reglab/housing_qa huggingface dataset:
18 DE Code § 3583 (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter V. Pre-Authorization Transparency|§ 3583. circumstances.

§ 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 pharmaceutical, the utilization review entity must complete its process or render an adverse determination and notify the covered person's health-care provider within 2 business days of obtaining a clean pre-authorization or of using services described in § 3377 of this title. (b) If a utilization review entity requires pre-authorization of a health-care service, the utilization review entity must grant a pre-authorization or issue an adverse determination and notify the covered person's health-care provider of the determination within 8 business days of receipt of a clean pre-authorization not submitted through electronic pre-authorization. For purposes of this subsection, a clean pre-authorization includes the results of any face-to-face clinical evaluation or second opinion that may be required. (c) If a utilization review entity requires pre-authorization of a health-care service, the utilization review entity must grant a pre-authorization or issue an adverse determination and notify the covered person's health-care provider of the determination within 5 business days of receipt of a clean pre-authorization through electronic pre-authorization. For purposes of this subsection, a clean pre-authorization includes the results of any face-to-face clinical evaluation or second opinion that may be required. 80 Del. Laws, c. 310, § 2;
18 DE Code § 3584. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter V. Pre-Authorization Transparency|§ 3584. Utilization review entity's obligations with respect to pre-authorization concerning emergency health-care services.

§ 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;
18 DE Code § 3585. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter V. Pre-Authorization Transparency|§ 3585. Retrospective denial.

§ 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 services on the basis of changes to medical necessity that have been pre-authorized and delivered while under coverage shall be null and void. A proper notification of policy changes validly delivered as per § 3372 of this title may void a pre-authorization if received after pre-authorization but before delivery of the service. 80 Del. Laws, c. 310, § 2;
18 DE Code § 3586. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter V. Pre-Authorization Transparency|§ 3586. Length of pre-authorization.

§ 3586. Length of pre-authorization. (a) A pre-authorization for pharmaceuticals shall be valid for 1 year from the date the health-care provider receives the pre-authorization, subject to confirmation of continued coverage and eligibility and to policy changes validly delivered as per § 3582 of this title and except as otherwise set by evidence-based treatment protocol. (b) A pre-authorization for a health-care service shall be valid for a period of time that is reasonable and customary for the specific service, but no less than 60 days, from the date the health-care provider receives the pre-authorization, subject to confirmation of continued coverage and eligibility and to policy changes validly delivered as per § 3582 of this title. 80 Del. Laws, c. 310, § 2;
18 DE Code § 3587. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter V. Pre-Authorization Transparency|§ 3587. Electronic standards for pharmaceutical pre-authorization.

§ 3587. Electronic standards for pharmaceutical pre-authorization. No later than January 1, 2018, the insurer must accept and respond to pre-authorization requests under the pharmacy benefit through a secure electronic transmission using the NCPDP SCRIPT standard ePA transactions. Facsimile, proprietary payer portals, and electronic forms shall not be considered electronic transmission.  80 Del. Laws, c. 310, § 2;
18 DE Code § 3588. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter V. Pre-Authorization Transparency|§ 3588. Health-care services deemed preauthorized if a utilization review entity fails to comply with the requirements of this subchapter.

§ 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 any health-care services subject to review to be automatically deemed preauthorized.  80 Del. Laws, c. 310, § 2;
18 DE Code § 3589. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter V. Pre-Authorization Transparency|§ 3589. Waiver prohibited.

§ 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 and void. 80 Del. Laws, c. 310, § 2;
18 DE Code § 3590. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter V. Pre-Authorization Transparency|§ 3590. Exemptions.

§ 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, Medicaid, or any other similar coverage under state or federal governmental plans. 80 Del. Laws, c. 310, § 2;
18 DE Code § 4101. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 41. Property Insurance Contracts|Subchapter I. Generally|§ 4101. Contracts subject to general provisions.

