CHAPTER 419
FORMERLY
HOUSE BILL NO. 446
AS AMENDED BY
HOUSE AMENDMENT NOS. 1 & 2
AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO SUPPLEMENTAL HEALTH INSURANCE COVERAGE FOR CHILDREN OF INSUREDS.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE :
Section 1. Amend Title 18 of the Delaware Code by adding thereto a new section to read:
"§3354. Supplemental coverage for children of insureds.
(a) Definitions. As used in this section:
(1) 'Carrier' means any entity that provides health insurance in this State. For the purposes of this section, carrier includes an insurance company, health service corporation, health maintenance organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation. 'Carrier' also includes any 3rd-party administrator or other entity that adjusts, administers, or settles claims in connection with health benefit plans.
(2) 'Covered person' means a person who claims to be entitled to receive benefits from a carrier.
(3) 'Dependent' means a covered person’s child by blood or by law who:
(A) is less than 24 years of age;
(B) is unmarried;
(C) has no dependents of his or her own;
(D) is a resident of Delaware or is enrolled as a full-time student at an accredited public or private institution of higher education; and
(E) is not actually provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, or church plan, or entitled to benefits under 42 U.S.C. § 1395 et. seq.
(a) If a carrier’s contract with a subscriber provides coverage for a covered person’s dependent under which coverage of the dependent terminates at a specific age before the dependent’s 24th birthday, the contract must nevertheless provide coverage to the dependent after that specific age until the dependent’s 24th birthday.
(b) Subsection (b) of this section may not be construed to require:
(1) coverage for services provided to a dependent prior to the effective date of this section;
(2) that an employer pay all or part of the cost of coverage for a dependent as provided pursuant to this section; or
(3) coverage for services rendered prior to a dependent's election pursuant to subsection (e) of this section and payment of premium required under subsection (g) of this section.
(a) A dependent covered by a covered person’s contract, where coverage under the contract’s language would terminate at a specific age before the dependent’s 24th birthday, may make a written election for coverage as a dependent pursuant to this section, until the dependent’s 24th birthday. The election must be made:
(1) within 30 days prior to the termination of coverage at the specific age provided in the contract’s language;
(2) within 30 days after meeting the requirements for dependent status as set forth in subsection (a) of this section, when coverage for the dependent under the contract’s language had previously terminated; or
(3) during an open enrollment period, as provided pursuant to the contract, if the dependent meets the requirements for dependent status as set forth in subsection (a) of this section during the open enrollment period.
Coverage for a dependent who makes a written election for coverage may not be conditioned upon or discriminate on the basis of lack of evidence of insurability.
(a) Notwithstanding the time limitations imposed by subsection (d) of this section, for twelve months after the effective date of this section, a dependent who qualifies for dependent status as set forth in subsection (a) of this section, but whose coverage as a dependent under a covered person’s contract terminated under the terms of the contract prior to the effective date of this section, may make a written election to reinstate coverage under that contract as a dependent pursuant to this section.
(b) Coverage for a dependent who makes a written election for coverage pursuant to subsection (d) of this section consists of coverage which is identical to the coverage that would have been provided to that dependent had he or she not been terminated from the contract due to his or her age.
(c) A covered person’s contract may require payment of a premium by the covered person or dependent, subject to any approvals required by Delaware law, for any period of coverage relating to a dependent’s written election for coverage pursuant to subsection (d) of this section. The payment may not exceed 102% of the applicable portion of the premium previously paid for that dependent’s coverage under the contract prior to the termination of coverage at the specific age provided in the contract.
(d) The applicable portion of the premium previously paid for a dependent’s coverage under subsection (g) of this section is determined pursuant to regulations promulgated by the Department of Insurance, based upon the difference between the contract’s rating tiers for adult and dependent coverage or family coverage, as appropriate, and single coverage, or based upon any other formula or dependent rating tier which provides a substantially similar result and is considered appropriate by the Department of Insurance.
(e) Coverage for a dependent provided pursuant to this section must be provided until the earlier of the following:
(1) the dependent is no longer a dependent as defined in subsection (a) of this section;
(2) the date on which coverage ceases under the contract by reason of a failure to make a timely payment of any premium required under the contract by the covered person or dependent for coverage provided pursuant to this section. The payment of any premium is considered to be timely if made within 30 days after the due date or within a longer period as provided for by the contract; or
(3) the date upon which the employer under whose contract coverage is provided to a dependent ceases to provide coverage to the covered person.
(a) Prominent notice regarding coverage for a dependent as provided pursuant to this section must be provided to a covered person by the carrier:
(1) in the certificate of coverage prepared for covered persons by the carrier on or about the date of commencement of coverage; and
(2) upon each renewal, but at least once annually; and
(3) within 30 days following the effective date of this section.".
Section 2. Amend Title 18 of the Delaware Code by adding thereto a new section to read:
"§3570. Supplemental coverage for children of insureds.
