18 Del. Admin. Code § 1320-5.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 1320-5.0 - Minimum Policy Standards

5.1 No carrier shall advertise, sell or otherwise offer for sale or cause to be offered for sale a policy that it purports to be a short-term, limited duration health insurance policy, unless that policy meets the definition of short-term, limited duration health insurance policy as defined in Section 4.0 of this regulation and the policy meets the following minimum standards:

5.1.1 The policy may not be issued for a period longer than three months;

5.1.2 The three-month policy term limit set in subsection 5.1 .1 is a single occurrence limit and may not be effectively extended by issuing the same policy for successive back-to-back terms or by issuing a different short-term, limited duration policy to the same policy holder more than once in any given year;

5.1.3 The carrier shall apply the same underwriting standards to all applicants, regardless of whether they have previously been covered by short-term, limited duration health insurance;

5.1.4 The policy contains the notice required in federal law as dictated in Section 6.0 of this regulation; and

5.1.5 The policy shall be offered at a rate that has an actuarially expected loss ratio of at least 60 percent.

5.2 Every carrier who offers a short-term, limited duration health insurance policy shall obtain the approval of the terms and conditions of that policy from the Commissioner before such policy may be offered for sale in this state.

5.3 The Commissioner reserves the right to reject for approval a short-term, limited duration health insurance policy that, in the opinion of the Commissioner, is unjust, unfair, or unfairly discriminatory to the policyholder, a person insured under the policy, or to a beneficiary of the policy.

18 Del. Admin. Code § 1320-5.0

22 DE Reg. 607 (1/1/2019)