reglab/housing_qa huggingface dataset:
18 DE Code § 3351B. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3351B. Experimental treatment coverage.

§ 3351B. Experimental treatment coverage. (a) No individual policy or contract of health insurance, or certificate issued thereunder, which is delivered, issued for delivery, or renewed in this State by any health insurer, health service corporation, or health maintenance organization 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, § 1;
18 DE Code § 3352. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3352. Newborn and infant hearing screening; coverage and reimbursement.

§ 3352. Newborn and infant hearing screening; coverage and reimbursement. (a) Any individual 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, §  2;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3353. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3353. Use of social security numbers on insurance cards.

§ 3353. 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, §  1;  70 Del. Laws, c. 186, §  1;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3355. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3355. Phenylketonuria (PKU) and other inherited metabolic diseases.

§ 3355. 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; (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, §  1;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3356. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3356. Required coverage for scalp hair prosthesis.

§ 3356. Required coverage for scalp hair prosthesis. (a) Every individual health insurance policy, contract or certificate that is 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 an artificial substitute for scalp hair that is 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, §  1;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3357. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3357. Hearing aid coverage.

§ 3357. 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 individual 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, §  1;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3358. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3358. Dental services for children with a severe disability.

§ 3358. 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 individual 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, §  1;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3359. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3359. Health insurance; pharmacies; electronic reimbursement.

§ 3359. Health insurance; pharmacies; electronic reimbursement. (a) This section shall apply to:  (1) Insurers and nonprofit health service plans that provide, directly or through a pharmacy benefit manager, coverage for prescription drugs under health insurance policies or contracts that are issued or delivered in this State; and (2) Health maintenance organizations that provide, directly or through a pharmacy benefit manager, coverage for prescription drugs under contracts that are issued or delivered in this State. (b) If an entity subject to this section requires a pharmacy to submit a request for payment electronically, then the pharmacy or its designated agent may choose to be reimbursed electronically, and in that event the entity shall electronically reimburse such pharmacy and shall provide the appropriate payment data electronically, provided that the electing pharmacy agrees to, and can accept claims details for the payments electronically and provide accurate electronic funds transfer information to the entity making payments. (c) An entity subject to this section may not impose on a pharmacy a processing fee for the electronic reimbursement or for providing payment data electronically. (d) Subsequent to January 6, 2010, any pharmacy that requires electronic reimbursement under this section shall allow an entity 45 days to become compliant herewith from the date of the pharmacy's initial request to commence electronic reimbursement between the parties. 77 Del. Laws, c. 116, §  1;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3359B. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3359B. Electronic medical (non-pharmaceutical) claims.

§ 3359B. Electronic medical (non-pharmaceutical) claims. (a) This section shall apply to all claims for healthcare services that are submitted and are not covered by § 3359 of this title. (b) For purposes of this section:  (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. “Carrier” also includes any third-party administrator or other entity that adjusts, administers, or settles claims in connection with health benefit plans.  (2) “Carrier” does not mean an entity that provides a plan of health insurance or health benefits 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 1397 et seq.), known as Medicare, Medicaid, or any other similar coverage under state or federal governmental plans.  (c) A carrier shall accept primary and secondary claims electronically from providers regardless of network status. (d) A carrier shall permit a provider to receive electronic remittance advice (ERA/835) files for claims payments upon the completion of the necessary agreements required by the carrier. (e) Any electronic claim shall be acknowledged by the carrier electronically no later than 2 business days following receipt of the claim to the entity submitting the claim. 82 Del. Laws, c. 111, § 2;
18 DE Code § 3360. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3360. Screening of infants and toddlers for developmental delays.

§ 3360. 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, §  1;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3367. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3367. Payment for emergency medical services.

§ 3367. 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 individual 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, §  1;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3368. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3368. No lifetime or annual limits [For application of this section, see 79 Del. Laws, c. 99, § 19].

§ 3368. No lifetime or annual limits [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) (1) Except as provided in subsection (b) of this section, 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 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 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 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 policy years beginning prior to January 1, 2014, 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 policy year beginning on or after September 23, 2010, but before September 23, 2011, $750,000. b. For a policy year beginning on or after September 23, 2011, but before September 23, 2012, $1,250,000. c. For policy 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, an issuer must take into account only essential health benefits.79 Del. Laws, c. 99, §  4;  80 Del. Laws, c. 310, § 1;  82 Del. Laws, c. 186, § 2;
18 DE Code § 3369. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3369. Notification and reasons for cancellation or nonrenewal [For application of this section, see 79 Del. Laws, c. 390, § 8].

§ 3369. 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 health insurance coverage by an insurer due to nonpayment of premiums shall be in writing, shall be delivered to the named policyholder or mailed to the named policyholder at the last known address of the named policyholder, shall state the effective date of the cancellation or nonrenewal and shall be accompanied by a written explanation of the specific reasons for the cancellation or nonrenewal. Proof of mailing of such cancellation or nonrenewal notice shall be retained by the insurer for a period of not less than 1 year. This section shall not apply to any policy issued under the Delaware Healthy Children Program or any long-term care policy where notice provisions regarding cancellations or nonrenewals are specifically addressed elsewhere in this title or in regulations promulgated thereunder. 79 Del. Laws, c. 390, §  3;  80 Del. Laws, c. 310, § 1;