reglab/housing_qa huggingface dataset:
18 DE Code § 7102. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 71. Long-Term Care Insurance|§ 7102. Scope.

§ 7102. Scope. The requirements of this chapter shall apply to policies delivered or issued for delivery in this State on or after January 1, 1990. This chapter is not intended to supersede the obligations of entities subject to this chapter to comply with the substance of other applicable insurance laws insofar as such laws do not conflict with this chapter; provided, however, that laws and regulations designed and intended to apply to Medicare supplement insurance policies shall not be applied to long-term care insurance. A policy which is not advertised, marketed or offered as long-term care insurance or nursing home insurance need not meet the requirements of this chapter. 67 Del. Laws, c. 102, §  1;
18 DE Code § 7104. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 71. Long-Term Care Insurance|§ 7104. Extraterritorial jurisdiction; group long-term care insurance.

§ 7104. Extraterritorial jurisdiction; group long-term care insurance. No group long-term care insurance coverage may be offered to a resident of this State under a group policy issued in another state to a group described in § 7103(4) of this title, unless this State or another state having statutory and regulatory long-term care insurance requirements substantially similar to those adopted in this State has made a determination that such requirements have been met. 67 Del. Laws, c. 102, §  1;  68 Del. Laws, c. 160, §  3;
18 DE Code § 7106. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 71. Long-Term Care Insurance|§ 7106. Nonforfeiture benefit requirement.

§ 7106. Nonforfeiture benefit requirement. (a) No insurer may issue or deliver a long-term care insurance policy in this State unless the insurer offers to the applicant the option to purchase a policy that provides for nonforfeiture benefits. (b) The Insurance Commissioner shall promulgate rules and regulations which specify the types of nonforfeiture benefits to be included in the policies and certificates, the standards for the benefits and the date nonforfeiture benefits must commence. 70 Del. Laws, c. 351, §  1;
18 DE Code § 7107. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 71. Long-Term Care Insurance|§ 7107. Administrative procedures.

§ 7107. Administrative procedures. The Commissioner shall issue reasonable regulations to establish minimum standards for marketing practices, agent compensation, agent testing, penalties and reporting practices for long-term care insurance, and any other rules and regulations necessary for or as an aid to the administration or effectuation of this chapter. Regulations adopted pursuant to this chapter shall be in accordance with the provisions of Chapter 101 of Title 29. 67 Del. Laws, c. 102, §  1;  68 Del. Laws, c. 160, §  8;  70 Del. Laws, c. 351, §  1;
18 DE Code § 7108. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 71. Long-Term Care Insurance|§ 7108. Title.

§ 7108. Title. This chapter shall be known and may be cited as the “Long-Term Care Insurance Act.” 67 Del. Laws, c. 102, §  1;  70 Del. Laws, c. 351, §  1;
18 DE Code § 7109. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 71. Long-Term Care Insurance|§ 7109. Penalties.

§ 7109. Penalties. In addition to any other penalties provided by the laws of this State, any insurer or agent found to have violated any requirement of this State relating to the regulation of long-term care insurance or the marketing of such insurance shall be subject to a fine of up to 3 times the amount of any commissions paid for each policy involved in the violation or up to $10,000, whichever is greater. 68 Del. Laws, c. 160, §  9;  70 Del. Laws, c. 351, §  1;
18 DE Code § 7201. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 72. Small Employer Health Insurance|§ 7201. Purpose.

§ 7201. Purpose. The purpose and intent of this chapter are to promote the availability of health insurance coverage to small employers regardless of their health status or claims experience, to prevent abusive rating practices, to require disclosure of rating practices to purchasers, to establish rules regarding renewability of coverage, to establish limitations on the use of preexisting condition exclusions, to provide for development of “basic” and “standard” health benefit plans to be offered to all small employers, to provide for establishment of a reinsurance program, and to improve the overall fairness and efficiency of the small group health insurance market. This chapter is not intended to provide a comprehensive solution to the problem of affordability of health care or health insurance. 68 Del. Laws, c. 175, §  1;  68 Del. Laws, c. 340, §  1;
18 DE Code § 7203. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 72. Small Employer Health Insurance|§ 7203. Applicability and scope.

§ 7203. Applicability and scope. This chapter shall apply to any health benefit plan provided by a small employer which provides coverage to the employees of such small employer in this State. 68 Del. Laws, c. 175, §§  1, 3;  68 Del. Laws, c. 340, §  1;
18 DE Code § 7204. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 72. Small Employer Health Insurance|§ 7204. Establishment of classes of business.

