reglab/housing_qa huggingface dataset:
18 DE Code § 3335. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3335. Newborn children.

§ 3335. Newborn children. (a) All individual and group health insurance policies providing coverage on an expense-incurred basis, and individual and group service or indemnity-type contracts issued by a nonprofit corporation, which provide coverage for a family member of the insured or subscriber, shall, as to such family members' coverage, also provide that the health insurance benefits applicable for children shall be payable with respect to a newly born child of the insured or subscriber from the moment of birth. (b) The coverage for newly born children shall consist of coverage for injury or sickness, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities as well as routine care furnished any infant from the moment of birth. (c) If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that notification of the birth of a newly born child, and payment of the required premium or fees, must be furnished to the insurer or nonprofit service or indemnity corporation within 31 days after the date of birth in order to have the coverage continued beyond such 31-day period. 59 Del. Laws, c. 529, §  1;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3337. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3337. Lead poisoning screening reimbursement [For application of this section, see 83 Del. Laws, c. 75, § 9].

§ 3337. Lead poisoning screening reimbursement [For application of this section, see 83 Del. Laws, c. 75, § 9]. (a) All individual health insurance policies which are delivered or issued for delivery in this State by any health insurer, health service corporation, health maintenance organization, or any health services and facilities reimbursement program operated by the State and which provide a benefit for outpatient services shall provide a benefit for a baseline lead poisoning screening or testing, as defined in § 2601 of Title 16. (b) Benefits must also be provided for lead poisoning screening, testing, diagnostic evaluations, screening and testing supplies, and home-visits for children who are at high risk for lead poisoning under guidelines and criteria established by the Division of Public Health. (c) The benefits required under subsections (a) and (b) of this section are a covered service, notwithstanding any policy exclusions for services which are part of or related to annual or routine examinations. (d) Nothing in this section prevents the operation of policy provisions such as deductibles, coinsurance allowable charge limitations, coordination of benefits, or provisions restricting coverage to services rendered by licensed, certified, or carrier-approved providers or facilities. (e) This section does not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, or other limited health insurance policies. 69 Del. Laws, c. 310, §  2;  80 Del. Laws, c. 310, § 1;  83 Del. Laws, c. 75, § 6;
18 DE Code § 3338. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3338. Coverage of cancer monitoring test.

§ 3338. Coverage of cancer monitoring test. (a) Every individual health, sickness or accident insurance policy, contract or certificate, which is delivered or issued for delivery in this State by any health insurer, health service corporation or health maintenance organization, and which provide benefits for outpatient services, shall provide to covered persons residing in this State a benefit for CA-125 monitoring of ovarian cancer subsequent to treatment. Such monitoring shall be deemed a covered service, notwithstanding any policy exclusions for services which are considered experimental or investigative; provided however, that nothing contained herein shall be deemed to provide coverage for routine screening. (b) Nothing in this section shall 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. (c) This act shall apply to all policies, contracts or certificates which are issued, renewed, modified, altered, amended or reissued after September 1, 1994. 69 Del. Laws, c. 405, §  1;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3338A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3338A. Equal reimbursement for oral and intravenous anticancer medication.

