reglab/statecodes huggingface dataset:
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter I. Group Health Insurance › § 3507. Credit union groups.

§ 3507. Credit union groups.
A policy may be issued to a credit union or to a trustee or trustees or agent designated by 2 or more credit unions, which credit union, trustee, trustees or agent shall be deemed the policyholder, to insure members of such credit unions for the benefit of persons other than the credit unit or credit unions, trustee or trustees, or agent or any of their officials, subject to the following requirements:
(1) The members eligible for insurance shall be all of the members of the credit union or credit unions, or all of any class or classes thereof.
(2) The premium for the policy shall be paid by the policyholder from the credit union's funds and, except as provided in paragraph (3) of this section, must insure all eligible members.
(3) An insurer may exclude or limit the coverage on any member 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 › § 3508. Discretionary groups.

§ 3508. Discretionary groups.
A policy may be issued to any other substantially similar group which, in the discretion of the Commissioner, may be subject to the issuance of a group health policy or contract.
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 › § 3509. Requirements for other groups; out-of-state groups.

§ 3509. Requirements for other groups; out-of-state groups.
(a) Group health insurance offered to a resident of this State under a group health insurance policy issued to a group other than those described in §§ 3502-3508 of this title shall be subject, where applicable, to the requirements of subsections (b)-(e) of this section.
(b) No such group health insurance policy shall be delivered or coverage offered in this State unless the Commissioner finds that:
(1) The issuance of such group policy is not contrary to the best interest of the public;
(2) The issuance of the group policy would result in economies of acquisition or administration;
(3) The benefits are reasonable in relation to the premiums charged; and
(4) The group is not affiliated with or controlled by (as those terms are defined in Chapter 50 of this title) an insurer unless approved by the Commissioner.
(c) No such group health insurance coverage may be offered in this State by an insurer under a policy issued in another state unless this State or another state having requirements substantially similar to those contained in paragraphs (b)(1)-(4) of this section has made a determination that such requirements have been met.
(d) The premium for the policy shall be paid either from the policyholders' funds or from funds contributed by the covered persons or from both.
(e) 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;  70 Del. Laws, c. 104, §§  1-4;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter I. Group Health Insurance › § 3510. Disclosure requirements for other groups.

§ 3510. Disclosure requirements for other groups.
(a) With respect to a program of insurance which if issued on a group basis would not qualify under §§ 3502-3508 of this title, if compensation of any kind will or may be paid to:
(1) A policyholder or sponsoring or endorsing entity in the case of a group policy; or
(2) A sponsoring or endorsing entity in the case of individual blanket or franchise polices marketed by means of direct response solicitation,
then in such cases the insurer shall cause to be distributed to prospective insureds a written notice that compensation will or may be paid.
(b) The written notice required by subsection (a) of this section shall be distributed:
(1) Whether compensation is direct or indirect; and
(2) Whether such compensation is paid to or retained by the policyholder or sponsoring or endorsing entity, or paid to or retained by a third party at the direction of the policyholder or sponsoring or endorsing entity, or any entity affiliated therewith by way of ownership, contract or employment.
(c) The notice required by subsection (a) of this section shall be placed on or accompany any application or enrollment form provided prospective insureds.
(d) As used in this section, the following terms shall have the meanings indicated:
(1) “Direct response solicitation” means a solicitation through a sponsoring or endorsing entity through the mails, telephone or other mass communications media;
(2) “Sponsoring or endorsing entity” means an organization which has arranged for the offering of a program of insurance in a manner which communicates that eligibility for participation in the program is dependent upon affiliation with such organization or that it encourages participation in the program.
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 › § 3511. Dependents' coverage.

§ 3511. Dependents' coverage.
Except for a policy issued under § 3503 of this title, a group health insurance policy may be extended to insure the employees or members with respect to their family members or dependents, or any class or classes thereof, subject to the following:
(1) The premium for the insurance shall be paid either from funds contributed by the employer, union, association or other person to whom the policy has been issued, or from funds contributed by the covered person, or from both. Except as provided in paragraph (2) of this section, a policy on which no part of the premium for the family members' or dependents' coverage is to be derived from funds contributed by the covered persons must insure all eligible employees or members with respect to their family members or dependents, or any class or classes thereof.
(2) An insurer may exclude or limit the coverage on any family member or dependent 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 › § 3512. Group health insurance standard provisions generally.

