reglab/statecodes huggingface dataset:
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3326. Renewability.

§ 3326. Renewability.
Health insurance policies, other than accident insurance only policies, in which the insurer reserves the right to refuse renewal on an individual basis, shall provide in substance in a provision thereof or in an endorsement thereon or rider attached thereto that subject to the right to terminate the policy upon nonpayment of premium when due, such right to refuse renewal may not be exercised so as to take effect before the renewal date occurring on, or after and nearest, each policy anniversary (or in the case of lapse and reinstatement, at the renewal date occurring on, or after and nearest, each anniversary of the last reinstatement), and that any refusal of renewal shall be without prejudice to any claim originating while the policy is in force. (The parenthetic reference to lapse and reinstatement may be omitted at the insurer's option.)
18 Del. C. 1953, §  3327;  56 Del. Laws, c. 380, §  1;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3327. Order of certain provisions.

§ 3327. Order of certain provisions.
The provisions which are the subject of §§ 3305-3326, inclusive, of this title, or any corresponding provisions which are used in lieu thereof in accordance with such sections shall be printed in the consecutive order of the provisions in such sections or, at the option of the insurer, any such provision may appear as a unit in any part of the policy, with other provisions to which it may be logically related, provided that the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a person to whom the policy is offered, delivered or issued.
18 Del. C. 1953, §  3328;  56 Del. Laws, c. 380, §  1;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3328. Third-party ownership.

§ 3328. Third-party ownership.
The word “insured,” as used in this subchapter, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured or from being entitled under such a policy to any indemnities, benefits, and rights provided therein.
18 Del. C. 1953, §  3329;  56 Del. Laws, c. 380, §  1;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3329. Requirements of other jurisdictions.

§ 3329. Requirements of other jurisdictions.
(a) Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this State, may contain any provision which is not less favorable to the insured or the beneficiary than the provisions of this chapter and which is prescribed or required by the law of the state or country under which the insurer is organized.
(b) Any policy of a domestic insurer may, when issued for delivery in any other state or country, contain any provision permitted or required by the laws of such other state or country.
18 Del. C. 1953, §  3330;  56 Del. Laws, c. 380, §  1;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3330. Policies issued for delivery in another state.

§ 3330. Policies issued for delivery in another state.
If any policy is issued by a domestic insurer for delivery to a person residing in another state, and if the insurance commissioner or corresponding public official of such other state has informed the Commissioner that any such policy is not subject to approval or disapproval by such official, the Commissioner may by ruling require that the policy meet the standards set forth in §§ 3303-3329, inclusive, of this title.
18 Del. C. 1953, §  3331;  56 Del. Laws, c. 380, §  1;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3331. Conforming to statute.

§ 3331. Conforming to statute.
(a) No policy provision which is not subject to this chapter shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to this chapter.
(b) A policy delivered or issued for delivery to any person in this State in violation of this chapter shall be held valid but shall be construed as provided in this chapter. When any provision in a policy subject to this chapter is in conflict with any provision of this chapter, the rights, duties, and obligations of the insurer, the insured and the beneficiary shall be governed by the provisions of this chapter.
18 Del. C. 1953, §  3332;  56 Del. Laws, c. 380, §  1;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3332. Age limit.

§ 3332. Age limit.
If any such policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force until the end of the period for which the premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy.
18 Del. C. 1953, §  3333;  56 Del. Laws, c. 380, §  1;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3333. Filing of rates.

§ 3333. Filing of rates.
Each insurer issuing health insurance policies for delivery in this State shall, before use thereof, file with the Commissioner its premium rates and classification of risks pertaining to such policies. The insurer shall adhere to its rates and classifications as filed with the Commissioner. The insurer may change such filings from time to time as it deems proper. The filing of rates shall be made pursuant to and under the requirements of Chapter 25 of this title.
18 Del. C. 1953, §  3334;  56 Del. Laws, c. 380, §  1;  60 Del. Laws, c. 388, §  3;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3334. Franchise health insurance law.

§ 3334. Franchise health insurance law.
Health insurance on a franchise plan is hereby declared to be that form of health insurance issued to:
(1) Three or more employees of any corporation, copartnership, or individual employer or any governmental corporation, agency or department thereof; or
(2) Ten or more members, employees or employees of members of any trade or professional association or of a labor union or of any other association having had an active existence for at least 2 years where such association or union has a constitution or bylaws and is formed in good faith for purposes other than that of obtaining insurance;
where such persons with or without their dependents are issued the same form of an individual policy varying only as to amounts and kinds of coverage applied for by such persons under an arrangement whereby the premiums on such policies may be paid to the insurer periodically by the employer, with or without payroll deductions, or by the association or union for its members, or by some designated person acting on behalf of such employer or association or union. The term “employees” as used herein may be deemed to include the officers, managers and employees and retired employees of the employer and the individual proprietor or partners if the employer is an individual proprietor or partnership.
18 Del. C. 1953, §  3335;  56 Del. Laws, c. 380, §  1;  80 Del. Laws, c. 310, § 1;
2023 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;
2023 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;
2023 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;
2023 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;
2023 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;
2023 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;
2023 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;
2023 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;
2023 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;
2023 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;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3344D. Cost sharing in diabetes equipment and supplies.

