reglab/housing_qa huggingface dataset:
18 DE Code § 3571K. (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|§ 3571K. Prohibition on excessive waiting periods [For application of this section, see 79 Del. Laws, c. 99, § 19].

§ 3571K. Prohibition on excessive waiting periods [For application of this section, see 79 Del. Laws, c. 99, § 19]. A group health plan and a health insurer offering group health insurance coverage shall not apply any waiting period that exceeds 90 days. As used in this section, “waiting period” means the period that must pass before coverage for an employee or dependent who is otherwise eligible to enroll under the terms of a group health plan can become effective. 79 Del. Laws, c. 99, §  8;
18 DE Code § 3571L. (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|§ 3571L. Nondiscrimination in health care [For application of this section, see 79 Del. Laws, c. 99, § 19].

§ 3571L. Nondiscrimination in health care [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) Providers. — A group health plan and a health insurer offering group health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health-care provider who is acting within the scope of that provider's license or certification under applicable state law. This section shall not require that a group health plan or health insurer contract with any health-care provider willing to abide by the terms and conditions for participation established by the plan or insurer. Nothing in this section shall be construed as preventing a group health plan, a health insurer or the Commissioner from establishing varying reimbursement rates based on quality or performance measures. (b) Individuals. — The provisions of § 1557 of the Patient Protection and Affordable Care Act (relating to nondiscrimination) [42 U.S.C. § 18116], as the law and its implementing regulations were in effect on January 1, 2018, apply with respect to a group health plan or health insurer offering group health insurance coverage. 79 Del. Laws, c. 99, §  8;  82 Del. Laws, c. 186, § 6;
18 DE Code § 3571M. (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|§ 3571M. Comprehensive health insurance coverage [For application of this section, see 79 Del. Laws, c. 99, § 19].

§ 3571M. Comprehensive health insurance coverage [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) Coverage for essential health benefits package. — A health insurer that offers health insurance coverage in the small group market shall ensure that such coverage includes the essential health benefits package in conformity with § 1302 of the Patient Protection and Affordable Care Act [42 U.S.C. § 18022], as the law and its implementing regulations were in effect on January 1, 2018, and state law. The Commissioner shall issue a regulation setting forth what constitutes “essential health benefits” for purposes of this section. (b) Cost-sharing under group health plans. — A group health plan shall ensure that any annual cost-sharing imposed under the plan does not exceed the limitations provided for under § 1302(c)(1) and (2) of the Patient Protection and Affordable Care Act [42 U.S.C. § 18022(c)(1) and (2)], as the law and its implementing regulations were in effect on January 1, 2018, and state law. (c) Child-only plans. — If a health insurer offers health insurance coverage in any level of coverage specified under § 1302(d) of the Patient Protection and Affordable Care Act [42 U.S.C. § 18022(d)], as the law and its implementing regulations were in effect on January 1, 2018, or state law, the health insurer shall also offer such coverage in that level as a plan in which the only enrollees are individuals who, as of the beginning of the plan year, are under the age of 21. (d) Dental only. — This section shall not apply to a plan described in § 1311(d)(2)(B)(ii) of the Patient Protection and Affordable Care Act [42 U.S.C. § 18031(d)(2)(B)(ii)], as the law and its implementing regulations were in effect on January 1, 2018.79 Del. Laws, c. 99, §  8;  81 Del. Laws, c. 79, § 30;  82 Del. Laws, c. 186, § 7;
18 DE Code § 3571O. (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|§ 3571O. Insurance offered through the state health insurance exchange [For application of this section, see 79 Del. Laws, c. 99, § 19].

§ 3571O. Insurance offered through the state health insurance exchange [For application of this section, see 79 Del. Laws, c. 99, § 19]. (a) A health insurer that offers health insurance coverage in the small group market through the state health insurance exchange program established pursuant to the Patient Protection and Affordable Care Act [P.L. 111-148] shall first satisfy all certification standards required by federal and state law, and the health insurer shall offer only those plans that are “qualified health plans” as required by federal and state law. (b) The Commissioner shall adopt regulations, in accordance with the Administrative Procedures Act [Chapter 101 of Title 29], that set forth the certification and compliance standards and requirements for health insurers operating within the state health exchange. 79 Del. Laws, c. 99, §  8;
18 DE Code § 3571Q. (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|§ 3571Q. Notification and reasons for cancellation or nonrenewal [For application of this section, see 79 Del. Laws, c. 390, § 8].