§ 3512. Group health insurance standard provisions generally.
No policy of group health insurance shall be delivered in this State unless it contains in substance the provisions set forth in §§ 3513-3527 of this title or provisions which in the opinion of the Commissioner are more favorable to persons insured, or at least a favorable to the persons insured and more favorable to the policyholder; provided, however,
(1) That §§ 3517, 3519, 3524, 3528 and 3529 of this title shall not apply to policies insuring persons under § 3503 of this title;
(2) That the standard provisions required for individual health insurance policies shall not apply to group health insurance policies; and
(3) That if any provision of this section is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the Commissioner, shall omit from such policy any inapplicable provision or part of a provision and shall modify any inconsistent provision or part of the provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy.
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 › § 3513. Grace period.

§ 3513. Grace period.
A group health insurance policy shall contain a provision that the policyholder is entitled to a grace period of 31 days for the payment of any premium due except the first, during which grace period the policy shall continue in force, unless the policyholder shall have given the insurer written notice of discontinuance in advance of the date of discontinuance and in accordance with the terms of the policy. The policy may provide that the policyholder shall be liable to the insurer for the payment of a pro rata premium for the time the policy was in force during such grace period.
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 › § 3514. Incontestability.

§ 3514. Incontestability.
A group health insurance policy shall contain a provision that the validity of the policy shall not be contested except for nonpayment of premiums, after it has been in force for 2 years from its date of issue; and that no statement made by any person covered under the policy relating to insurability shall be used in contesting the validity of the insurance with respect to which such statement was made after such insurance has been in force prior to the contest for a period of 2 years during such person's lifetime nor unless it is contained in a written instrument signed by the person making such statement; provided, however, that no such provision shall preclude the assertion at any time of defenses based upon the person's ineligibility for coverage under the policy or upon other provisions in the policy.
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 › § 3515. Application; statements deemed representations.

§ 3515. Application; statements deemed representations.
A group health insurance policy shall contain a provision that a copy of the application, if any, of the policyholder shall be attached to the policy when issued, that all statements made by the policyholder or by the person insured shall be deemed representations and not warranties, and that no statement made by any person insured shall be used in any contest unless a copy of the instrument containing the statement is or has been furnished to such person or, in the event of the death or incapacity of the insured person, to the individual's beneficiary or personal representative.
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 › § 3516. Insurability.

§ 3516. Insurability.
A group health insurance policy shall contain a provision setting forth the conditions, if any, under which the insurer reserves the right to require a person eligible for insurance to furnish evidence of individual insurability satisfactory to the insurer as a condition to part or all of the individual's coverage.
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 › § 3518. Misstatement of age.

§ 3518. Misstatement of age.
If the premiums or benefits vary by age, there shall be a provision specifying an equitable adjustment of premiums or of benefits, or both, to be made in the event the age of a covered person has been misstated, such provision to contain a clear statement of the method of adjustment to be used.
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 › § 3519. Certificate.

§ 3519. Certificate.
A group health insurance policy shall contain a provision that the insurer will issue to the policyholder for delivery to each person insured a certificate setting forth a statement as to the insurance protection to which that person is entitled, to whom the insurance benefits are payable, and a statement as to any family members' or dependents' coverage.
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 › § 3520. Notice of claim.

§ 3520. Notice of claim.
A group health insurance policy shall contain a provision that written notice of claim must be given to the insurer within 20 days after the occurrence or commencement of any loss covered by the policy. Failure to give notice within such time shall not invalidate nor reduce any claim if it shall be shown not to have been reasonably possible to give such notice and that notice was given as soon as was reasonably possible.
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 › § 3521. Claim forms.

§ 3521. Claim forms.
A group health insurance policy shall contain a provision that the insurer will furnish to the person making claim, or to the policyholder for delivery to such person, such forms as are usually furnished by it for filing proof of loss. If such forms are not furnished before the expiration of 15 days after the insurer receives notice of any claim under the policy, the person making such claim shall be deemed to have complied with the requirements of the policy as to proof of loss upon submitting, within the time fixed in the policy for filing proof of loss, written proof covering the occurrence, character and extent of the loss for which claim is made.
The nonhospital claim form to be used under this provision is the Health Care Financing Administration Form-1500 or its successor. This form requirement shall not apply to medical payments made by the federal government, prescription drug claims, dental claims or claims using an electronic paperless submission process.
66 Del. Laws, c. 175, §  1;  68 Del. Laws, c. 416, §  2;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter I. Group Health Insurance › § 3522. Proofs of loss; disability.