§ 4101. Contracts subject to general provisions. All contracts of property insurance covering subjects located in this State are subject to the applicable provisions of Chapter 27 (The Insurance Contract) of this title, and to other applicable provisions of this title. 18 Del. C. 1953, §  4101;  56 Del. Laws, c. 468, §  1;
18 DE Code § 4102. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 41. Property Insurance Contracts|Subchapter I. Generally|§ 4102. Attorneys' fees.

§ 4102. Attorneys' fees. The court upon rendering judgment against any insurer upon any policy of property insurance, as “property” insurance is defined in § 904 of this title, shall allow the plaintiff a reasonable sum as attorneys' fees to be taxed as part of the costs. 18 Del. C. 1953, §  4102;  56 Del. Laws, c. 468, §  1;
18 DE Code § 4103. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 41. Property Insurance Contracts|Subchapter II. Basic Property Protection Plan|§ 4103. Definitions.

§ 4103. Definitions. As used in this subchapter, unless the context otherwise requires:  (1) “Basic property insurance” means insurance against direct loss to any property caused by perils as defined and limited in the standard fire policy and extended coverage endorsement as filed with the Commissioner. (2) “Commissioner” means the Insurance Commissioner of the State of Delaware. (3) “Inspection bureau” means any organization designated by the Commissioner to make inspections to determine the insurability and conditions of the properties where basic property insurance is sought. (4) “Premiums written” means gross direct premiums charged on all policies of basic property insurance and the basic property insurance premium components of all multiperil policies, less return premiums, dividends paid or credited to policyholders and the unabsorbed portion of premium deposits. (5) “Qualified property” means all real and tangible personal property at fixed locations, whether or not subject to exposure from an external hazard located on property not owned or controlled by the prospective insured, and whether or not subject to exposure from riot hazard which:  a. Complies with applicable state laws and regulations and local building codes and ordinances; and b. Is not commonly owned or controlled, or combinable for rating purposes, with property insured for similar coverages elsewhere; and c. Has characteristics of ownership, condition or occupancy which do not violate public policy. d. For purposes of homeowners and insurance and fire protection insurance, no policy shall exclude a dwelling unit or personal property within the dwelling unit from coverage as being unoccupied if:  1. The unit is regularly maintained; 2. Utility services are available and in use; and 3. The unit remains furnished as a dwelling unit, provided, however, that this protection shall not apply if the dwelling unit remains unoccupied beyond a period of 60 consecutive days. e. The Commissioner shall require the insurer to notify the insured of the 60-day exception contained in paragraph (5)d. of this section.18 Del. C. 1953, §  4103;  56 Del. Laws, c. 468, §  2;  58 Del. Laws, c. 23, §  1;  64 Del. Laws, c. 371, §  1;
18 DE Code § 4104. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 41. Property Insurance Contracts|Subchapter II. Basic Property Protection Plan|§ 4104. Purpose.

§ 4104. Purpose. The purposes of this subchapter are:  (1) To assure stability in the property insurance market of this State; (2) To make basic property insurance available for qualified property established by this section; (3) To encourage maximum use in obtaining basic property insurance of the available, normal insurance market provided by the private property insurance industry; (4) To provide for equitable distribution among authorized insurers of the responsibility for insuring qualified property for which basic property insurance cannot be obtained through the normal insurance market.18 Del. C. 1953, §  4104;  56 Del. Laws, c. 468, §  2;
18 DE Code § 4105. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 41. Property Insurance Contracts|Subchapter II. Basic Property Protection Plan|§ 4105. Inspection.

§ 4105. Inspection. (a) Any person having an insurable interest in real and tangible personal property at a fixed location who has made a diligent effort to obtain basic property insurance in the normal insurance market shall be entitled upon request to an inspection of the property by representatives of the inspection bureau. Such request shall be upon forms and in accordance with procedures reviewed by the Commissioner. (b) The plan of operation of the inspection bureau, the manner and scope of the inspection and the form of the inspection report shall be submitted by the inspection bureau in written report for review by the Commissioner. (c) A copy of the inspection report shall be made available to the applicant or the applicant's agent or the insurer upon request. 18 Del. C. 1953, §  4105;  56 Del. Laws, c. 468, §  2;  70 Del. Laws, c. 186, §  1;
18 DE Code § 4106. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 41. Property Insurance Contracts|Subchapter II. Basic Property Protection Plan|§ 4106. Establishment of industry placement facility.

