reglab/statecodes huggingface dataset:
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter V. Registration of Pharmacy Benefits Managers › § 3351A. Definitions [For application of this section, see 83 Del. Laws, c. 256, § 15].

§ 3351A. Definitions [For application of this section, see 83 Del. Laws, c. 256, § 15].
For purposes of this subchapter:
(1) “Pharmacy benefits management services” means all of the following:
a. The procurement of prescription drugs at a negotiated rate for dispensation within this State to beneficiaries.
b. The administration or management of prescription drug coverage provided by a purchaser for beneficiaries.
c. Any of the following services provided with regard to the administration of prescription drug coverage:
1. Mail service pharmacy.
2. Claims processing, retail network management, and payment of claims to pharmacies for prescription drugs dispensed to beneficiaries.
3. Clinical formulary development and management services.
4. Rebate contracting and administration. For purposes of this paragraph (1)c.4., “rebate” means as defined in § 3361A of this title.
5. Patient compliance, therapeutic intervention, and generic substitution programs.
6. Disease management programs.
(2) “Pharmacy benefits manager” means as defined under § 3302A of this title.
(3) “Purchaser” means a person that does all of the following:
a. Provides prescription drug coverage or benefits in this State.
b. Enters into agreement with a pharmacy benefits manager for the provision of pharmacy benefits management services.
82 Del. Laws, c. 115, § 4;  83 Del. Laws, c. 256, § 8;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter V. Registration of Pharmacy Benefits Managers › § 3352A. Applicability.

§ 3352A. Applicability.
This subchapter does not apply to plans 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 a state or federal government plan.
82 Del. Laws, c. 115, § 4;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter V. Registration of Pharmacy Benefits Managers › § 3353A. Registration required [For application of this section, see 83 Del. Laws, c. 256, § 15].

§ 3353A. Registration required [For application of this section, see 83 Del. Laws, c. 256, § 15].
(a) A pharmacy benefits manager shall register with the Commissioner as a pharmacy benefits manager before providing pharmacy benefits management services in this State to a purchaser.
(b) A purchaser may not enter into an agreement or contract with a pharmacy benefits manager that has not registered with the Commissioner.
(c) A pharmacy benefits manager applying for registration shall do all of the following:
(1) File with the Commissioner an application on the form that the Commissioner provides.
(2) Pay to the Commissioner a $1,000 nonrefundable registration fee.
(d) The Commissioner may require any additional information or submissions from a pharmacy benefits manager that may be reasonably necessary to verify the information contained in the application.
(e) Subject to § 3355A of this title, the Commissioner shall register each pharmacy benefits manager that meets the requirements of this section.
(f) Except where prohibited by state or federal law, a pharmacy benefits manager applying for registration is deemed to have appointed the Commissioner as agent for service of process in an action or proceeding arising in this State out of or in connection with the exercise of the registration. The appointment of the Commissioner as agent for service of process is irrevocable during the period within which a cause of action against the pharmacy benefits manager may arise out of transactions with respect to pharmacy benefits management services provided in this State. The process must be served on the Commissioner or a Deputy Insurance Commissioner or another person designated by the Commissioner by rule or regulation.
82 Del. Laws, c. 115, § 4;  83 Del. Laws, c. 256, § 9;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter V. Registration of Pharmacy Benefits Managers › § 3354A. Expiration and renewal of registration [For application of this section, see 83 Del. Laws, c. 256. §  15].

§ 3354A. Expiration and renewal of registration [For application of this section, see 83 Del. Laws, c. 256. §  15].
(a) A pharmacy benefits manager registration expires on May 1 after its effective date unless it is renewed as provided under this section.
(b) A pharmacy benefits manager may renew its registration for an additional 1-year term if the pharmacy benefits manager otherwise is entitled to be registered and does all of the following:
(1) Files with the Commissioner a registration renewal application on the form that the Commissioner requires.
(2) Pays to the Commissioner a $1,000 nonrefundable renewal fee.
(c) An application for renewal of a pharmacy benefits manager registration is to be considered made in a timely manner if it is postmarked on or before the date the pharmacy benefits manager's registration expires.
(d) The Commissioner may require additional information or submissions from a pharmacy benefits manager that may be reasonably necessary to verify the information contained in the registration renewal application.
(e) Subject to §§ 3355A of this title, the Commissioner shall renew the registration of each pharmacy benefits manager that meets the requirements of this section.
82 Del. Laws, c. 115, § 4;  83 Del. Laws, c. 256, § 10;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter V. Registration of Pharmacy Benefits Managers › § 3355A. Denial, suspension, or revocation of registration [For application of this section, see 83 Del. Laws, c. 256, §  15].