§ 3344D. Cost sharing in diabetes equipment and supplies.
(a) For purposes of this section, “diabetes equipment and supplies” means blood glucose meters and strips, urine testing strips, syringes, continuous glucose monitors and supplies, and insulin pump supplies.
(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 any diabetes equipment or supplies must cap the total amount that a covered individual is required to pay for diabetes equipment and supplies at no more than $35 per month for each enrolled individual, regardless of the amount or types of diabetes equipment or supplies needed to fill the individual's prescriptions. The $35 per month cap includes deductible payments and cost-sharing amounts charged once a deductible is met, except that the $35 cap does not apply to deductible payments charged by high deductible health plans or catastrophic health plans.
(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, 2023.
83 Del. Laws, c. 521, § 1;
2023 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;
2023 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;
2023 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;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3351B. Experimental treatment coverage.

§ 3351B. Experimental treatment coverage.
(a) No individual policy or contract of health insurance, or certificate issued thereunder, which is delivered, issued for delivery, or renewed in this State by any health insurer, health service corporation, or health maintenance organization shall deny coverage, payment, or reimbursement for a National Coverage Determination Service on the basis that the service, item, test, or treatment is experimental or investigational.
(b) “National Coverage Determination Service” as used in this section shall mean a service, item, test, or treatment which has been determined to be covered nationally by the Secretary of the U.S. Department of Health and Human Services pursuant to the Social Security Act, § 1869 (f) [42 U.S.C. § 1395ff].
81 Del. Laws, c. 266, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3352. Newborn and infant hearing screening; coverage and reimbursement.

§ 3352. Newborn and infant hearing screening; coverage and reimbursement.
(a) Any individual health insurance policy which is delivered, issued for delivery, renewed, extended, or modified in this State by any health-care insurer and which provides coverage for a child shall be deemed to provide coverage for hearing loss screening tests of newborns and infants provided by a hospital before discharge.
(b) The amount of reimbursement for newborn or infant hearing screening provided under such a policy shall be consistent with reimbursement of other medical expenses under the policy, including the imposition of co-payment, coinsurance, deductible, or any dollar limit or other cost-sharing provisions otherwise applicable under the policy.
75 Del. Laws, c. 116, §  2;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3353. Use of social security numbers on insurance cards.

§ 3353. Use of social security numbers on insurance cards.
(a) As used in this section, “insurance card” means a card that a person or entity provides to an individual so that the individual may present the card to establish the eligibility of the individual or the individual's dependents to receive health, dental, optical, or accident insurance benefits, prescription drug benefits, or benefits under a managed care plan or a plan provided by a health maintenance organization, a health services plan corporation, or a similar entity.
(b) No person or entity which provides an insurance card shall use an individual's social security number as the identification number on that insurance card.
75 Del. Laws, c. 179, §  1;  70 Del. Laws, c. 186, §  1;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3355. Phenylketonuria (PKU) and other inherited metabolic diseases.

§ 3355. Phenylketonuria (PKU) and other inherited metabolic diseases.
(a) Definitions. — In this section the following words shall have the meanings indicated:
(1) “Inherited metabolic diseases” shall mean diseases caused by an inherited abnormality of biochemistry. The words “inherited metabolic diseases” shall also include any diseases for which the State screens newborn babies.
(2) a. “Low protein modified formula or food product” means a formula or food product that is:
1. Specially formulated to have less than 1 gram of protein per serving; and
2. Intended to be used under the direction of a physician for the dietary treatment of an inherited metabolic disease.
b. “Low protein modified food product” does not include a natural food that is naturally low in protein.
(3) “Medical formula or food” means a formula or food that is:
a. Intended for the dietary treatment of an inherited metabolic disease for which nutritional requirements and restrictions have been established by medical research; and
b. Formulated to be consumed or administrated enterally under the direction of a physician.
(b) Application of this section. — The provisions of this section shall apply to any health insurance contract that:
(1) Provides coverage for a family member of the insured;
(2) Is delivered or issued for delivery in the State.
(c) A health insurance contract shall, under the family member coverage, include coverage for medical formulas and foods and low protein modified formulas and modified food products for the treatment of inherited metabolic diseases, if such medical formulas and foods or low protein modified formulas and food products are:
(1) Prescribed as medically necessary for the therapeutic treatment of inherited metabolic diseases; and
(2) Administered under the direction of a physician.
76 Del. Laws, c. 176, §  1;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3356. Required coverage for scalp hair prosthesis.

