Delaware Small Group Medical Insurance Regulations

In Delaware, small group medical insurance is regulated by the Delaware insurance code. The purpose of the small group insurance statute is to promote the availability of health insurance to small businesses, provide for the development of basic health plans and improve the fairness and efficiency of small group insurance. While the state regulations do not solve all the problems in the national health care system, they do provide a way for the small businessowner to provide quality coverage for his employees.

Availability

• Carriers are required to offer two types of health plans: a basic or lower-priced health benefit plan or a standard health benefit plan. In Delaware, a business can get health insurance as long as it has at least one employee within the state who works at least 50 percent of her or her working days during the preceding quarter. Insurance carriers cannot exclude any employees due to preexisting conditions.

Premium Restrictions

• According to the Delaware code, carriers cannot charge more than 20 percent above the index rate for a similar business. The index rate is the average of the highest premium rate and the base premium rate a carrier can charge. Factors in a premium rate for a business include the history of previous claims, employee health status and the duration of coverage.

Policy Renewal

• Small business insurance policies will be renewed annually unless the policy falls under the following criteria: nonpayment of premium, fraud or misrepresentation, noncompliance with participation and contribution requirements or misuse of the carrier's provider network. On renewal of a company insurance policy, the carrier cannot raise the premium more than 15 percent from the previous year.