Free Group Health Insurance Study Guide
Delaware Life, Accident & Health exam — Group Health Insurance.
The national guide covers group underwriting, master contracts and certificates, federal COBRA, coordination of benefits and conversion. Delaware's group and blanket health rules are in 18 Del. C. Chapter 35. They include a state continuation law, often called mini-COBRA, for small employers that federal COBRA doesn't reach.
Group policy provisions (Chapter 35)
| Provision | Delaware rule |
|---|---|
| Grace period | 31 days after the first premium. The policy stays in force (3513) |
| Incontestability | The policy can't be contested, except for nonpayment, after two years from issue (3514) |
| Preexisting conditions | Group health policies, other than listed limited and excepted benefits, may not exclude conditions that existed before coverage began (3517(a)) |
| Payment of benefits | Non-disability benefits within 60 days of proof. Loss-of-time benefits at least monthly (3523) |
| Facility of payment | Up to $5,000 to a relative when benefits are payable to an estate, a minor or an incompetent person (3524) |
| Legal actions | No suit until 90 days after proof of loss is filed, and suit within three years after proof is due. Individual policies wait 60 days (3526) |
| Noncontributory plans | Must cover all eligible employees except those who decline in writing (3502(2)) |
| Waiting periods | No more than 90 days (3571K) |
| Cancellation notices | In writing, with the effective date and reasons. Proof of mailing is kept one year (3571Q) |
Mini-COBRA (18 Del. C. 3571F)
- Who qualifies: employees of employers with 1 to 19 employees, who aren't covered by federal COBRA.
- Prior coverage: continuously insured for the full three months before coverage ended.
- Qualifying events: layoff, divorce, and loss of dependent status, among others.
- Not available to: anyone covered by or eligible for Medicare, or able to get other group coverage.
- Notice and election: the employer gives notice within 30 days of the event. The person elects within 30 days of the notice. The administrator tells the insurer within 14 days.
- Cost: no more than 102% of the group rate, paid monthly.
- Length: nine months, ending sooner on late payment or if the group policy ends.
Small, association, franchise and blanket groups
- Small employer: no more than 50 eligible employees, mostly in Delaware, on at least half of its working days in the prior quarter (7202).
- Bona fide associations: must have existed at least five years, been formed for purposes other than insurance, and not tie membership to health status (3506).
- Franchise health insurance: individual policies issued to 3 or more employees of one employer, or 10 or more members of an association or union (3334).
- Blanket health insurance covers groups such as:
- passengers of common carriers
- students, sports teams and camps
- volunteer fire companies
- Blanket members don't need individual applications or certificates (3540, 3542).
Exam traps
- Delaware mini-COBRA covers employers with 1 to 19 employees and lasts nine months at 102%.
- The group legal-actions wait is 90 days, versus 60 days for individual policies.
- Group facility of payment goes up to $5,000. Individual policies allow $1,000.
Practice Group Health Insurance questions All Life, Accident & Health topics
Practice questions are study aids generated for exam preparation and are not actual exam questions. Content is provided for educational purposes and is not legal advice. Verify current statutes, rules, and exam specifications with the Insurance Department and the exam administrator before relying on it.