§ 3571Q. Notification and reasons for cancellation or nonrenewal [For application of this section, see 79 Del. Laws, c. 390, § 8]. A notice of cancellation or nonrenewal of group health insurance coverage by an insurer due to nonpayment of premiums shall be in writing, shall be delivered to the policyholder or mailed to the policyholder at the last known address of the policyholder, shall state the effective date of the cancellation or nonrenewal and shall be accompanied by a written explanation of the specific reasons for the cancellation or nonrenewal. Proof of mailing of such cancellation or nonrenewal notice shall be retained by the insurer for a period of not less than 1 year. This section shall not apply to any long-term care policy where notice provisions regarding cancellations or nonrenewals are specifically addressed elsewhere in this title or in regulations promulgated thereunder. 79 Del. Laws, c. 390, §  4;
18 DE Code § 3571T. (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|§ 3571T. Coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome.

§ 3571T. Coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. (a) All group and blanket health insurance policies, contracts, or certificates that are delivered, issued for delivery, renewed, extended, or modified in this State by any health insurer, health service corporation, or health maintenance organization shall provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, including the use of intravenous immunoglobulin therapy. (b) At any time that the State is required by the Secretary of the United States Department of Health and Human Services, or its successor agency, to defray the cost of any coverage for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome required under subsection (a) of this section, the requirements under subsection (a) of this section are inoperative and the State may not assume any obligation for the cost of coverage for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome. 81 Del. Laws, c. 400, § 2;
18 DE Code § 3571V. (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|§ 3571V. Time of submitting claim for reimbursement.

§ 3571V. Time of submitting claim for reimbursement. (a) For purposes of this section:  (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. “Carrier” also includes any third-party administrator or other entity that adjusts, administers, or settles claims in connection with health benefit plans.  (2) “Carrier” does not mean an entity that provides 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 1397 et seq.), known as Medicare, Medicaid, or any other similar coverage under state or federal governmental plans. (b) Regardless of network status, a carrier shall permit a provider a minimum of 180 days from the date a covered service is rendered to submit a claim for reimbursement. Any contract between a carrier and provider that prohibits a provider from submitting a claim beyond the minimum time limit required under this section shall not be deemed a violation of this section.  82 Del. Laws, c. 111, § 4;
18 DE Code § 3571W. (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|§ 3571W. Electronic medical claims.

§ 3571W. Electronic medical claims. (a) This section shall apply to all claims for healthcare services that are submitted as part of group or blanket health insurance contracts. (b) For purposes of this section:  (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. “Carrier” also includes any third-party administrator or other entity that adjusts, administers, or settles claims in connection with health benefit plans.  (2) “Carrier” does not mean an entity that provides 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 1397 et seq.), known as Medicare, Medicaid, or any other similar coverage under state or federal governmental plans.  (c) A carrier shall accept primary and secondary claims electronically from providers regardless of network status.  (d) A carrier shall permit a provider to receive electronic remittance advice (ERA/835) files for claims payments upon the completion of the necessary agreements required by the carrier.  (e) Any electronic claim shall be acknowledged by the carrier electronically no later than 2 business days following receipt of the claim to the entity submitting the claim. 82 Del. Laws, c. 111, § 4;
18 DE Code § 3571X. (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|§ 3571X. Medication assisted treatment for drug and alcohol dependencies.