§ 3522. Proofs of loss; disability.
When applicable, a group health insurance policy shall contain a provision that in the case of claim for loss of time for disability, written proof of such loss must be furnished to the insurer within 90 days after the commencement of the period for which the insurer is liable, and that subsequent written proofs of the continuance of such disability must be furnished to the insurer at such intervals as the insurer may reasonably require, and that in the case of claim for any other loss, written proof of such loss must be furnished to the insurer within 90 days after the date of such loss. Failure to furnish such proof within such time shall not invalidate nor reduce any claim if it was not reasonably possible to furnish such proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity of the claimant, later than 1 year from the time proof is otherwise required.
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 › § 3523. Time for payment of benefits.

§ 3523. Time for payment of benefits.
A group health insurance policy shall contain a provision that all benefits payable under the policy other than benefits for loss of time will be payable not more than 60 days after receipt of proof, and that, subject to due proof of loss, all accrued benefits payable under the policy for loss of time will be paid not less frequently than monthly during the continuance of the period for which the insurer is liable, and that any balance remaining unpaid at the termination of such period will be paid as soon as possible after receipt of such proof.
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 › § 3524. Payment of benefits.

§ 3524. Payment of benefits.
A group health insurance policy shall contain a provision that benefits for loss of life of the person insured shall be payable to the beneficiary designated by the person insured. However, if the policy contains conditions pertaining to family status, the beneficiary may be the family member specified by the policy terms. In either case, payment of these benefits is subject to the provisions of the policy in the event no such designated or specified beneficiary is living at the death of the person insured. All other benefits of the policy shall be payable to the person insured. The policy may also provide that if any benefit is payable to the estate of a person, or to a person who is a minor or otherwise not competent to give a valid release, the insurer may pay such benefit, up to an amount not exceeding $5,000, to any relative by blood or connection by marriage of such person who is deemed by the insurer to be equitably entitled thereto.
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 › § 3525. Physical examinations.

§ 3525. Physical examinations.
A group health insurance policy shall contain a provision that the insurer shall have the right and opportunity to examine the person or the individual for whom claim is made when and so often as it may reasonably require during the pendency of claim under the policy and also the right and opportunity to make an autopsy in the case of death where it is not prohibited by law.
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 › § 3526. Legal actions.

§ 3526. Legal actions.
A group health insurance policy shall contain a provision that no action at law or in equity shall be brought to recover on the policy prior to the expiration of 90 days after proof of loss has been filed in accordance with the requirements of the policy and that no such action shall be brought at all unless brought within 3 years from the expiration of the time within which proof of loss is required by the policy.
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 › § 3527. Information to debtors.

§ 3527. Information to debtors.
In the case of a policy insuring debtors, a group health insurance policy shall contain a provision that the insurer will furnish to the policyholder for delivery to each debtor insured under the policy a certificate of insurance describing the coverage and specifying that the benefits payable shall first be applied to reduce or extinguish the indebtedness.
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 › § 3528. Direct payment of hospital or medical services.

§ 3528. Direct payment of hospital or medical services.
Any group health policy may provide that all or any portion of any indemnities provided by any such policy on account of hospital, nursing, medical or surgical services may, at the insurer's option, be paid directly to the hospital or person rendering such services, but the policy may not require that the service be rendered by a particular hospital or person. Payments so made shall discharge the insurer's obligation with respect to the amount of insurance so paid.
18 Del. C. 1953, §  3504;  56 Del. Laws, c. 380, §  1;  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 › § 3529. Readjustment of premiums; dividends.

§ 3529. Readjustment of premiums; dividends.
Any contract of group health insurance may provide for the readjustment of the rate of premium based upon the experience thereunder. If a policy dividend is hereafter declared or a reduction in rate is hereafter made or continued for the first or any subsequent year of insurance under any policy of group health insurance heretofore or hereafter issued to any policyholder, the excess, if any, of the aggregate dividends or rate reductions under such policy and all other group insurance policies of the policyholder over the aggregate expenditure for insurance under such policies made from funds contributed by the policyholder, or by an employer of insured persons, or by a union or associations which the insured persons belong, including expenditures made in connection with administration of such policies, shall be applied by the policyholder for the sole benefit of insured employees or members.
18 Del. C. 1953, §  3505;  56 Del. Laws, c. 380, §  1;  66 Del. Laws, c. 175, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter II. Blanket Health Insurance › § 3542. Application and certificates not required.

