18 Del. Admin. Code § 1410-4.0

Current through Register Vol. 28, No. 5, November 1, 2024
Section 1410-4.0 - Definitions

The following words and terms, when used in this regulation, have the following meaning unless the context clearly indicates otherwise:

"Carrier" means any entity that provides health insurance in this State. For the purposes of this section, "carrier" includes an insurance company, health service corporation, health maintenance organization, managed care organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation. "Carrier" also includes any third-party administrator or other entity that adjusts, administers, or settles claims in connection with a health benefit plan. "Carrier" also includes any carrier who administers a health benefit plan under 31 Del.C. § 505 (3).

"Commissioner" means the Insurance Commissioner of the State of Delaware.

"Department" means the Delaware Department of Insurance.

"FR" means financial requirements, and includes but is not limited to deductibles, copayments, coinsurance, and out-of-pocket maximums.

"Health benefit plan" means any hospital or medical policy or certificate, major medical expense insurance, health service corporation subscriber contract, or health maintenance organization subscriber contract, as defined and qualified under 18 Del.C. §§ 3343 and 3578, and any assistance provided to an individual under 31 Del.C. § 505 (3).

"Mental health parity report" means the report that is to be submitted to the Department and to the Delaware Health Information Network pursuant to Section 5.0 of this regulation.

"MHPAEA" means the Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185 a) as amended and supplemented.

"MH/SUD benefits" means mental health and substance use disorder benefits.

"M/S benefits" means medical and surgical benefits.

"NQTL" means non-quantitative treatment limitation, and includes but is not limited to preauthorization requirements and first-fail requirements.

"QTL" means quantitative treatment limitation, and includes but is not limited to lifetime limits, episode limits, and day and visit limits.

18 Del. Admin. Code § 1410-4.0

22 DE Reg. 1025 (6/1/2019)