Delaware Code Title 18 Sec. 7211 – Health benefit plan committee
(a) The Commissioner shall appoint a Health Benefit Plan Committee. The Committee shall be composed of representatives of carriers, small employers and employees, health-care providers and producers.
Terms Used In Delaware Code Title 18 Sec. 7211
- Basic health benefit plan: means a lower cost health benefit plan developed pursuant to § 7211 of this title. See Delaware Code Title 18 Sec. 7202
- Commissioner: means the Insurance Commissioner of this State. See Delaware Code Title 18 Sec. 7202
- Committee: means the Health Benefit Plan Committee created pursuant to § 7211 of this title. See Delaware Code Title 18 Sec. 7202
- 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
- Standard health benefit plan: means a health benefit plan developed pursuant to § 7211 of this title. See Delaware Code Title 18 Sec. 7202
(b) The Committee shall recommend the form and level of coverages to be made available by small employer carriers pursuant to § 7207 of this title.
(c) The Committee shall recommend benefit levels, cost sharing levels, exclusions and limitations for the basic health benefit plan and the standard health benefit plan. The Committee shall also design a basic health benefit plan and a standard health benefit plan which contain benefit and cost sharing levels that are consistent with the basic method of operation and the benefit plans of health maintenance organizations, including any restrictions imposed by federal law.
(1) The plans recommended by the Committee may include cost containment features such as:
a. Utilization review of health-care services, including review of medical necessity of hospital and physician services;
b. Case management;
c. Selective contracting with hospitals, physicians and other health-care providers;
d. Reasonable benefit differentials applicable to providers that participate or do not participate in arrangements using restricted network provisions; and
e. Other managed care provisions.
(2) The Committee shall submit the health benefit plans described in paragraph (c)(1) of this section to the Commissioner and the Delaware Health Care Commission for approval within 180 days after the appointment of the Committee.