reglab/housing_qa huggingface dataset:
18 DE Code § 3510. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3510. Disclosure requirements for other groups.

§ 3510. Disclosure requirements for other groups. (a) With respect to a program of insurance which if issued on a group basis would not qualify under §§ 3502-3508 of this title, if compensation of any kind will or may be paid to:  (1) A policyholder or sponsoring or endorsing entity in the case of a group policy; or (2) A sponsoring or endorsing entity in the case of individual blanket or franchise polices marketed by means of direct response solicitation, then in such cases the insurer shall cause to be distributed to prospective insureds a written notice that compensation will or may be paid. (b) The written notice required by subsection (a) of this section shall be distributed:  (1) Whether compensation is direct or indirect; and (2) Whether such compensation is paid to or retained by the policyholder or sponsoring or endorsing entity, or paid to or retained by a third party at the direction of the policyholder or sponsoring or endorsing entity, or any entity affiliated therewith by way of ownership, contract or employment. (c) The notice required by subsection (a) of this section shall be placed on or accompany any application or enrollment form provided prospective insureds. (d) As used in this section, the following terms shall have the meanings indicated:  (1) “Direct response solicitation” means a solicitation through a sponsoring or endorsing entity through the mails, telephone or other mass communications media; (2) “Sponsoring or endorsing entity” means an organization which has arranged for the offering of a program of insurance in a manner which communicates that eligibility for participation in the program is dependent upon affiliation with such organization or that it encourages participation in the program.66 Del. Laws, c. 175, §  1;
18 DE Code § 3511. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3511. Dependents' coverage.

§ 3511. Dependents' coverage. Except for a policy issued under § 3503 of this title, a group health insurance policy may be extended to insure the employees or members with respect to their family members or dependents, or any class or classes thereof, subject to the following:  (1) The premium for the insurance shall be paid either from funds contributed by the employer, union, association or other person to whom the policy has been issued, or from funds contributed by the covered person, or from both. Except as provided in paragraph (2) of this section, a policy on which no part of the premium for the family members' or dependents' coverage is to be derived from funds contributed by the covered persons must insure all eligible employees or members with respect to their family members or dependents, or any class or classes thereof. (2) An insurer may exclude or limit the coverage on any family member or dependent as to whom evidence of individual insurability is not satisfactory to the insurer.66 Del. Laws, c. 175, §  1;
18 DE Code § 3512. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3512. Group health insurance standard provisions generally.

§ 3512. Group health insurance standard provisions generally. No policy of group health insurance shall be delivered in this State unless it contains in substance the provisions set forth in §§ 3513-3527 of this title or provisions which in the opinion of the Commissioner are more favorable to persons insured, or at least a favorable to the persons insured and more favorable to the policyholder; provided, however, (1) That §§ 3517, 3519, 3524, 3528 and 3529 of this title shall not apply to policies insuring persons under § 3503 of this title; (2) That the standard provisions required for individual health insurance policies shall not apply to group health insurance policies; and (3) That if any provision of this section is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the Commissioner, shall omit from such policy any inapplicable provision or part of a provision and shall modify any inconsistent provision or part of the provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy.66 Del. Laws, c. 175, §  1;
18 DE Code § 3513. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3513. Grace period.

§ 3513. Grace period. A group health insurance policy shall contain a provision that the policyholder is entitled to a grace period of 31 days for the payment of any premium due except the first, during which grace period the policy shall continue in force, unless the policyholder shall have given the insurer written notice of discontinuance in advance of the date of discontinuance and in accordance with the terms of the policy. The policy may provide that the policyholder shall be liable to the insurer for the payment of a pro rata premium for the time the policy was in force during such grace period. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3514. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3514. Incontestability.

§ 3514. Incontestability. A group health insurance policy shall contain a provision that the validity of the policy shall not be contested except for nonpayment of premiums, after it has been in force for 2 years from its date of issue; and that no statement made by any person covered under the policy relating to insurability shall be used in contesting the validity of the insurance with respect to which such statement was made after such insurance has been in force prior to the contest for a period of 2 years during such person's lifetime nor unless it is contained in a written instrument signed by the person making such statement; provided, however, that no such provision shall preclude the assertion at any time of defenses based upon the person's ineligibility for coverage under the policy or upon other provisions in the policy. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3515. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3515. Application; statements deemed representations.

§ 3515. Application; statements deemed representations. A group health insurance policy shall contain a provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued, that all statements made by the policyholder or by the person insured shall be deemed representations and not warranties, and that no statement made by any person insured shall be used in any contest unless a copy of the instrument containing the statement is or has been furnished to such person or, in the event of the death or incapacity of the insured person, to the individual's beneficiary or personal representative. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3516. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3516. Insurability.

§ 3516. Insurability. A group health insurance policy shall contain a provision setting forth the conditions, if any, under which the insurer reserves the right to require a person eligible for insurance to furnish evidence of individual insurability satisfactory to the insurer as a condition to part or all of the individual's coverage. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3518. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3518. Misstatement of age.

