Signed by Governor John Carney, Jr.

Vote Smart's Synopsis:

Vote to pass a bill that requires healthcare coverage under Affordable Care Act provisions.

Highlights:

• Requires health insurers to allow employers to purchase health insurance coverage for a group health plan at any point in the year except for cases in the small group market in which a group is not able to comply with a material plan provision relating to employer contribution or group participation rules under applicable state law, and in the cases of qualified health plans offered in the Small Business Health Options Program (SHOP) (Sec. 5).

• Establishes the following that was in effect January 1, 2018 from the Patient Protection and Affordable Care Act, as the law (Sec. 7 & 12):

• Provisions relating to nondiscrimination in regards to group health plans or health insurers offering group health insurance coverage;

• Health insurance coverage with essential health benefits packages in regards to health insurance coverage in the small group market and the individual market;

• Limitations on annual cost-sharing for group health plans and individual health insurance policies; 

• Any level of coverage previously offered as a plan for enrollees under the age of 21;

• Specifies that rates for health insurance coverage provided in the small group market and the individual market will be determined by the following (Sec. 8 & 13):

• Whether the plan or coverage covers an individual or family;

• Rating area;

• Age; and

• Tobacco Use.

• Defines “essential health benefits” as essential health benefits under Section 1302(b) of the Patient Protection and Affordable Care Act, as the law and its implementing regulations were in effect on January 1, 2018; Delaware law; and applicable state regulations (Sec. 2).

• Defines “employer contribution rule” as a requirement relating to the minimum level or amount of employer contribution toward the premium for enrollment of participants and beneficiaries (Sec. 5).

• Defines “group participation rule” as a requirement relating to the minimum number of participants or beneficiaries that must be enrolled in relation to a specific percentage or number of eligible individuals or employees of an employer (Sec. 5).

• Requires health insurers to charge the same premium rate to all enrollees without considering whether the plan is offered through the state health exchange or whether the plan is provided directly from the health insurer or through an agent (Sec. 8).

• Prohibits a policy or contract from denying, excluding, and limiting benefits for a covered individual for losses arising from a preexisting condition (Sec. 9).

• Requires carriers in the individual market to allow individuals to buy health insurance coverage during an annual open enrollment period (Sec. 10).

• Requires enrollees to receive 30 calendar days after the date of the qualifying event to elect coverage as was in effect January 1, 2018 (Sec. 10).

Full Bill Text

Vote Smart's Synopsis:

Vote to pass a bill that requires healthcare coverage under Affordable Care Act provisions.

Highlights:

• Requires health insurers to allow employers to purchase health insurance coverage for a group health plan at any point in the year except for cases in the small group market in which a group is not able to comply with a material plan provision relating to employer contribution or group participation rules under applicable state law, and in the cases of qualified health plans offered in the Small Business Health Options Program (SHOP) (Sec. 5).

• Establishes the following that was in effect January 1, 2018 from the Patient Protection and Affordable Care Act, as the law (Sec. 7 & 12):

• Provisions relating to nondiscrimination in regards to group health plans or health insurers offering group health insurance coverage;

• Health insurance coverage with essential health benefits packages in regards to health insurance coverage in the small group market and the individual market;

• Limitations on annual cost-sharing for group health plans and individual health insurance policies; 

• Any level of coverage previously offered as a plan for enrollees under the age of 21;

• Specifies that rates for health insurance coverage provided in the small group market and the individual market will be determined by the following (Sec. 8 & 13):

• Whether the plan or coverage covers an individual or family;

• Rating area;

• Age; and

• Tobacco Use.

• Defines “essential health benefits” as essential health benefits under Section 1302(b) of the Patient Protection and Affordable Care Act, as the law and its implementing regulations were in effect on January 1, 2018; Delaware law; and applicable state regulations (Sec. 2).

• Defines “employer contribution rule” as a requirement relating to the minimum level or amount of employer contribution toward the premium for enrollment of participants and beneficiaries (Sec. 5).

• Defines “group participation rule” as a requirement relating to the minimum number of participants or beneficiaries that must be enrolled in relation to a specific percentage or number of eligible individuals or employees of an employer (Sec. 5).

• Requires health insurers to charge the same premium rate to all enrollees without considering whether the plan is offered through the state health exchange or whether the plan is provided directly from the health insurer or through an agent (Sec. 8).

• Prohibits a policy or contract from denying, excluding, and limiting benefits for a covered individual for losses arising from a preexisting condition (Sec. 9).

• Requires carriers in the individual market to allow individuals to buy health insurance coverage during an annual open enrollment period (Sec. 10).

• Requires enrollees to receive 30 calendar days after the date of the qualifying event to elect coverage as was in effect January 1, 2018 (Sec. 10).

Full Bill Text