§ 3571X. Medication assisted treatment for drug and alcohol dependencies. (a) For purposes of this section, “medication-assisted treatment” means the use of U.S. Food and Drug Administration-approved medications, in combination with counseling and behavioral therapies, to provide a whole patient approach to the treatment of drug and alcohol dependencies. (b) If group health insurance coverage provides prescription medication benefits for the treatment of mental illness and drug and alcohol dependencies, a health insurer must place at least 1 formulation of a medication-assisted treatment on the lowest tier of the drug formulary developed and maintained by the carrier, including each of the following:  (1) Buprenorphine. (2) Naltrexone. (3) Naloxone. (4) A product containing both buprenorphine and naloxone. (c) A health insurer that provides coverage for prescription drugs must cover the fees associated with the administration or dispensing of methadone dispensed at an opioid treatment program as defined under 42 C.F.R. § 8.2. (d) A health insurer shall provide benefits under this section as follows:  (1) Not impose a prior authorization requirement. (2) Must authorize coverage of prescription medicine without imposing a step therapy requirement for at least 1 formulation of each prescription medication for medication-assisted treatment that is on each tier of the drug formulary developed and maintained by the health insurer.82 Del. Laws, c. 199, § 2;
18 DE Code § 3571Y. (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|§ 3571Y. Coverage for epinephrine autoinjectors.

§ 3571Y. Coverage for epinephrine autoinjectors. (a) For purposes of this section, “epinephrine autoinjector” means a single-use device used for the automatic injection of a premeasured dose of epinephrine into the human body.  (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 medically-necessary epinephrine autoinjectors for individuals who are 18 years of age or under by including at least 1 formulation of epinephrine autoinjectors on the lowest tier of the drug formulary developed and maintained by the carrier.  (c) 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, 2021. 83 Del. Laws, c. 42, § 2;
18 DE Code § 3573. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter IV. Large Employer Health Insurance Standards|§ 3573. Limitations on preexisting condition limitations [For application of this section, see 79 Del. Laws, c. 99, § 19].

§ 3573. Limitations on preexisting condition limitations [For application of this section, see 79 Del. Laws, c. 99, § 19]. A health benefit plan that covers a large group in this State:  (1) Shall not deny, exclude or limit benefits for a covered individual because of a preexisting condition; (2) May impose an affiliation period. An affiliation period shall run concurrently with any waiting period. A health maintenance organization may, in lieu of an affiliation period, use an alternative method to address adverse selection with the prior approval of the Commissioner; (3) Shall waive an affiliation period for the period of time an individual was previously covered by creditable coverage if such creditable coverage was continuous to a date not more than 63 days prior to the effective date of the new coverage. For purposes of calculating continuous coverage, a waiting period shall not be considered a gap in coverage. This paragraph shall not preclude application of any waiting period applicable to all new enrollees under the plan. The method of crediting and certifying coverage shall be determined by the Commissioner by regulation; and (4) May not exclude coverage for late enrollees for a preexisting condition. A health benefit plan shall not establish rules for eligibility for any individual to enroll under the plan based on any health status-related factors in relation to the individual or a dependent of the individual. 71 Del. Laws, c. 143, §  14;  73 Del. Laws, c. 89, §  1;  76 Del. Laws, c. 176, §  3;  79 Del. Laws, c. 99, §  9;
18 DE Code § 3575. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter IV. Large Employer Health Insurance Standards|§ 3575. Rate regulation.

§ 3575. Rate regulation. A carrier offering a large group health benefit plan may not require any individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution that is greater than such premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status-related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual. This prohibition shall not be construed to restrict the amount that an employer may be charged for coverage under a large group health benefit plan or to prevent a carrier from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention, if not otherwise prohibited by law. 71 Del. Laws, c. 143, §  14;  73 Del. Laws, c. 89, §  1;  76 Del. Laws, c. 176, §  3;
18 DE Code § 3576. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter IV. Large Employer Health Insurance Standards|§ 3576. Mental health parity.

§ 3576. Mental health parity. A carrier offering a large group health plan shall comply with the provisions of 42 U.S.C. § 300gg-5, Public Law 104-204 and any subsequent changes in federal law. 71 Del. Laws, c. 143, §  14;  73 Del. Laws, c. 89, §  1;  76 Del. Laws, c. 176, §  3;
18 DE Code § 3577. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter IV. Large Employer Health Insurance Standards|§ 3577. Newborns and mothers health protection.