§ 7204. Establishment of classes of business. (a) A small employer carrier may establish more than 1 class of business only to reflect substantial differences in expected claims experience or administrative costs related to the following reasons:  (1) The small employer carrier uses more than 1 type of system for the marketing and sale of health benefit plans to small employers; (2) The small employer carrier has acquired a class of business from another small employer carrier; or (3) The small employer carrier provides coverage to 1 or more association groups that meet the requirements of § 3506 of this title. (b) A small employer carrier may establish no more than 9 classes of business under subsection (a) of this section, except as provided for in subsection (d) of this section. (c) The Commissioner may establish regulations to provide for periods of transition in order for a small employer carrier to come into compliance with subsections (a) and (b) of this section in the instance of acquisition of a block of business from another small employer carrier. (d) The Commissioner may approve the establishment of more than 9 classes of business upon a finding that such action would enhance the efficiency and fairness of the small employer marketplace. (e) A small employer carrier shall not transfer a small employer involuntarily into or out of a class of business. A small employer carrier shall not offer to transfer a small employer into or out of a class of business unless such offer is made to transfer all small employers in the class of business without regard to case characteristics, claim experience, health status or duration of coverage since issue. 68 Del. Laws, c. 340, §  1;
18 DE Code § 7206. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 72. Small Employer Health Insurance|§ 7206. Renewability of coverage.

§ 7206. Renewability of coverage. (a) A health benefit plan subject to this chapter shall be renewable with respect to all eligible employees or dependents, at the option of the small employer, except in any of the following cases:  (1) Nonpayment of the required premiums; (2) Fraud or misrepresentation of the small employer or, with respect to coverage of individual insureds, the insureds or their representatives; (3) Noncompliance with the carrier's minimum participation requirements; (4) Noncompliance with the carrier's employer contribution requirements; (5) Repeated misuse of a provider network provision; (6) The small employer carrier elects to nonrenew all of its health benefit plans delivered or issued for delivery to small employers in this State. In such a case the carrier shall:  a. Provide advance notice of its decision under this paragraph to the commissioner in each state in which it is licensed; and b. Provide notice of the decision not to renew coverage to all affected small employers and to the commissioner in each state in which an affected insured individual is known to reside at least 180 days prior to the nonrenewal of any health benefit plans by the carrier. Notice to the commissioner under this subparagraph shall be provided at least 3 working days prior to the notice to the affected small employers; (7) The Commissioner finds that the continuation of the coverage would:  a. Not be in the best interests of the policyholders or certificate holders; b. Impair the carrier's ability to meet its contractual obligations. In such instance the Commissioner shall assist affected small employers in finding replacement coverage; (8) With respect to a carrier that offers a health benefit plan through a managed care plan, there is no longer any enrollee in connection with such plan that lives, resides or works in the service area of the carrier; (9) An employer is no longer actively engaged in the business in which it was engaged on the effective date of the plan; or (10) With respect to coverage that is made available only through 1 or more bona fide associations, the membership of an employer ceases. (b) A small employer carrier that elects not to renew a health benefit plan under paragraph (a)(6) of this section shall be prohibited from writing new business in the small employer market in this State for a period of 5 years from the date of notice to the Commissioner. (c) In the case of a small employer carrier doing business in 1 established geographic service area of the State, the rules set forth in this chapter shall apply only to the carrier's operations in that service area. 68 Del. Laws, c. 175, §  1;  68 Del. Laws, c. 340, §  1;  71 Del. Laws, c. 143, §  7;
18 DE Code § 7208. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 72. Small Employer Health Insurance|§ 7208. Notice of intent to operate as a risk-assuming carrier.

§ 7208. Notice of intent to operate as a risk-assuming carrier. (a) (1) Each small employer carrier desiring to operate as a risk-assuming carrier shall make application to the Commissioner within 30 days of January 4, 1993 to operate as a risk-assuming carrier, pursuant to § 7209 of this title. (2) The Commissioner may permit a carrier to modify its status at any time for good cause shown. (3) The Commissioner shall establish an application process for small employer carriers seeking to change their status under this subsection. (b) A reinsuring carrier that applies and is approved to operate as a risk-assuming carrier shall not be permitted to continue to reinsure any health benefit plan with the Program. Such a carrier shall pay a prorated assessment based upon business issued as a reinsuring carrier for any portion of the year that the business was reinsured. 68 Del. Laws, c. 340, §  1;
18 DE Code § 7209. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 72. Small Employer Health Insurance|§ 7209. Application to become a risk-assuming carrier.

