§ 3610 — Comprehensive health insurance coverage [For application of this section, see 79 Del. Laws, c. 99, § 19]

(a)Coverage for essential health benefits package. —

A health insurer that offers health insurance coverage in the individual market shall ensure that such coverage includes the essential health benefits package in conformity with § 1302 of the Patient Protection and Affordable Care Act [42 U.S.C. § 18022], as the law and its implementing regulations were in effect on January 1, 2025, and state law. The Commissioner shall issue a regulation setting forth what constitutes “essential health benefits” for purposes of this section.

(b)Cost-sharing under individual health insurance policies. —

An individual health insurance policy shall ensure that any annual cost-sharing imposed under the plan does not exceed the limitations provided for under § 1302(c)(1) of the Patient Protection and Affordable Care Act [42 U.S.C. § 18022(c)(1)], as the law and its implementing regulations were in effect on January 1, 2025, and state law.

(c)Child-only plans. —

If a health insurer offers health insurance coverage in any level of coverage specified under § 1302(d) of the Patient Protection and Affordable Care Act [42 U.S.C. § 18022(d)], as the law and its implementing regulations were in effect on January 1, 2025, or state law, the health insurer shall also offer such coverage in that level as a plan in which the only enrollees are individuals who, as of the beginning of the plan year, are under age 21.

(d)Dental only. —

This section does not apply to a plan described in § 1311(d)(2)(B)(ii) of the Patient Protection and Affordable Care Act [42 U.S.C. § 18031(d)(2)(B)(ii)], as the law and its implementing regulations were in effect on January 1, 2025.

Legislative History

79 Del. Laws, c. 99, § 13 ; 81 Del. Laws, c. 79, § 31 ; 82 Del. Laws, c. 186, § 12 ; 85 Del. Laws, c. 89, § 8