reglab/housing_qa huggingface dataset:
18 DE Code § 6304. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 63. Health Service Corporations|§ 6304. Certificate of authority; when required; application.

§ 6304. Certificate of authority; when required; application. (a) No corporation shall engage in the business of a health service corporation without first obtaining a certificate of authority therefor from the Commissioner, except that this provision shall not apply to corporations which are engaged in such business in this State on November 1, 1968. (b) Application for a certificate of authority as a health service corporation shall be made on forms supplied by the Commissioner and containing such information as the Commissioner shall reasonably deem necessary. The application shall be accompanied by a filing fee of $25 and copies of the following documents:  (1) Certificate of incorporation; (2) Bylaws; (3) Forms of all proposed contracts between the applicant and participating hospitals, physicians and other providers of health services showing the terms under which services are to be furnished to subscribers or members; (4) Forms of all proposed contracts and optional riders to be offered for subscribers or members; (5) Tables of rates to be charged for each such contract or rider or a statement of the rating formulas to be used in lieu of fixed rates; (6) Financial statement of the corporation, including the amounts of contributions paid or agreed to be paid to the corporation for working capital and the name or names of each contributor and the terms of each contribution; (7) A statement of the areas in which the corporation proposes to operate; and (8) A list of the names and addresses of the members of the board of directors or other governing body of the corporation and its principal officers. (c) Every corporation engaging in the business of a health service corporation pursuant to the exception stated in subsection (a) of this section above, shall, within 30 days after November 1, 1968, file with the Commissioner copies of all the documents referred to in paragraphs (b)(1)-(8) of this section, above, and pay therewith a filing fee of $25. 18 Del. C. 1953, §  6304;  56 Del. Laws, c. 380, §  1;  70 Del. Laws, c. 186, §  1;
18 DE Code § 6305. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 63. Health Service Corporations|§ 6305. Issuance of certificate of authority.

§ 6305. Issuance of certificate of authority. The Commissioner shall issue a certificate of authority to the applicant when it is shown to the Commissioner's satisfaction that:  (1) The applicant is established as a bona fide nonprofit health service corporation; (2) Arrangements have been made by the applicant reasonably to assure provision of the services covered by its contracts and riders; (3) The amounts provided as working capital of the corporation are repayable, without interest, only out of operating revenues; (4) The amount of money actually available for working capital is sufficient to carry on the plan for a period of 2 months from the date of issuance of the certificate of authority.18 Del. C. 1953, §  6305;  56 Del. Laws, c. 380, §  1;  70 Del. Laws, c. 186, §  1;
18 DE Code § 6306. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 63. Health Service Corporations|§ 6306. Filing required for contract or rate changes.

§ 6306. Filing required for contract or rate changes. No new or changed contract or rider shall be offered to the public and no new or changed rate or rating formula shall be charged or employed, unless documentation with respect thereto as specified in § 6304(b) of this title is first filed with the Commissioner. 18 Del. C. 1953, §  6306;  56 Del. Laws, c. 380, §  1;
18 DE Code § 6307. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 63. Health Service Corporations|§ 6307. Annual report; examination.

§ 6307. Annual report; examination. (a) Not later than March 1 of each year every such corporation shall file with the Commissioner a statement sworn to by at least 2 of its principal officers, showing its financial condition on the last day of the next preceding calendar year. Such statement shall be in the general form as is currently in general and customary use in the United States for health insurance and may be submitted on standard office-size paper. (b) The Commissioner may appoint an examiner to examine into the affairs of the corporation. Such person shall have the power of visitation and examination, shall have free access to all the books, papers and documents relating to the business of the corporation and may require the officers, agents or employees thereof, or any other persons, to testify under oath concerning the affairs, transactions and conditions at least every 3 years. Except, that the confidentiality of information relating to the diagnosis and treatment of the members of such corporation shall be strictly maintained by the examiner. The reasonable cost of the examination shall be paid by the corporation upon completion of the examination. 18 Del. C. 1953, §  6307;  56 Del. Laws, c. 380, §  1;  64 Del. Laws, c. 322, §  1;  69 Del. Laws, c. 343, §  1;
18 DE Code § 6308. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 63. Health Service Corporations|§ 6308. Suspension or revocation of authority to do business.

