18 Del. Admin. Code § 1405-5.0

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

Section 1405-5.0 - Applicability of federal preemption requirements

5.1 Notwithstanding any other provision of law, and except as provided in this regulation, any association or MEWA that provides coverage in this state for medical, surgical, chiropractic, physical therapy, speech pathology, audiology, professional mental health, dental, hospital, or optometric expense, whether such coverage is by direct payment, reimbursement, or otherwise, shall be presumed to be subject to the jurisdiction of the Department unless the association or MEWA shows that while providing such services it is exempt from State jurisdiction as a result of federal preemption.

5.2 An association or MEWA may show that it is subject to federal jurisdiction by providing to the Commissioner the appropriate certificate of license issued by the federal agency which permits or qualifies it to provide those services for which it is licensed or certified. For the avoidance of doubt, an M-1 filing with the U.S. Department of Labor shall not, in and of itself, be sufficient to overcome the presumption of the Department's jurisdiction as set forth in this Section.

5.3 Except as otherwise set forth herein, any MEWA or association that is unable to show that it is subject to federal jurisdiction shall submit to an examination by the Commissioner to determine whether the organization and solvency of such association or MEWA is in compliance with the applicable provisions of Delaware law.

5.4 Any association or MEWA that is unable to show that it is subject to federal jurisdiction shall be subject to all appropriate provisions of this regulation regarding the conduct of its business.

5.5 Until such time as the Department issues regulations specific to self-insured MEWAs and associations, self-insured MEWAs and associations shall be subject to all provisions of Title 18 of the Delaware Code and all regulations promulgated thereunder to the extent not inconsistent with the provisions of ERISA, including but not limited to:

*	Licensure;

*	Mandated benefits;

*	Reserves; and

*	Financial reporting.

18 Del. Admin. Code § 1405-5.0

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