Delaware Health Insurance Guide
Delaware Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As a Delaware resident you can choose from a variety of health insurance programs including plans for individuals and group plans provided by private insurance carriers, as well as Delaware State-funded plans, and federal programs such as Medicaid and COBRA.
Delaware is not a guarantee issue state. That means private insurance companies are not required to sell health insurance to individuals who do not meet their underwriting criteria. You can be turned down for any number of reasons, including your current or past health, lifestyle habits and age. If you are accepted, the insurer has the right to limit your coverage with an elimination rider exempting them from paying claims on any preexisting condition you named on your applications. Delaware law also allows insurers to look back at your health history for the past 60 months to determine whether there are any unstated preexisting conditions. In addition, if you make any claims during the first two years your policy is in effect, the insurer can also look back at your health history 60 months back from the initial application and deny payment for any undisclosed pre-existing condition.
Delaware is a guaranteed renewal state. Regardless of your health, your insurer must renew your policy as long as you’ve paid your premiums on time and haven’t defrauded the company or, in some cases, moved out of an HMO service area. However, since there are no rate caps imposed on insurers by Delaware, your insurer can increase your premium at renewal for any reason.
If your Delaware health insurance is provided through your employer’s group plan, your coverage cannot be denied or subject to higher premiums because of your health, although some limited-time restrictions are permitted for new enrollees with pre-existing conditions.
Delaware Mandated Health Benefits
Delaware laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Blood lead poisoning
- Breast reconstruction
- Cervical cancer and HPV screening
- Clinical trials
- Colorectal and prostate cancer screening
- Diabetic supplies
- Drug abuse treatment
- Emergency services
- Maternity stays
- Newborn hearing screening
- Off-label drug use
- Coverage for newborn children under the parent's policy
- Coverage for continuation dependents under the parent's policy
- Coverage for dependent students under the parent’s policy
Types of Health Insurance Plans Available in Delaware
The following major medical health insurance plans are generally available in Delaware. Major medical plans cover illness and injuries, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity or Fee for Service Health Insurance
Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health care providers and facilities. Depending on your plan, you will have to pay a deductible and/or co-payment.
Health Maintenance Organizations (HMOs)
HMO plans require you to select a primary care physician (PCP) from a prescribed network of providers. You cannot see a specialist without a referral from your PCP. Comprehensive health care services include preventive care, medical treatments and hospitalization. There is no deductible, but there are co-pays when services are rendered and for any prescriptions. HMOs offer the advantage of relatively affordable premiums and low out-of-pocket costs as long as you stay within the network. Non-emergency services out of network are usually not reimbursed.
Preferred Provider Organizations (PPOs)
Like HMOs, there is a network of preferred providers in a PPO, but you can opt to see a provider outside the network if you don’t mind paying higher co-pays. Unlike HMOs, you need not select a PPC or secure a referral to see a specialist. PPOs typically have deductibles you must satisfy, as well as higher co-pays. The trade-off is greater freedom of choice in providers and services.
Point-of-Service Plans (POS)
A POS plan is a hybrid of HMOs and PPOs; you get the lowers costs of the former and the freedom of choice of the latter. You are required to select a PPC, but he or she can refer you to specialists in and out of network. Medical care provided out of network involves a deductible and either a percentage of the costs not covered by the POS, or the difference between what the provider charges and what your POS considers reasonable and customary for the service. There is no deductible for in-network services, but there is a small co-pay.
Alternative Health Programs in Delaware
Delaware Healthy Kids – This provides low-cost coverage for eligible resident children under the age of 19 whose families meet income requirements based on size of family and gross income. There is a six-month waiting period for children who previously had health coverage, although that can be waived under certain circumstances. Pre-existing conditions are not excluded under Delaware Healthy Kids. Comprehensive services include: office visits, well-baby and well-child checkups, hospice care, hospitalization, prescription drugs, lab work and x-rays, immunization, speech and hearing therapy, mental health counseling, physical therapy, emergency and ambulance services, drug and alcohol abuse treatment, and eye exams. Services are provided through three managed care plans. The program must be renewed every 12 months, and eligibility may be subject to review.
Screening for Life - This provides low-income women with access to free breast and cervical cancer screenings. If cancer is diagnosed, women are eligible for full coverage through Medicare.
Delaware Cancer Treatment Program – Uninsured and underinsured Delaware residents diagnosed with cancer may qualify for cancer treatment coverage under this program.
Delaware health insurance programs are regulated by the Delaware Department of Insurance and Delaware Health and Social Services.
Get access to Delaware health insurance quotes from http://www.EINSURANCE.com/health-insurance/.
Delaware Insurance Department
841 Silver Lake Blvd.
Dover, DE 19904
Delaware Healthy Children Program
Screening for Life
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
110 William Street
New York, NY 10038