§ 4106. Establishment of industry placement facility. An industry placement facility shall be established by authorized insurers to formulate and administer a program for the equitable distribution and placement of applications for basic property insurance for qualified property which has been so inspected. Separate classifications may be established for the purpose of equitable distribution. Such programs should be intended to conform with the applicable provisions of the National Insurance Development Corporation Act of 1968 [former 12 U.S.C. § 1749bbb et seq., repealed], or other such title as such federal legislation may bear upon enactment. 18 Del. C. 1953, §  4106;  56 Del. Laws, c. 468, §  2;  58 Del. Laws, c. 23, §  2;
18 DE Code § 4107. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 41. Property Insurance Contracts|Subchapter II. Basic Property Protection Plan|§ 4107. Review.

§ 4107. Review. Any facility, plan, program or form required under this subchapter shall be subject to review by the Commissioner and deemed to meet the requirements of this subchapter unless disapproved. 18 Del. C. 1953, §  4107;  56 Del. Laws, c. 468, §  2;
18 DE Code § 4108. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 41. Property Insurance Contracts|Subchapter II. Basic Property Protection Plan|§ 4108. Failure of industry placement facility program.

§ 4108. Failure of industry placement facility program. If the Commissioner finds, after a reasonable period of time, that the plan of operation set forth in § 4106 of this title is not creating a market which meets the purposes of that section, the Commissioner may order the implementation of §§ 4109 and 4110 of this title. 18 Del. C. 1953, §  4108;  56 Del. Laws, c. 468, §  2;  70 Del. Laws, c. 186, §  1;
18 DE Code § 4109. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 41. Property Insurance Contracts|Subchapter II. Basic Property Protection Plan|§ 4109. Joint underwriting association.

§ 4109. Joint underwriting association. (a) After hearing and upon promulgation of an order by the Commissioner pursuant to § 4108 of this title, a joint underwriting association shall be created consisting of all insurers authorized to write and engaged in writing within this State, on a direct basis, fire and extended coverage insurance, including insurers covering such perils in homeowners and commercial multiple peril package policies. Every such insurer shall be a member of the association and shall remain a member as a condition of its authority to continue to transact such kinds of insurance within this State. (b) The association shall, pursuant to this chapter and the plan of operation and with respect to basic property insurance on qualified property, have the power to:  (1) Cause its members to issue policies of insurance to applicants; (2) Assume reinsurance from members; and (3) Cede reinsurance. (c) Within 90 days following the effective date of the order of the Commissioner, the association shall submit to the Commissioner for review a proposed plan of operation, consistent with the provisions of this subchapter, which shall provide for economical, fair and nondiscriminatory administration and for the prompt and efficient provision of basic property insurance to promote orderly community development, including, but not limited to, preliminary assessment of all members for initial expenses necessary to commence operations, establishment of necessary facilities, management of the association, assessment of members to defray losses and expenses, commission arrangements, reasonable underwriting standards and limits of liability, acceptance and cession of reinsurance, and procedures for determining amounts of insurance to be provided. (d) The plan of operation shall be subject to review by the Commissioner, after consultation with affected individuals and organizations, and shall take effect 10 days thereafter in the absence of any disapproval. If the Commissioner disapproves all or any part of the proposed plan of operation, the association shall, within 30 days, submit for review an appropriately revised plan of operation or part thereof, and, if the association fails to do so, or if the revised plan so filed is unacceptable, the Commissioner shall promulgate such a plan of operation or part thereof as the Commissioner may deem necessary to carry out the purpose of this subchapter. (e) The association may, on its own initiative, or at the request of the Commissioner, amend the plan of operation or part thereof subject to review by the Commissioner. 18 Del. C. 1953, §  4109;  56 Del. Laws, c. 468, §  2;  70 Del. Laws, c. 186, §  1;
18 DE Code § 4110. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 41. Property Insurance Contracts|Subchapter II. Basic Property Protection Plan|§ 4110. Procedures.