§ 3355A. Denial, suspension, or revocation of registration [For application of this section, see 83 Del. Laws, c. 256, §  15].
(a) The Commissioner may deny a registration to a pharmacy benefits manager applicant or refuse to renew, suspend, or revoke the registration of, or issue a cease and desist order to, a pharmacy benefits manager if the pharmacy benefits manager, or an officer, director, or employee of the pharmacy benefits manager, does any of the following:
(1) Makes a material misstatement, misrepresentation, or omission in a registration or registration renewal application.
(2) Fraudulently or deceptively obtains or attempts to obtain a registration or renewal of a registration.
(3) In connection with the administration of pharmacy benefits management services, commits fraud or engages in illegal or dishonest activities.
(4) Violates any provision of this chapter or a regulation adopted under this chapter.
(b) [Repealed.]
(c) If the action by the Commissioner is to deny or not renew a registration, the Commissioner shall notify the pharmacy benefits manager of the decision, in writing, including the reason for the denial or nonrenewal of the registration. The pharmacy benefits manager may, within 10 days after the Commissioner provides notice under this subsection, make written demand on the Commissioner for a hearing before the Commissioner to determine the reasonableness of the Commissioner's action. A hearing under this subsection must be held under §§ 323 through 328 of this title.
(d) This section does not limit any other regulatory authority of the Commissioner under this title.
82 Del. Laws, c. 115, § 4;  83 Del. Laws, c. 256, § 11;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter V. Registration of Pharmacy Benefits Managers › § 3356A. Recordkeeping requirements.

§ 3356A. Recordkeeping requirements.
A pharmacy benefits manager shall maintain adequate books and records about each purchaser for which the pharmacy benefits manager provides pharmacy benefits management services as follows:
(1) In accordance with prudent standards of record keeping.
(2) For the duration of the agreement between the pharmacy benefits manager and the purchaser.
(3) For 3 years after the pharmacy benefits manager ceases to provide pharmacy benefits management services for the purchaser.
82 Del. Laws, c. 115, § 4;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter V. Registration of Pharmacy Benefits Managers › § 3357A. Examination of affairs, transactions, accounts, and records.

§ 3357A. Examination of affairs, transactions, accounts, and records.
(a) Whenever the Commissioner considers it advisable, the Commissioner may examine the affairs, transactions, accounts, and records of a registered pharmacy benefits manager.
(b) The examination must be conducted under § 320 of this title.
(c) The expense of an examination is to be borne by the pharmacy benefits manager being examined. The expense includes the reasonable and proper expenses of the Commissioner, and the Commissioner's examiners and assistants, including expert assistance, and a reasonable per diem as to the examiners and assistants as necessarily incurred in the examination. The pharmacy benefits manager examined shall promptly pay the examination expense on presentation by the Commissioner or the Commissioner's examiner of a reasonably detailed written account of the examination expense.
(d) The Commissioner shall issue reports of the examination and investigation under § 321 of this title.
82 Del. Laws, c. 115, § 4;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter V. Registration of Pharmacy Benefits Managers › § 3358A. Permit required for nonresident pharmacy to deliver prescription drugs or devices.

§ 3358A. Permit required for nonresident pharmacy to deliver prescription drugs or devices.
A pharmacy benefits manager may not ship, mail, or deliver prescription drugs or devices to a person in this State through a nonresident pharmacy unless the nonresident pharmacy holds a permit issued under § 2535 of Title 24.
82 Del. Laws, c. 115, § 4;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter VI. Pharmacy Benefits Manager Network Requirements [For application of this subchapter, see 83 Del. Laws, c. 256, §? 15] › § 3361A. Definitions [For application of this section, see 83 Del. Laws, c. 256, §  15].

§ 3361A. Definitions [For application of this section, see 83 Del. Laws, c. 256, §  15].
For purposes of this subchapter:
(1) “Claim” means as defined under § 3321A of this title.
(2) “Insured” means an individual covered by health insurance offered by an insurer.
(3) “Insurer” means as defined under § 3321A of this title.
(4) “Pharmacist” means as defined under § 2502 of Title 24.
(5) “Pharmacy” means as defined under § 2502 of Title 24.
(6) “Pharmacy benefits manager” means as defined under § 3302A of this title.
(7) “Pharmacy benefits manager network” means a network of pharmacists or pharmacies that are offered by an agreement or contract to provide pharmacy goods or services.
(8) “Pharmacy goods or services” means as defined under § 3325A of this title.
(9) a. “Rebate” means a discount or other price concession, or a payment that is both of the following:
1. Based on utilization of a prescription drug.
2. Paid by a manufacturer or third party, directly or indirectly, to the pharmacy benefits manager, pharmacy services administrative organization, or pharmacy after a claim has been processed and paid at a pharmacy.
b. “Rebate” includes incentives, disbursements, and reasonable estimates of a volume-based or category-based discount.
83 Del. Laws, c. 256, § 12;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter VI. Pharmacy Benefits Manager Network Requirements [For application of this subchapter, see 83 Del. Laws, c. 256, §? 15] › § 3362A. Pharmacy benefits manager network [For application of this section, see 83 Del. Laws, c. 256, §  15].

