Delaware § 5203 - Specifications of the coverage.

§ 5203. Specifications of the coverage.

(a) The basic health care insurance plan for state employees shall be equivalent to the “minimum creditable coverage” as defined by applicable federal law and include coverage for contraceptive methods under § 5203A of this title.

(b) (1) The plan shall be for all of the following:

a. Regular employees and eligible pensioners under 65 years of age.

b. Employees and eligible pensioners 65 years of age or over who are not entitled to services, rights, or benefits under the federal Medicare Program, 42 U.S.C. § 1395 et seq.

c. For eligible pensioners entitled to services, rights, or benefits under the federal Medicare Program, a plan that is supplemental to Medicare parts A and B as follows:

1. For eligible pensioners first employed before January 1, 2025, a plan that is comparable to the Special Medicfill Medicare Supplement plan offered under this section on October 1, 2024.

2. For eligible pensioners first employed on or after January 1, 2025, 1 or more Medicare supplement plans that are not high deductible plans.

(2) In addition to a plan under paragraph (b)(1)c. of this section, the coverage may include a plan under Medicare part C for eligible pensioners entitled to services, rights, or benefits under the federal Medicare Program if all of the following apply to the plan:

a. The plan is only for eligible pensioners first employed on or after January 1, 2025.

b. Each eligible pensioner can choose whether to enroll in a plan under paragraph (b)(1)c. of this section or the plan under this paragraph (b)(2).

(c) (1) The basic plan must provide coverage for chronic care management and primary care and coverage at a reimbursement rate that is not less than the Medicare reimbursement for comparable physician services.

(2) Coverage for chronic care management must not be subject to patient deductibles, copayments, or fees.

(3) If a comparable Medicare reimbursement rate is not available, a plan shall reimburse for services at the rates generally available under Medicare for services such as office visits and prolonged preventive services, which may be further delineated by regulation.

(d) The plan may not place any annual or lifetime numerical limitations on physical therapy or chiropractic care visits for the purpose of treating back pain.

29 Del. C. 1953, §  5203;  57 Del. Laws, c. 319;  57 Del. Laws, c. 350;  69 Del. Laws, c. 64, §  66;  72 Del. Laws, c. 204, §  4;  78 Del. Laws, c. 14, §§  6, 7;  81 Del. Laws, c. 323, § 3;  81 Del. Laws, c. 392, §§   8, 10;  81 Del. Laws, c. 430, §§   4, 7;  82 Del. Laws, c. 141, § 24;  83 Del. Laws, c. 237, § 8;  84 Del. Laws, c. 279, § 2;  84 Del. Laws, c. 475, § 2;