TITLE 18

Insurance Code

Suretyship

CHAPTER 87. The Delaware Health Insurance Individual Market Stabilization Reinsurance Program


As used in this chapter, unless the context clearly indicates a different meaning, the following words and phrases shall have the meaning ascribed to them in this section:

(1) “Affordable Care Act” means the Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 (2010).

(2) “Assessment” means any payment required to be made under § 8703 of this title.

(3) “Carrier” means any entity that provides health insurance in this State. For the purposes of this chapter, carrier includes an insurance company, health service corporation, health maintenance organization, managed care organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation.

(4) “Commission” and “DHCC” mean the Delaware Health Care Commission created pursuant to § 9902 of Title 16.

(5) “Commissioner” means the Insurance Commissioner of the State of Delaware.

(6) “Department” means the Delaware Department of Insurance.

(7) “Individual health benefit plan” means any policy offered in the individual market that is subject to the single risk pool requirements of § 1312(c)(1) of the Affordable Care Act [42 U.S.C. § 18032(c)(1)].

(8) “Program” means the Delaware Health Insurance Individual Market Stabilization Reinsurance Program created by § 9903(g) of Title 16.

82 Del. Laws, c. 61, § 2.;

(a) This chapter shall apply to the following licensees:

(1) Any carrier, as defined under §  8701 of this title.

(2) Any other person or entity subject to regulation by the State that provide either of the following:

a. Products that are subject to the fee under § 9010 of the Affordable Care Act [26 U.S.C. Preceding § 4001, note].

b. Products that may be subject to an assessment by the State under this chapter.

(b) This chapter shall not apply to plans of health insurance or health benefits designed for issuance to persons eligible for coverage under Titles XVIII, XIX, and XXI of the Social Security Act (42 U.S.C. §§ 1395 et seq., 1396 et seq., and 1397aa et seq.), known as Medicare, Medicaid; Chapter 52 of Title 29; or any other similar coverage under state or federal governmental plans.

(c) This chapter shall not apply to stand-alone dental insurance, stand-alone vision insurance, long-term care insurance, disability income insurance and all accident-only insurance.

82 Del. Laws, c. 61, § 2.;

(a) The purpose of this section is to establish a funding mechanism for the Delaware Health Insurance Individual Market Stabilization and Reinsurance Program created by § 9903(g) of Title 16.

(b) Following successful approval of Delaware’s § 1332 [42 U.S.C. § 18052] waiver application under the Affordable Care Act by the Centers for Medicare and Medicaid Services and beginning in calendar year 2020, any carrier subject to this chapter shall be assessed 2.75% annually on all amounts used to calculate the entity’s premium tax liability or the amount of the entity’s premium tax exemption value for the previous calendar year.

(c) Each carrier, entity, or person subject to the assessment pursuant to this section shall submit payment to the Delaware Department of Insurance on or before March 1 of each year.

(d) Upon receipt of the funds paid to the Department pursuant to subsection (c) of this section, the Commissioner shall remit the total amount to the Commission to be held on reserve for the funding and administering of the Program in accordance with § 9903(g) of Title 16.

(e) In the event that the federal government reinstates the health insurance providers fee defined under § 9010 of the Affordable Care Act [26 U.S.C. Preceding § 4001, note] for a particular calendar year, the State shall reduce its own assessment for the corresponding calendar year as defined in subsection (b) of this section to 1% on all amounts used to calculate an entity’s premium tax liability or the amount of the entity’s premium tax exemption value for the previous calendar year.

(f) In the event Delaware’s § 1332 [42 U.S.C. § 18052] waiver under the Affordable Care Act is invalidated, revoked, or expires by the Centers for Medicare and Medicaid Services, Delaware may no longer collect the assessment defined under this section.

(g) The State may not hold more than 5 years of operating and administrative funds to cover the Program. In the event collections exceed that amount, the State must notify the carriers that the following year’s assessment will be waived.

(h) Funding deposited into the Delaware Health Insurance Individual Market Stabilization Reinsurance Fund shall be used by the Department of Health and Social Services, in conjunction with the Department, to operate and administer the Fund, and such funding shall also be used by the Department of Health and Social Services to secure federal matching funds available through § 1332 of the Affordable Care Act [42 U.S.C. § 18052].

(i) In the event that funding is insufficient to cover the administration and operations of the Program, the Department of Health & Social Services may suspend the program until funding is identified and secured.

82 Del. Laws, c. 61, § 2.;