§ 3542. Application and certificates not required.
An individual application need not be required from a person covered under a blanket health policy or contract nor shall it be necessary for the insurer to furnish each person a certificate.
18 Del. C. 1953, §  3508;  56 Del. Laws, c. 380, §  1;  66 Del. Laws, c. 175, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter II. Blanket Health Insurance › § 3543. Payment of benefits under blanket policy.

§ 3543. Payment of benefits under blanket policy.
All benefits under any blanket health policy or contract shall be payable to the person insured, or to his or her designated beneficiary or beneficiaries, or to his or her estate, except that if the person insured be a minor or otherwise not competent to give a valid release, such benefits may be made payable to his or her parent, guardian or other person actually supporting him or her. Except, however, that the policy may provide that all or a portion of any indemnities provided by any such policy on account of hospital, nursing, medical or surgical services may, at the option of the insurer, and unless the insured requests otherwise in writing not later than the time of filing proofs of such loss, be paid directly to the hospital or person rendering such services, but the policy may not require that the service be rendered by a particular hospital or person. Payment so made shall discharge the obligation of the insurer with respect to the amount of insurance so paid.
18 Del. C. 1953, §  3509;  56 Del. Laws, c. 380, §  1;  66 Del. Laws, c. 175, §  1;  70 Del. Laws, c. 186, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3550. Newborn children.

§ 3550. Newborn children.
All group and blanket health insurance policies providing coverage for a family member of the insured or a subscriber shall, as to such family member's 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 in accordance with § 3335 of this title.
59 Del. Laws, c. 529, §  2;  66 Del. Laws, c. 175, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3551. Filing of rates.

§ 3551. Filing of rates.
Except for credit health insurance, the rates of group health insurance and blanket health insurance shall be filed pursuant to and be subject to the requirements of Chapter 25 of this title. Rates for credit health insurance shall be filed pursuant to the requirements of Chapter 37 of this title.
60 Del. Laws, c. 388, §  4;  66 Del. Laws, c. 175, §  1;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3554. Lead poison screening reimbursement [For application of this section, see 83 Del. Laws, c. 75, § 9].

§ 3554. Lead poison screening reimbursement [For application of this section, see 83 Del. Laws, c. 75, § 9].
(a) All group and blanket 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 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 provision 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, §  3;  83 Del. Laws, c. 75, § 7;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3555. Coverage of cancer monitoring tests.

§ 3555. Coverage of cancer monitoring tests.
(a) All group and blanket health insurance policies, which are delivered or issued for delivery in this State by any health insurer, health service corporation or health maintenance organization, and which provide benefits for outpatient services, shall provide to covered persons residing or having their principal place of employment in this State, a benefit for CA-125 monitoring of ovarian cancer subsequent to treatment. Such monitoring shall be deemed a covered service, notwithstanding any policy exclusions for services which are considered experimental or investigative; provided however, that nothing contained herein shall be deemed to provide coverage for routine screening.
(b) Nothing in this section shall prevent the operation of such policy provisions such as deductibles, coinsurance, allowable charge limitations, coordination of benefits or provisions restricting coverage to services by licensed, certified or carrier-approved providers or facilities.
(c) This act shall apply to all policies, contracts or certificates which are issued, renewed, modified, altered, amended or reissued after September 1, 1994.
69 Del. Laws, c. 405, §  2;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3555A. Equal reimbursement for oral and intravenous anticancer medication.

