Annual year-in-review shows continued success for Delaware consumers

The Delaware Department of Insurance’s 105 team members are highlighting key achievements from their service to Delaware residents in 2024 including consumer assistance, attraction of new companies, expansions of coverage, supporting enhanced primary care access, and substantial funds contributed to the state.

“Our team’s annual report provides not just insight into our achievements; it offers Delawareans a better understanding of the diverse work of our department and the role we play in our state and across the globe. From protecting and advocating for consumers, to combating fraud, to ensuring a fair and resilient insurance market, our contributions to our community continue to grow, as do our duties,” shared Insurance Commissioner Trinidad Navarro. “Insurance regulation remains a changing landscape. But what remains unchanged each year is our dedication to meeting the challenges and opportunities of the future with a consumer-focused mindset, and our ability to deliver results.”

The Delaware Health Insurance Marketplace has continued to grow, with roughly 45,000 policyholders in 2024. 7,971 participants had a premium at or below $10/month. During Open Enrollment for 2025 plans, a record-setting 52,931 Delawareans enrolled in high-quality coverage from four carriers.

Health insurance rates are submitted alongside affordability standards data to the department’s Office of Value-Based Health Care Delivery, which endeavors to support a robust, high-quality primary care environment. They reviewed a total of 10 affordability standard template submissions across Large Group, Small Group, and Individual markets. This work includes a mandate for designated spending in primary care, which will reach nearly $59 million for 2024, an increase of $17 million year-over-year. This includes a projected $15 million in direct, prospective payments to primary care providers engaged in care transformation, an increase of $8 million year-over-year.

In addition to supporting healthcare providers, the work of the department also provides substantial funding to state entities. For the fiscal year ending June 30, 2024 the department’s work resulted in $159.1 million to the state’s General Fund and Special Funds that provide vital resources to volunteer fire companies, police, ambulance, and others.

Resident-focused programs continued to succeed in 2024 as well. Consumer Services staff processed a total of 5,223 complaints and inquiries, nearly 1,000 more than the prior year. They successfully recovered over $6 million of about $13.4 million in dispute. The Medicare Assistance Bureau held 4,864 one-on-one counseling sessions, working to save consumers an estimated $2.21 million. The Medicare Assistance Bureau hosted and participated in 56 public events. Helping residents address claim settlement issues outside of court, the Legal Division reported 384 arbitration cases open, 193 settling before hearing, and a total amount of $517,871 awarded.

And, recognizing the increasing complexity of the coverage, Commissioner Navarro launched the Office of Long-Term Care Insurance Assistance. Comprised of existing staff who received special training in related matters, the new office aims to improve consumer education and advocacy in these matters.

In 2024 the eighth consecutive decrease in workers’ compensation insurance rates was approved. A successful legislative effort will build upon these decreases by lowering the threshold for businesses to participate in enhanced safety and savings through the Workplace Safety Program’s efforts to help businesses. 932 employers participated in Workplace Safety during 2024, saving approximately $4.9 million in premiums through safety credits.

Market Conduct staff completed 43 insurer interrogatories, 25 Level 1 market analyses, 2 Level 2 analyses, and 8 exams including a large re-examination on an insurer’s Mental Health Parity compliance. There are currently 15 exams open, and 3 multi-state examinations active. Fines of $1.17 million were paid by insurers in 2024, these dollars go to the state’s General Fund.

The most recent data available from the Bureau of Examination, Rehabilitation and Guaranty shows their oversight of 150 domestic companies with $809 billion in assets, as well as 2,304 other companies operating in the state. This represents 1 new domestic, 155 new licenses, and a $40 billion increase in assets managed. This team completed 22 traditional financial exams in 2024 and has 37 in progress.

The Fraud Bureau’s 13 staff members processed 751 new referrals, an increase of more than 100 year over year. They closed a total of 577 cases, with 734 cases open. 22 criminal cases closed carried approximately 90 criminal charges, and several civil penalties.

As implementation of the Healthy Delaware Families Act, the state’s Paid Family Medical Leave law, continues, DOI reviewed and approved offerings from 17 companies that meet or exceed state requirements. In total, Life and Health staff reviewed 1,374 filings, 665 rates, 2,503 forms, and 913 advertisements. The Property and Casualty team reviewed 387 filings, 243 rates, 898 forms, and 231 rules. Commercial filings reviewed were 2,434, with 1,927 rates, 20,402 forms, and 2,152 rules filed.

In addition, the department issued 56,675 licenses to agents, adjusters, brokers, producers, and other businesses in 2024, bringing total licensees to 306,855. Oversight of these licensees included 24 regulatory actions issued and 80 hearings.

The Captive Bureau continues to foster a highly competitive domicile, issuing licenses to 56 new captives in 2024, with total active licenses at 660.

The department led and engaged with more than 50 policy efforts with partners in the legislature and industry, including key efforts to improve distribution of funds to volunteer fire companies, enhancements to health insurance coverage, and other consumer-friendly efforts. Legal staff processed 6 new bulletins, revised or reissued 17, and expired 25. Regulatory changes include 2 adoptions, 1 repealed, and 1 exempt order regulation. 86 FOIA requests were received, with just 4 outstanding in the new year. As the appointed agent for service of process, the Commissioner acts as the designated legal representative responsible for receiving legal documents on behalf of insurers and insurance personnel operating in the state. In 2024, 1,702 actions were served through the Commissioner.

