Group and Blanket Health Insurance

What this document is

Delaware Code Title 18 Chapter 35 - Group and Blanket Health Insurance (Secs. 3501 onward) is a state statute published by Delaware Code Online (delcode.delaware.gov), Delaware General Assembly. It is one of the Delaware documents that insurance license exam questions are written from, including delaware life & health practice questions. This page summarizes it and points to the official version, which is the text to rely on.

Sections cited in practice questions

Each practice answer shows the exact passage it comes from. These are sections of this document that questions cite, with a short excerpt from the source text.

• 18 Del. C. Chapter 35 § 3582(e)(2) (Pre-Authorization: Qualifications of Appeal Reviewers)

  “An insurer, health-benefit plan, health-service corporation, or utilization review entity must ensure that all appeals of an adverse determination related to a clean pre-authorization request submitted by a physician or representative of a physician are reviewed and determined by a physician who...”

• 18 Del. C. Chapter 35 § 3582(e)(5) (Utilization Review Entity Appeal and Access Requirements)

  “An insurer, health-benefit plan, or health-service corporation must ensure then that any utilization review entity used to perform utilization review complies with all of the following: a. Performs utilization review on weekends. b. Provides access to a medical director or other clinical...”

• 18 Del. C. Chapter 35 § 3543 (Payment of benefits under blanket policy)

  “All benefits under any blanket health policy or contract shall be payable to the person insured, or to his or her designated beneficiary or beneficiaries, or to his or her estate, except that if the person insured be a minor or otherwise not competent to give a valid release, such benefits may be...”

• 18 Del. C. Chapter 35 § 3542 (Application and certificates not required)

  “An individual application need not be required from a person covered under a blanket health policy or contract nor shall it be necessary for the insurer to furnish each person a certificate.”

• 18 Del. C. Chapter 35 § 3521 (Claim forms)

  “If such forms are not furnished before the expiration of 15 days after the insurer receives notice of any claim under the policy, the person making such claim shall be deemed to have complied with the requirements of the policy as to proof of loss upon submitting, within the time fixed in the...”

• 18 Del. C. Chapter 35 § 3521 (Claim Forms)

  “A group health insurance policy shall contain a provision that the insurer will furnish to the person making claim, or to the policyholder for delivery to such person, such forms as are usually furnished by it for filing proof of loss. If such forms are not furnished before the expiration of 15...”

• 18 Del. C. Chapter 35 § 3571F(4)c. (Continuation of group health coverage: election and effective date)

  “Each covered employee or eligible dependent shall notify the administrator or its designee of its election of continuation coverage under this section within 30 days of notice under paragraph (4)b. of this section. The coverage shall be effective as of the date of the qualifying event and shall be...”

• 18 Del. C. Chapter 35 § 3571F (Continuation of Group Coverage)

  “The covered employee or eligible dependent requesting the continuation of coverage must pay to the administrator or its designee, on a monthly basis, the amount of contribution required to be paid by the covered employee or eligible dependent to continue the coverage. b. The premium contribution...”

• 18 Del. C. Chapter 35 § 3571F(1) (Continuation of group health coverage: who is eligible)

  “Continuation shall only be available to a covered employee or eligible dependent who has been continuously insured under a group policy or for similar benefits under any group policy that it replaced, during the entire 3-month period ending with such termination.”

• 18 Del. C. Chapter 35 § 3571F(6)a. (Continuation of group health coverage: how long it lasts)

  “Continuation of coverage under the group policy for any covered employee or eligible dependent shall terminate upon failure to satisfy paragraph (2) of this section or, if earlier, at the first to occur of the following: 1. The date 9 months after the date the covered employee’s or eligible...”

• 18 Del. C. Chapter 35 § 3527 (Information to Debtors)

  “In the case of a policy insuring debtors, a group health insurance policy shall contain a provision that the insurer will furnish to the policyholder for delivery to each debtor insured under the policy a certificate of insurance describing the coverage and specifying that the benefits payable...”

• 18 Del. C. Chapter 35 § 3503 (Debtor groups)

  “A policy may be issued to a creditor or its parent holding company or to a trustee or trustees or agent designated by 2 or more creditors, which creditor, holding company, affiliate, trustee, trustees or agent shall be deemed the policyholder, to insure debtors of the creditors with respect to...”

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More Delaware sources

• Del. Code tit. 18, ch. 29: Life insurance contracts - standard policy provisionsState statute
• Delaware Code Title 18, Ch. 017 - Licensing of Professional Insurance PersonnelState statute
• Delaware Code Title 18, Ch. 023 - Unfair Practices in the Insurance BusinessState statute
• Delaware Code Title 18, Ch. 29 - Life Insurance and Annuity ContractsState statute
• Delaware Code Title 18, Ch. 031 - Life Insurance ContractsState statute
• Delaware Code Title 18, Ch. 035 - Group and Blanket Health InsuranceState statute
• Delaware Code Title 18 Chapter 17 - Licensing of Professional Insurance Personnel (Secs. 1701-1724)State statute
• Delaware Code Title 18 Chapter 17A - Licensing of Public Adjusters (Secs. 1750-1761)State statute