§ 3518. Misstatement of age. If the premiums or benefits vary by age, there shall be a provision specifying an equitable adjustment of premiums or of benefits, or both, to be made in the event the age of a covered person has been misstated, such provision to contain a clear statement of the method of adjustment to be used. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3519. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3519. Certificate.

§ 3519. Certificate. A group health insurance policy shall contain a provision that the insurer will issue to the policyholder for delivery to each person insured a certificate setting forth a statement as to the insurance protection to which that person is entitled, to whom the insurance benefits are payable, and a statement as to any family members' or dependents' coverage. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3520. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3520. Notice of claim.

§ 3520. Notice of claim. A group health insurance policy shall contain a provision that written notice of claim must be given to the insurer within 20 days after the occurrence or commencement of any loss covered by the policy. Failure to give notice within such time shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to give such notice and that notice was given as soon as was reasonably possible. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3521. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3521. Claim forms.

§ 3521. Claim forms. A group health insurance policy shall contain a provision that the insurer will furnish to the person making claim, or to the policyholder for delivery to such person, such forms as are usually furnished by it for filing proof of loss. If such forms are not furnished before the expiration of 15 days after the insurer receives notice of any claim under the policy, the person making such claim shall be deemed to have complied with the requirements of the policy as to proof of loss upon submitting, within the time fixed in the policy for filing proof of loss, written proof covering the occurrence, character and extent of the loss for which claim is made. The nonhospital claim form to be used under this provision is the Health Care Financing Administration Form-1500 or its successor. This form requirement shall not apply to medical payments made by the federal government, prescription drug claims, dental claims or claims using an electronic paperless submission process. 66 Del. Laws, c. 175, §  1;  68 Del. Laws, c. 416, §  2;
18 DE Code § 3522. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3522. Proofs of loss; disability.

§ 3522. Proofs of loss; disability. When applicable, a group health insurance policy shall contain a provision that in the case of claim for loss of time for disability, written proof of such loss must be furnished to the insurer within 90 days after the commencement of the period for which the insurer is liable, and that subsequent written proofs of the continuance of such disability must be furnished to the insurer at such intervals as the insurer may reasonably require, and that in the case of claim for any other loss, written proof of such loss must be furnished to the insurer within 90 days after the date of such loss. Failure to furnish such proof within such time shall not invalidate nor reduce any claim if it was not reasonably possible to furnish such proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity of the claimant, later than 1 year from the time proof is otherwise required. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3523. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3523. Time for payment of benefits.

§ 3523. Time for payment of benefits. A group health insurance policy shall contain a provision that all benefits payable under the policy other than benefits for loss of time will be payable not more than 60 days after receipt of proof, and that, subject to due proof of loss, all accrued benefits payable under the policy for loss of time will be paid not less frequently than monthly during the continuance of the period for which the insurer is liable, and that any balance remaining unpaid at the termination of such period will be paid as soon as possible after receipt of such proof. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3524. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3524. Payment of benefits.

§ 3524. Payment of benefits. A group health insurance policy shall contain a provision that benefits for loss of life of the person insured shall be payable to the beneficiary designated by the person insured. However, if the policy contains conditions pertaining to family status, the beneficiary may be the family member specified by the policy terms. In either case, payment of these benefits is subject to the provisions of the policy in the event no such designated or specified beneficiary is living at the death of the person insured. All other benefits of the policy shall be payable to the person insured. The policy may also provide that if any benefit is payable to the estate of a person, or to a person who is a minor or otherwise not competent to give a valid release, the insurer may pay such benefit, up to an amount not exceeding $5,000, to any relative by blood or connection by marriage of such person who is deemed by the insurer to be equitably entitled thereto. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3525. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3525. Physical examinations.

§ 3525. Physical examinations. A group health insurance policy shall contain a provision that the insurer shall have the right and opportunity to examine the person or the individual for whom claim is made when and so often as it may reasonably require during the pendency of claim under the policy and also the right and opportunity to make an autopsy in the case of death where it is not prohibited by law. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3526. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3526. Legal actions.

§ 3526. Legal actions. A group health insurance policy shall contain a provision that no action at law or in equity shall be brought to recover on the policy prior to the expiration of 90 days after proof of loss has been filed in accordance with the requirements of the policy and that no such action shall be brought at all unless brought within 3 years from the expiration of the time within which proof of loss is required by the policy. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3527. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3527. Information to debtors.

§ 3527. Information to debtors. In the case of a policy insuring debtors, a group health insurance policy shall contain a provision that the insurer will furnish to the policyholder for delivery to each debtor insured under the policy a certificate of insurance describing the coverage and specifying that the benefits payable shall first be applied to reduce or extinguish the indebtedness. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3528. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3528. Direct payment of hospital or medical services.

