reglab/housing_qa huggingface dataset:
18 DE Code § 3555. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3555. Coverage of cancer monitoring tests.

§ 3555. Coverage of cancer monitoring tests. (a) All group and blanket health insurance policies, which are 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 or having their principal place of employment 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 such 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, §  2;
18 DE Code § 3555A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3555A. Equal reimbursement for oral and intravenous anticancer medication.

§ 3555A. Equal reimbursement for oral and intravenous anticancer medication. (a) Every group or blanket 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, §  2;
18 DE Code § 3555B. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3555B. Coverage of drugs approved for treatment of certain cancers [For application of this section, see 81 Del. Laws, c. 180, §§ 3 and 4].

§ 3555B. Coverage of drugs approved for treatment of certain cancers [For application of this section, see 81 Del. Laws, c. 180, §§ 3 and 4]. No group or blanket policy or contract of health insurance, or certificate issued thereunder which is delivered, issued for delivery, renewed, modified, altered, or amended in this State 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 for the treatment of the cancer, or in the case of targeted therapy, the target at issue. 81 Del. Laws, c. 180, § 2;
18 DE Code § 3556A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3556A. Primary care coverage [For application of this section, see 81 Del. Laws, c. 392, §  12] [Effective Jan. 1, 2027].

§ 3556A. Primary care coverage [For application of this section, see 81 Del. Laws, c. 392, §  12] [Effective Jan. 1, 2027]. (a) For purposes of this section:  (1) a. “Carrier” means any entity that provides health insurance in this State. “Carrier” includes an insurance company, health service corporation, health maintenance organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation. “Carrier” also includes any third-party administrator or other entity that adjusts, administers, or settles claims in connection with health benefit plans.  b. “Carrier” does not mean a plan of health insurance or health benefits designed for issuance to persons eligible for coverage under Titles XVIII, XIX, and XXI of the Social Security Act (42 U.S.C. §§ 1395 et seq., 1396 et seq. and 1397aa. et seq.), known as Medicare, Medicaid, or any other similar coverage under state or federal governmental plans.  (2) “Chronic care management” means the services in the Chronic Care Management Services Program, as administered by the Centers for Medicare and Medicaid Services, and includes Current Procedural Terminology (“CPT”) codes 99487, 99489, and 99490.  (3) “Medicare” means the federal Medicare Program (U.S. Public Law 89-87, as amended) (42 U.S.C. § 1395 et seq.).  (4) “Primary care” means health care provided by a physician or an individual licensed under Title 24 to provide health care, with whom the patient has initial contact and by whom the patient may be referred to a specialist and includes family practice, pediatrics, internal medicine, and geriatrics.  (b) (1) A carrier shall provide coverage for chronic care management and primary care at a reimbursement rate that is not less than the Medicare reimbursement for comparable services.  (2) This subsection applies to a group health insurance policy, plan, or contract that is delivered, issued for delivery, or renewed by a carrier on or after January 1, 2019.  (c) If a comparable Medicare reimbursement rate is not available, a carrier shall reimburse for services at the rates generally available under Medicare for services such as office visits and prolonged preventive services, which may be further delineated by regulation.  (d) (1) The Department shall arbitrate disagreements regarding rates under this section. The parties must pay the cost of the arbitration.  (2) The Department shall adopt regulations to implement the requirements of this subsection no later than March 31, 2019.  (e) The provisions of this section may not be waived by contract. Any contractual arrangement in conflict with the provisions of this section or that purports to waive any requirements of this section is void.  81 Del. Laws, c. 392, § 6;  82 Del. Laws, c. 141, § 24;  83 Del. Laws, c. 237, §§  6, 8;  83 Del. Laws, c. 237, §  14;
18 DE Code § 3557. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3557. Child abuse or neglect — Group coverage.

§ 3557. Child abuse or neglect — Group coverage. No group or blanket policy, 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, §  17;
18 DE Code § 3559A-3559C. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3559A-3559C. Insurance coverage for diabetes; annual pap smear coverage reimbursement; colorectal cancer screening.