§ 3356. Required coverage for scalp hair prosthesis.
(a) Every individual health insurance policy, contract or certificate that is delivered or issued for delivery in this State by any health insurer, health service corporation or managed care organization which provide for medical or hospital expenses and also provide coverage for other prostheses, shall provide coverage for expenses for a scalp hair prosthesis worn for hair loss suffered as a result of alopecia areata, resulting from an autoimmune disease. Such coverage shall be subject to the same limitations and guidelines as other prostheses, provided that such coverage for alopecia areata shall not exceed $500 per year.
(b) For purposes of this section:
(1) “Prostheses” means artificial appliances used to replace lost natural structures. Prostheses include, but are not limited to, artificial arms, legs, breasts, or glass eyes.
(2) “Scalp hair prosthesis” means an artificial substitute for scalp hair that is made specifically for a specific individual.
(c) Such coverage may be subject to annual deductibles and co-insurance 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.
(d) 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 as part of any yearly informational packet sent to the insured, participant, policyholder, subscriber and beneficiary.
76 Del. Laws, c. 314, §  1;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3357. Hearing aid coverage.

§ 3357. Hearing aid coverage.
(a) For purposes of this section, the term “hearing aid” means any nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing, but excluding batteries, cords, and other assistive listening devices such as FM systems.
(b) Every individual health insurance contract, including each policy or contract issued by a health service corporation, which is delivered, issued for delivery, or renewed in this State on or after January 1, 2009, shall provide coverage of up to $1000 per individual hearing aid, per ear, every 3 years, for children less than 24 years of age, covered as a dependent by the policy holder.
(c) The insured may choose a hearing aid exceeding $1,000 and pay the difference in cost above the amount of coverage required by this section. Reimbursement shall be provided according to the respective principles and policies of the insurer. The insurer may require the policyholder to provide a prescription or show proof through other suitable documentation of the need for a hearing aid and nothing contained in this section shall preclude the insurer from conducting managed care, medical necessity, or utilization review or 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.
(d) This section does not apply to insurance coverage providing benefits for:
(1) Hospital confinement indemnity;
(2) Disability income;
(3) Accident only;
(4) Long-term care;
(5) Medicare supplement;
(6) Limited benefit health;
(7) Specified diseased indemnity;
(8) Sickness or bodily injury or death by accident, or both; and
(9) Other limited benefit policies.
76 Del. Laws, c. 244, §  1;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3358. Dental services for children with a severe disability.

§ 3358. Dental services for children with a severe disability.
(a) Definitions. — As used in this section:
(1) “Child with a severe disability” means a person under the age of 21 who, due to a significant mental or physical condition, illness, or disease, is likely to require specialized treatment or supports to secure effective access to dental care. The written certification of a child's treating physician, advance practice nurse, or licensed psychologist shall be sufficient to qualify a person as a “child with a severe disability.”
(2) “Dental services” means the full range of diagnostic and treatment services within the scope of benefits available under the health insurance contract or policy.
(b) Application of section. — This section applies to every individual health insurance contract, including each policy or contract issued by a health service corporation, which is delivered, issued for delivery, or renewed in this State which provides coverage for dental services for a child.
(c) Payment authorization. — Every contract or policy described in subsection (b) of this section shall authorize payment to a licensed practitioner for dental services to a child with a severe disability irrespective of lack of contractual or network status. Unless otherwise negotiated with the practitioner in advance, such payment shall be in an amount at least equal to the insurer's reasonable and customary compensation for the same or similar services in the same geographical area. A nonnetwork practitioner accepting payment under this section may not balance bill the insured.
(d) Preservation of contract limits. — Nothing in this section shall prevent the application of contract or policy provisions involving deductibles, coinsurance, maximum dollar limitations or coordination of benefits, provided that such limits shall be applied using in-network standards.
(e) Waiver. — The Commissioner may establish, by regulation, standards authorizing the issuance of a waiver to an insurer from application of this section. At a minimum, such waiver standards shall only permit a time-limited, renewable waiver upon submission of clear and convincing documentation of the numerical and geographical availability of in-network practitioners willing and able to effectively treat a child with a severe disability.
77 Del. Laws, c. 54, §  1;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3359. Health insurance; pharmacies; electronic reimbursement.

§ 3359. 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, 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.
(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.
(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, §  1;  80 Del. Laws, c. 310, § 1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33. HEALTH INSURANCE CONTRACTS › Subchapter I. General Provisions › § 3359B. Electronic medical (non-pharmaceutical) claims.

§ 3359B. Electronic medical (non-pharmaceutical) claims.
(a) This section shall apply to all claims for healthcare services that are submitted and are not covered by § 3359 of this title.
(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, § 2;