§ 3555A. Equal reimbursement for oral and intravenous anticancer medication.
(a) Every group or blanket policy or contract of health insurance, or certificate issued thereunder, which is delivered, issued for delivery, renewed, modified, altered, or amended in this State on or after January 1, 2013, and which provides medical, major medical, or similar comprehensive-type coverage, and provides coverage for prescription drugs, and which also provides coverage for anticancer medication, must provide coverage for a prescribed, orally administered anticancer medication used to kill or slow the growth of cancerous cells, and must apply the lower cost sharing of either:
(1) Anticancer medication under the prescription drug benefit, or
(2) Intravenous or injected anticancer medications.
For purposes of this section, the term “cost sharing” may include co-pays, coinsurance, and deductibles, as considered appropriate by the Commissioner.
(b) An insurer who provides coverage under this section and any participating entity through which the insurer offers health services may not:
(1) Vary the terms of the policy for the purpose of or with the effect of avoiding compliance with this section;
(2) Provide incentives, monetary or otherwise, to encourage a covered person to accept less than the minimum protections available under this section;
(3) Penalize in any way or reduce or limit the compensation of a healthcare practitioner for recommending or providing care to a covered person in accordance with this section;
(4) Provide incentives, monetary or otherwise, to a healthcare practitioner relating to the services provided pursuant to this section, intended to induce or have the effect of inducing the practitioner to provide care to a covered person in a manner inconsistent with this section; or
(5) Achieve compliance with this section by imposing an increase in cost sharing for an oral, intravenous, or injected anticancer medication covered under the policy on and following May 1, 2012.
(c) Nothing in this section may be interpreted to prohibit an insurer from requiring prior authorization for any anticancer treatment.
(d) Nothing in this section may be interpreted to require coverage for anticancer medication.
78 Del. Laws, c. 233, §  2;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3555B. Coverage of drugs approved for treatment of certain cancers [For application of this section, see 81 Del. Laws, c. 180, §§ 3 and 4].

§ 3555B. Coverage of drugs approved for treatment of certain cancers [For application of this section, see 81 Del. Laws, c. 180, §§ 3 and 4].
No group or blanket policy or contract of health insurance, or certificate issued thereunder which is delivered, issued for delivery, renewed, modified, altered, or amended in this State that directly or indirectly covers the treatment of cancer shall limit or exclude coverage for a drug approved by the United States Food and Drug Administration by mandating that the insured shall first be required to fail to successfully respond to a different drug or drugs or prove a history of failure of such drug or drugs; provided, however that the use of such drug or drugs is consistent with best practices for the treatment of stage 4 advanced, metastatic cancer or in the case of other cancers, the use of the drug is supported by national clinical guidelines, national standards of care, or for the treatment of the cancer, or in the case of targeted therapy, the target at issue.
81 Del. Laws, c. 180, § 2;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3557. Child abuse or neglect — Group coverage.

§ 3557. Child abuse or neglect — Group coverage.
No group or blanket policy, contract or certificate issued thereunder, of health insurance which provides medical coverage for a child and which:
(1) Covers a child who resides in this State; or
(2) Is delivered or issued for delivery within the State
shall limit medical insurance coverage for any child referred by the Division of Family Services or law enforcement agency for suspected child abuse or neglect, including requiring referral by a primary physician.
71 Del. Laws, c. 199, §  17;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3559A-3559C. Insurance coverage for diabetes; annual pap smear coverage reimbursement; colorectal cancer screening.

§§ 3559A-3559C. Insurance coverage for diabetes; annual pap smear coverage reimbursement; colorectal cancer screening.
Transferred to present §§ 3560 to 3562 by 73 Del. Laws, c. 89, § 5, effective June 30, 2001.
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3560. Insurance coverage for diabetes.

§ 3560. Insurance coverage for diabetes.
(a) Every individual or group hospital service corporation contract, individual or group medical service corporation contract, individual or group health service corporation contract, individual health insurance policy, group health insurance policy, and contract for health-care services that provides hospital services, outpatient services, or medical expense benefits and provides coverage for prescription drugs, and is delivered, issued, executed or renewed in this State pursuant to this title or is approved for issuance or renewal in this State by the Insurance Commissioner shall provide benefits to any subscriber or other person covered thereunder for expenses incurred for the following equipment and supplies for the treatment of diabetes if recommended in writing or prescribed by a physician:
insulin pumps, blood glucose meters and strips, urine testing strips, insulin, syringes, and pharmacological agents for controlling blood sugar strips, insulin, syringes, and pharmacological agents for controlling blood sugar.
(b) The benefits required by this section shall be provided to the same extent as for any other sickness under the contract.
(c) This section shall apply to all hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
(d) The Insurance Commissioner may promulgate and periodically update a list of additional diabetes equipment and related supplies that are medically necessary for the treatment of diabetes and for which benefits shall be provided according to the provisions of this section.
(e) This section shall apply to all contracts and policies issued, renewed, modified, altered, amended or reissued 90 days and thereafter from June 30, 2000.
(f) Nothing in this section shall apply to accident-only, specified disease, hospital indemnity, Medicare supplement long-term care, disability income or other limited benefit health insurance policies.
72 Del. Laws, c. 376, §  1;  73 Del. Laws, c. 89, §  5;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3560A. Cost sharing in prescription insulin drugs.