§ 3338A. Equal reimbursement for oral and intravenous anticancer medication. (a) Every individual policy or contract of health insurance, or certificate issued thereunder, which is delivered, issued for delivery, renewed, modified, altered, or amended in this State on or after January 1, 2013, and which provides medical, major medical, or similar comprehensive-type coverage, and provides coverage for prescription drugs, and which also provides coverage for anticancer medication, must provide coverage for a prescribed, orally administered anticancer medication used to kill or slow the growth of cancerous cells, and must apply the lower cost sharing of either:  (1) Anticancer medication under the prescription drug benefit; or (2) Intravenous or injected anticancer medications. For purposes of this section, the term “cost sharing” may include co-pays, coinsurance, and deductibles, as considered appropriate by the Commissioner. (b) An insurer who provides coverage under this section and any participating entity through which the insurer offers health services may not:  (1) Vary the terms of the policy for the purpose of or with the effect of avoiding compliance with this section; (2) Provide incentives, monetary or otherwise, to encourage a covered person to accept less than the minimum protections available under this section; (3) Penalize in any way or reduce or limit the compensation of a healthcare practitioner for recommending or providing care to a covered person in accordance with this section; (4) Provide incentives, monetary or otherwise, to a healthcare practitioner relating to the services provided pursuant to this section, intended to induce or have the effect of inducing the practitioner to provide care to a covered person in a manner inconsistent with this section; or (5) Achieve compliance with this section by imposing an increase in cost sharing for an oral, intravenous, or injected anticancer medication covered under the policy on and following May 1, 2012. (c) Nothing in this section may be interpreted to prohibit an insurer from requiring prior authorization for any anticancer treatment. (d) Nothing in this section may be interpreted to require coverage for anticancer medication. 78 Del. Laws, c. 233, §  1;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3338B. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3338B. Coverage of drugs approved for treatment of certain cancers [For application of this section, see 81 Del. Laws, c. 180, §§ 3 and 4].

§ 3338B. Coverage of drugs approved for treatment of certain cancers [For application of this section, see 81 Del. Laws, c. 180, §§ 3 and 4]. No individual policy or contract of health insurance, or certificate issued thereunder, which is delivered, issued for delivery, renewed, modified, altered, or amended in this State by any health insurer, health service corporation or health maintenance organization that directly or indirectly covers the treatment of cancer shall limit or exclude coverage for a drug approved by the United States Food and Drug Administration by mandating that the insured shall first be required to fail to successfully respond to a different drug or drugs or prove a history of failure of such drug or drugs; provided, however that the use of such drug or drugs is consistent with best practices for the treatment of stage 4 advanced, metastatic cancer or, in the case of other cancers, the use of the drug is supported by national clinical guidelines, national standards of care, or peer reviewed medical literature for the treatment of the cancer, or in the case of targeted therapy, the target at issue. 81 Del. Laws, c. 180, § 1;
18 DE Code § 3340. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3340. Child abuse or neglect — Individual coverage.

§ 3340. Child abuse or neglect — Individual coverage. No individual policy or contract, or certificate issued thereunder, of health insurance which provides medical coverage for a child and which (1) covers a child who resides in this State, or (2) is delivered or issued for delivery within the State, shall limit medical insurance coverage for any child referred by the Division of Family Services or law enforcement agency for suspected child abuse or neglect, including requiring referral by a primary physician. 71 Del. Laws, c. 199, §  16;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3341. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3341. Newborns and mothers health protection.

§ 3341. Newborns and mothers health protection. A carrier offering a health benefit plan shall comply with the provisions of 42 U.S.C. § 300gg-51 and any subsequent changes in federal law. 71 Del. Laws, c. 143, §  16;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3344. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3344. Insurance coverage for diabetes.

§ 3344. Insurance coverage for diabetes. (a) Every individual or group hospital service corporation contract, individual or group medical service corporation contract, individual or group health service corporation contract, individual health insurance policy, group health insurance policy and contract for health-care services that provides hospital services, outpatient services or medical expense benefits, provides coverage for prescription drugs; and is delivered, issued, executed or renewed in this State pursuant to Title 18 or is approved for issuance or renewal in this State by the Insurance Commissioner shall provide benefits to any subscriber or other person covered thereunder for expenses incurred for the following equipment and supplies for the treatment of diabetes, if recommended in writing or prescribed by a physician: insulin pumps, blood glucose meters and strips, urine testing strips, insulin, syringes, and pharmacological agents for controlling blood sugar. (b) The benefits required by this section shall be provided to the same extent as for any other sickness under the contract. (c) This section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium. (d) The Insurance Commissioner may promulgate and periodically update a list of additional diabetes equipment and related supplies that are medically necessary for the treatment of diabetes and for which benefits shall be provided according to the provisions of this section. (e) This section shall apply to all contracts and policies issued, renewed, modified, altered, amended or reissued 90 days and thereafter from the date of enactment. (f) Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, Medicare supplement long-term care, disability income or other limited benefit health insurance policies. 72 Del. Laws, c. 376, §  2;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3344B. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3344B. Cost sharing in prescription insulin drugs.

