reglab/housing_qa huggingface dataset:
18 DE Code § 3362A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter VI. Pharmacy Benefits Manager Network Requirements [For Application of This Statute, See 83 Del. Laws, C. 256, §? 15]|§ 3362A. Pharmacy benefits manager network [For application of this statute, see 83 Del. Laws, c. 256, §  15].

§ 3362A. Pharmacy benefits manager network [For application of this statute, see 83 Del. Laws, c. 256, §  15]. (a) A pharmacy benefits manager shall provide a reasonably adequate and accessible pharmacy benefits manager network for the provision of prescription drugs, which provides for convenient patient access to pharmacies within a reasonable distance from a patient's residence. (b) A pharmacy benefits manager may not deny a pharmacy the opportunity to participate in a pharmacy benefits manager network at preferred participation status if the pharmacy is willing to accept the terms and conditions that the pharmacy benefits manager has established for other pharmacies as a condition of preferred network participation status. (c) A mail-order pharmacy may not be included in the calculations for determining pharmacy benefits manager network adequacy under this section. 83 Del. Laws, c. 256, § 12;
18 DE Code § 3363A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter VI. Pharmacy Benefits Manager Network Requirements [For Application of This Statute, See 83 Del. Laws, C. 256, §? 15]|§ 3363A. Reports [For application of this statute, see 83 Del. Laws, c. 256, §  15].

§ 3363A. Reports [For application of this statute, see 83 Del. Laws, c. 256, §  15]. (a) A pharmacy benefits manager shall provide a pharmacy benefits manager network adequacy report describing the pharmacy benefits manager network and the pharmacy benefits manager network's accessibility in this State. The Commissioner shall adopt regulations setting the time and manner for providing the report.  (b) A pharmacy benefits manager shall report to the Commissioner on a quarterly basis all of the following information for each insurer:  (1) The itemized amount of pharmacy benefits manager revenue sources, including professional fees, administrative fees, processing fees, audits, direct and indirect renumeration fees, or any other fees. (2) The aggregate amount of rebates distributed to the appropriate insurer. (3) The aggregate amount of rebates passed on to insureds of each insurer at the point of sale that reduced the insureds' applicable deductible, copayment, coinsurance, or other cost-sharing amount. (4) The individual and aggregate amount the insurer paid to the pharmacy benefits manager for pharmacy goods or services itemized by all of the following:  a. Pharmacy. b. Product. c. Goods and services. (5) The individual and aggregate amount a pharmacy benefits manager paid for pharmacy goods or services itemized by all of the following:  a. Pharmacy.  b. Product.  c. Goods and services.  (c) The information provided under subsection (b) of this section is confidential and not subject to subpoena or the Freedom of Information Act, Chapter 100 of Title 29. 83 Del. Laws, c. 256, § 12;
18 DE Code § 3371A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter VII. Prohibited Practices; Penalties; Enforcement [For Application of This Statute, See 83 Del. Laws, C. 256, §? 15]|§ 3371A. Definitions [For application of this statute, see 83 Del. Laws, c. 256, §  15].

§ 3371A. Definitions [For application of this statute, see 83 Del. Laws, c. 256, §  15]. For purposes of this subchapter:  (1) “Board of Pharmacy” means the Delaware State Board of Pharmacy. (2) “Claim” means as defined under § 3321A of this title.  (3) “Insurer” means as defined under § 3321A of this title. (4) “Pharmacist” means as defined under § 2502 of Title 24. (5) “Pharmacy” means as defined under § 2502 of Title 24. (6) “Pharmacy benefits manager” means as defined under § 3302A of this title. (7) “Pharmacy benefits manager network” means a network of pharmacists or pharmacies that are offered by an agreement or contract to provide pharmacy goods or services. (8) “Pharmacy goods or services” means as defined under § 3325A of this title. (9) “Spread pricing” means the model of prescription drug pricing in which the pharmacy benefits manager charges a health benefit plan a contracted price for prescription drugs, and the contracted price for the prescription drugs differs from the amount the pharmacy benefits manager directly or indirectly pays the pharmacist or pharmacy for pharmacy goods or services.83 Del. Laws, c. 256, § 13;
18 DE Code § 3372A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter VII. Prohibited Practices; Penalties; Enforcement [For Application of This Statute, See 83 Del. Laws, C. 256, §? 15]|§ 3372A. Prohibited practices [For application of this statute, see 83 Del. Laws, c. 256, §  15].