§ 3362A. Pharmacy benefits manager network [For application of this section, see 83 Del. Laws, c. 256, §  15].
(a) A pharmacy benefits manager shall provide a reasonably adequate and accessible pharmacy benefits manager network for the provision of prescription drugs, which provides for convenient patient access to pharmacies within a reasonable distance from a patient's residence.
(b) A pharmacy benefits manager may not deny a pharmacy the opportunity to participate in a pharmacy benefits manager network at preferred participation status if the pharmacy is willing to accept the terms and conditions that the pharmacy benefits manager has established for other pharmacies as a condition of preferred network participation status.
(c) A mail-order pharmacy may not be included in the calculations for determining pharmacy benefits manager network adequacy under this section.
83 Del. Laws, c. 256, § 12;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter VI. Pharmacy Benefits Manager Network Requirements [For application of this subchapter, see 83 Del. Laws, c. 256, §? 15] › § 3363A. Reports [For application of this section, see 83 Del. Laws, c. 256, §  15].

§ 3363A. Reports [For application of this section, see 83 Del. Laws, c. 256, §  15].
(a) A pharmacy benefits manager shall provide a pharmacy benefits manager network adequacy report describing the pharmacy benefits manager network and the pharmacy benefits manager network's accessibility in this State. The Commissioner shall adopt regulations setting the time and manner for providing the report.
(b) A pharmacy benefits manager shall report to the Commissioner on a quarterly basis all of the following information for each insurer:
(1) The itemized amount of pharmacy benefits manager revenue sources, including professional fees, administrative fees, processing fees, audits, direct and indirect renumeration fees, or any other fees.
(2) The aggregate amount of rebates distributed to the appropriate insurer.
(3) The aggregate amount of rebates passed on to insureds of each insurer at the point of sale that reduced the insureds' applicable deductible, copayment, coinsurance, or other cost-sharing amount.
(4) The individual and aggregate amount the insurer paid to the pharmacy benefits manager for pharmacy goods or services itemized by all of the following:
a. Pharmacy.
b. Product.
c. Goods and services.
(5) The individual and aggregate amount a pharmacy benefits manager paid for pharmacy goods or services itemized by all of the following:
a. Pharmacy.
b. Product.
c. Goods and services.
(c) The information provided under subsection (b) of this section is confidential and not subject to subpoena or the Freedom of Information Act, Chapter 100 of Title 29.
83 Del. Laws, c. 256, § 12;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter VII. Prohibited Practices; Penalties; Enforcement [For application of this subchapter, see 83 Del. Laws, c. 256, §? 15] › § 3371A. Definitions [For application of this section, see 83 Del. Laws, c. 256, §  15].

§ 3371A. Definitions [For application of this section, see 83 Del. Laws, c. 256, §  15].
For purposes of this subchapter:
(1) “Board of Pharmacy” means the Delaware State Board of Pharmacy.
(2) “Claim” means as defined under § 3321A of this title.
(3) “Insurer” means as defined under § 3321A of this title.
(4) “Pharmacist” means as defined under § 2502 of Title 24.
(5) “Pharmacy” means as defined under § 2502 of Title 24.
(6) “Pharmacy benefits manager” means as defined under § 3302A of this title.
(7) “Pharmacy benefits manager network” means a network of pharmacists or pharmacies that are offered by an agreement or contract to provide pharmacy goods or services.
(8) “Pharmacy goods or services” means as defined under § 3325A of this title.
(9) “Spread pricing” means the model of prescription drug pricing in which the pharmacy benefits manager charges a health benefit plan a contracted price for prescription drugs, and the contracted price for the prescription drugs differs from the amount the pharmacy benefits manager directly or indirectly pays the pharmacist or pharmacy for pharmacy goods or services.
83 Del. Laws, c. 256, § 13;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter VII. Prohibited Practices; Penalties; Enforcement [For application of this subchapter, see 83 Del. Laws, c. 256, §? 15] › § 3372A. Prohibited practices [For application of this section, see 83 Del. Laws, c. 256, §  15].

