18 Del. Admin. Code § 1308-13.0

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

Section 1308-13.0 - Status of carriers as small employer carriers

13.1 Within 30 days after the effective date of 18 Del.C. Ch. 72, each carrier providing health benefit plans in this state shall make a filing with the Commissioner indicating whether the carrier intends to operate as a small employer carrier in this state under the terms of this Regulation.

13.2 Subject to section 13.3, a carrier shall not offer health benefit plans to small employers, or continue to provide coverage under health benefit plans previously issued to small employers in this state, unless the filing provided pursuant to section 13.1 indicates that the carrier intends to operate as a small employer carrier in this state.

13.3

13.3.1 If the filing made pursuant to section 13.1 indicates that a carrier does not intend to operate as a small employer carrier in this state, the carrier may continue to provide coverage under health benefit plans previously issued to small employers in this state only if the carrier complies with the following provisions:

13.3.1.1 The carrier complies with the requirements of 18 Del.C. Ch. 72 (other than 18 Del.C. § 7208, 7209, and 7210) with respect to each of the health benefit plans previously issued to small employers by the carrier.

13.3.2 The carrier provides coverage to each new entrant to a health benefit plan previously issued to a small employer by such carrier. The provisions of 18 Del.C. Ch. 72 (other than 18 Del.C. § 7208, 7209, and 7210) and this Regulation shall apply to the coverage issued to such new entrants.

13.3.3 The carrier complies with the requirements of 18 Del.C. Ch. 72 § 3 and section 11.0 of this Regulation as they apply to small employers whose coverage has been terminated by the carrier and to individuals and small employers whose coverage has been limited or restricted by the carrier.

13.4 A carrier that continues to provide coverage pursuant to this subsection shall not be eligible to participate in the reinsurance program established under 18 Del.C. § 7210.

13.5 If the filing made pursuant to 13.1 indicates that a carrier does not intend to operate as a small employer carrier in this state, the carrier shall be precluded from operating as a small employer carrier in this state (except as provided for in section 13.3) for a period of five (5) years from the date of such filing. Upon a written request from such a carrier, the Commissioner may reduce the period provided for in such sentence if the Commissioner finds that permitting the carrier to operate as a small employer carrier would be in the best interests of the small employers in the state.

18 Del. Admin. Code § 1308-13.0