§ 3372A. Prohibited practices [For application of this statute, see 83 Del. Laws, c. 256, §  15]. A pharmacy benefits manager or representative of a pharmacy benefits manager may not do any of the following:  (1) Engage in spread pricing. (2) Cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading. (3) Unless reviewed and approved by the Commissioner, charge a pharmacist or pharmacy a fee related to the adjudication of a claim, including a fee for any of the following:  a. The receipt and processing of a pharmacy claim. b. The development or management of claims processing services in a pharmacy benefits manager network. c. Participation in a pharmacy benefits manager network. (4) Unless reviewed and approved by the Commissioner in coordination with the Board of Pharmacy, require pharmacy accreditation standards or certification requirements inconsistent with, more stringent than, or in addition to requirements of the Board of Pharmacy.  (5) Violate § 3325A(b) of this title. (6) Violate § 3362A of this title. (7) Pay or reimburse a pharmacy or pharmacist for the ingredient drug product component of pharmacist services less than the national average drug acquisition cost, or if the national average drug acquisition cost is unavailable, the wholesale acquisition cost. (8) Make or permit any reduction of payment for pharmacy goods or services by a pharmacy benefits manager or an insurer directly or indirectly to a pharmacy under a reconciliation process to an effective rate of reimbursement, including generic effective rates, brand effective rates, direct and indirect remuneration fees, or any other reduction or aggregate reduction of payment. (9) After adjudication of a claim for pharmacy goods or services, directly or indirectly retroactively deny or reduce the claim unless 1 or more of the following applies:  a. The original claim was intentionally submitted fraudulently. b. The original claim payment was incorrect because the pharmacy or pharmacist had already been paid for the pharmacy goods or services. c. The pharmacy goods or services were not properly rendered by the pharmacy or pharmacist.83 Del. Laws, c. 256, § 13;
18 DE Code § 3373A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33A. Pharmacy Benefits Managers [For Application of This Chapter, See 80 Del. Laws, C. 245, §? 2]|Subchapter VII. Prohibited Practices; Penalties; Enforcement [For Application of This Statute, See 83 Del. Laws, C. 256, §? 15]|§ 3373A. Penalties and enforcement [For application of this statute, see 83 Del. Laws, c. 256, §  15].

§ 3373A. Penalties and enforcement [For application of this statute, see 83 Del. Laws, c. 256, §  15]. (a) If the Commissioner determines that a pharmacy benefits manager has violated any provision of this chapter or any regulation adopted under this chapter, the Commissioner may, after notice and a hearing, issue an order that requires the pharmacy benefits manager to do 1 or more of the following:  (1) Cease and desist from the identified violation and further similar violations. (2) Take specific affirmative action to correct the violation. (3) Make restitution of money, property, or other assets to a person that has suffered financial injury because of the violation. (4) Pay a fine in an amount determined by the Commissioner, not to exceed $10,000, for each violation of this chapter. (5) Pay the costs, including applicable attorneys' fees, incurred by the Commissioner in bringing the action. (b) A hearing under this section must be held under §§ 323 through 328 of this title and any regulations adopted by the Commissioner. (c) The Commissioner may adopt regulations to enforce this chapter and to establish a complaint process and set associated fees to address grievances and appeals brought under this chapter. 82 Del. Laws, c. 115, § 4;  83 Del. Laws, c. 256, § 14;
18 DE Code § 3501. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3501. Group policies must meet group requirements.

§ 3501. Group policies must meet group requirements. Except as provided in § 3509 of this title, no policy of group health insurance shall be delivered in this State unless it conforms to one of the descriptions contained in §§ 3502-3508 of this title. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3502. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3502. Employee groups.

§ 3502. Employee groups. A policy may be issued to an employer, or to the trustees of a fund established by an employer, which employer or trustees shall be deemed the policyholder, to insure employees of the employer for the benefit of persons other than the employer, subject to the following requirements:  (1) The employees eligible for insurance under the policy shall be all of the employees of the employer, or all of any class or classes thereof. The policy may provide that the term “employees” shall include the employees of 1 or more subsidiary corporations, and the employees, individual proprietors and partners of 1 or more affiliated corporations, proprietorships or partnerships if the business of the employer and of such affiliated corporations, proprietorships or partnerships is under common control. The policy may provide that the term “employees” shall include the individual proprietor or partners if the employer is an individual proprietorship or partnership. The policy may provide that the term “employees” shall include retired employees, former employees and directors of a corporate employer. A policy issued to insure the employees of a public body may provide that the term “employees” shall include elected or appointed officials. The policy may provide that the term “employee” does not include farm laborers employed in agriculture. (2) The premium for the policy shall be paid either from the employer's funds or from funds contributed by the insured employees, or from both. Except as provided in paragraph (3) of this section, a policy on which no part of the premium is to be derived from funds contributed by the insured employees must insure all eligible employees, except those who reject such coverage in writing. (3) An insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer.66 Del. Laws, c. 175, §  1;
18 DE Code § 3503. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3503. Debtor groups.