§ 3344B. Cost sharing in prescription insulin drugs. (a) For purposes of this section, “prescription insulin drug” means a drug containing insulin that is dispensed under Chapter 47 of Title 16 for the treatment of diabetes. (b) An individual health insurance policy, contract, or certificate that is delivered, issued for delivery, renewed, extended, or modified in this State that provides coverage for prescription insulin drugs must do all of the following:  (1) Cap the total amount that a covered individual is required to pay for covered prescription insulin drugs at no more than $100 per month for each enrolled individual, regardless of the amount or types of insulin needed to fill the covered individual's prescriptions. The $100 per month cap includes deductible payments and cost-sharing amounts charged once a deductible is met. (2) Include at least 1 formulation of each of the following types of prescription insulin drugs on the lowest tier of the drug formulary developed and maintained by the carrier:  a. Rapid-acting. b. Short-acting. c. Intermediate-acting. d. Long-acting. (3) For purposes of paragraph (b)(2) of this section, the “lowest tier of the drug formulary” means either of the following:  a. If the prescription insulin drug is a generic drug, the lowest tier for generic drugs. b. If the prescription insulin drug is a brand-name drug, the lowest tier for brand-name drugs. (c) Except as provided under paragraph (b)(1) of this section, nothing in this section prevents the operation of a policy provision required by this section as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility. (d) This section applies to all policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2020. 82 Del. Laws, c. 250, § 1;
18 DE Code § 3344C. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3344C. Coverage for insulin pumps.

§ 3344C. Coverage for insulin pumps. (a) For purposes of this section, “insulin pump” means a small, portable medical device that is approved by the U.S. Food and Drug Administration to provide continuous subcutaneous insulin infusion. (b) All individual health insurance policies, contracts, or certificates that are delivered, issued for delivery, renewed, extended, or modified in this State shall provide coverage for a medically-necessary insulin pump at no cost to a covered individual, including deductible payments and cost-sharing amounts charged once a deductible is met. (c) Except as provided under subsection (b) of this section, nothing in this section prevents the operation of a policy provision required by this section as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility. (d) This section does not apply to any of the following:  (1) Accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policies. (2) A high deductible health plan if providing coverage under subsection (b) of this section would cause the plan to fail to be treated as a high deductible health plan under § 223(c)(2) of the Internal Revenue Code [26 U.S.C. § 223(c)(2)]. (3) A catastrophic health plan if providing coverage under subsection (b) of this section would cause the plan to fail to be treated as a catastrophic plan under § 1302(e) of the Patient Protection and Affordable Care Act, 42 U.S.C. § 18022(e). (e) This section applies to all policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2021. 83 Del. Laws, c. 241, § 1;
18 DE Code § 3345. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3345. Annual pap smear coverage reimbursement.

§ 3345. Annual pap smear coverage reimbursement. All individual health insurance policies which are delivered or issued for delivery in this State by any health insurer, health service corporation, health maintenance organization or any health services and facilities reimbursement program operated by the State and which provide a benefit for outpatient services shall also provide a benefit for an annual benefit for 1 cervical cancer screening, known as a “pap smear,” for all females aged 18 and over. This section shall apply to all policies, contracts, certificates or programs issued, renewed, modified, altered, amended or reissued on or after January 1, 2001. 72 Del. Laws, c. 408, §  1;  73 Del. Laws, c. 61, §  1;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3347. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3347. Required coverage for reconstructive surgery following mastectomies.