§ 3372A. Prohibited practices [For application of this section, see 83 Del. Laws, c. 256, §  15].
A pharmacy benefits manager or representative of a pharmacy benefits manager may not do any of the following:
(1) Engage in spread pricing.
(2) Cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal, or offer that is untrue, deceptive, or misleading.
(3) Unless reviewed and approved by the Commissioner, charge a pharmacist or pharmacy a fee related to the adjudication of a claim, including a fee for any of the following:
a. The receipt and processing of a pharmacy claim.
b. The development or management of claims processing services in a pharmacy benefits manager network.
c. Participation in a pharmacy benefits manager network.
(4) Unless reviewed and approved by the Commissioner in coordination with the Board of Pharmacy, require pharmacy accreditation standards or certification requirements inconsistent with, more stringent than, or in addition to requirements of the Board of Pharmacy.
(5) Violate § 3325A(b) of this title.
(6) Violate § 3362A of this title.
(7) Pay or reimburse a pharmacy or pharmacist for the ingredient drug product component of pharmacist services less than the national average drug acquisition cost, or if the national average drug acquisition cost is unavailable, the wholesale acquisition cost.
(8) Make or permit any reduction of payment for pharmacy goods or services by a pharmacy benefits manager or an insurer directly or indirectly to a pharmacy under a reconciliation process to an effective rate of reimbursement, including generic effective rates, brand effective rates, direct and indirect remuneration fees, or any other reduction or aggregate reduction of payment.
(9) After adjudication of a claim for pharmacy goods or services, directly or indirectly retroactively deny or reduce the claim unless 1 or more of the following applies:
a. The original claim was intentionally submitted fraudulently.
b. The original claim payment was incorrect because the pharmacy or pharmacist had already been paid for the pharmacy goods or services.
c. The pharmacy goods or services were not properly rendered by the pharmacy or pharmacist.
83 Del. Laws, c. 256, § 13;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter VII. Prohibited Practices; Penalties; Enforcement [For application of this subchapter, see 83 Del. Laws, c. 256, §? 15] › § 3373A. Penalties and enforcement [For application of this section, see 83 Del. Laws, c. 256, §  15].

§ 3373A. Penalties and enforcement [For application of this section, see 83 Del. Laws, c. 256, §  15].
(a) If the Commissioner determines that a pharmacy benefits manager has violated any provision of this chapter or any regulation adopted under this chapter, the Commissioner may, after notice and a hearing, issue an order that requires the pharmacy benefits manager to do 1 or more of the following:
(1) Cease and desist from the identified violation and further similar violations.
(2) Take specific affirmative action to correct the violation.
(3) Make restitution of money, property, or other assets to a person that has suffered financial injury because of the violation.
(4) Pay a fine in an amount determined by the Commissioner, not to exceed $10,000, for each violation of this chapter.
(5) Pay the costs, including applicable attorneys' fees, incurred by the Commissioner in bringing the action.
(b) A hearing under this section must be held under §§ 323 through 328 of this title and any regulations adopted by the Commissioner.
(c) The Commissioner may adopt regulations to enforce this chapter and to establish a complaint process and set associated fees to address grievances and appeals brought under this chapter.
82 Del. Laws, c. 115, § 4;  83 Del. Laws, c. 256, § 14;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter VIII. Fairness in Cost-Sharing for Pharmacy Benefits Managers [For application of this subchapter, see 83 Del. Laws, c. 522, § 4] › § 3381A. Definitions [For application of this subchapter, see 83 Del. Laws, c. 522, § 4].

§ 3381A. Definitions [For application of this subchapter, see 83 Del. Laws, c. 522, § 4].
For purposes of this subchapter:
(1) “Cost-sharing requirement” means any copayment, coinsurance, deductible, or annual limitation on cost-sharing (including a limitation subject to 42 U.S.C. §§ 18022(c) and 300gg-6(b)), required by or on behalf of an enrollee in order to receive a specific health care service, including a prescription drug, covered by a health benefit plan.
(2) “Enrollee” means any individual entitled to health care services from an insurer.
(3) “Health benefit plan” means a policy, contract, certification, or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.
(4) “Health care service” means a policy, contract, certification, or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services.
(5) “Insurer” means as defined under § 3321A of this title.
(6) “Person” means a natural person, corporation, mutual company, unincorporated association, partnership, joint venture, limited liability company, trust, estate, foundation, not-for-profit corporation, unincorporated organization, government or governmental subdivision or agency.
(7) “Pharmacy benefits manager” means as defined under § 3302A of this title, and shall include any person, business, or other entity that, pursuant to a contract or under an employment relationship with an insurer, either directly or through an intermediary, manages the prescription drug benefit provided by the insurer, including the processing and payment of claims for prescription drugs, the performance of drug utilization review, the processing of drug prior authorization requests, the adjudication of appeals or grievances related to the prescription drug benefit, contracting with network pharmacies, and/or controlling the cost of covered prescription drugs.
83 Del. Laws, c. 522, § 3;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 33A. Pharmacy Benefits Managers [For application of this chapter, see 80 Del. Laws, c. 245, §? 2] › Subchapter VIII. Fairness in Cost-Sharing for Pharmacy Benefits Managers [For application of this subchapter, see 83 Del. Laws, c. 522, § 4] › § 3382A. Fairness in cost-sharing [For application of this subchapter, see 83 Del. Laws, c. 522, § 4].

