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SPONSOR: Rep. Gorman & Rep. Kamela Smith & Sen. Cruce
Reps. Osienski, Berry, Burns, Morrison, K. Johnson,
Snyder-Hall, Harris; Sens. Sokola, Hansen, Huxtable,
Seigfried, Pinkney, Lockman
HOUSE OF REPRESENTATIVES
153rd GENERAL ASSEMBLY
HOUSE BILL NO. 338
AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO HEALTH CARRIER COVERAGE OF
IMMUNIZATIONS AND PREVENTIVE SERVICES.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:
1 Section 1. Amend § 3363, Title 18 of the Delaware Code by making deletions as shown by strike through and
2 insertions as shown by underline as follows:
3 § 3363. Recommended immunizations. immunizations and preventive services.
4 (b) A health carrier shall provide coverage for the following items and services. A health carrier shall not impose
5 any costs, such as a copayment, coinsurance or deductible with respect to the following items and services:
6 (1) Except as otherwise provided in this section, evidence-based items or services that have in effect had a
7 rating of “A” or “B” in the recommendations of the United States Preventive Services Task Force that were in effect on
8 January 1, 2025 with respect to the individual involved; involved.
9 (2) Immunizations for routine use in children, adolescents and adults that have in effect a recommendation
10 from were recommended by the Advisory Committee on Immunization Practices of the Centers for Disease Control
11 and Prevention Prevention in effect on January 1, 2025, or other immunizations that were supported by national
12 clinical guidelines or national standards of care in effect on January 1, 2025, with respect to the individual involved.
13 For purposes of this paragraph, a recommendation from the Advisory Committee on Immunization Practices of the
14 Centers for Disease Control and Prevention is considered in effect after it has been adopted by the Director of the
15 Centers for Disease Control and Prevention, and a recommendation is considered to be for routine use if it is listed on
16 the Immunization Schedules of the Centers for Disease Control and Prevention; Prevention.
17 (3) With respect to infants, children and adolescents, evidence-informed preventive care, and screenings
18 provided for in comprehensive guidelines supported by the Health Resources and Services Administration; and
19 Administration in effect on January 1, 2025.
20 (4) With respect to women, to the extent not described in paragraph (b)(1) of this section, evidence-informed
21 preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and
22 Services Administration. Administration in effect on January 1, 2025.
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23 (c) A health carrier is not required to provide coverage for any items or services specified in any recommendation
24 or guideline described in subsection (b) of this section after the recommendation or guideline is no longer described in
25 subsection (b) of this section. [Repealed.]
26 (e) For purposes of subsection (b) of this section and for purpose of any other provision of law, the United States
27 Preventive Services Task Force recommendations regarding breast cancer screening, mammography and prevention issued
28 in or around November 2009 are not considered to be current. [Repealed.]
29 (f) A health carrier shall at least annually at the beginning of each new plan year or policy year, whichever is
30 applicable, revise the preventive services covered under its health benefit plans pursuant to this section consistent with the
31 recommendations of the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices
32 of the Centers for Disease Control and Prevention and the guidelines with respect to infants, children, adolescents and
33 women evidence-based preventive care and screenings provided for in comprehensive guidelines supported by the Health
34 Resources and Services Administration in effect at the time. [Repealed.]
35 (m) Nothing in this section prohibits a health carrier from providing coverage for items and services in addition to
36 those recommended by the United States Preventive Services Task Force or the Advisory Committee on Immunization
37 Practices of the Centers for Disease Control and Prevention, or provided by guidelines supported by the Health Resources
38 and Services Administration, or from denying coverage for items and services that are not recommended by that task force
39 or that advisory committee, or under those guidelines. Administration. A health carrier may impose cost-sharing
40 requirements for a treatment not described in this section even if the treatment results from an item or service described
41 herein.
42 Section 2. Amend § 3558, Title 18 of the Delaware Code by making deletions as shown by strike through and
43 insertions as shown by underline as follows:
44 § 3558. Immunizations and preventive services.
45 (a) This section applies to any health carrier providing coverage under an individual or group health benefit plan.
46 (1) This section does not apply to grandfathered plan coverage.
