Terms Used In Delaware Code > Title 19 > Chapter 23 > Subchapter IV - Compulsory Insurance, Self-Insurance and Substitute Compensation Systems

• 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
• 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.
• Applicant: shall mean :

  a. See Delaware Code Title 18 Sec. 7103

• Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
• 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• Board: means the board of directors of the program established pursuant to § 7210 of this title [repealed].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
• Certificate: shall mean , for the purposes of this chapter, any certificate issued under a group long-term care insurance policy, which policy has been delivered or issued for delivery in this State. See Delaware Code Title 18 Sec. 7103
• Child: means a person who has not reached the age of 18 years. See Delaware Code Title 1 Sec. 302
• 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: shall mean the Insurance Commissioner of this State. See Delaware Code Title 18 Sec. 7103
• 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
• Continuance: Putting off of a hearing ot trial until a later time.
• Contract: A legal written agreement that becomes binding when signed.
• 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

• Damages: Money paid by defendants to successful plaintiffs in civil cases to compensate the plaintiffs for their injuries.
• 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
• Employee: means every person in service of any corporation (private, public, municipal or quasi-public), association, firm or person, excepting those employees excluded by this subchapter, under any contract of hire, express or implied, oral or written, or performing services for a valuable consideration, excluding spouse and minor children of a farm employer unless the spouse or minor child is a bona fide employee of a farm employer and is named in an endorsement to the farm employer's contract of insurance, and excluding any person whose employment is casual and not in the regular course of the trade, business, profession or occupation of his or her employer, and not including persons to whom articles or materials are furnished or repaired, or adopted for sale in the worker's own home, or on the premises not under the control or management of the employer. See Delaware Code Title 19 Sec. 2301
• 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
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• Group long-term care insurance: shall mean a long-term care insurance policy which is delivered or issued for delivery in this State and issued to:

  a. See Delaware Code Title 18 Sec. 7103

• 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

• 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
• Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
• 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
• Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
• Long-term care insurance: shall mean any insurance policy or rider advertised, marketed, offered or designed to provide coverage for not less than 12 consecutive months for each covered person on an expense incurred, indemnity, prepaid or other basis, for 1 or more necessary or medically necessary diagnostic, preventive, therapeutic, rehabilitative, maintenance or personal care services, provided in a setting other than an acute care unit of a hospital. See Delaware Code Title 18 Sec. 7103
• 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
• Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
• 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
• Policy: shall mean , for the purposes of this chapter, any policy, contract, subscriber agreement, rider or endorsement delivered or issued for delivery in this State by an insurer; fraternal benefit society; nonprofit health, hospital or medical service corporation; prepaid health plan; health maintenance organization or any similar organization. See Delaware Code Title 18 Sec. 7103
• 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
• Program: means the Delaware Small Employer Reinsurance Program created by § 7210 of this title [repealed]. See Delaware Code Title 18 Sec. 7202
• 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
• Rescission: The cancellation of budget authority previously provided by Congress. The Impoundment Control Act of 1974 specifies that the President may propose to Congress that funds be rescinded. If both Houses have not approved a rescission proposal (by passing legislation) within 45 days of continuous session, any funds being withheld must be made available for obligation.
• 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
• 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
• Trustee: A person or institution holding and administering property in trust.
• 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
• United States: includes its territories and possessions and the District of Columbia. 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 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