HB 39 — AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO HEALTH INSURANCE.

Summary

This bill requires that inadvertent out-of-network services be included in individual and group health insurance policies as well as group and blank health insurance policies. This bill defines inadvertent out-of-network services are those services that are covered under a policy or contract of health insurances, but are provided by an out-of-network provider in an in-network facility, or when in-network health care services are unavailable or not made available to the insured in the facility. Inadvertent out-of-network services also includes laboratory testing ordered by an in-network provider but performed by an out-of-network laboratory.

Bill Text

• Bill Text View text Current pdf

AI-generated reading aid from the bill's amendatory text — verify against the official bill.

This bill amends existing Delaware law to clarify and enhance the provisions regarding emergency care and inadvertent out-of-network services under health insurance policies.

• § 3349

  Nothing in this section shall prevent the operation of policy provisions involving deductibles or copayments.

  This clause is removed to ensure clarity on the applicability of deductibles and copayments in emergency care scenarios.

• § 3349

  As used in this section “emergency medical condition” means a medical or behavioral condition the onset of which is sudden, that manifests itself by symptoms of sufficient severity, including, but not limited to, severe pain, that a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in: → As used in this section: (1) “Emergency medical condition” means a medical or behavioral condition the onset of which is sudden, that manifests itself by symptoms of sufficient severity, including, but not limited to, severe pain, that a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in any of the following:

  This redefinition clarifies the language used to describe an emergency medical condition.

• § 3349

  jeopardy. → jeopardy; serious impairment to such person’s bodily functions; serious impairment or dysfunction of any bodily organ or part of such person; or serious disfigurement of such person.

  This expands the definition of what constitutes an emergency medical condition to include additional serious consequences.

• § 3565

  Nothing in this section shall prevent the operation of policy provisions involving deductibles or copayments.

  This clause is removed, similarly to the change in § 3349, for consistency and clarity.

• § 3565

  As used in this section: (1) “emergency Emergency medical condition” means a medical or behavioral condition the onset of which is sudden, that manifests itself by symptoms of sufficient severity, including, but not limited to, severe pain, that a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in any of the following: → As used in this section: (1) “Emergency medical condition” means a medical or behavioral condition the onset of which is sudden, that manifests itself by symptoms of sufficient severity, including, but not limited to, severe pain, that a prudent layperson, possessing an average knowledge of medicine and health, could reasonably expect the absence of immediate medical attention to result in any of the following:

  This slight adjustment standardizes the definitions provided for emergency conditions across sections.

Action History

1. December 18, 2020

   Introduced and Assigned to Health & Human Development Committee in House

Sponsors

• Bryan Townsend · Primary
• Darius J. Brown · Primary
• Stephanie L. Hansen · Cosponsor
• Trey Paradee · Cosponsor
• Brian Pettyjohn · Cosponsor
• Marie Pinkney · Cosponsor
• Nicole Poore · Cosponsor
• David P. Sokola · Cosponsor
• Laura V. Sturgeon · Cosponsor
• William Bush · Cosponsor
• William J. Carson · Cosponsor
• Krista Griffith · Cosponsor
• Debra Heffernan · Cosponsor
• Kendra Johnson · Cosponsor
• Larry Lambert · Cosponsor
• Melissa Minor-Brown · Cosponsor
• Eric Morrison · Cosponsor
• Edward S. Osienski · Cosponsor
• Daniel B. Short · Cosponsor
• Michael F. Smith · Cosponsor
• Jeffrey N. Spiegelman · Cosponsor
• Kimberly Williams · Cosponsor
• Madinah Wilson-Anton · Cosponsor
• John L. Mitchell · Cosponsor
• John A. Kowalko · Cosponsor
• Sherry Dorsey Walker · Cosponsor
• Paul S. Baumbach · Cosponsor
• Bruce C. Ennis · Cosponsor
• Sarah McBride · Primary
• David Bentz · Primary

Subjects