§ 3560A. Cost sharing in prescription insulin drugs.
(a) For purposes of this section, “prescription insulin drug” means a drug containing insulin that is dispensed under Chapter 47 of Title 16 for the treatment of diabetes.
(b) A group or blanket health insurance policy, contract, or certificate that is delivered, issued for delivery, renewed, extended, or modified in this State that provides coverage for prescription insulin drugs must do all of the following:
(1) Cap the total amount that a covered individual is required to pay for covered prescription insulin drugs at no more than $100 per month for each enrolled individual, regardless of the amount or types of insulin needed to fill the covered individual's prescriptions. The $100 per month cap includes deductible payments and cost-sharing amounts charged once a deductible is met.
(2) Include at least 1 formulation of each of the following types of prescription insulin drugs on the lowest tier of the drug formulary developed and maintained by the carrier:
a. Rapid-acting.
b. Short-acting.
c. Intermediate-acting.
d. Long-acting.
(3) For purposes of paragraph (b)(2) of this section, the “lowest tier of the drug formulary” means either of the following:
a. If the prescription insulin drug is a generic drug, the lowest tier for generic drugs.
b. If the prescription insulin drug is a brand-name drug, the lowest tier for brand-name drugs.
(c) Except as provided under paragraph (b)(1) of this section, nothing in this section prevents the operation of a policy provision required by this section as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility.
(d) This section applies to all policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2020.
82 Del. Laws, c. 250, § 2;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3560B. Coverage for insulin pumps.

§ 3560B. Coverage for insulin pumps.
(a) For purposes of this section, “insulin pump” means a small, portable medical device that is approved by the U.S. Food and Drug Administration to provide continuous subcutaneous insulin infusion.
(b) All group and blanket health insurance policies, contracts, or certificates that are delivered, issued for delivery, renewed, extended, or modified in this State shall provide coverage for a medically-necessary insulin pump at no cost to a covered individual, including deductible payments and cost-sharing amounts charged once a deductible is met.
(c) Except as provided under subsection (b) of this section, nothing in this section prevents the operation of a policy provision required by this section as a deductible, coinsurance, allowable charge limitation, coordination of benefits, or a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility.
(d) This section does not apply to any of the following:
(1) Accident-only, specified disease, hospital indemnity, Medicare supplement, long-term care, disability income, or other limited benefit health insurance policies.
(2) A high deductible health plan if providing coverage under subsection (b) of this section would cause the plan to fail to be treated as a high deductible health plan under § 223(c)(2) of the Internal Revenue Code [26 U.S.C. §  223(c)(2)].
(e) This section applies to all policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2021.
83 Del. Laws, c. 241, § 2;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3560C. Cost sharing in diabetes equipment and supplies.

§ 3560C. 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) A 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, § 2;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3561. Annual pap smear coverage reimbursement.

§ 3561. Annual pap smear coverage reimbursement.
All group and blanket health insurance policies which are delivered or issued for delivery in this State by any health insurer, health service corporation, health maintenance organization or any health services and facilities reimbursement program operated by the State and which provide a benefit for outpatient services shall also provide a benefit for an annual benefit for 1 cervical cancer screening, known as a “pap smear,” for all females aged 18 and over.
This section shall apply to all policies, contracts, certificates or programs issued, renewed, modified, altered, amended or reissued on or after January 1, 2001.
72 Del. Laws, c. 408, §  2;  73 Del. Laws, c. 61, §  2;  73 Del. Laws, c. 89, §  5;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3562. Colorectal cancer screening.