§ 6308. Suspension or revocation of authority to do business. The Commissioner may, after hearing, suspend or revoke the right to do business or the certificate of authority for any of the following causes:  (1) If the corporation is no longer qualified therefor under this chapter; (2) For a violation by the corporation of a provision of this chapter; or (3) Upon any applicable ground under this chapter or any of the chapters specified in § 6309 of this title for which the certificate of authority of an insurer may be suspended or revoked.18 Del. C. 1953, §  6308;  56 Del. Laws, c. 380, §  1;
18 DE Code § 6309. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 63. Health Service Corporations|§ 6309. Other provisions applicable.

§ 6309. Other provisions applicable. (a) Such corporations shall be subject to this chapter and to the following chapters of this title, to the extent applicable and not in conflict with the express provisions of this chapter:  (1) Chapter 1 (General Definitions and Provisions). (2) Chapter 3 (The Insurance Commissioner). (3) Chapter 23 (Unfair Practices in the Insurance Business). (4) Chapter 25 (Rates and Rating Organizations). (5) Subchapter II of Chapter 58 (Risk-Based Capital (RBC) for Health Organizations). (6) Chapter 59 (Rehabilitation and Liquidation). (7) Chapter 34 (Medicare Supplement Insurance Minimum Standards). (8) Chapter 36 (Individual Health Insurance Minimum Standards). (b) Such corporations shall also be subject to §§ 3349A, 3365, 3565A and 3571G of this title. 18 Del. C. 1953, §  6309;  56 Del. Laws, c. 380, §  1;  60 Del. Laws, c. 388, §§  5, 6;  63 Del. Laws, c. 262, §  4;  64 Del. Laws, c. 142, §  3;  78 Del. Laws, c. 276, §  3;  79 Del. Laws, c. 425, §  4;  79 Del. Laws, c. 435, §  3;
18 DE Code § 6401. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6401. Legislative intent.

§ 6401. Legislative intent. It is the intent of the General Assembly in enacting this chapter to provide that the Insurance Commissioner regulate managed care organizations, including financial solvency, established or operated in this State. It is the intent of the General Assembly that such organizations be subject only to the provisions of this chapter, including those other chapters of this title expressly included in § 6411 of this title, and no insurance law hereinafter enacted shall be deemed to apply to managed care organizations unless they are specifically referred to therein. 63 Del. Laws, c. 382, §  1;  66 Del. Laws, c. 124, §§  1, 2;  71 Del. Laws, c. 229, §§  1, 2;  75 Del. Laws, c. 362, §  2;
18 DE Code § 6402. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6402. Short title.

§ 6402. Short title. This chapter shall be known and may be cited as the “Delaware Managed Care Organization Act” or the “Delaware MCO Act.” 63 Del. Laws, c. 382, §  1;  66 Del. Laws, c. 124, §  7;  71 Del. Laws, c. 229, §  8;  75 Del. Laws, c. 362, §  2;
18 DE Code § 6403. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6403. Definitions.

§ 6403. Definitions. As used in this chapter, unless the context clearly indicates a different meaning, the following words and phrases shall have the meaning ascribed to them in this section:  (1) “Basic health services” means a range of services including at least the following: usual physician services, hospitalization, laboratory, x-ray, emergency and preventive services and out-of-area coverage. (2) “Certified managed care organization” means a managed care organization which has been issued a certificate of authority under this title. (3) “Department” means the Delaware Department of Insurance. (4) “Health-care services” means any service included in the furnishing to any individual of medical or dental care, or hospitalization or incidental to the furnishing of such care or hospitalization, as well as the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing or healing human illness, injury or physical disability. (5) “Managed care organization” means a public or private organization, organized under the laws of any state, which:  a. Makes health-care services, including at least the basic health services defined in paragraph (1) of this section above, available to enrolled participants; b. Is primarily compensated (except for copayment) for the provision of basic health-care services to enrolled participants on a predetermined periodic rate basis; and c. Provides physicians' services. The organization may also arrange for health-care services on a prepayment or other financial basis.63 Del. Laws, c. 382, §  1;  66 Del. Laws, c. 124, §§  1, 3-5;  71 Del. Laws, c. 229, §§  1, 3;  72 Del. Laws, c. 441, §  1;  75 Del. Laws, c. 362, §  2;
18 DE Code § 6406. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6406. Annual report.

