Bill Text: DE HB367 | 2009-2010 | 145th General Assembly | Draft


Bill Title: An Act To Amend Title 18 Of The Delaware Code Relating To Unfair Acts In The Business Of Insurance.

Spectrum: Bipartisan Bill

Status: (Introduced - Dead) 2010-05-12 - Reported Out of Committee (ECONOMIC DEVELOPMENT/BANKING/INSURANCE/COMMERCE) in House with 1 Favorable, 5 On Its Merits [HB367 Detail]

Download: Delaware-2009-HB367-Draft.html


SPONSOR:

Rep. D. Short & Rep. Hudson & Sen. Blevins;

 

Reps. Briggs King, Hocker, Oberle, Carson, Kowalko; Sen. Sokola

HOUSE OF REPRESENTATIVES

145th GENERAL ASSEMBLY

HOUSE BILL NO. 367

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO UNFAIR ACTS IN THE BUSINESS OF INSURANCE.


BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:


Section 1.Amend Chapter 23, Title 18, Delaware Code by adding a new section to read as follows:

"§ 2319.Not-medically-necessary error by insurer.

(a)                 A health insurer, health service corporation, or health maintenance organization may not unreasonably deny coverage for a medical procedure or test that the insurer decides is not medically necessary.It shall be presumed that such denial is unreasonable if an insured individual seeks medical care at his or her own expense after a denial of such coverage, and the procedure or test is proven to be medically necessary based upon the results of the procedure or test or upon the medical condition found.

(b)                 If an insurer is found to have unreasonably denied coverage pursuant to subsection (a) of this section, the insurer shall reimburse the insured for all expenses incurred and associated with the procedure or test at 100% of the incurred expenses.In addition, any out-of-pocket expenses, including but not limited to deductibles, co-pays, and coinsurance of the insured's healthcare benefit plan that would have been the responsibility of the insured must be reimbursed by the insurer to the insured individual.The insurer shall also be responsible for any damages sustained by the insured due to the delay in obtaining the procedure or test resulting from the insurer's unreasonable denial of such coverage.".


SYNOPSIS

This bill requires an insurer who denies coverage for a procedure or test as medically unnecessary to reimburse an insured for all expenses, including out-of-pocket expenses, if the insured pays for the procedure or test and the procedure or test is proven to be medically necessary.

Section 2307 of Title 18 contains the procedures to be used by the Insurance Commissioner when he or she has reason to believe that an insurer has engaged in an unfair practice, such as denying coverage as medically unnecessary.

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