§ 3562. Colorectal cancer screening.
(a) All group and blanket health insurance policies which are delivered or issued for delivery or renewed in this State on or after January 1, 2001, by any health insurer or health service corporation shall provide coverage for colorectal cancer screening.
(b) Colorectal cancer screening covered by this section shall include:
(1) For persons 50 years of age or older screening with an annual fecal occult blood test, flexible sigmoidoscopy or colonoscopy, or in appropriate circumstances radiologic imaging or other screening modalities, shall be provided as determined by the Secretary of Health and Social Services of this State after consideration of recommendations of the Delaware Cancer Consortium and the most recently published recommendations established by the American College of Gastroenterology, the American Cancer Society, the United States Preventive Task Force Services for the ages, family histories and frequencies referenced in such recommendations and deemed appropriate by the attending physician.
(2) For persons who are deemed at high risk for colon cancer because of:
a. Family history of familial adenomatous polyposis;
b. Family history of hereditary nonpolyposis colon cancer;
c. Chronic inflammatory bowel disease;
d. Family history of breast, ovarian, endometrial, colon cancer or polyps; or
e. A background, ethnicity or lifestyle such that the health-care provider treating the participant or beneficiary believes he or she is at elevated risk;
screening with an annual fecal occult blood test, flexible sigmoidoscopy or colonoscopy, or in appropriate circumstances radiologic imaging or other screening modalities, or other screening modalities, shall be provided as determined by the Secretary of Health and Social Services of this State after consideration of recommendations of the Delaware Cancer Consortium and the most recently published recommendations established by the American College of Gastroenterology, the American Cancer Society, the United States Preventive Task Force Services for the ages, family histories and frequencies referenced in such recommendations and deemed appropriate by the attending physician.
(3) For all persons covered pursuant to paragraph (b)(1) or (b)(2) of this section, colorectal cancer screening shall include the use of anesthetic agents, including general anesthesia, in connection with colonoscopies and endoscopies performed in accordance with generally-accepted standards of medical practice and all applicable patient safety laws and regulations, if the use of such anesthetic agents is medically necessary in the judgment of the treating physician.
72 Del. Laws, c. 416, §  2;  70 Del. Laws, c. 186, §  1;  73 Del. Laws, c. 89, §  5;  76 Del. Laws, c. 338, §§  3, 4;  76 Del. Laws, c. 406, §  2;
2023 Delaware Code › Title 18 - Insurance Code › Chapter 35. GROUP AND BLANKET HEALTH INSURANCE › Subchapter III. Provisions Applicable to Group and Blanket Health Insurance › § 3563. Required coverage for reconstructive surgery following mastectomy.

§ 3563. Required coverage for reconstructive surgery following mastectomy.
(a) All group and blanket health insurance policies, contracts or certificates that are delivered or issued for delivery in this State by any health insurer, health service corporation or managed care organization which provide medical and surgical benefits with respect to a mastectomy shall provide, in a case of an insured, participant, policyholder, subscriber and beneficiary who is receiving benefits in connection with such mastectomy, in a manner determined in consultation with the attending physician and the patient, coverage for:
(1) All stages of reconstruction of the breast on which the mastectomy has been performed;
(2) Surgery and reconstruction of the other breast to produce a symmetrical appearance; and
(3) Prostheses and physical complications of mastectomy, including lymphedemas.
Such coverage may be subject to annual deductibles and coinsurance provisions as may be deemed appropriate and as are consistent with those established for other benefits under the plan of coverage. Written notice of the availability of such coverage shall be delivered to the insured, participant, policyholder, subscriber and beneficiary upon enrollment and annually thereafter.
(b) All group and blanket health benefit plans shall provide notice to each insured, participant, policyholder, subscriber and beneficiary under such plan regarding the coverage required by this section in accordance herewith. Such notice shall be in writing and prominently positioned in any literature or correspondence made available or distributed by the plan and shall be transmitted:
(1) In the next mailing made by the plan to the insured, participant, policyholder, subscriber and beneficiary;
(2) As part of any yearly informational packet sent to the insured, participant, policyholder, subscriber and beneficiary;
(3) Not later than June 30, 2001, whichever is earliest.
(c) A group or blanket health benefit plan may not deny to a patient eligibility or continued eligibility to enroll or to renew coverage under the terms of the plan solely for the purpose of avoiding the requirements of this section, and may not penalize or otherwise reduce or limit the reimbursement of an attending provider, or provide incentives (monetary or otherwise) to an attending provider, or induce such provider to provide care to an individual insured, participant, policyholder, subscriber and beneficiary in a manner inconsistent with this section.
(d) Nothing in this section shall be construed to prevent a group health benefit plan from negotiating the level and type of reimbursement with a provider for care provided in accordance with this section.
73 Del. Laws, c. 89, §  1;