Terms Used In Delaware Code > Title 18 > Chapter 72 - Small Employer Health Insurance

• Actuarial certification: means a written statement by a member of the American Academy of Actuaries, or other individual acceptable to the Commissioner, that a small employer carrier is in compliance with the provisions of § 7205 of this title, based upon an examination and including a review of the appropriate records and the actuarial assumptions and methods used by the small employer carrier in establishing premium rates for applicable health benefit plans. See Delaware Code Title 18 Sec. 7202
• Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
• affiliated: means any entity or person who directly or indirectly through 1 or more intermediaries, controls or is controlled by, or is under common control with, a specified entity or person. See Delaware Code Title 18 Sec. 7202
• Affiliation period: means a period of time not to exceed 2 months (3 months for late enrollees) during which a health maintenance organization does not collect premiums and coverage issued is not effective. See Delaware Code Title 18 Sec. 7202
• Base premium rate: means , for each class of business as to a rating period, the lowest premium rate charged or that could have been charged under a rating system for that class of business by the small employer carrier to small employers with similar case characteristics for health benefit plans with the same or similar coverage. See Delaware Code Title 18 Sec. 7202
• 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
• Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. ^{Source: OCC}
• Board: means the Industrial Accident Board. See Delaware Code Title 19 Sec. 2301
• Board: means the board of directors of the program established pursuant to § 7210 of this title [repealed]. See Delaware Code Title 18 Sec. 7202
• Bona fide association: means , with respect to health insurance coverage offered in Delaware, an association which:

  a. See Delaware Code Title 18 Sec. 7202

• Carrier: means any entity that provides health insurance in this State. See Delaware Code Title 18 Sec. 7202
• Case characteristics: means demographic or other objective characteristics of a small employer that are considered by the small employer carrier in the determination of premium rates for the small employer, provided that claim experience, health status and duration of coverage shall not be case characteristics for the purposes of this chapter. See Delaware Code Title 18 Sec. 7202
• Class of business: means all of a carrier's business unless more than 1 class is established pursuant to § 7204 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
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Creditable coverage: means , with respect to an individual, health benefits or coverage provided under any of the following:

  a. See Delaware Code Title 18 Sec. 7202

• Department: means the Department of Labor. See Delaware Code Title 19 Sec. 2301
• Dependent: A person dependent for support upon another.
• Dependent: means a spouse, a child under the age of 26 years, and an unmarried child of any age who is medically certified as totally disabled and dependent upon the parent. See Delaware Code Title 18 Sec. 7202
• Eligible employee: means an employee who works on a full-time basis and has a normal work week of 30 or more hours. See Delaware Code Title 18 Sec. 7202
• Employer: includes all those who employ others unless they are excluded from the application of this chapter by any provision of this subchapter, and if the employer is insured, the term shall include the insurer as far as practicable; employer shall also include the governing body for which employable relief recipients are assigned work under §§ 901-905 of Title 31. See Delaware Code Title 19 Sec. 2301
• 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
• Fiscal year: The fiscal year is the accounting period for the government. For the federal government, this begins on October 1 and ends on September 30. The fiscal year is designated by the calendar year in which it ends; for example, fiscal year 2006 begins on October 1, 2005 and ends on September 30, 2006.
• 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
• Health status-related factor: means any of the following factors:

  a. See Delaware Code Title 18 Sec. 7202

• Index rate: means , for each class of business as to a rating period for small employers, the arithmetic average of the applicable base premium rate and the corresponding highest premium rate. See Delaware Code Title 18 Sec. 7202
• Insurance carrier: means any insurance corporation, mutual association or company or interinsurance exchange which insures employers against liability under this chapter or against liability at common law for accidental injuries to employees. See Delaware Code Title 19 Sec. 2301
• Late enrollee: means an eligible employee or dependent who requests enrollment in a group health benefit plan following the initial enrollment period during which such individual is entitled to enroll under the terms of the health benefit plan, if such initial enrollment period is a period of at least 30 days. See Delaware Code Title 18 Sec. 7202
• Medical care: means amounts paid for:

  a. See Delaware Code Title 18 Sec. 7202

• Month: means a calendar month, unless otherwise expressed. See Delaware Code Title 1 Sec. 302
• New business premium rate: means , for each class of business as to a rating period, the lowest premium rate charged or offered or which could have been charged or offered by the small employer carrier to small employers with similar case characteristics for newly issued health benefit plans with the same or similar coverage. See Delaware Code Title 18 Sec. 7202
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Plan of operation: means the plan of operation of the program established pursuant to § 7210 of this title [repealed]. See Delaware Code Title 18 Sec. 7202
• Premium: means all moneys paid by a small employer and eligible employees as a condition of receiving coverage from a small employer carrier, including any fees or other contributions associated with the health benefit plan. See Delaware Code Title 18 Sec. 7202
• Producer: means agent and/or broker. 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
• qualifying existing coverage: means benefits or coverage provided under:

  a. See Delaware Code Title 18 Sec. 7202

• Quorum: The number of legislators that must be present to do business.
• Rating period: means the calendar period for which premium rates established by a small employer carrier are assumed to be in effect. See Delaware Code Title 18 Sec. 7202
• Reinsuring carrier: means a small employer carrier participating in the reinsurance program pursuant to § 7210 of this title [repealed]. See Delaware Code Title 18 Sec. 7202
• Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
• Restricted network provision: means any provision of a health benefit plan that conditions the payment of benefits, in whole or in part, on the use of health-care providers that have entered into a contractual arrangement with the carrier pursuant to Chapter 64 of this title or otherwise to provide health-care services to covered individuals. 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
• Standard health benefit plan: means a health benefit plan developed pursuant to § 7211 of this title. See Delaware Code Title 18 Sec. 7202
• Unhealthy lifestyle choices: means smoking or maintaining excessive weight, blood pressure or cholesterol, other than due to organic causes that are being treated by a physician, as those conditions or actions may be more fully defined by regulation by the Commissioner. See Delaware Code Title 18 Sec. 7202
• Waiting period: means , with respect to a group health plan and an individual who is a potential participant in or beneficiary of the plan, the period that must pass with respect to the individual before the individual is eligible for benefits under the terms of the plan. See Delaware Code Title 18 Sec. 7202
• Year: means a calendar year, and is equivalent to the words "year of our Lord. See Delaware Code Title 1 Sec. 302