§ 3347. Required coverage for reconstructive surgery following mastectomies. (a) All individual health insurance policies, contracts or certificates that are delivered or issued for delivery in this State by any health insurer, health service corporation or managed care organization which provide medical and surgical benefits with respect to a mastectomy shall provide, in a case of an insured, participant, policyholder, subscriber, and beneficiary who is receiving benefits in connection with such mastectomy, in a manner determined in consultation with the attending physician and the patient, coverage for:  (1) All stages of reconstruction of the breast on which the mastectomy has been performed; (2) Surgery and reconstruction of the other breast to produce a symmetrical appearance; and (3) Prostheses and physical complications of mastectomy, including lymphedemas. Such coverage may be subject to annual deductibles and coinsurance 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. (b) All individual 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:  (1) In the next mailing made by the plan to the insured, participant, policyholder, subscriber and beneficiary; (2) As part of any yearly informational packet sent to the insured, participant, policyholder, subscriber and beneficiary; or (3) Not later than June 30, 2001, whichever is earliest. (c) An individual health benefit plan may not deny to a patient eligibility or continued eligibility to enroll or to renew coverage under the terms of the plan solely for the purpose of avoiding the requirements of this section, and may not penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide incentives (monetary or otherwise) to an attending provider, or induce such provider to provide care to an individual insured, participant, policyholder, subscriber and beneficiary in a manner inconsistent with this section. (d) Nothing in this section shall be construed to prevent a health benefit plan from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section. 73 Del. Laws, c. 89, §  2;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3350. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3350. Prescription medication.

§ 3350. Prescription medication. (a) This section applies to every policy or contract of health insurance, including each policy or contract issued by a health service corporation, which is delivered or issued for delivery in this State and which provides coverage for outpatient prescription drugs. (b) Every policy or contract of health insurance described in subsection (a) of this section shall provide coverage for any outpatient drug prescribed to treat a covered person for a covered chronic, disabling or life-threatening illness if the drug:  (1) Has been approved by the Food and Drug Administration for at least 1 indication; and (2) Is recognized for treatment of the indication for which the drug is prescribed in:  a. A prescription drug reference compendium approved by the Insurance Commissioner for purposes of this section; or b. Substantially accepted peer reviewed medical literature. (c) Coverage of a drug required by this section shall include coverage of medically necessary services associated with administration of the drug. (d) This section does not require coverage for:  (1) Medication that may be obtained without a physician's prescription; (2) Experimental drugs not otherwise approved for the proposed use or indication by the Food and Drug Administration; or (3) Any disease, condition, service or treatment that is excluded from coverage under the policy. (e) Nothing in this section shall prevent the operation of policy provisions involving deductibles, coinsurance, allowable charge limitations, maximum dollar policy limitations or coordination of benefits. 73 Del. Laws, c. 96, §  7;  73 Del. Laws, c. 315, §  4;  80 Del. Laws, c. 310, § 1;
18 DE Code § 3350B. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 33. Health Insurance Contracts|Subchapter I. General Provisions|§ 3350B. Copayment or coinsurance for prescription drugs limited [For application of this section, see 82 Del. Laws, c. 57, § 3].

§ 3350B. Copayment or coinsurance for prescription drugs limited [For application of this section, see 82 Del. Laws, c. 57, § 3]. (a) Definitions. — (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. (2) “Contract price” — means the lowest price a pharmacy is paid for the acquisition of a prescription drug based on a contract that a pharmacy has with a carrier or pharmacy benefits manager. “Contract price” includes a dispensing fee set by a contract between a pharmacy and a carrier or pharmacy benefits manager. (3) “Pharmacy” — means as defined in § 2502 of Title 24. (4) “Pharmacy benefit manager” — means as defined under § 3302A of this title. (b) Application. — This section applies to a carrier that provides coverage, either directly or through a pharmacy benefits manager, for prescription drugs under a health insurance policy or contract that is issued or delivered in this State. (c) A carrier subject to this section may not impose a copayment or coinsurance requirement for a covered prescription drug that exceeds the lesser of one of the following:  (1) The applicable copayment or coinsurance that would apply for the prescription drug in the absence of this section. (2) The amount an individual would pay for the prescription drug if the individual were paying the usual and customary price. (3) The contract price for the prescription drug.82 Del. Laws, c. 57, § 1;