d) Every health insurance policy covered by this section shall entitle children covered by the policy to receive developmental screenings at ages 9 months, 18 months, and 30 months. 77 Del. Laws, c. 207, §  2;
18 DE Code § 3571H. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3571H. Payment for emergency medical services.

§ 3571H. Payment for emergency medical services. (a) As used in this section:  (1) “Ambulance” shall have the same definition set forth in § 9702 of Title 16. (2) “Basic life support” shall have the same definition set forth in § 9702 of Title 16. (3) “Emergency medical services provider agency” shall have the same definition set forth in § 9802 of Title 16. (4) “Volunteer fire company” shall mean the duly organized volunteer fire companies in the State. (b) Notwithstanding any provision precluding an assignment of benefits in any group or blanket health insurance policy, contract, certificate or plan, delivered or issued for delivery in this State by any insurer, health service corporation, or health maintenance organization, when a volunteer fire company or other emergency medical services provider agency certified by the Delaware State Fire Prevention Commission renders covered emergency medical services or supplies, including but not limited to basic life support and ambulance service, any payment or reimbursement made by an insurer, health service corporation or health maintenance organization for such covered emergency medical services or supplies shall be paid directly to the volunteer fire company or other certified emergency medical services provider agency, or their designee, without regard to whether a contract exists between the volunteer fire company or certified emergency medical services provider agency and the insurer, health service corporation or health maintenance organization, and otherwise without regard to whether the volunteer fire company or emergency medical services provider agency is a part of any network maintained by the insurer, health service corporation or health maintenance organization. (c) The limitations on balance billing provided in § 3348 of this title shall not apply to billing for emergency medical services within the scope of this section provided by volunteer fire companies or emergency medical services provider agencies certified by the Delaware State Fire Prevention Commission. (d) This section shall apply to all policies, contracts, certificates or plans issued, renewed, modified, altered, amended or reissued on or after July 1, 2013. (e) Nothing in this section should apply to supplemental health insurance policies that do not provide expense or reimbursement coverage for emergency medical services, basic life support or ambulance services. 79 Del. Laws, c. 76, §  2;
18 DE Code § 3571I. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3571I. No lifetime or annual limits [For application of this section, see 79 Del. Laws, c. 9, § 19].

§ 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 establish any lifetime limit on the dollar amount of benefits for any individual. (2) a. Except as provided in paragraph (a)(2)b., subsections (b) and (d) of this section, a group health plan, or a health insurance issuer offering group or individual health insurance coverage, may not establish any annual limit on the dollar amount of benefits for any individual. b. A health flexible spending arrangement (as defined in § 106(c)(2) of the Internal Revenue Code) [26 U.S.C. § 106(c)(2)] is not subject to the requirement in paragraph (a)(2)a. of this section. (b) (1) The rules of this section do not prevent a group health plan, or a health insurance issuer offering group or individual health insurance coverage, from placing annual or lifetime dollar limits with respect to any individual on specific covered benefits that are not essential health benefits to the extent that such limits are otherwise permitted under applicable federal or state law. (2) The rules of this section do not prevent a group health plan, or a health insurance issuer offering group or individual health insurance coverage, from excluding all benefits for a condition. However, if any benefits are provided for a condition, then the requirements of this section apply. Other requirements of federal or state law may require coverage of certain benefits. (c) The term “essential health benefits” as used in this section means essential health benefits under § 1302(b) of the Patient Protection and Affordable Care Act [42 U.S.C. § 18022(b)], as the law and its implementing regulations were in effect on January 1, 2018; Delaware law; and applicable state regulations. (d) (1) With respect to plan years beginning prior to January 1, 2014, a group health plan, or a health insurance issuer offering group or individual health insurance coverage, may establish, for any individual, an annual limit on the dollar amount of benefits that are essential health benefits, provided the limit is no less than the following amounts:  a. For a plan year beginning on or after September 23, 2010, but before September 23, 2011, $750,000. b. For a plan year beginning on or after September 23, 2011, but before September 23, 2012, $1,250,000. c. For plan years beginning on or after September 23, 2012, but before January 1, 2014, $2,000,000. (2) In determining whether an individual has received benefits that meet or exceed the applicable amount described in paragraph (d)(1) of this section, a plan or issuer must take into account only essential health benefits.79 Del. Laws, c. 99, §  8;  82 Del. Laws, c. 186, § 4;