§ 3382A. Fairness in cost-sharing [For application of this subchapter, see 83 Del. Laws, c. 522, § 4].
(a) Cost-sharing calculation. —
When calculating an enrollee's contribution to any applicable cost-sharing requirement, a pharmacy benefits manager shall include any cost-sharing amounts paid by the enrollee or on behalf of the enrollee by another person. If under federal law, application of this requirement would result in health savings account ineligibility under § 223 of the federal Internal Revenue Code [26 U.S.C. §  223], this requirement shall apply for health savings account-qualified high deductible health plans with respect to the deductible of such a plan after the enrollee has satisfied the minimum deductible under [26 U.S.C.] § 223, except with respect to items or services that are preventive care pursuant to [26 U.S.C.] § 223(c)(2)(C) of the federal Internal Revenue Code, in which case the requirements of this subsection shall apply regardless of whether the minimum deductible under [26 U.S.C.] § 223 has been satisfied.
(b) Rule-making. —
The Insurance Commissioner may promulgate rules and regulations as may be necessary or appropriate to implement and administer this section.
83 Del. Laws, c. 522, § 3;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 34. MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › § 3401. Definitions.

§ 3401. Definitions.
(a) “Applicant” means:
(1) In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and
(2) In the case of a group Medicare supplement policy, the proposed certificate holder.
(b) “Certificate” means, for the purposes of this chapter, any certificate delivered or issued for delivery in this State under a group Medicare supplement policy.
(c) “Certificate form” means the form on which the certificate is delivered or issued for delivery by the issuer.
(d) “Issuer” includes insurance companies, fraternal benefit societies, health-care service plans, health maintenance organizations and any other entity delivering or issuing for delivery in this State Medicare supplement policies or certificates.
(e) “Medicare” means the “Health Insurance for the Aged Act,” Title XVIII of the Social Security Amendments of 1965 [42 U.S.C. § 1395 et seq.], as then constituted or later amended.
(f) “Medicare supplement policy” means a group or individual policy of accident and sickness insurance or a subscriber contract of hospital and medical service associations or health maintenance organizations, other than a policy issued pursuant to a contract under § 1876 of the Federal Social Security Act (42 U.S.C. § 1395mm), or an issued policy under a demonstration project specified in the 42 U.S.C. § 1395(g)(1), which is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare.
(g) “Policy form” means the form on which the policy is delivered or issued for delivery by the issuer.
63 Del. Laws, c. 262, §  2;  67 Del. Laws, c. 45, §  1;  68 Del. Laws, c. 237, §  1;  70 Del. Laws, c. 156, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 34. MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › § 3402. Applicability; scope.

§ 3402. Applicability; scope.
(a) Except as otherwise specifically provided in this title, this chapter shall apply to:
(1) All Medicare supplement policies delivered or issued for delivery in this State on or after May 13, 1992; and
(2) All certificates issued under group Medicare supplement policies, which certificates have been delivered or issued for delivery in this State.
(b) This chapter shall not apply to a policy of 1 or more employers or labor organizations, or of the trustees of a fund established by 1 or more employers or labor organizations, or combination thereof, for employees or former employees or a combination thereof, or for members or former members, or a combination thereof, of the labor organizations.
(c) Except as otherwise provided in § 3405(d) of this title, the provisions of this chapter are not intended to prohibit or apply to insurance policies or health-care benefit plans, including group conversion policies, provided to Medicare eligible persons which policies are not marketed or held to be Medicare supplement policies or benefit plans.
67 Del. Laws, c. 45, §  1;  68 Del. Laws, c. 237, §  1;  70 Del. Laws, c. 156, §§  2, 3;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 34. MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › § 3404. Loss ratio standards.