§ 3528. Direct payment of hospital or medical services. Any group health policy may provide that all or any portion of any indemnities provided by any such policy on account of hospital, nursing, medical or surgical services may, at the insurer's option, be paid directly to the hospital or person rendering such services, but the policy may not require that the service be rendered by a particular hospital or person. Payments so made shall discharge the insurer's obligation with respect to the amount of insurance so paid. 18 Del. C. 1953, §  3504;  56 Del. Laws, c. 380, §  1;  66 Del. Laws, c. 175, §  1;
18 DE Code § 3529. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3529. Readjustment of premiums; dividends.

§ 3529. Readjustment of premiums; dividends. Any contract of group health insurance may provide for the readjustment of the rate of premium based upon the experience thereunder. If a policy dividend is hereafter declared or a reduction in rate is hereafter made or continued for the first or any subsequent year of insurance under any policy of group health insurance heretofore or hereafter issued to any policyholder, the excess, if any, of the aggregate dividends or rate reductions under such policy and all other group insurance policies of the policyholder over the aggregate expenditure for insurance under such policies made from funds contributed by the policyholder, or by an employer of insured persons, or by a union or associations which the insured persons belong, including expenditures made in connection with administration of such policies, shall be applied by the policyholder for the sole benefit of insured employees or members. 18 Del. C. 1953, §  3505;  56 Del. Laws, c. 380, §  1;  66 Del. Laws, c. 175, §  1;
18 DE Code § 3542. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter II. Blanket Health Insurance|§ 3542. Application and certificates not required.

§ 3542. Application and certificates not required. An individual application need not be required from a person covered under a blanket health policy or contract nor shall it be necessary for the insurer to furnish each person a certificate. 18 Del. C. 1953, §  3508;  56 Del. Laws, c. 380, §  1;  66 Del. Laws, c. 175, §  1;
18 DE Code § 3543. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter II. Blanket Health Insurance|§ 3543. Payment of benefits under blanket policy.

§ 3543. Payment of benefits under blanket policy. All benefits under any blanket health policy or contract shall be payable to the person insured, or to his or her designated beneficiary or beneficiaries, or to his or her estate, except that if the person insured be a minor or otherwise not competent to give a valid release, such benefits may be made payable to his or her parent, guardian or other person actually supporting him or her. Except, however, that the policy may provide that all or a portion of any indemnities provided by any such policy on account of hospital, nursing, medical or surgical services may, at the option of the insurer, and unless the insured requests otherwise in writing not later than the time of filing proofs of such loss, be paid directly to the hospital or person rendering such services, but the policy may not require that the service be rendered by a particular hospital or person. Payment so made shall discharge the obligation of the insurer with respect to the amount of insurance so paid. 18 Del. C. 1953, §  3509;  56 Del. Laws, c. 380, §  1;  66 Del. Laws, c. 175, §  1;  70 Del. Laws, c. 186, §  1;
18 DE Code § 3550. (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|§ 3550. Newborn children.

§ 3550. Newborn children. All group and blanket health insurance policies providing coverage for a family member of the insured or a subscriber shall, as to such family member's coverage, also provide that the health insurance benefits applicable for children shall be payable with respect to a newly-born child of the insured or subscriber from the moment of birth in accordance with § 3335 of this title. 59 Del. Laws, c. 529, §  2;  66 Del. Laws, c. 175, §  1;
18 DE Code § 3551. (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|§ 3551. Filing of rates.

§ 3551. Filing of rates. Except for credit health insurance, the rates of group health insurance and blanket health insurance shall be filed pursuant to and be subject to the requirements of Chapter 25 of this title. Rates for credit health insurance shall be filed pursuant to the requirements of Chapter 37 of this title. 60 Del. Laws, c. 388, §  4;  66 Del. Laws, c. 175, §  1;
18 DE Code § 3554. (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|§ 3554. Lead poison screening reimbursement [For application of this section, see 83 Del. Laws, c. 75, § 9].

§ 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 or issued for delivery in this State by any health insurer, health service corporation, health maintenance organization, or any health services and facilities reimbursement program operated by the State which provide a benefit for outpatient services shall provide a benefit for a baseline lead poisoning screening or testing, as defined in § 2601 of Title 16. (b) Benefits must also be provided for lead poisoning screening, testing, diagnostic evaluations, screening and testing supplies, and home visits for children who are at high risk for lead poisoning under guidelines and criteria established by the Division of Public Health. (c) The benefits required under subsections (a) and (b) of this section are a covered service, notwithstanding any policy exclusions for services which are part of, or related to, annual or routine examinations. (d) Nothing in this section prevents the operation of policy provisions such as deductibles, coinsurance allowable charge limitations, coordination of benefits, or provision restricting coverage to services rendered by licensed, certified, or carrier-approved providers or facilities. (e) This section does not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or other limited health insurance policies. 69 Del. Laws, c. 310, §  3;  83 Del. Laws, c. 75, § 7;