47 (2) For purposes of this section, “grandfathered plan coverage” means coverage provided by a health
48 carrier in which an individual was enrolled on March 23, 2010, for as long as it maintains that status in accordance
49 with federal regulations.
50 (3) This section shall not apply to accident-only, specified diseases, hospital, indemnity, disability income
51 or other fixed indemnity policies.
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52 (b) A health carrier shall provide coverage for the following items and services. A health carrier shall not impose
53 any costs, such as a copayment, coinsurance or deductible with respect to the following items and services:
54 (1) Except as otherwise provided in this section, evidence-based items or services that have in effect had
55 a rating of A or B in the recommendations of the United States Preventive Services Task Force that were in effect
56 on January 1, 2025 with respect to the individual involved; involved.
57 (2) Immunizations for routine use in children, adolescents and adults that have in effect a
58 recommendation from were recommended by the Advisory Committee on Immunization Practices of the Centers
59 for Disease Control and Prevention Prevention in effect on January 1, 2025, or other immunizations that were
60 supported by national clinical guidelines or national standards of care in effect on January 1, 2025, with respect to
61 the individual involved. For purposes of this paragraph, a recommendation from the Advisory Committee on
62 Immunization Practices of the Centers for Disease Control and Prevention is considered in effect after it has been
63 adopted by the Director of the Centers for Disease Control and Prevention, and a recommendation is considered to
64 be for routine use if it is listed on the Immunization Schedules of the Centers for Disease Control and Prevention;
65 Prevention.
66 (3) With respect to infants, children and adolescents, evidence-informed preventive care, and screenings
67 provided for in comprehensive guidelines supported by the Health Resources and Services Administration; and
68 Administration in effect on January 1, 2025.
69 (4) With respect to women, to the extent not described in paragraph (b)(1) of this section, evidence-
70 informed preventive care and screenings provided for in comprehensive guidelines supported by the Health
71 Resources and Services Administration. Administration in effect on January 1, 2025.
72 (c) A health carrier is not required to provide coverage for any items or services specified in any recommendation
73 or guideline described in subsection (b) of this section after the recommendation or guideline is no longer described in
74 subsection (b) of this section. [Repealed.]
75 (e) For purposes of subsection (b) of this section and for purpose of any other provision of law, the United States
76 Preventive Services Task Force recommendations regarding breast cancer screening, mammography and prevention issued
77 in or around November 2009 are not considered to be current. [Repealed.]
78 (f) A health carrier shall at least annually at the beginning of each new plan year or policy year, whichever is
79 applicable, revise the preventive services covered under its health benefit plans pursuant to this section consistent with the
80 recommendations of the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices
81 of the Centers for Disease Control and Prevention and the guidelines with respect to infants, children, adolescents and
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82 women evidence-based preventive care and screenings provided for in comprehensive guidelines supported by the Health
83 Resources and Services Administration in effect at the time. [Repealed.]
84 (m) Nothing in this section prohibits a health carrier from providing coverage for items and services in addition to
85 those recommended by the United States Preventive Services Task Force or the Advisory Committee on Immunization
86 Practices of the Centers for Disease Control and Prevention, or provided by guidelines supported by the Health Resources
87 and Services Administration, or from denying coverage for items and services that are not recommended by that task force
88 or that advisory committee, or under those guidelines. Administration. A health carrier may impose cost-sharing
89 requirements for a treatment not described in this section even if the treatment results from an item or service described
90 herein.
SYNOPSIS
This Act clarifies that individual, group, and blanket health insurance carriers must provide for and pay for
services (including immunizations) that were recommended by the Advisory Committee on Immunization Practices of the
Center for Disease Control (CDC) and the comprehensive guidelines supported by the Health Resources and Services
Administration (HRSA) that were in effect as of January 1, 2025. They must also cover immunizations that were supported
by national clinical guidelines or national standards of care in effect on January 1, 2025.
To that end, this Act removes provisions that permit carriers to deny coverage for these items or services simply
because they are not currently recommended by the Advisory Committee on Immunization Practices of the CDC and the
comprehensive guidelines supported by the HRSA. This Act also removes obsolete United States Preventative Task Force
provisions related to breast cancer screening from 2009.
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1041530007Every fact on this page links to its source, starting with the official bill record.