CHAPTER 444

FORMERLY

SENATE BILL NO. 335

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO HEALTH INSURANCE FOR CHILDREN AND MEDICAID RECIPIENTS.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:

Section 1. Amend Title 18 of the Delaware Code by adding a new chapter to read as follows:

"Chapter 40. Health Insurance for Children and Persons on Medicaid. Section 4001. Scope of Chapter.

The provisions of this chapter shall apply to:

(1) Any insurer providing insurance of human beings against bodily injury, disablement or death by accident or accidental means, or the expense thereof, or against disablement or expense resulting from sickness, and every insurance appertaining thereto;

(2) A health service corporation, notwithstanding any provision to the contrary in Chapter 63 of this title;

(3) A health maintenance organization, notwithstanding any provision to the contrary in Chapter 64 of this title;

(4) A group health plan, as defined in section 607 (1) of the Federal Employee Retirement Income Security Act of 1974;

(5) An entity offering a service benefit plan;

(6) A self-funded entity or group providing health care coverage; and

(1) Any person or entity which provides coverage in this State for

medical, surgical, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital, or optometric expenses, whether such coverage is by direct payment, reimbursement or otherwise.

Section 4002. Health Insurance for Children.

(a) No health Insurer shall deny enrollment of a child under the health coverage of the child's parent on the ground that:

(1) the child was born out of wedlock;

(2) the child is not claimed as a dependent on the parent's Federal income tax return; or

(1) the child does not reside with the parent or in the insurer's
service area.

(b) In any case in which a parent is required by a court or administrative order to provide health coverage for a child and the parent Is eligible for family health coverage through a health insurer, such health insurer shall;

(1) permit such parent to enroll under such family coverage any such child who is otherwise eligible for such coverage (without regard to any enrollment season restrictions);

(2) if such parent is enrolled but falls to make application to obtain coverage of such child, enroll such child under such family coverage upon application by the child's other parent or by a State agency administering a program under part D, Title IV of the Federal Social Security Act, or Title XIX of the Federal Social Security Act; and Chapter 444

(3) not disenroll (or eliminate coverage of) such a child unless the health insurer is provided satisfactory written evidence that:

(A) such court or administrative order is no longer in effect, or

(B) the child is or will be enrolled in comparable health coverage through another health insurer which will take effect not later than the effective date of such disenrollment.

(c) In any case in which a child has health coverage through the health insurer of a noncustodial parent, the insurer shall:

(1) provide such information to the custodial parent as may be necessary for the child to obtain benefits through such coverage;

(2) permit the custodial parent (or provider, with the custodial parent's approval) to submit claims for covered services without the approval of the noncustodial parent; and

(1) make payment on claims submitted in accordance with paragraph (2) directly to such custodial parent, the provider, or the State agency administering a program under part D, Title IV of the Federal Social Security Act or Title XIX of the Federal Social Security Act.

Section 4003. Health Insurance for Persons on Medicaid.

(a) No health insurer, in enrolling an individual or in making any payments for benefits to the individual or on the individual's behalf, shall take into account that the individual is eligible for or is provided medical assistance under a Medicaid Plan of this State or any other State.

(a) Where a State agency has been assigned the rights of an individual eligible for medical assistance under Title XIX of the Federal Social Security Act and such individual is covered for health benefits from a health insurer, no such health insurer shall impose requirements on the State agency that are different from requirements applicable to an agent or assignee of any other individual so covered.

Section 4004. Definition.

For the purposes of this chapter, the term "health insurer" includes, without limitation, an insurer providing insurance of human beings against bodily injury, disablement or death by accident or accidental means, or the expense thereof, or against disablement or expense resulting from sickness, and every insurance appertaining thereto; a health service corporation, a health maintenance organization; a group health plan, as defined in Section 607 (1) of the Federal Employee Retirement Income Security Act of 1974; and entity offering a service benefit plan; a self-funded entity or group providing health care coverage; and any person or other entity which provides coverage in this State for medical, surgical, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital, or optometric expenses, whether such coverage is by direct payment, reimbursement or otherwise.

Section 4005. Administrative Procedures.

The Commissioner may issue regulations in accordance with Section 314 of this Title and Chapter 101 of Title 29 for the implementation and administration of this chapter."

Section 2. Separability.

If any section, subsection, sentence, clause or provision of this act is held invalid, the remainder of this Act shall not be affected.

Approved July 15, 1994.