CHAPTER 157

FORMERLY

SENATE BILL NO. 71

AS AMENDED BY

SENATE AMENDMENT NO. 2

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO HEALTH INSURANCE AND BENEFITS.

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

Section 1. Amend §3343(a)(1), Title 18, Delaware Code by adding the following sentence to the end of that paragraph: “Carrier also includes any third-party administrator or other entity that adjusts, administers, or settles claims in connection with health benefit plans.”

Section 2. Amend Section 3577(a)(1), Title 18, Delaware Code, by adding a new sentence at the end of that paragraph to read as follows:

“Carrier also includes any third-party administrator or other entity that adjusts; administers or settles claims in connection with health benefit plans.”

Section 3. Amend §3602(3), Title 18, Delaware Code, by adding a sentence at the end of that subsection to read as follows: “Carrier also includes any third-party administrator or other entity that adjusts, administers, or settles claims in connection with health benefit plans.”

Section 4. Amend Title 18, Section 102 of the Delaware Code by adding a new subsection (12) thereto to read as follows:

"(12) ‘Third Party Administrator’ shall mean a person, firm or entity who directly or indirectly underwrites, collects charges or premiums from, or who approves, denies, adjusts or settles claims on residents of this state, in connection with health coverage offered or provided by an insurer. A third party administrator shall be subject to the jurisdiction of the Department of Insurance. A third party administrator shall not include any person, firm or entity who operates a billing and/or paying service only and who does not perform any of the other functions of a third party administrator described above. Additionally, a third party administrator shall not include any person, firm or entity which holds a certificate of authority as an insurer, health service corporation, MCO, or HMO under Title 18 of the Delaware Code. The Commissioner shall promulgate regulations which shall provide for the registration, licensing and regulation of third party administrators and enforcement of applicable Title 18 provisions to third party administrators. Third party administrators doing business in this State shall pay all fees and costs for registration, examination, assessments, fines and/or penalties as provided for in this Title or as the Commissioner shall establish by regulation. All revenues from the application of this provision to third party administrators shall be deposited in accordance with the provisions of 18 Del. C. §305."

Approved July 15, 2003