§ 7209. Application to become a risk-assuming carrier. (a) A small employer carrier may apply to become a risk-assuming carrier by filing an application with the Commissioner in a form and manner prescribed by the Commissioner. (b) The Commissioner shall consider the following factors in evaluating an application filed under subsection (a) of this section:  (1) The carrier's financial condition; (2) The carrier's history of rating and underwriting small employer groups; (3) The carrier's commitment to market fairly to all small employers in the State or its established geographic service area, as applicable; (4) The carrier's experience with managing the risk of small employer groups; and (5) The effect of approval and disapproval on the small employer insurance market and the Delaware Small Employer Health Reinsurance Program pursuant to § 7210 of this title [repealed]. (c) The Commissioner may rescind the approval granted to a risk-assuming carrier under this section if the Commissioner finds that:  (1) The carrier's financial condition will no longer support the assumption of risk from issuing coverage to small employers in compliance with § 7207 of this title without the protection afforded by the Program; (2) The carrier has failed to market fairly to all small employers in the State or its established geographic service area, as applicable; or (3) The carrier has failed to provide coverage to eligible small employers as required in § 7207 of this title. (d) A small employer carrier electing to be a risk-assuming carrier shall not be subject to the provisions of § 7210 of this title [repealed]. 68 Del. Laws, c. 340, §  1;  69 Del. Laws, c. 403, §  6;
18 DE Code § 7211. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 72. Small Employer Health Insurance|§ 7211. Health benefit plan committee.

§ 7211. Health benefit plan committee. (a) The Commissioner shall appoint a Health Benefit Plan Committee. The Committee shall be composed of representatives of carriers, small employers and employees, health-care providers and producers. (b) The Committee shall recommend the form and level of coverages to be made available by small employer carriers pursuant to § 7207 of this title. (c) The Committee shall recommend benefit levels, cost sharing levels, exclusions and limitations for the basic health benefit plan and the standard health benefit plan. The Committee shall also design a basic health benefit plan and a standard health benefit plan which contain benefit and cost sharing levels that are consistent with the basic method of operation and the benefit plans of health maintenance organizations, including any restrictions imposed by federal law. (1) The plans recommended by the Committee may include cost containment features such as:  a. Utilization review of health-care services, including review of medical necessity of hospital and physician services; b. Case management; c. Selective contracting with hospitals, physicians and other health-care providers; d. Reasonable benefit differentials applicable to providers that participate or do not participate in arrangements using restricted network provisions; and e. Other managed care provisions. (2) The Committee shall submit the health benefit plans described in paragraph (c)(1) of this section to the Commissioner and the Delaware Health Care Commission for approval within 180 days after the appointment of the Committee.68 Del. Laws, c. 340, §  1;
18 DE Code § 7212. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 72. Small Employer Health Insurance|§ 7212. Periodic market evaluation.

§ 7212. Periodic market evaluation. The board, in consultation with the Committee, shall study and report at least every 3 years to the Commissioner on the effectiveness of this chapter. The report shall analyze the effectiveness of the chapter in promoting rate stability, product availability and coverage affordability. The report may contain recommendations for actions to improve the overall effectiveness, efficiency and fairness of the small employer group health insurance marketplace. The report shall address whether carriers and producers are fairly and actively marketing or issuing health benefit plans to small employers in fulfillment of the purposes of the chapter. The report may contain recommendations for market conduct or other regulatory standards or action. 68 Del. Laws, c. 340, §  1;
18 DE Code § 7213. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 72. Small Employer Health Insurance|§ 7213. Waiver of certain state laws.

§ 7213. Waiver of certain state laws. No law requiring the coverage of a health-care service or benefit, or requiring the reimbursement, utilization or inclusion of a specific category of licensed health-care practitioner, shall apply to a basic health benefit plan delivered or issued for delivery to small employers in this State pursuant to this chapter. 68 Del. Laws, c. 340, §  1;
18 DE Code § 7214. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 72. Small Employer Health Insurance|§ 7214. Administrative procedures.

§ 7214. Administrative procedures. The Commissioner shall issue regulations in accordance with § 314 of this title and Chapter 101 of Title 29, for the implementation and administration of this chapter. 68 Del. Laws, c. 340, §  1;
18 DE Code § 7216. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 72. Small Employer Health Insurance|§ 7216. Regulations; exceptions.

§ 7216. Regulations; exceptions. (a) The Commissioner may establish regulations to implement the provisions of this section and to assure that rating practices used by small employer carriers are consistent with the purposes of this chapter, including regulations that:  (1) Assure that differences in rates charged for health benefit plans by small employer carriers are reasonable and reflect objective differences in plan design (not including differences due to the nature of the groups assumed to select particular health benefit plans); and (2) Prescribe the manner in which case characteristics may be used by small employer carriers. (b) The Commissioner may suspend for a specified period the application of paragraph (a)(1) of this section as to the premium rates applicable to 1 or more small employers included within a class of business of a small employer carrier for 1 or more rating periods upon a filing by the small employer carrier and a finding by the Commissioner either that the suspension is reasonable in light of the financial condition of the small employer carrier or that the suspension would enhance the efficiency and fairness of the marketplace for small employer health insurance. 68 Del. Laws, c. 175, §  1;  68 Del. Laws, c. 340, §  1;
18 DE Code § 7217. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 72. Small Employer Health Insurance|§ 7217. Disclosure of rating practices; certification of compliance.

