Delaware Code Title 18 Sec. 7206 – Renewability of coverage
(a) A health benefit plan subject to this chapter shall be renewable with respect to all eligible employees or dependents, at the option of the small employer, except in any of the following cases:
(1) Nonpayment of the required premiums;
(2) Fraud or misrepresentation of the small employer or, with respect to coverage of individual insureds, the insureds or their representatives;
(3) Noncompliance with the carrier‘s minimum participation requirements;
(4) Noncompliance with the carrier’s employer contribution requirements;
(5) Repeated misuse of a provider network provision;
(6) The small employer carrier elects to nonrenew all of its health benefit plans delivered or issued for delivery to small employers in this State. In such a case the carrier shall:
a. Provide advance notice of its decision under this paragraph to the commissioner in each state in which it is licensed; and
b. Provide notice of the decision not to renew coverage to all affected small employers and to the commissioner in each state in which an affected insured individual is known to reside at least 180 days prior to the nonrenewal of any health benefit plans by the carrier. Notice to the commissioner under this subparagraph shall be provided at least 3 working days prior to the notice to the affected small employers;
(7) The Commissioner finds that the continuation of the coverage would:
a. Not be in the best interests of the policyholders or certificate holders;
b. Impair the carrier’s ability to meet its contractual obligations.
In such instance the Commissioner shall assist affected small employers in finding replacement coverage;
(8) With respect to a carrier that offers a health benefit plan through a managed care plan, there is no longer any enrollee in connection with such plan that lives, resides or works in the service area of the carrier;
(9) An employer is no longer actively engaged in the business in which it was engaged on the effective date of the plan; or
(10) With respect to coverage that is made available only through 1 or more bona fide associations, the membership of an employer ceases.
Terms Used In Delaware Code Title 18 Sec. 7206
- Carrier: means any entity that provides health insurance in this State. See Delaware Code Title 18 Sec. 7202
- Commissioner: means the Insurance Commissioner of this State. See Delaware Code Title 18 Sec. 7202
- Established geographic service area: means a geographic area, as approved by the Commissioner and based on the carrier's certificate of authority to transact insurance in this State, within which the carrier is authorized to provide coverage. See Delaware Code Title 18 Sec. 7202
- Fraud: Intentional deception resulting in injury to another.
- Health benefit plan: means any hospital or medical expense policy or certificate, hospital or medical service corporation contract, health maintenance organization or health service corporation subscriber contract or any other similar health contract, including a high deductible medical expense policy used in conjunction with a medical savings account, subject to the jurisdiction of the Commissioner available for use, offered or sold to an individual in the State of Delaware. See Delaware Code Title 18 Sec. 7202
- Small employer: means any person, firm, corporation, partnership or association that is actively engaged in business that, on at least 50% of its working days during the preceding calendar quarter, employed no more than 50 eligible employees, the majority of whom were employed within this State. See Delaware Code Title 18 Sec. 7202
- Small employer carrier: means a carrier that offers health benefit plans covering eligible employees of 1 or more small employers in this State. See Delaware Code Title 18 Sec. 7202
- State: means the State of Delaware; and when applied to different parts of the United States, it includes the District of Columbia and the several territories and possessions of the United States. See Delaware Code Title 1 Sec. 302
(b) A small employer carrier that elects not to renew a health benefit plan under paragraph (a)(6) of this section shall be prohibited from writing new business in the small employer market in this State for a period of 5 years from the date of notice to the Commissioner.
(c) In the case of a small employer carrier doing business in 1 established geographic service area of the State, the rules set forth in this chapter shall apply only to the carrier’s operations in that service area.
68 Del. Laws, c. 175, § ?1; 68 Del. Laws, c. 340, § ?1; 71 Del. Laws, c. 143, § ?7;