§ 3503. Debtor groups. A policy may be issued to a creditor or its parent holding company or to a trustee or trustees or agent designated by 2 or more creditors, which creditor, holding company, affiliate, trustee, trustees or agent shall be deemed the policyholder, to insure debtors of the creditors with respect to their indebtedness, subject to the following requirements:  (1) The debtors eligible for insurance under the policy shall be all of the debtors of the creditor or creditors, or all of any class or classes thereof. The policy may provide that the term “debtors” shall include:  a. Borrowers of money or purchasers or lessees of goods, services or property for which payment is arranged through a lease or credit transaction; b. The debtors of 1 or more subsidiary corporations; and c. The debtors of 1 or more affiliated corporations, proprietorships or partnerships if the business of the policyholder and of such affiliated corporations, proprietorships or partnerships is under common control. (2) The premium for the policy shall be paid either from the creditor's funds, or from charges collected from the insured debtors, or from both. Except as provided in paragraph (3) of this section, a policy on which no part of the premium is to be derived from funds contributed by insured debtors specifically for their insurance must insure all eligible debtors. (3) An insurer may exclude any debtors as to whom evidence of individual insurability is not satisfactory to the insurer. (4) The total amount of insurance payable with respect to an indebtedness shall not exceed the greater of the total of scheduled payments or actual amount of unpaid indebtedness as to the creditor. The insurer may exclude any payments which are delinquent on the date the debtor becomes disabled as defined in the policy. (5) The insurance may be payable to the creditor or any successor to the right, title and interest of the creditor. Such payment or payments shall reduce or extinguish the unpaid indebtedness of the debtor to the extent of each such payment and any excess of the insurance shall be payable to the insured or the estate of the insured. (6) Notwithstanding the preceding provisions of this section, insurance on agricultural credit transaction commitments may be written up to the amount of the loan commitment. Insurance on educational credit transaction commitments may be written up to the amount of the loan commitment less the amount of any repayments made on the loan.66 Del. Laws, c. 175, §  1;
18 DE Code § 3504. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3504. Labor union or employee organization groups.

§ 3504. Labor union or employee organization groups. A policy may be issued to a labor union, or similar employee organization which shall be deemed to be the policyholder, to insure members of such union or organization for the benefit of persons other than the union or organization or any of its officials, representatives or agents, subject to the following requirements:  (1) The members eligible for insurance under the policy shall be all of the members of the union or organization, or all of any class or classes thereof. (2) The premium for the policy shall be paid either from funds of the union or organization, or from funds contributed by the insured members specifically for their insurance, or from both. Except as provided in paragraph (3) of this section, a policy on which no part of the premium is to be derived from funds contributed by the insured members specifically for the insurance must insure all eligible members, except those who reject such coverage in writing. (3) An insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3505. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3505. Trustee groups.

§ 3505. Trustee groups. A policy may be issued to a trust, or to the trustee or trustees of a fund, established or adopted by 2 or more employers, or by 1 or more labor unions or similar employee organizations, or by 1 or more employers and 1 or more labor unions or similar employee organizations, which trust or trustee or trustees shall be deemed the policyholder, to insure employee of the employer or members of the unions or organizations for the benefit of persons other than the employers or the unions or organizations, subject to the following requirements:  (1) The persons eligible for insurance shall be all of the employees of the employers or all of the members of the unions or organizations, or all of any class or classes thereof. The policy may provide that the term “employees” shall include the employees of 1 or more subsidiary corporations, and the employees, individual proprietors and partners of 1 or more affiliated corporations, proprietorships or partnerships if the business of the employer and of such affiliated corporations, proprietorships or partnerships is under common control. The policy may provide that the term “employees” shall include the individual proprietor or partners if the employer is an individual proprietorship or partnership. The policy may provide that the term “employees” shall include retired employees, former employees and directors of a corporate employer. The policy may provide that the term “employees” shall include the trustees or their employees, or both, if their duties are principally connected with such trusteeship. (2) The premium for the policy shall be paid from funds contributed by the employer or employers of the insured persons, or by the union or unions or similar employee organizations, or by both, or from funds contributed by the insured persons from both the insured persons and the employer(s) or union(s) or similar employee organization(s). Except as provided in paragraph (3) of this section, a policy on which no part of the premium is to be derived from funds contributed by the insured persons specifically for their insurance must insure all eligible persons, except those who reject such coverage in writing. (3) An insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3506. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3506. Association groups.

