2021 Delaware Code
Title 29 - State Government
Chapter 52. Health Care Insurance
§ 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) The plan shall be for regular employees and eligible pensioners under 65 years of age and for employees and eligible pensioners over 65 years of age who are not entitled to services, rights or benefits under the federal Medicare Program (U.S. Public Law 89-97, as amended) [42 U.S.C. § 1395 et seq.]; and a plan which is supplemental to Medicare parts A and B, or constructed as a plan under Medicare part C, for eligible pensioners entitled to services, rights or benefits under the federal Medicare Program.
(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;