§ 3404. Loss ratio standards.
Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The Commissioner shall issue reasonable regulations to establish minimum standards for loss ratios of Medicare supplement policies on the basis of incurred claims experience, or incurred health-care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis, and earned premiums in accordance with accepted actuarial principles and practices.
63 Del. Laws, c. 262, §  2;  67 Del. Laws, c. 45, §  1;  68 Del. Laws, c. 237, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 34. MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › § 3405. Disclosure standards.

§ 3405. Disclosure standards.
(a) In order to provide for full and fair disclosure in the sale of Medicare supplement policies, no Medicare supplement policy or certificate shall be delivered in this State unless an outline of coverage is delivered to the applicant at the time application is made.
(b) The Commissioner shall prescribe the format and content of the outline of coverage required by subsection (a) of this section. For purposes of this section, “format” means style, arrangements and overall appearance, including such items as the size, color and prominence of type and arrangement of text and captions. Such outline of coverage shall include:
(1) A description of the principal benefits and coverage provided in the policy;
(2) A statement of the renewal provisions, including any reservation by the issuer of a right to change premiums; and disclosure of the existence of any automatic renewal premium increases based on the policyholder's age;
(3) A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions.
(c) The Commissioner may prescribe by regulation a standard form and the contents of an informational brochure for persons eligible for Medicare, which is intended to improve the buyer's ability to select the most appropriate coverage and improve the buyer's understanding of Medicare. Except in the case of direct response insurance policies, the Commissioner may require by regulation that the information brochure be provided to any prospective insureds eligible for Medicare concurrently with delivery of the outline of coverage. With respect to direct response insurance policies, the Commissioner may require by regulation that the prescribed brochure be provided upon request to any prospective insureds eligible for Medicare, but in no event later than the time of policy delivery.
(d) The Commissioner may adopt regulations for captions or notice requirements, determined to be in the public interest and designed to inform prospective insureds that particular insurance coverages are not Medicare supplement coverages, for all accident and sickness insurance policies sold to persons eligible for Medicare, other than:
(1) Medicare supplement policies;
(2) Disability income policies;
(3), (4) [Repealed.]
(e) The Commissioner may adopt reasonable regulations to govern the full and fair disclosure of the information in connection with the replacement of accident and sickness policies, subscriber contracts or certificates by persons eligible for Medicare.
63 Del. Laws, c. 262, §  2;  67 Del. Laws, c. 45, §  1;  68 Del. Laws, c. 237, §  1;  70 Del. Laws, c. 156, §  4;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 34. MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › § 3406. Notice of free examination.

§ 3406. Notice of free examination.
Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the applicant shall have the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. Any refund made pursuant to this section shall be paid directly to the applicant by the issuer in a timely manner.
63 Del. Laws, c. 262, §  2;  67 Del. Laws, c. 45, §  1;  68 Del. Laws, c. 237, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 34. MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › § 3407. Filing requirements for advertising.

§ 3407. Filing requirements for advertising.
Every issuer of Medicare supplement insurance policies or certificates in this State shall provide a copy of any Medicare supplement advertisement intended for use in this State whether through written, radio or television medium to the Commissioner of Insurance of this State for review or approval by the Commissioner to the extent it may be required under state law.
67 Del. Laws, c. 45, §  1;  68 Del. Laws, c. 237, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 34. MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › § 3409. Penalties.

§ 3409. Penalties.
In addition to any other applicable penalties for violations of the Insurance Code, the Commissioner may require issuers violating any provision of this chapter or regulations promulgated pursuant to this chapter to cease marketing any Medicare supplement policy or certificate in this State which is related directly or indirectly to a violation or may require such issuer to take such actions as are necessary to comply with the provisions of this chapter, or both.
67 Del. Laws, c. 45, §  1;  68 Del. Laws, c. 237, §  1;  76 Del. Laws, c. 354, §§   1, 2;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 34. MEDICARE SUPPLEMENT INSURANCE MINIMUM STANDARDS › § 3410. Coverage for persons eligible for Medicare due to disability.