§ 7217. Disclosure of rating practices; certification of compliance. (a) In connection with the offering for sale of any health benefit plan to a small employer, a small employer carrier shall make a reasonable disclosure, as part of its solicitation and sales materials, of all of the following:  (1) The extent to which premium rates for a specified small employer are established or adjusted based upon the actual or expected variation in claims costs or actual or expected variation in health status of the employees of the small employer and their dependents; (2) The provisions of the health benefit plan concerning the small employer carrier's right to change premium rates and the factors, other than claim experience that affect changes in premium rates; (3) The provisions relating to renewability of policies and contracts; (4) The provisions relating to any preexisting condition provision; and (5) The benefits available under all health benefit plans for which the employer is qualified. (b) Each small employer carrier shall maintain at its principal place of business a complete and detailed description of its rating practices and renewal underwriting practices, including information and documentation that demonstrate that its rating methods and practices are based upon commonly accepted actuarial assumptions and are in accordance with sound actuarial principles. (c) Each small employer carrier shall file with the Commissioner annually on or before March 15, an actuarial certification certifying that the carrier is in compliance with this chapter and that the rating methods of the small employer carrier are actuarially sound. Such certification shall be in a form and manner, and shall contain such information, as specified by the Commissioner. A copy of the certification shall be retained by the small employer carrier at its principal place of business. (d) A small employer carrier shall make information and documentation described in subsection (b) of this section available to the Commissioner upon request. Except in cases of violations of this chapter, the information shall be considered proprietary and trade secret information and shall not be subject to disclosure by the Commissioner to persons outside of the Department except as agreed to by the small employer carrier or as ordered by a court of competent jurisdiction. 68 Del. Laws, c. 175, §  1;  68 Del. Laws, c. 340, §  1;  71 Del. Laws, c. 143, §  13;
18 DE Code § 7218. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 72. Small Employer Health Insurance|§ 7218. Factors for premium rates; premium rate variations; premium rate adjustments; “stop-loss” policies prohibited.

§ 7218. Factors for premium rates; premium rate variations; premium rate adjustments; “stop-loss” policies prohibited. (a) The only factors, other than plan design and family composition, that may be considered by a small employer carrier in setting premium rates for small employer health insurance are age, health status, and size of the group. “Health status” as used in this section means medical condition, including physical and mental illnesses; claims experience; receipt of health care; evidence of insurability; medical history; and unhealthy lifestyle choices as defined in § 7202 of this title. (b) The maximum premium rate variation between high and low small employer health insurance risk groups of 2 to 50 employees is a ratio of 5 for the high risk groups to 1 for the low risk groups. The ratio of premium rate variation between high and low risk small employee groups of 2 to 50 employees must decrease by a factor of .5 for high risk groups annually on July 1, until the premium rate variation ratio is 3 for the high risk groups to 1 for the low risk groups. (c) The maximum premium rate variation between high and low small employer health insurance risk groups of a single employee, known as “groups of one,” is a ratio of 6 for the high risk groups to 1 for the low risk groups. The ratio of premium rate variation between high and low risk small employer groups of 1 must decrease by a factor of .5 for high risk groups of 1 annually on July 1, until the premium rate variation ratio is 4 for the high risk groups to 1 for the low risk groups. Nothing in this provision may be construed to create separate risk pools for groups of one and groups of 2 to 50. (d) A group may not receive a premium rate adjustment for a change in the health status of the members of the group that exceeds 15%, whether higher or lower, from the prior year. (e) A small employer health insurance carrier may make available, issue, or renew a “stop loss” policy to a small employer if that small employer employs more than 5 eligible employees, the majority of whom are employed within this State, on at least 50% of its working days during the preceding calendar quarter. (f) Nothing herein shall apply to any company licensed under Chapter 69 of this title. 77 Del. Laws, c. 388, §§  1, 2;  78 Del. Laws, c. 25, §  1;  81 Del. Laws, c. 420, § 1;
18 DE Code § 7301. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 73. Pharmacy Access Act|§ 7301. Title.

§ 7301. Title. This chapter shall be known as the “Pharmacy Access Act.” 69 Del. Laws, c. 227, §  1;