Delaware Code Title 18 Sec. 3573 – Limitations on preexisting condition limitations
A health benefit plan that covers a large group in this State:
(1) Shall not deny, exclude or limit benefits for a covered individual because of a preexisting condition;
(2) May impose an affiliation period. An affiliation period shall run concurrently with any waiting period. A health maintenance organization may, in lieu of an affiliation period, use an alternative method to address adverse selection with the prior approval of the Commissioner;
(3) Shall waive an affiliation period for the period of time an individual was previously covered by creditable coverage if such creditable coverage was continuous to a date not more than 63 days prior to the effective date of the new coverage. For purposes of calculating continuous coverage, a waiting period shall not be considered a gap in coverage. This paragraph shall not preclude application of any waiting period applicable to all new enrollees under the plan. The method of crediting and certifying coverage shall be determined by the Commissioner by regulation; and
(4) May not exclude coverage for late enrollees for a preexisting condition.
Terms Used In Delaware Code Title 18 Sec. 3573
- 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 premium and coverage issued is not effective. See Delaware Code Title 18 Sec. 3572
- Creditable coverage: means , with respect to an individual, health benefits or coverage provided under any of the following:
- Dependent: A person dependent for support upon another.
- Health benefit plan: means any hospital or medical policy or certificate, major medical expense insurance policy or certificate, any hospital or medical service plan contract, health maintenance organization or health service corporation subscriber contract or any other similar health contract subject to the jurisdiction of the Commissioner. See Delaware Code Title 18 Sec. 3572
- 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
- Waiting period: means , with respect to a group health plan and an individual who is a potential participant or beneficiary in 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. 3572
A health benefit plan shall not establish rules for eligibility for any individual to enroll under the plan based on any health status-related factors in relation to the individual or a dependent of the individual.
71 Del. Laws, c. 143, § ?14; 73 Del. Laws, c. 89, § ?1; 76 Del. Laws, c. 176, § ?3; 79 Del. Laws, c. 99, § ?9;