§ 3410. Coverage for persons eligible for Medicare due to disability.
(a) Each Medicare supplement policy or applicable certificate that an issuer currently, or at any time hereafter, makes available in this State shall be made available to any applicant under the age of 65 who is eligible for Medicare due to a disability, including, without limitation, end-stage renal disease, provided that the applicant submits his or her application during the first 6 months immediately following such applicant's enrollment in Part B of Medicare or by January 15, 2014, whichever is later. The issuance or effectiveness of any Medicare supplement policy pursuant to this section shall not be conditioned on, nor shall the price of the policy be discriminatory based upon, the medical or health status or receipt of health care by the applicant; and no insurer shall perform individual medical underwriting on any applicant in connection with the issuance of a policy pursuant to this section.
(b) Premium rates for Medicare supplement policies and certificates issued pursuant to this section may differ between persons who qualify for Medicare who are 65 years of age or older and those who qualify for Medicare by reason of disability or end-stage renal disease and who are younger than 65 years of age. For those Medicare supplement policies and certificates that are issued to persons who are younger than 65 years of age and who qualify for Medicare by reason of disability or end-stage renal disease, insurers shall establish 2 separate rating pools for such persons, 1 pool specifically for end-stage renal disease and a separate pool for all other disabilities. For purposes of this section, any differences in premium rates shall be pursuant to rate schedules that are based on sound actuarial principles and shall be reasonable in relation to the benefits provided.
(c) Medicare supplement policies issued pursuant to this section shall be separately underwritten from other Medicare supplement policies, and risks assumed by issuers pursuant to subsection (a) of this section shall not be subsidized by purchasers of Medicare supplement policies that were not issued pursuant to subsection (a) of this section.
79 Del. Laws, c. 101, §  1;  70 Del. Laws, c. 186, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter I. Group Health Insurance › § 3501. Group policies must meet group requirements.

§ 3501. Group policies must meet group requirements.
Except as provided in § 3509 of this title, no policy of group health insurance shall be delivered in this State unless it conforms to one of the descriptions contained in §§ 3502-3508 of this title.
66 Del. Laws, c. 175, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter I. Group Health Insurance › § 3502. Employee groups.

§ 3502. Employee groups.
A policy may be issued to an employer, or to the trustees of a fund established by an employer, which employer or trustees shall be deemed the policyholder, to insure employees of the employer for the benefit of persons other than the employer, subject to the following requirements:
(1) The employees eligible for insurance under the policy shall be all of the employees of the employer, or all of any class or classes thereof. The policy may provide that the term “employees” shall include the employees of 1 or more subsidiary corporations, and the employees, individual proprietors and partners of 1 or more affiliated corporations, proprietorships or partnerships if the business of the employer and of such affiliated corporations, proprietorships or partnerships is under common control. The policy may provide that the term “employees” shall include the individual proprietor or partners if the employer is an individual proprietorship or partnership. The policy may provide that the term “employees” shall include retired employees, former employees and directors of a corporate employer. A policy issued to insure the employees of a public body may provide that the term “employees” shall include elected or appointed officials. The policy may provide that the term “employee” does not include farm laborers employed in agriculture.
(2) The premium for the policy shall be paid either from the employer's funds or from funds contributed by the insured employees, or from both. Except as provided in paragraph (3) of this section, a policy on which no part of the premium is to be derived from funds contributed by the insured employees must insure all eligible employees, except those who reject such coverage in writing.
(3) An insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer.
66 Del. Laws, c. 175, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter I. Group Health Insurance › § 3503. Debtor groups.

§ 3503. Debtor groups.
A policy may be issued to a creditor or its parent holding company or to a trustee or trustees or agent designated by 2 or more creditors, which creditor, holding company, affiliate, trustee, trustees or agent shall be deemed the policyholder, to insure debtors of the creditors with respect to their indebtedness, subject to the following requirements:
(1) The debtors eligible for insurance under the policy shall be all of the debtors of the creditor or creditors, or all of any class or classes thereof. The policy may provide that the term “debtors” shall include:
a. Borrowers of money or purchasers or lessees of goods, services or property for which payment is arranged through a lease or credit transaction;
b. The debtors of 1 or more subsidiary corporations; and
c. The debtors of 1 or more affiliated corporations, proprietorships or partnerships if the business of the policyholder and of such affiliated corporations, proprietorships or partnerships is under common control.
(2) The premium for the policy shall be paid either from the creditor's funds, or from charges collected from the insured debtors, or from both. Except as provided in paragraph (3) of this section, a policy on which no part of the premium is to be derived from funds contributed by insured debtors specifically for their insurance must insure all eligible debtors.
(3) An insurer may exclude any debtors as to whom evidence of individual insurability is not satisfactory to the insurer.
(4) The total amount of insurance payable with respect to an indebtedness shall not exceed the greater of the total of scheduled payments or actual amount of unpaid indebtedness as to the creditor. The insurer may exclude any payments which are delinquent on the date the debtor becomes disabled as defined in the policy.
(5) The insurance may be payable to the creditor or any successor to the right, title and interest of the creditor. Such payment or payments shall reduce or extinguish the unpaid indebtedness of the debtor to the extent of each such payment and any excess of the insurance shall be payable to the insured or the estate of the insured.
(6) Notwithstanding the preceding provisions of this section, insurance on agricultural credit transaction commitments may be written up to the amount of the loan commitment. Insurance on educational credit transaction commitments may be written up to the amount of the loan commitment less the amount of any repayments made on the loan.
66 Del. Laws, c. 175, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter I. Group Health Insurance › § 3504. Labor union or employee organization groups.

