Group health insurance policies issued or renewed after December 31, 2021, must provide coverage for a medically necessary insulin pump at no cost to a covered individual. An insurer may limit the coverage to only those expenses incurred through a network provider.

However, the requirement does not apply to qualified high deductible health plans as such coverage would be considered impermissible and render participants ineligible for HSA contributions. Current IRS guidance provides that insulin, glucometers and hemoglobin A1C testing are considered preventive care and may be covered prior to the statutory HSA deductible, but pumps are not included in that guidance.

Employer plan sponsors should work with their insurers to communicate the coverage change to participants. 

SB 107 »

Group health insurance policies that provide coverage for outpatient services must provide benefits for lead poisoning screening, testing, diagnostic evaluations, screening/testing supplies and home visits for children who are at risk for lead poisoning. The coverage may be subject to the plan’s normal cost-sharing provisions. The requirement applies to policies issued or renewed after December 31, 2021.

Employer plan sponsors should work with their insurers to communicate the coverage change to participants.

HB 222 »

On June 15, 2021, Gov. Carney signed HB 95 into law. The new law applies to policies issued or renewed after December 31, 2021. Such policies must provide coverage for medically necessary epinephrine autoinjectors for participants who are 18 years of age or under by including at least one formulation of epinephrine autoinjectors on the lowest tier of the drug formulary developed and maintained by the carrier. Epinephrine autoinjector means a single-use device used for the automatic injection of a premeasured dose of epinephrine into the human body.

Employers should understand the new coverage and work with carriers to revise and distribute the certificate of coverage to covered employees.

HB 95 »

On June 15, 2021, Gov. Carney signed HB 111 into law. Effective immediately, the new law prohibits life insurance disability policies from discriminating against an individual solely because they have been prescribed pre-exposure prophylaxis medication to prevent HIV infection. Specifically, an insurer cannot refuse to renew, refuse to issue, cancel, restrict coverage or add a premium rating factor based on such fact.

Because of privacy issues, an employer likely will not know if an employee is on such medication. However, the employer should work with insurers to make sure that policies comply and any necessary plan document amendments are made.

HB 111 »

On April 13, 2021, Gov. Carney signed SB 32 into law. The new law, effective immediately, expands the nondiscrimination standards in insurance. Specifically, a carrier may not discriminate in the offer of an insurance policy or the premiums charged based on gender identity or race.

For this purpose, gender identity is defined as a gender-related identity, appearance, expression or behavior of a person, regardless of the person's assigned sex at birth. Gender identity may be demonstrated by consistent and uniform assertion of the gender identity or any other evidence that the gender identity is sincerely held as part of a person's core identity; provided, however, that gender identity shall not be asserted for any improper purpose.

For this purpose, race is expanded to include traits historically associated with race, including hair texture and a protective hairstyle (such as braids, locks and twists).

Insurers and plan sponsors should be aware of these changes to the nondiscrimination standards.

SB 32 »

dThe Department of Insurance has revised and reissued Bulletin No. 86 to clarify coverage requirements related to gender identity. Effective September 4, 2020, health insurance policies are:

• Prohibited from denying, cancelling, terminating, limiting, refusing to issue or renew, or restricting insurance coverage or benefits based on an individual’s gender identity or transgender status
• Prohibited from denying, excluding or limiting coverage for medically necessary services based on the patient’s gender identify if the services are otherwise covered
• Prohibited from containing a blanket exclusion for gender dysphoria, gender identity disorder, medically necessary surgeries or other treatments related to gender transition
• Prohibited from imposing different premiums or rates for insurance coverage based on an insured’s gender identity

This bulletin will govern any fully insured policy issued in Delaware, so plan sponsors should familiarize themselves with these rules.