§ 3577. Newborns and mothers health protection. A carrier offering a health benefit plan shall comply with the provisions of 42 U.S.C. § 300gg-4 and any subsequent changes in federal law. 71 Del. Laws, c. 143, §  14;  73 Del. Laws, c. 89, §  1;  76 Del. Laws, c. 176, §  3;
18 DE Code § 3579. (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter IV. Large Employer Health Insurance Standards|§ 3579. Health insurance; pharmacies; electronic reimbursement.

§ 3579. Health insurance; pharmacies; electronic reimbursement. (a) This section shall apply to:  (1) Insurers and nonprofit health service plans that provide, directly or through a pharmacy benefit manager, coverage for prescription drugs under health insurance policies or contracts that are issued or delivered in this State; and (2) Health maintenance organizations that provide, directly or through a pharmacy benefit manager, coverage for prescription drugs under contracts that are issued or delivered in this State. (b) If an entity subject to this section requires a pharmacy to submit a request for payment electronically, then the pharmacy or its designated agent may choose to be reimbursed electronically, and in that event the entity shall electronically reimburse such pharmacy and shall provide the appropriate payment data electronically. (c) An entity subject to this section may not impose on a pharmacy a processing fee for the electronic reimbursement or for providing payment data electronically, provided that the electing pharmacy agrees to, and can accept claims details for the payments electronically and provide accurate electronic funds transfer information to the entity making payments. (d) Subsequent to January 6, 2010, any pharmacy that requires electronic reimbursement under this section shall allow an entity 45 days to become compliant herewith from the date of the pharmacy's initial request to commence electronic reimbursement between the parties. 77 Del. Laws, c. 116, §  2;
18 DE Code § 3582 (2021)
2021 Delaware Code|Title 18 - Insurance Code|Chapter 35. Group and Blanket Health Insurance|Subchapter V. Pre-Authorization Transparency|§ 3582. requirements.

§ 3582 Disclosure and review of pre-authorization requirements. (a) A utilization review entity shall make any current pre-authorization requirements and restrictions readily accessible on its website and in written or electronic form upon request for covered persons, health-care providers, and others with access to the website. Information from a utilization review entity that is not an insurer, health-benefit plan, or health-service corporation shall make this information available at an electronic pre-authorization portal that is accessible in real time. Requirements shall be described in detail but also in clear, easily-understandable language. Clinical criteria shall be described in language easily understandable by a health-care provider practicing in the same clinical area. (b) If an insurer, health-benefit plan, or health-service corporation intends either to implement a new pre-authorization requirement or restriction, or amend an existing requirement or restriction, they shall ensure that the new or amended requirement is not implemented unless their website has been updated to reflect the new or amended requirement or restriction. This shall not extend to expansion of coverage for new health-care services. (c) If an insurer, health-benefit plan, or health-service corporation intends either to implement a new pre-authorization requirement or restriction, or amend an existing requirement or restriction, they shall provide covered persons who are currently authorized by the utilization review entity for coverage of the affected health-care service and all contracted health-care providers who provide affected health-care service or services of written notice of the new or amended requirement or amendment no less than 60 days before the requirement or restriction is implemented. Such notice may be delivered electronically or by other means. (d) Insurers, health-benefit plans, and health-service corporations utilizing pre-authorization shall report de-identified statistics regarding pre-authorization approvals, denials, and appeals to the Delaware Health Information Network in a format and frequency, no less than twice annually, of the Delaware Health Information Network's request. The Department may also request this data at any time. The statistics shall include, but may be expanded upon or further delineated by regulation, categories for all of the following:  (1) For denials, the aggregated reasons for denials such as, but not limited to, medical necessity or incomplete pre-authorization submission. (2) For appeals:  a. Practitioner specialty;  b. Medication, diagnostic test, or diagnostic procedure;  c. Indication offered; d. Reason for underlying denial; and e. Number of denials overturned upon appeal.80 Del. Laws, c. 310, § 2;