§ 3504. Labor union or employee organization groups.
A policy may be issued to a labor union, or similar employee organization which shall be deemed to be the policyholder, to insure members of such union or organization for the benefit of persons other than the union or organization or any of its officials, representatives or agents, subject to the following requirements:
(1) The members eligible for insurance under the policy shall be all of the members of the union or organization, or all of any class or classes thereof.
(2) The premium for the policy shall be paid either from funds of the union or organization, or from funds contributed by the insured members specifically for their insurance, or from both. Except as provided in paragraph (3) of this section, a policy on which no part of the premium is to be derived from funds contributed by the insured members specifically for the insurance must insure all eligible members, except those who reject such coverage in writing.
(3) An insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer.
66 Del. Laws, c. 175, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter I. Group Health Insurance › § 3505. Trustee groups.

§ 3505. Trustee groups.
A policy may be issued to a trust, or to the trustee or trustees of a fund, established or adopted by 2 or more employers, or by 1 or more labor unions or similar employee organizations, or by 1 or more employers and 1 or more labor unions or similar employee organizations, which trust or trustee or trustees shall be deemed the policyholder, to insure employee of the employer or members of the unions or organizations for the benefit of persons other than the employers or the unions or organizations, subject to the following requirements:
(1) The persons eligible for insurance shall be all of the employees of the employers or all of the members of the unions or organizations, or all of any class or classes thereof. The policy may provide that the term “employees” shall include the employees of 1 or more subsidiary corporations, and the employees, individual proprietors and partners of 1 or more affiliated corporations, proprietorships or partnerships if the business of the employer and of such affiliated corporations, proprietorships or partnerships is under common control. The policy may provide that the term “employees” shall include the individual proprietor or partners if the employer is an individual proprietorship or partnership. The policy may provide that the term “employees” shall include retired employees, former employees and directors of a corporate employer. The policy may provide that the term “employees” shall include the trustees or their employees, or both, if their duties are principally connected with such trusteeship.
(2) The premium for the policy shall be paid from funds contributed by the employer or employers of the insured persons, or by the union or unions or similar employee organizations, or by both, or from funds contributed by the insured persons from both the insured persons and the employer(s) or union(s) or similar employee organization(s). Except as provided in paragraph (3) of this section, a policy on which no part of the premium is to be derived from funds contributed by the insured persons specifically for their insurance must insure all eligible persons, except those who reject such coverage in writing.
(3) An insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer.
66 Del. Laws, c. 175, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter I. Group Health Insurance › § 3506. Association groups.

§ 3506. Association groups.
(a) “Bona fide association” means, with respect to health insurance coverage offered in Delaware, an association which:
(1) Has been actively in existence for at least 5 years;
(2) Has been formed and maintained in good faith for purposes other than obtaining insurance and does not condition membership on the purchase of association-sponsored insurance;
(3) Does not condition membership in the association on any health status-related factor relating to an individual (including an employee of an employer or a dependent of an employee) and clearly so states in all membership and application materials;
(4) Makes health insurance coverage offered through the association available to all members regardless of any health status-related factor relating to such members (or individuals eligible for coverage through a member) and clearly so states in all marketing and application materials;
(5) Does not make health insurance coverage offered through the association available other than in connection with a member of the association and clearly so states in all marketing and application materials; and
(6) Provides and annually updates information necessary for the Commissioner to determine whether or not an association meets the definition of a bona fide association before qualifying as a bona fide association for the purposes of this chapter.
(b) An association policy shall be subject to the following requirements:
(1) The policy may insure members of such association or associations, employees thereof or employees of members or 1 or more of the preceding or all of any class or classes thereof for the benefit of persons other than the employer.
(2) The premium for the policy shall be paid from funds contributed by the association or associations or by the employer members, or by both, or from funds contributed by the covered persons or from both the covered persons and the association, associations or employer members.
(3) A policy on which no part of the premium is to be derived from funds contributed by the covered persons specifically for their insurance must insure all eligible persons, except those who reject such coverage in writing.
66 Del. Laws, c. 175, §  1;  71 Del. Laws, c. 143, §  15;