Bulletin No. 86 »

Under existing state law, policies providing hospital, medical and surgical coverage must also provide coverage for certain telehealth services. Effective July 17, 2020, and expiring July 1, 2021, House Substitute 1 for H.B. 348 expands that coverage to include telehealth services provided without the use of visual communication. This would include services provided via non-smart phones and landline connections. The plan cannot require a previously established relationship between the participant and the healthcare provider prior to the telehealth visit. The healthcare provider must be licensed to provide services in Delaware or the state in which they are located. Finally, coverage for telehealth services must include prescribing of controlled substances, including opioids.

The insurer providing the group policy should make the appropriate changes to the plan’s benefits to comply with the law. Employer plan sponsors should revise any plan documentation and communications as necessary to inform participants of the expanded coverage.

House Substitute 1 for H.B. 348 »

On March 20, 2020, the Department of Insurance published Bulletin No. 116. The new bulletin is meant to provide additional guidance to carriers relating to COVID-19, particularly pertinent to the governor’s March 13, 2020, declaration of a state of emergency. The bulletin requests that carriers suspend cancellations and nonrenewals due to nonpayment of premium during the pendency of the state of emergency. In addition, the bulletin states that carriers should fully reimburse providers who are providing telemedicine services through telehealth, including all telehealth/telemedicine services (not just those relating to COVID-19).

The bulletin also states that early diagnosis and treatment of COVID-19 is imperative, and therefore that prior authorization requirements should be waived relating to the lab testing and treatment of confirmed or suspected COVID-19 patients. Finally, the bulletin states that catastrophic health coverage plans may be amended to provide pre-deductible coverage for services associated with the diagnosis and/or treatment of COVID-19 (normally, such plans may not provide coverage of an essential health benefits before an enrollee meets the plan’s deductible).

The bulletin contains no new employer requirements; employers should work with their carriers in understanding the bulletin’s directives for COVID-19-related coverage items and services.

Bulletin No. 116 »

On March 9, 2020, the Department of Insurance published Bulletin No. 115, which relates to health insurance coverage for the coronavirus (COVID-19). According to the bulletin, small and individual plans must cover essential health benefits (EHBs), which include COVID-19-related laboratory tests.

For all fully insured plans (regardless of size), carriers cannot exclude a service for coverage solely because the service is provided through telemedicine services (which include a variety of platforms, including telephones, remote patient monitoring devices, and other electronic means such as web cameras and mobile video chat). In addition, carriers cannot use pre-authorization requirements as a barrier to access necessary treatment for COVID-19, and should expedite utilization review and appeal process for COVID-19 when medically appropriate.

On prescription drugs, an expedited formulary exception may be requested if the insured is suffering from a health condition that may seriously jeopardize the insured’s health, life or ability to regain maximum function, or if the insured is undergoing a current course of treatment using a non-formulary prescription drug. Additionally, PBMs are prohibited from requiring prior authorization for coverage of a 72-hour supply of medication that is for a non-controlled substance in an emergency. The Department expects insurers to provide for early refills or replacements of lost or damaged medications (even if the potential for quarantine is high). Lastly, consumers must be able to access their necessary prescriptions from a local retail pharmacy, even if their prescription supply is normally provided by mail order, without concern of a penalty.

Lastly, the bulletin states that carriers must cover diagnostic testing and waive patient cost sharing (deductibles, copayments and coinsurance), including for in-person and telemedicine visits.

The new bulletin applies directly to carriers, but are important reminders on coverage of COVID-19-relates services and items.

Bulletin No. 115 »

On March 6, 2020, the Department of Insurance published Bulletin No. 114. The bulletin reminds carriers that initial depression screenings are considered a preventive service under the ACA, and therefore an enrollee should not be charged any cost sharing (deductible, copayment or coinsurance) for those screenings. The bulletin points to the American Psychiatric Association’s definition of “depression,” which is a common and serious illness that negatively affects how a person feels, thinks and acts. The bulletin reminds carriers that all people, starting at age 12, should be screened for depression (according to the U.S. Preventive Services Task Force).

The bulletin applies to carriers, but is helpful information for employers with regard to their fully insured plans and with regard to employees who may ask questions on coverage of initial depression screenings.

Bulletin No. 114 »