Terms Used In Delaware Code > Title 18 > Chapter 21 - Unauthorized Insurers -- Prohibitions, Process and Advertising

• 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.
• Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
• Answer: The formal written statement by a defendant responding to a civil complaint and setting forth the grounds for defense.
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• Attorney-at-law: A person who is legally qualified and licensed to practice law, and to represent and act for clients in legal proceedings.
• 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}
• Claim: means a request from a pharmacy or pharmacist to be reimbursed for the cost of filling or refilling a prescription for a drug or for providing a medical supply or device. See Delaware Code Title 18 Sec. 3321A
• Contract: A legal written agreement that becomes binding when signed.
• Contracted pharmacy: means a pharmacy that participates in the network of a pharmacy benefits manager through a contract with a pharmacy benefits manager, a pharmacy services administration organization, or a group purchasing organization. See Delaware Code Title 18 Sec. 3321A
• Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
• Drug shortage list: means a list of drug products listed on the federal Food and Drug Administration's Drug Shortages website. See Delaware Code Title 18 Sec. 3321A
• Emergency: means a situation that will result in loss of life, limb or organ function. See Delaware Code Title 18 Sec. 3335A
• Fraud: Intentional deception resulting in injury to another.
• Freedom of Information Act: A federal law that mandates that all the records created and kept by federal agencies in the executive branch of government must be open for public inspection and copying. The only exceptions are those records that fall into one of nine exempted categories listed in the statute. ^{Source: OCC}
• Insurer: means any entity that provides health insurance coverage in this State as defined in § 903 of this title. See Delaware Code Title 18 Sec. 3321A
• Maximum allowable cost: means the maximum amount that a pharmacy benefits manager will reimburse a pharmacist or pharmacy for the cost of a multi-sourced drug, medical product, or device. See Delaware Code Title 18 Sec. 3321A
• Maximum allowable cost list: means the multi-source generic drugs, medical products, and devices for which a maximum allowable cost has been established by a pharmacy benefits manager or a purchaser. See Delaware Code Title 18 Sec. 3321A
• Network providers: means those pharmacists and pharmacies who provide covered health-care services or supplies to an insured or a member pursuant to a contract with an insurer or pharmacy benefits manager. See Delaware Code Title 18 Sec. 3321A
• Pharmacist: means as defined under § 2502 of Title 24. See Delaware Code Title 18 Sec. 3321A
• Pharmacy: means as defined under § 2502 of Title 24. See Delaware Code Title 18 Sec. 3321A
• Pharmacy benefit manager: has the meaning given in § 3302A of this title. See Delaware Code Title 18 Sec. 3335A
• Pharmacy benefits management services: means as defined under § 3351A of this title. See Delaware Code Title 18 Sec. 3321A
• Pharmacy benefits manager: means as defined under § 3302A of this title. See Delaware Code Title 18 Sec. 3321A
• Plaintiff: The person who files the complaint in a civil lawsuit.
• Prior authorization: means a requirement by a carrier or health-insurance plan that providers submit a request or other prior notification to the carrier for evaluation of appropriateness of the request or if the prescription is medically necessary before treatment is rendered. See Delaware Code Title 18 Sec. 3335A
• Purchaser: means as defined under § 3351A of this title. See Delaware Code Title 18 Sec. 3321A
• Service of process: The service of writs or summonses to the appropriate party.
• Subpoena: A command to a witness to appear and give testimony.
• United States: includes its territories and possessions and the District of Columbia. See Delaware Code Title 1 Sec. 302