18 Del. Admin. Code § 1405-17.0

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

Section 1405-17.0 - Insurance Agents and Brokers

17.1 Any person, including a licensed or unlicensed agent, a broker, or other individual, soliciting, offering, or selling a health benefit plan on behalf of a fully insured association or MEWA to a Delaware employer or a Delaware resident shall comply with the following requirements:

17.1.1 Notify the Commissioner in writing prior to engaging in any conduct in connection with such sale. This written notification shall include, at a minimum:

17.1.1.1 The soliciting person's name, address, telephone number, and email address;

17.1.1.2 The name of the fully insured association or MEWA; and

17.1.1.3 All materials in the soliciting person's possession used for the purposes of soliciting, offering, or selling the health benefit plan, including advertising and marketing materials;

17.1.2 Prior to completing a sale, disclose to the employer or resident that:

17.1.2.1 He/she is being compensated for the sale of the health benefit plan;

17.1.2.2 The employer or resident has the option of purchasing insurance on the Delaware Health Exchange;

17.1.2.3 Purchasing such a health benefit plan may prevent the employer or individual from accessing premium subsidies and cost sharing reductions; and

17.1.2.4 Purchasing such a health benefit plan may be more expensive than purchasing a plan on the Delaware Health Exchange.

17.1.3 Provide the employer or resident with a crosswalk of benefits comparing the fully insured association or MEWA health benefit plan with plans offered on the Delaware Health Insurance Marketplace; and

17.1.4 Prior to engaging in or assisting any person to engage in offering a fully insured association or MEWA health benefit plan, carry out and document appropriate due diligence to establish, at a minimum, the following:

17.1.4.1 That the insurer is licensed in the State;

17.1.4.2 That the association or MEWA is licensed in the State;

17.1.4.3 That the disclosures listed in subsection 17.1 .2 are in the policy document; and

17.1.4.4 That the advertising and marketing materials he/she is using have been approved by the Department.

17.2 Any person, including a licensed or unlicensed agent, a broker, or other individual, soliciting, offering, or selling a health benefit plan on behalf of a fully insured association, MEWA, or entity holding itself out to be such a fully insured association or MEWA, having knowledge or a reasonable suspicion that a fully insured association, MEWA, or entity holding itself out to be a fully insured association or MEWA in this State is not in compliance with the requirements of this regulation shall immediately report to the Commissioner in writing regarding the identity of the entity, any known contact information or other materials, and the nature of the entity's practices triggering this reporting. This reporting obligation also requires such person to report to the Commissioner any person, including a licensed or unlicensed agent, a broker, or other individual, soliciting, offering, or selling a health benefit plan on behalf of a fully insured association, MEWA, or entity holding itself out to be such a fully insured association or MEWA in this State without complying with the requirements of this rule. The confidentiality provisions of subsection 16.3 .2 shall apply to this subsection.

18 Del. Admin. Code § 1405-17.0

22 DE Reg. 509 (12/1/2018) (Final)