§ 6406. Annual report. (a) Every managed care organization shall annually, on or before June 1, file with the Department a report covering the preceding fiscal year. (b) Such report shall include:  (1) A financial statement of the organization, including its balance sheet and receipts and disbursements for the preceding fiscal year; and (2) A statement explaining any material change in the information originally submitted pursuant to this title.63 Del. Laws, c. 382, §  1;  66 Del. Laws, c. 124, §  7;  71 Del. Laws, c. 229, §  1;  75 Del. Laws, c. 362, §  2;
18 DE Code § 6407. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6407. Prohibited practices.

§ 6407. Prohibited practices. (a) No managed care organization or representative thereof may cause or knowingly permit the use of advertising or solicitation which is untrue or misleading. (b) No managed care organization may cancel or refuse to renew the enrollment of an enrollee solely on the basis of the enrollee's health. This subsection shall not prevent a managed care organization from canceling the enrollment of an enrollee if the enrollee misrepresented the state of the enrollee's health at the time of enrollment. This subsection shall not prevent a managed care organization from canceling or refusing to renew an enrollment for reasons other than an enrollee's health, including without limitation nonpayment of premiums or fraud by the enrollee. (c) The Department shall have exclusive authority to investigate violations of this section. 63 Del. Laws, c. 382, §  1;  66 Del. Laws, c. 124, §  7;  70 Del. Laws, c. 186, §  1;  71 Del. Laws, c. 229, §  1;  75 Del. Laws, c. 362, §  2;
18 DE Code § 6408. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6408. Rules and regulations.

§ 6408. Rules and regulations. The Department shall have authority to promulgate such reasonable rules and regulations as are necessary to carry out this chapter. Such rules or regulations shall conform to and be promulgated pursuant to the Administrative Procedures Act, Chapter 101 of Title 29. 63 Del. Laws, c. 382, §  1;  66 Del. Laws, c. 124, §  7;  75 Del. Laws, c. 362, §  2;
18 DE Code § 6409. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6409. Fees.

§ 6409. Fees. Every managed care organization subject to this chapter shall pay $750 for filing an application for a certificate of authority and $500 for filing an annual report. 75 Del. Laws, c. 362, §  2;
18 DE Code § 6410. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6410. Provision of professional services.

§ 6410. Provision of professional services. (a) A managed care organization shall have a medical director. The medical director shall be licensed to practice medicine in Delaware in accordance with § 1702 of Title 24. The medical director's duties shall include, at a minimum, those specified in regulations promulgated by the Department pursuant to the authority granted. The medical director may assign duties to other physicians and nonphysician personnel employed by, or under contract to, the managed care organization, provided, however, that the medical director shall retain responsibility for assigned duties. Any decision to deny a covered service shall be rendered by a physician. (b) A certified managed care organization may contract with, or employ, any licensed health-care professional to provide health-care services, notwithstanding any statute, rule or regulation to the contrary. No managed care organization delivering health-care services in this State shall engage in a contract with or employ, for the delivery of such services, any person who does not hold a Delaware license to practice the profession for which such person is engaged or employed, if such practice requires a license. 63 Del. Laws, c. 382, §  1;  66 Del. Laws, c. 124, §§  7, 11-15;  71 Del. Laws, c. 229, §§  1, 7;  72 Del. Laws, c. 200, §§  1, 2;  75 Del. Laws, c. 362, §  2;
18 DE Code § 6411. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6411. Relationship to other laws.

