Delaware Code Title 18 Sec. 7209 – Application to become a risk-assuming carrier
(a) A small employer carrier may apply to become a risk-assuming carrier by filing an application with the Commissioner in a form and manner prescribed by the Commissioner.
Terms Used In Delaware Code Title 18 Sec. 7209
- 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
- Program: means the Delaware Small Employer Reinsurance Program created by § 7210 of this title [repealed]. See Delaware Code Title 18 Sec. 7202
- Risk-assuming carrier: means a small employer carrier whose application is approved by the Commissioner pursuant to § 7209 of this title. 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) The Commissioner shall consider the following factors in evaluating an application filed under subsection (a) of this section:
(1) The carrier’s financial condition;
(2) The carrier’s history of rating and underwriting small employer groups;
(3) The carrier’s commitment to market fairly to all small employers in the State or its established geographic service area, as applicable;
(4) The carrier’s experience with managing the risk of small employer groups; and
(5) The effect of approval and disapproval on the small employer insurance market and the Delaware Small Employer Health Reinsurance Program pursuant to § 7210 of this title [repealed].
(c) The Commissioner may rescind the approval granted to a risk-assuming carrier under this section if the Commissioner finds that:
(1) The carrier’s financial condition will no longer support the assumption of risk from issuing coverage to small employers in compliance with § 7207 of this title without the protection afforded by the Program;
(2) The carrier has failed to market fairly to all small employers in the State or its established geographic service area, as applicable; or
(3) The carrier has failed to provide coverage to eligible small employers as required in § 7207 of this title.
(d) A small employer carrier electing to be a risk-assuming carrier shall not be subject to the provisions of § 7210 of this title [repealed].