Delaware insurance law and regulation
News that affects your health insurance and planning
June 16, 2019 – Status of alternative non-ACA health plans: Delaware does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, does not permit insurers to sell non-compliant transitional policies in the individual market. Delaware limits the sale of short-term coverage more strictly than the federal government. A maximum policy of 3 months is allowed on an initial policy and a maximum under multiple policies of up to 3 months per year is allowed.
March 19, 2019 – A Delaware Insurance Department official addressed the reasons that Association Health Plans are not gaining traction as some federal administrators had hoped. In August 2018 the Department of Labor introduced a final rule for Association Health Plans that did not pre-empt state law governing associations and health plans, resulting in dual regulation at both a state and federal level. For now, this is not a viable option for Delaware residents.
12/20/2018 – The state of Delaware has significantly higher health care costs than the national average and the state spends 30% of its budget on health costs vs about 20% foot the nation. One of the measures to combat his is adoption of price control benchmark that is designed to keep price increases at 3.8% for the coming year. We do not know how well the price benchmark program will work.
12/15/2018 – The Dover Amish do not believe in insurance but manage their health care costs anyway.
11/13/2018 – The Trump administration approved a new type of less expensive health insurance. The new short term insurance offers less coverage and is available for a full year in other states. However,Delaware state officials are limiting its use within the state to a maximum of 3 months. Delaware residents can likely still buy the full years’ coverage when they are outside their home state.
The history of health care planning in Delaware (Information is outdated and links may be expired)
9/3/2015 Highmark Health will offer fewer health insurance product choices in 2016 to the residents of Pennsylvania, Delaware and West Virginia.
8/29/2014 Choose Health Delaware scheduled a series of seminars to be held in the month of September for enrollers advance of the fall open enrollment system. The entent is to avoid some of theproblems that characterized last year’s enrollment season. Health insurance lans and rates for 2015 have already been reviewed by the Department of Insurance.
2/11/ 2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.
7/26/2013 Affordable Smart Term Life Insurance is now available to most Delaware residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
2/27/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
7/12/2012 Blue Cross Blue Shield of Delaware that covers 395,000 people in the state has been renamed Highmark Blue Cross Blue Shield Delaware. Pittsburg-based Highmark covers almost 5 million people in the region (Pennsylvania, West Virginia and Delaware) and is one of the largest Blue Cross organizations in the U.S.
7/3/2012 Delaware’s legislature passed a mandate to add coverage for autism and specialty drugs. The new law will boost the cost of all types of major medical insurance.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS)reported that as of June 30, 2011 Blue Cross Blue Shield of Delaware, Aetna Health and Coventry Health Care of Delaware are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
10/17/2011 State law H 161 enacted as Chapter No. 141 on 7/25/2011 requires that individual health insurance coverage be available to children under the age of 19 with pre-existing medical conditions.
3/2/2011 2011 premium rate increases: Delaware’s Insurance Commissioner Karen Weldin Stewart announced the 2011 rate increase approval of 9.9% for Golden Rule Insurance Company (operating as UnitedHealthOne). The company had requested a 10.4% increase. Standard Security Life Insurance rate increase of 9.8% was approved as requested. The largest approved rate increases were for Celtic Insurance, Time Insurance (operating as Assurant Health) and John Alden Insurance Company all above 29%. Other health insurance companies in Delaware may have rate increase requests still pending review so policies applied for now are still issued at 2010 rates.
2/12/2011 With dozens of health plans choices available online offering a wide range of pricing and benefits, how do you find the best combination of price and benefits? Celtic Insurance realizes that the choices can be overwhelming; the company offers more than 40 possible health plan designs in many parts of the United States. A new feature called “Help Me Choose” lets users easily and quickly select the benefits they value most and narrows the list down to a few of the best choices. No personal information is required other than zip code and date of birth.
2/7/2011 The state’s pre-existing condition insurance plan (PCIP) monthly premium rates (per person):
PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods. PCIP applicants who are approved to participate in PCIP can choose from three plan options, with different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays. The HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt account where you can deposit funds for eligible medical expenses. Each of the three PCIP plan options provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a deductible before PCIP pays for your health care and prescriptions. After you pay the deductible, you will pay 20% of medical costs in-network. The maximum you will pay out-of-pocket for covered services in a calendar year is $5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the amount the plan pays for your care. If you apply for PCIP coverage on the government Web site, you will be billed for the premium once your application is approved. You will need to send in your payment in order for your coverage to be effective. Please do not send in the premium before you are billed. Note that your premium may increase if you age into a higher rate tier, or if PCIP adjusts its premiums to any changes in the commercial market.
12/16/2010 Delaware Department of Health and Social Services officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, Delaware Department of Health and Social Services said that it would: 1) Conduct a planning process involving key stakeholders that will enable the State to make an informed decision concerning the implementation of a Health Benefit Exchange, 2) Identify the advantages and disadvantages of implementing a State-run Exchange, a regional Exchange, or an Exchange administered by the federal government, 3) Utilize State resources, consultant support, and stakeholder participation to inform decision-making related to the establishment of an Exchange in the State of Delaware, 4) Solicit the widest-possible involvement from public and private stakeholders through the development of targeted working groups as appropriate, and 5) Convene public meetings which will provide a vehicle for both dissemination of information and citizen feedback.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in Delaware is now available at Freedom Benefits.
11/12/2009 A statute is approved to add virtual colonoscopy as an approved colorectal screening modality.