§ 6411. Relationship to other laws. (a) Managed care organizations shall be subject to this chapter and to the following chapters of this title, as amended from time to time, to the extent applicable and not in conflict with the express provisions of this chapter. For purposes of the following chapters only, a managed care organization shall be treated as a health insurer, and its coverages shall be deemed to be “medical and hospital expense-incurred insurance policies” for purposes of Chapter 25 of this title:  (1) Chapter 1 of this title (General Definitions and Provisions). (2) Chapter 3 of this title (The Insurance Commissioner). (3) Chapter 5 of this title (Authorization of Insurers and General Requirements). (4) Chapter 9 of this title (Kinds of Insurance; Limits of Risk; Reinsurance). (5) Chapter 11 of this title (Assets and Liabilities). (6) Chapter 13 of this title (Investments). (7) Chapter 15 of this title (Administration of Deposits). (8) Chapter 17 of this title (Licensing of Professional Insurance Personnel). (9) Chapter 21 of this title (Unauthorized Insurers — Prohibitions, Process and Advertising). (10) Chapter 23 of this title (Unfair Practices in the Insurance Business). (11) Chapter 25 of this title (Rates and Rating Organizations). (12) Chapter 27 of this title (The Insurance Contract). (13) Chapter 33 of this title (Health Insurance Contracts). (14) Chapter 34 of this title (Medicare Supplement Insurance Minimum Standards). (15) Chapter 35 of this title (Group and Blanket Health Insurance). (16) Chapter 36 of this title (Individual Health Insurance Minimum Standards). (17) Chapter 50 of this title (Insurance Holding Company System Registration). (18) Subchapter II of Chapter 58 of this title (Risk-Based Capital (RBC) for Health Organizations). (19) Chapter 59 of this title (Rehabilitation and Liquidation). (20) Chapter 44 of this title (Delaware Life and Health Insurance Guaranty Association Act). (b) A certified managed care organization shall not be deemed to be practicing medicine and the managed care organization shall be exempt from statutes, rules and regulations relating to the practice of medicine. A certified managed care organization shall not be deemed to be practicing any other licensed health-care profession, and the managed care organization shall be exempt from statutes, rules and regulations relating to such professions. (c) Except as provided in § 6407 of this title, solicitation of enrollees by a certified managed care organization or its employees shall not be construed as a violation of any statute, rule or regulation relating to solicitation or advertising by health professionals. 63 Del. Laws, c. 382, §  1;  66 Del. Laws, c. 124, §§  1, 11-15;  69 Del. Laws, c. 404, §  1;  71 Del. Laws, c. 229, §§  1, 7;  72 Del. Laws, c. 200, §§  1, 2;  75 Del. Laws, c. 362, §  2;  79 Del. Laws, c. 425, §  5;  82 Del. Laws, c. 113, § 11;
18 DE Code § 6412. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6412. Confidentiality of health information.

§ 6412. Confidentiality of health information. Any data or information pertaining to the diagnosis, treatment or health of any enrollee or applicant obtained from such person or from any health-care provider by any managed care organization shall be held in confidence and shall not be disclosed to any person except upon the express consent of the enrollee or applicant, or the enrollee's or applicant's physician, or pursuant to statute or court order for the production of evidence or the discovery thereof, or in the event of claim or litigation between such person and the managed care organization wherein such data or information is pertinent. The communication of such data or information from a health care provider to a managed care organization shall not prevent such data or information from being deemed confidential for purposes of the Delaware Uniform Rules of Evidence. 63 Del. Laws, c. 382, §  1;  66 Del. Laws, c. 124, §  7;  70 Del. Laws, c. 186, §  1;  71 Del. Laws, c. 229, §  1;  75 Del. Laws, c. 362, §  2;
18 DE Code § 6413. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6413. Freedom of choice.