§ 4110. Procedures. (a) Any member of the association may cede to the association basic property insurance written on qualified property, to the extent, if any, and on the terms and conditions set forth in the plan of operation. (b) All members of the association shall participate in its writings, expenses, profits and losses in the proportion that the premiums written by each such member (but excluding (1) premiums on farm or manufacturing property, and (2) that portion of premiums attributable to the operation of the association) during the preceding calendar year bear to the aggregate premiums written in this State by all members of the association. Such participation by each insurer in the association shall be determined annually on the basis of such premiums written during the preceding calendar year, as disclosed in the annual statements and other reports filed by the insurer with the Commissioner. (c) The association shall be governed by a board of 11 directors, elected annually by cumulative voting by the members of the association, whose votes in such election shall be weighed in accordance with each member's premiums written during the preceding calendar year. The first board shall be elected at a meeting of the members or their authorized representatives, which shall be held within 30 days after approval of the plan of operation as provided in § 4109 of this title. 18 Del. C. 1953, §  4110;  56 Del. Laws, c. 468, §  2;
18 DE Code § 4111. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 41. Property Insurance Contracts|Subchapter II. Basic Property Protection Plan|§ 4111. Examinations.

§ 4111. Examinations. The operation of the inspection bureau, the industry placement facility and any joint underwriting association shall at all times be subject to the supervision and regulation of the Commissioner. The Commissioner, or any person designated by the Commissioner, shall have the power of visitation of and examination into such operations and free access to all books, records, files, papers and documents that relate to such operations, may summon and qualify witnesses under oath, and may examine directors, officers, agents or employees or any other person having knowledge of such operations. 18 Del. C. 1953, §  4111;  56 Del. Laws, c. 468, §  2;  70 Del. Laws, c. 186, §  1;
18 DE Code § 4112. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 41. Property Insurance Contracts|Subchapter II. Basic Property Protection Plan|§ 4112. Appeals.

§ 4112. Appeals. Any person aggrieved by any action or decision of the inspection bureau or industry placement facility may appeal to the Commissioner within 30 days from the action or the decision. The Commissioner shall after hearing held upon not less than 10 days written notice to the aggrieved person and the inspection bureau or the industry placement facility issue an order approving the action or decision, disapproving the action or decision or directing the inspection bureau or the industry placement facility to reassign and place the application pursuant to said plan. 18 Del. C. 1953, §  4112;  56 Del. Laws, c. 468, §  2;
18 DE Code § 4113. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 41. Property Insurance Contracts|Subchapter II. Basic Property Protection Plan|§ 4113. Nonliability as to information, statements.

§ 4113. Nonliability as to information, statements. There shall be no liability on the part of, and no cause of action of any nature shall arise against, insurers, the inspection bureau, the industry placement facility, the joint underwriting association or their agents or employees, or the Commissioner or authorized representatives of the Commissioner, for any inspections undertaken or statements made by them in any reports and communications concerning the property to be insured or at the time of the hearings conducted in connection therewith, or in the findings required by this chapter. 18 Del. C. 1953, §  4113;  56 Del. Laws, c. 468, §  2;  70 Del. Laws, c. 186, §  1;
18 DE Code § 4120. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 41. Property Insurance Contracts|Subchapter III. Declinations, Renewals and Cancellations of Property Insurance Contracts|§ 4120. Scope of subchapter.

§ 4120. Scope of subchapter. This subchapter shall apply to policies of property insurance, other than policies of inland marine insurance and policies of property insurance issued through a residual market mechanism, covering risks to property located in this State which take effect or are renewed after January 19, 1986, and which insure any of the following contingencies:  (1) Loss of or damage to real property which consists of not more than 4 residential units, 1 of which is the principal place of residence of the named insured; or (2) Loss of or damage to personal property in which the named insured has an insurable interest where:  a. The personal property is used for personal, family or household purposes; and b. The personal property is within a residential dwelling.65 Del. Laws, c. 199, §  1;