18 Del. Admin. Code § 1405-4.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 1405-4.0 - Filing Requirements

4.1 Initial filing requirements

4.1.1 No association or MEWA or intermediary of an association or MEWA may offer either a fully insured employee welfare benefit plan or solicit any resident of this state to make application or effectuate coverage under an association plan or MEWA in Delaware unless:

4.1.1.1 The association or MEWA is duly licensed with the Department. An association or MEWA seeking to offer a fully-insured health benefit plan shall make application for a license to the Department and shall not offer such plans in this State until it is licensed;

4.1.1.2 The association's or MEWA's application for licensure is approved by the Department; and

4.1.1.3 The plan intermediary has ascertained that the MEWA represented has complied with this Section.

4.1.2 The application for licensure for a fully insured association or MEWA shall be on a form prescribed by the Department and shall include the following:

4.1.2.1 A certification of an officer, director, or trustee of the fully insured association or MEWA that states:

4.1.2.1.1 Name of the association or MEWA;

4.1.2.1.2 Names and business addresses of all principals, officers, directors, and trustees;

4.1.2.1.3 Names and addresses of the employer members;

4.1.2.1.4 Names and addresses of trustees or other persons responsible for the MEWA's or the association's operation;

4.1.2.1.5 Mailing address, email address, and telephone number at which communications are to be received;

4.1.2.1.6 Eligibility requirements for membership in the association or MEWA; and

4.1.2.1.7 The fees, if any, charged for membership in the association or MEWA;

4.1.2.2 A copy of any policy or contract describing benefits offered by the association or the MEWA;

4.1.2.3 A copy of the organizational documents of the association or MEWA, including the articles of incorporation, by-laws or trust instrument;

4.1.2.4 A statement that the benefits or coverage are fully insured;

4.1.2.5 A copy of the association's or MEWA's certificate of good standing from the state in which the association or MEWA is registered as a business;

4.1.2.6 The name of the insurer that insures the association or MEWA;

4.1.2.7 The name and contact information for the Delaware registered agent for service of process on the association or MEWA;

4.1.2.8 A certification of an officer, director, or trustee of the fully insured association or MEWA that states compliance with 18 Del.C. § 3506;

4.1.2.9 A description of the membership requirements;

4.1.2.10 A copy of any document executed by an employer to become a member of the association, including application for membership in the association;

4.1.2.11 Biographical affidavits for all trustees, officers, directors, and other members of the association or MEWA's governing body responsible for the operation of the association or MEWA;

4.1.2.12 The names, addresses, and qualifications of persons who will solicit, negotiate, procure, or effect applications for coverage with the association or MEWA;

4.1.2.13 A copy of all current policies or contracts of insurance issued to the association or MEWA that provide coverage for health care benefits and services to be offered in Delaware;

4.1.2.14 A copy of all current contracts between the association or MEWA and insurers to provide coverage for health care benefits and services to be offered in Delaware;

4.1.2.15 A copy of all current advertising and marketing materials used by the association or MEWA;

4.1.2.16 The names and addresses of all administrators and organizations, including third party administrators or intermediaries, responsible for the operation of the association or MEWA that complies with the following:

4.1.2.16.1 The association or MEWA contact shall be the person responsible for filing all applicable forms and changes in information with the Department; and

4.1.2.16.2 The regulatory contact shall be the person responsible for receiving notice of laws regulations, bulletins, and the like that may affect the plan;

4.1.2.17 The most recent audited financial statement as defined in Section 12.0 of this regulation;

4.1.2.18 A copy of the most recent M-1 form as filed with United States Department of Labor; and

4.1.2.19 A $1000 filing fee.

4.2 Annual filing requirements

4.2.1 Following licensure, a fully insured association or MEWA that offers a plan in the State shall annually, on or before July 1, submit the following information:

4.2.1.1 A Proof of Coverage form that:

4.2.1.1.1 Affirms that all the covered benefits are fully insured on a direct basis by an insurer; and

4.2.1.1.2 Is completed and certified by an officer, director, or trustee of the association or MEWA;

4.2.1.2 Demographic Information, on a form prescribed by the Department, providing association, MEWA, third party administrator, intermediary, regulatory, and insurer contacts, that complies with the following:

4.2.1.2.1 The association or MEWA contact shall be the person responsible for filing all applicable forms and changes in information with the Department; and

4.2.1.2.2 The regulatory contact shall be the person responsible for receiving notice of laws, regulations, bulletins, and the like that may affect the plan;

4.2.1.3 Notice of any changes in information previously filed with the Commissioner, which shall include, but is not limited to, the following items:

*	Biographical Affidavits of any new trustees, officers, directors, or other members of the association's or MEWA's governing body;

*	The names, addresses, and qualifications of any new individuals responsible for the conduct of the plan's affairs, including any third-party administrators;

*	The names, addresses, and qualifications of any new persons who will solicit, negotiate, procure, or effect applications for coverage with the plan;

*	The names and addresses of any new employers and participants enrolled in the plan;

*	Any new policy or amendment;

*	Any new Trust Agreement, Plan Document, Plan Summary, or Bylaws;

*	Any new advertising and marketing material; and,

*	Any other new agreements;

4.2.1.4 The most recent audited financial statement as defined in Section 12.0 of this regulation; and

4.2.1.5 A $150.00 filing fee.

4.3 If, subsequent to a filing under subsections 4.1 or 4.2, changes occur so that the information contained in the filing is no longer accurate, the MEWA, association, or intermediary that made the filing shall, within fifteen days of the date the change is effective, file the changes with the Department.

4.4 The Commissioner shall conduct a completeness review of a filing submitted under this Section and shall notify the applicant in writing of any deficiencies found during the completeness review within 30 business days of receipt. An applicant shall address any deficiencies in its application within 15 business days of notice thereof. Upon written request from the applicant and for good cause shown, the Commissioner may extend this 15-business day timeframe to correct any deficiencies in the application or renewal for an additional 30 business days. The Department shall notify the applicant in writing of its response to any such request.

4.5 If the Commissioner rejects a complete initial licensure application, or a subsequent annual registration application filed pursuant to this Section, the Department shall advise the applicant in writing that the application is denied and shall specify the reason for denial. The applicant may make written demand upon the Commissioner within 15 business days for a hearing before the Commissioner to determine the reasonableness of the Commissioner's action. The hearing shall be held pursuant to 18 Del.C. § 323.

18 Del. Admin. Code § 1405-4.0

22 DE Reg. 509 (12/1/2018) (Final)