§ 6413. Freedom of choice. In order to promote freedom of choice by employers and others in Delaware who purchase group health-care coverage, it shall be unlawful for any insurer, health service corporation or other person in the business of providing or insuring health-care services or coverage, to offer any insurance or health-care coverage to any person in this State on a basis which would preclude such person from allowing some members of a group to elect to enroll in a certified managed care organization, either by means of an express prohibition or by requiring the same payment regardless of such election; provided, however, that it shall not be unlawful for such persons to offer insurance or coverage on a basis where the rates or cost thereof are calculated according to the number of persons in the group for which such coverage is provided. The Department shall have authority to enforce this section. 63 Del. Laws, c. 382, §  1;  66 Del. Laws, c. 124, §  7;  71 Del. Laws, c. 229, §  1;  75 Del. Laws, c. 362, §  2;
18 DE Code § 6414. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6414. Nondisclosure clause.

§ 6414. Nondisclosure clause. A managed care organization contract shall contain no provision or nondisclosure clause prohibiting physicians or other health-care providers from giving patients information regarding diagnoses, prognoses and treatment options. 63 Del. Laws, c. 382, §  1;  66 Del. Laws, c. 124, §  7;  70 Del. Laws, c. 186, §  1;  70 Del. Laws, c. 537, §  3;  71 Del. Laws, c. 229, §  1;  75 Del. Laws, c. 362, §  2;
18 DE Code § 6415. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6415. Refusal to contract.

§ 6415. Refusal to contract. A managed care organization shall not refuse to contract with or compensate for covered services an otherwise eligible health-care provider solely because that provider has in good faith communicated with 1 or more of the provider's current, former or prospective patients regarding the provisions, terms or requirements of the health maintenance organization's products or services as they relate to the needs of that provider's patients. 63 Del. Laws, c. 382, §  1;  66 Del. Laws, c. 124, §  7;  70 Del. Laws, c. 186, §  1;  70 Del. Laws, c. 537, §  3;  71 Del. Laws, c. 229, §  1;  75 Del. Laws, c. 362, §  2;
18 DE Code § 6418. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6418. Indemnification and immunity of employees.

§ 6418. Indemnification and immunity of employees. (a) An employee of the Department who participates in the program shall not be liable in any action for damages to any person for any action taken within the scope of that employee's function in the program. The Attorney General shall defend the person in any civil suit and the State shall provide indemnification for any damages awarded. (b) The carrier that is the subject of the review shall not be liable in any action for damages to any person for any action taken to implement a determination of the independent review organization pursuant to this chapter. (c) Any physician serving on the IURO chosen by the Insurance Commissioner or designee to hear an appeal shall not be liable in any action for damages to any person for any action taken within the scope of that physician's function in the program. 72 Del. Laws, c. 441, §  1;  70 Del. Laws, c. 186, §  1;  75 Del. Laws, c. 362, §  2;
18 DE Code § 6419. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 64. Regulation of Managed Care Organizations|§ 6419. Violations; penalties.

§ 6419. Violations; penalties. (a) A carrier that violates any provision of this chapter shall be liable to a civil penalty of not less than $250 and not greater than $10,000 for each day that the carrier is in violation of the chapter if 10-days notice in writing is given of the intent to levy the penalty and, at the discretion of the Insurance Commissioner or designee, the carrier has 30 days, or such additional time as the Insurance Commissioner or designee shall determine to be reasonable, to remedy the condition which gave rise to the violation and fails to do so within the time allowed. (b) The Insurance Commissioner or designee may issue an order directing a carrier or a representative of a carrier to cease and desist from engaging in any act or practice in violation of the provisions of this chapter. (c) Within 20 days after service of the order of cease and desist, the respondent may request a hearing on the question of whether acts or practices in violation of this section have occurred. The hearing shall be conducted pursuant to the Administrative Procedure Act [Chapter 101 of Title 29], and judicial review shall be available as provided therein. This appeal shall not stay the cease and desist order. (d) In the case of any violation of the provisions of this chapter, if the Insurance Commissioner or designee elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued pursuant to subsection (b) of this section, the Insurance Commissioner or designee may institute a proceeding to obtain injunctive relief in accordance with the applicable court rules. 72 Del. Laws, c. 441, §  1;  75 Del. Laws, c. 362, §  2;