§ 3506. Association groups. (a) “Bona fide association” means, with respect to health insurance coverage offered in Delaware, an association which:  (1) Has been actively in existence for at least 5 years; (2) Has been formed and maintained in good faith for purposes other than obtaining insurance and does not condition membership on the purchase of association-sponsored insurance; (3) Does not condition membership in the association on any health status-related factor relating to an individual (including an employee of an employer or a dependent of an employee) and clearly so states in all membership and application materials; (4) Makes health insurance coverage offered through the association available to all members regardless of any health status-related factor relating to such members (or individuals eligible for coverage through a member) and clearly so states in all marketing and application materials; (5) Does not make health insurance coverage offered through the association available other than in connection with a member of the association and clearly so states in all marketing and application materials; and (6) Provides and annually updates information necessary for the Commissioner to determine whether or not an association meets the definition of a bona fide association before qualifying as a bona fide association for the purposes of this chapter. (b) An association policy shall be subject to the following requirements:  (1) The policy may insure members of such association or associations, employees thereof or employees of members or 1 or more of the preceding or all of any class or classes thereof for the benefit of persons other than the employer. (2) The premium for the policy shall be paid from funds contributed by the association or associations or by the employer members, or by both, or from funds contributed by the covered persons or from both the covered persons and the association, associations or employer members. (3) A policy on which no part of the premium is to be derived from funds contributed by the covered persons specifically for their insurance must insure all eligible persons, except those who reject such coverage in writing.66 Del. Laws, c. 175, §  1;  71 Del. Laws, c. 143, §  15;
18 DE Code § 3507. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3507. Credit union groups.

§ 3507. Credit union groups. A policy may be issued to a credit union or to a trustee or trustees or agent designated by 2 or more credit unions, which credit union, trustee, trustees or agent shall be deemed the policyholder, to insure members of such credit unions for the benefit of persons other than the credit unit or credit unions, trustee or trustees, or agent or any of their officials, subject to the following requirements:  (1) The members eligible for insurance shall be all of the members of the credit union or credit unions, or all of any class or classes thereof. (2) The premium for the policy shall be paid by the policyholder from the credit union's funds and, except as provided in paragraph (3) of this section, must insure all eligible members. (3) An insurer may exclude or limit the coverage on any member as to whom evidence of individual insurability is not satisfactory to the insurer.66 Del. Laws, c. 175, §  1;
18 DE Code § 3508. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3508. Discretionary groups.

§ 3508. Discretionary groups. A policy may be issued to any other substantially similar group which, in the discretion of the Commissioner, may be subject to the issuance of a group health policy or contract. 66 Del. Laws, c. 175, §  1;
18 DE Code § 3509. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter I. Group Health Insurance|§ 3509. Requirements for other groups; out-of-state groups.

§ 3509. Requirements for other groups; out-of-state groups. (a) Group health insurance offered to a resident of this State under a group health insurance policy issued to a group other than those described in §§ 3502-3508 of this title shall be subject, where applicable, to the requirements of subsections (b)-(e) of this section. (b) No such group health insurance policy shall be delivered or coverage offered in this State unless the Commissioner finds that:  (1) The issuance of such group policy is not contrary to the best interest of the public; (2) The issuance of the group policy would result in economies of acquisition or administration; (3) The benefits are reasonable in relation to the premiums charged; and (4) The group is not affiliated with or controlled by (as those terms are defined in Chapter 50 of this title) an insurer unless approved by the Commissioner. (c) No such group health insurance coverage may be offered in this State by an insurer under a policy issued in another state unless this State or another state having requirements substantially similar to those contained in paragraphs (b)(1)-(4) of this section has made a determination that such requirements have been met. (d) The premium for the policy shall be paid either from the policyholders' funds or from funds contributed by the covered persons or from both. (e) An insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer. 66 Del. Laws, c. 175, §  1;  70 Del. Laws, c. 104, §§  1-4;