(a) Definitions. As used in this section:
(1) 'Carrier' means any entity that provides health insurance in this State. For the purposes of this section, carrier includes an insurance company, health service corporation, health maintenance organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation. 'Carrier' also includes any 3rd-party administrator or other entity that adjusts, administers, or settles claims in connection with health benefit plans.
(2) 'Covered person' means a person who claims to be entitled to receive benefits from a carrier.
(3) 'Dependent' means a covered person’s child by blood or by law who:
(A) is less than 24 years of age;
(B) is unmarried;
(C) has no dependents of his or her own;
(D) is a resident of Delaware or is enrolled as a full-time student at an accredited public or private institution of higher education; and
(E) is not actually provided coverage as a named subscriber, insured, enrollee, or covered person under any other group or individual health benefits plan, group health plan, or church plan, or entitled to benefits under 42 U.S.C. §1395 et. seq.
(a) If a carrier’s contract with a subscriber provides coverage for a covered person’s dependent under which coverage of the dependent terminates at a specific age before the dependent’s 24th birthday, the contract must nevertheless provide coverage to the dependent after that specific age until the dependent’s 24th birthday.
(b) Subsection (b) of this section may not be construed to require:
(1) coverage for services provided to a dependent prior to the effective date of this section;
(2) that an employer pay all or part of the cost of coverage for a dependent as provided pursuant to this section; or
(3) coverage for services rendered prior to a dependent's election pursuant to subsection (e) of this section and payment of premium required under subsection (g) of this section.
(a) A dependent covered by a covered person’s contract, where coverage under the contract’s language would terminate at a specific age before the dependent’s 24th birthday, may make a written election for coverage as a dependent pursuant to this section, until the dependent’s 24th birthday. The election must be made:
(1) within 30 days prior to the termination of coverage at the specific age provided in the contract’s language;
(2) within 30 days after meeting the requirements for dependent status as set forth in subsection (a) of this section, when coverage for the dependent under the contract’s language had previously terminated; or
(3) during an open enrollment period, as provided pursuant to the contract, if the dependent meets the requirements for dependent status as set forth in subsection (a) of this section during the open enrollment period.
Coverage for a dependent who makes a written election for coverage may not be conditioned upon or discriminate on the basis of lack of evidence of insurability.
(a) Notwithstanding the time limitations imposed by subsection (d) of this section, for twelve months after the effective date of this section, a dependent who qualifies for dependent status as set forth in subsection (a) of this section, but whose coverage as a dependent under a covered person’s contract terminated under the terms of the contract prior to the effective date of this section, may make a written election to reinstate coverage under that contract as a dependent pursuant to this section.
(b) Coverage for a dependent who makes a written election for coverage pursuant to subsection (d) of this section consists of coverage which is identical to the coverage that would have been provided to that dependent had he or she not been terminated from the contract due to his or her age.
(c) A covered person’s contract may require payment of a premium by the covered person or dependent, subject to any approvals required by Delaware law, for any period of coverage relating to a dependent’s written election for coverage pursuant to subsection (d) of this section. The payment may not exceed 102% of the applicable portion of the premium previously paid for that dependent’s coverage under the contract prior to the termination of coverage at the specific age provided in the contract.
(d) The applicable portion of the premium previously paid for a dependent’s coverage under subsection (g) of this section is determined pursuant to regulations promulgated by the Department of Insurance, based upon the difference between the contract’s rating tiers for adult and dependent coverage or family coverage, as appropriate, and single coverage, or based upon any other formula or dependent rating tier which provides a substantially similar result and is considered appropriate by the Department of Insurance.
(e) Coverage for a dependent provided pursuant to this section must be provided until the earlier of the following:
(1) the dependent is no longer a dependent as defined in subsection (a) of this section;
(2) the date on which coverage ceases under the contract by reason of a failure to make a timely payment of any premium required under the contract by the covered person or dependent for coverage provided pursuant to this section. The payment of any premium is considered to be timely if made within 30 days after the due date or within a longer period as provided for by the contract; or
(3) the date upon which the employer under whose contract coverage is provided to a dependent ceases to provide coverage to the covered person.
(a) Prominent notice regarding coverage for a dependent as provided pursuant to this section must be provided to a covered person by the carrier:
(1) in the certificate of coverage prepared for covered persons by the carrier on or about the date of commencement of coverage; and
(2) upon each renewal, but at least once annually; and
(3) within 30 days following the effective date of this section.".
Section 3. This Act becomes effective 90 days after the State of Delaware provides benefits fully consistent with its provisions for participants in the State of Delaware’s employee benefit plan.
Section 4. Notwithstanding any other language in this Act, the surcharge imposed on participants in the State employee benefit plan who wish to purchase the additional benefits provided for by this Act must be sufficient to fund the anticipated medical costs associated with those benefits.
Approved July 10, 2006