18 Del. Admin. Code § 1405-16.0
Current through Register Vol. 28, No. 5, November 1, 2024
Section 1405-16.0 - Notification to the Department by Insurers of Contracts with Fully insured Associations or MEWAs16.1 An insurer shall notify the Department by December 31st of each year of all health insurance contracts and administrative-services-only contracts it issued, renewed, or had in force at any time during the 12-month period of that calendar year, that covered association or MEWA with members having employees or dependents in Delaware.16.2 The health insurance contract between the insurer and the fully insured association or MEWA shall contain a provision whereby the insurer shall maintain, for the benefit of certificate holders, a deposit account covering 30 days of claims should the contract be cancelled or terminated. The insurer shall notify the Department within 5 days of any cancellation or termination of a contract that covered a fully insured association or MEWA with members having employees or dependents in Delaware.16.3 Reporting Requirement for Fraudulent Fully Insured Association or MEWA Activity 16.3.1 An insurer having knowledge or a reasonable suspicion that a fully insured association, MEWA, or entity holding itself out to be a fully insured association or MEWA in this state is not in compliance with the requirements of this rule shall immediately report to the Commissioner, in writing, regarding the identity of the entity, any known contact information or other materials, and the nature of the entity's practices that triggered this reporting. This reporting obligation also requires an insurer report to the Commissioner any person, including a licensed or unlicensed agent, a broker, or other individual, soliciting, offering, or selling a health benefit plan on behalf of a fully insured association, MEWA, or entity holding itself out to be such a fully insured association or MEWA in this state without complying with the requirements of this regulation.16.3.2 Confidentiality 16.3.2.1 The documents and evidence provided pursuant to this subsection or obtained by the Commissioner in an investigation of suspected or actual conduct in violation of this regulation shall be privileged and confidential and shall not be a public record and shall not be subject to discovery or subpoena in any private civil action pursuant to 29 Del.C. Ch. 100 or any confidentiality provision set forth in Delaware Title 18.16.3.2.2 Subsection 16.3.2.1 of this subsection does not prohibit release by the Commissioner of documents and evidence obtained in an investigation of suspected or actual conduct in violation of this rule:16.3.2.2.1 In administrative or judicial proceedings to enforce laws administered by the Commissioner;16.3.2.2.2 To federal, state, or local law enforcement or regulatory agencies, or to the National Association of Insurance Commissioners; or16.3.2.2.3 At the Commissioner's discretion.16.3.3 Release of documents and evidence under subsection 16.3 .2 of this subsection does not abrogate or modify the privilege granted in subsection 16.3 .1 of this subsection.18 Del. Admin. Code § 1405-16.0
22 DE Reg. 509 (12/1/2018) (Final)