§ 3559A-3559C. Insurance coverage for diabetes; annual pap smear coverage reimbursement; colorectal cancer screening. Transferred to present §§ 3560 to 3562 by 73 Del. Laws, c. 89, § 5, effective June 30, 2001.
18 DE Code § 3560. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3560. Insurance coverage for diabetes.

§ 3560. 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 and provides coverage for prescription drugs, and is delivered, issued, executed or renewed in this State pursuant to this title 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 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 June 30, 2000. (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, §  1;  73 Del. Laws, c. 89, §  5;
18 DE Code § 3560A. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3560A. Cost sharing in prescription insulin drugs.

§ 3560A. 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) A group or blanket 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, § 2;
18 DE Code § 3560B. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3560B. Coverage for insulin pumps.

§ 3560B. 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 group and blanket 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)]. (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, § 2;
18 DE Code § 3561. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3561. Annual pap smear coverage reimbursement.

§ 3561. Annual pap smear coverage reimbursement. All group and blanket 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, §  2;  73 Del. Laws, c. 61, §  2;  73 Del. Laws, c. 89, §  5;
18 DE Code § 3562. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3562. Colorectal cancer screening.

§ 3562. Colorectal cancer screening. (a) All group and blanket health insurance policies which are delivered or issued for delivery or renewed in this State on or after January 1, 2001, by any health insurer or health service corporation shall provide coverage for colorectal cancer screening. (b) Colorectal cancer screening covered by this section shall include:  (1) For persons 50 years of age or older screening with an annual fecal occult blood test, flexible sigmoidoscopy or colonoscopy, or in appropriate circumstances radiologic imaging or other screening modalities, shall be provided as determined by the Secretary of Health and Social Services of this State after consideration of recommendations of the Delaware Cancer Consortium and the most recently published recommendations established by the American College of Gastroenterology, the American Cancer Society, the United States Preventive Task Force Services for the ages, family histories and frequencies referenced in such recommendations and deemed appropriate by the attending physician. (2) For persons who are deemed at high risk for colon cancer because of:  a. Family history of familial adenomatous polyposis; b. Family history of hereditary nonpolyposis colon cancer; c. Chronic inflammatory bowel disease; d. Family history of breast, ovarian, endometrial, colon cancer or polyps; or e. A background, ethnicity or lifestyle such that the health-care provider treating the participant or beneficiary believes he or she is at elevated risk; screening with an annual fecal occult blood test, flexible sigmoidoscopy or colonoscopy, or in appropriate circumstances radiologic imaging or other screening modalities, or other screening modalities, shall be provided as determined by the Secretary of Health and Social Services of this State after consideration of recommendations of the Delaware Cancer Consortium and the most recently published recommendations established by the American College of Gastroenterology, the American Cancer Society, the United States Preventive Task Force Services for the ages, family histories and frequencies referenced in such recommendations and deemed appropriate by the attending physician. (3) For all persons covered pursuant to paragraph (b)(1) or (b)(2) of this section, colorectal cancer screening shall include the use of anesthetic agents, including general anesthesia, in connection with colonoscopies and endoscopies performed in accordance with generally-accepted standards of medical practice and all applicable patient safety laws and regulations, if the use of such anesthetic agents is medically necessary in the judgment of the treating physician.72 Del. Laws, c. 416, §  2;  70 Del. Laws, c. 186, §  1;  73 Del. Laws, c. 89, §  5;  76 Del. Laws, c. 338, §§  3, 4;  76 Del. Laws, c. 406, §  2;
18 DE Code § 3563. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter III. Provisions Applicable to Group and Blanket Health Insurance|§ 3563. Required coverage for reconstructive surgery following mastectomy.

§ 3563. Required coverage for reconstructive surgery following mastectomy. (a) All group and blanket 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 group and blanket health benefit plans shall provide notice to each insured, participant, policyholder, subscriber and beneficiary under such plan regarding the coverage required by this section in accordance herewith. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan and shall be transmitted:  (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; (3) Not later than June 30, 2001, whichever is earliest. (c) A group or blanket 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 group 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, §  1;