Health Insurance in Delaware

Health Insurance in Delaware
Having a suitable health insurance provides protection against financial woes rising from the occurrence of illness or an injury. A good assessment of all potential risks and its impact on your finances is mandatory. In the U.S., approximately 47 million people are uninsured, among whom a majority of families are exposed to the lack of proper health coverage. For those families who are not covered by their employers’ group plan, there are low-cost state sponsored health insurance programs that provide insurance to the medically-uninsurable individuals.

In 2008, Delaware was ranked 35th healthiest state to live in according to the America’s Health Rankings. The state was on the 34th and 30th position in 2007 and 2006 respectively. Several factors contributed to the fall in Delaware’s health care system including high crime rate, prevalence of binge drinking and cases of infectious diseases. The state of Delaware, with more than eight hundred fifty-seven thousand people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide low-cost coverage to the uninsurable citizens of Delaware who meet specific eligibility requirements of age and income.

The Delaware Insurance Department manages and administers all kinds of insurance sold through private-market health insurers as well as public health coverage programs. Despite the state’s strong public health funding, low percentage of poverty among children and smoking prevalence, approximately 11.7% of the state population is still uninsured. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, roughly 39.2% of Delaware’s uninsured citizens come under the above 200% FPL category.

Buying health coverage is not quite straightforward. However, with the help of a licensed health insurance agent/broker, you can select a proper health insurance plan with benefits perfect for your family.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Delaware. These regulations apply to all insurance companies offering individual or family health insurance in Delaware:

Medical Underwriting
Yes
Pre-Existing Condition Exclusion Period
No Limit
Look Back Period
60 months
Look Back Standard
Prudent person
Mandatory Benefits
Cancer screening for women, breast cancer screening, cervical cancer screening, reconstructive surgery after mastectomy, direct access to OB/GYNs, OB/GYNs as primary care providers, eating disorder parity
Market Rate Restrictions
None
Guaranteed Issue Options
None
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Delaware. These regulations apply to all insurance companies offering small group health insurance in Delaware:

Small Group Size
1-50 (5including owner)
Employee Qualifications
Two employees must work for
at least 6 months out of the
year, and work 20 hours per
week for coverage
Guaranteed Issue
Yes
Premium Rating Factors
Rate Bands
Rate Adjustment Factors
35%
Look-Back Period
6 months
Pre-existing condition exclusionary period
12 months
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Delaware. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
No
Eligible Group Sizes
NA
Extension of Benefits Period – Standard
NA
Extension of Benefits Period – Disabled
NA
Maximum Premium Increase
NA
State Legislation Reference
NA
Additional Notes
NA
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Delaware to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, Delaware does not offer health insurance coverage through state high risk pool program for individuals who are medically-uninsurable.

Children’s Health Insurance Program

Through shared funding from the federal government, the State of Delaware provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name

Delaware Healthy Children Program (5DHCP)
Website
https://www.dhss.delaware.gov/dss/dhcp.html
Phone Number
800-996-9969
Apply Online
Yes
Age Limits
19
Insurance Carrier
Delaware Physicians Care, Inc., Unison Health Plan, and Diamond State Partners.
Length of Coverage
12 months
Residency Requirements
Delaware residents, U.S. citizens, qualified aliens or non-citizen
Other Eligibility Requirements
A child who has comprehensive health insurance is not eligible for the Delaware Healthy Children Program.
A child with more limited coverage may still be eligible for the Delaware Healthy Children Program.
Pre-Existing Condition Exclusions
No
Cost
Premium payments are $10, $15 or $25 per household per month, depending on your income.
For every 3 months you pay in advance, you’ll get the 4th month free.
With the exception of non-emergency visits to hospital emergency rooms, there are no co-payments.
Prescriptions are covered at 100%.

Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Delaware:

Governing Agency
Delaware Health and Social Services
Website
https://www.dhss.delaware.gov/dss/medicaid.html
Phone Number
800-996-9969
Residency Requirements
Delaware residents, U.S. citizens, qualified legal residents
Federal Poverty Line Income Limits
Pregnant women and infants age 0-1: 200% FPL
Children (5ages 1-5): 133% FPL
Parents: 117% FPL
Children ages 6-19 and working parents: 100% FPL (5also aged, blind and disabled)
SSI recipients: 133% FPL
Additional Resources

Delaware Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Delaware’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Delaware: At-A-Glance
Provides exclusive health data of Delaware. Statehealthfacts.org is a project of the Henry J. Kaiser Family Foundation and is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.