Delaware continued to be a national presence in insurance regulation, with Commissioner Navarro completing his service as Chair of the Northeast Zone of the National Association of Insurance Commissioners (NAIC). In 2025, he has been selected as Co-Vice Chair for the Market Regulation and Consumer Affairs Committee, as a member of the Innovation, Cybersecurity, and Technology Committee, as Chair of the Antifraud Task Force, and on 10 other NAIC committees. With peers across the country, staff participate in the Insurance Regulatory Examiners Society (IRES) as State Chair and on the Career Development Seminar committee, as well as being members of the Securities & Insurance Licensing Association. Locally, the Commissioner and staff participate in committees, including: the Behavioral Health Crisis Services Board, Delaware Health Care Commission, EARNs Board, Non-Acute Long Stay Task Force, Plans Management Board, Primary Care Reform Collaborative, Rare Disease Advisory Council, Retiree Healthcare Benefits Advisory subcommittee, the Delaware Automobile Insurance Plan and FAIR Plan Committees, the State Employee Benefits Committee (SEBC), and serve on the Delaware’s Workers’ Compensation Oversight Panel.

Teams continued to achieve professional growth goals, including a graduation from the Continuous Improvement Practitioner program and 4 internal promotions. Per the mandate of the Department of Human Resources, the HR team successfully submitted 22 maintenance review packages for future statewide classification changes.

Staff also participated in many outreach events, including the Positively Dover African American Festival, the Apple Scrapple Festival, Brandywine Arts Festival, Bug and Bud Festival, Clayton Fire Prevention Open House, the Diabetes Wellness Expo, the Delaware Business Insight Summit, the Delaware Business Expo, Dover Days, Down Syndrome Walk, Family Preparedness Day, Middletown Peach Festival, Milford Freedom Walk Festival, Newark Community Day, the 55+ Expo, and of course, the Delaware State Fair. In addition to participating in the Delaware Employees’ Charitable Campaign, the Department also engaged in several charitable events including blood drives, food insecurity donations, and breast cancer awareness.

Cigna Medicare Advantage enrollees eligible to seek new coverage, including Guaranteed Issue Medigap

The Delaware Department of Insurance and its Medicare Assistance Bureau (DMAB) are working to make consumers aware that the Centers for Medicare and Medicaid Services (CMS), a federal agency, has completed a review of the impact of the Bayhealth-Cigna Medicare Advantage termination. They have determined that this termination significantly changes the Cigna provider network.

As a result, consumers on Cigna Medicare Advantage plans are eligible for a Special Election Period beginning the month the enrollees are notified and ending two months after the month eligibility notices are received. Individuals who use this Special Election Period to elect Original Medicare will have Medigap Guaranteed Issue rights – they cannot be denied enrollment regardless of health status. The Guaranteed Issue rights begin 60 days before the Medicare Advantage Plan coverage ends and end 63 days after the Medicare Advantage coverage ends.

Consumers engaged in Cigna Medicare Advantage coverage through an employer-sponsored plan should note that provider terminations are subject to the same CMS requirements for determining Special Election Periods. Enrollees should check with their employer to determine any additional coverage options available should they choose to disenroll from the employer-sponsored plan.

Cigna is required to notify affected members of their Special Election Period eligibility with a letter that must include information about the Special Election Period and their right to Guaranteed Issue Medigap coverage. Consumers are encouraged to contact the Delaware Medicare Assistance Bureau upon receipt of their notice from Cigna to discuss enrollment options.

Insurance Commissioner Trinidad Navarro notes that the department is aware of additional contracting changes between Delaware health systems and Medicare Advantage plans, but it is not yet known if these will be deemed significant network changes. While only the federal government has direct authority over these plans, Commissioner Navarro and colleagues from the National Associations of Insurance Commissioners continue to advocate for federal responses including these Special Election Periods.

About the Delaware Medicare Assistance Bureau
The Delaware Medicare Assistance Bureau provides free one-on-one health insurance counseling for people eligible for Medicare. Residents can call DMAB at 1 (800) 336-9500 or (302) 674-7364 to set up a free, confidential session or visit the DMAB website for important educational resources. Counselors can assist with Medicare, Medicare Advantage, Medigap (Medicare Supplement Insurance), long-term care insurance, billing issues, prescription savings, and much more. insurance.delaware.gov/dmab

Additionally, Workplace Safety Program eligibility changes will help more companies stay safe and save money

Insurance Commissioner Trinidad Navarro announced today that workers’ compensation insurance rates will decrease for the eighth year in a row, effective December 1. The voluntary market is expected to decrease average loss costs by 8.4%, and the residual market will see an average rate reduction of 9.21%. The announcement follows confirmation of the Delaware Compensation Rating Bureau (DCRB) filing by independent actuaries, and a public hearing with DCRB and the State’s Ratepayer Advocate. Actual savings will vary by policy.

“Delaware’s businesses used to pay some of the highest workers’ compensation premiums in the country, but I am proud to say that from the start of my administration to today, we have been able to approve rate decreases every single year,” said Commissioner Navarro. “In fact, these consecutive and significant reductions prompted us to work with partners to amend the premium threshold at which companies can receive additional premium discounts through participation in our Workplace Safety Program.”

This year’s decrease in worker’s compensation insurance rates continues the reversal of voluntary and residual market trends. With the residual market expected to see a greater rate decrease, it shows that companies who previously could only obtain coverage in this ‘last resort’ market, due to cost, high risk, or claims history, can now obtain traditional voluntary market coverage. This is the third year of this trend, which indicates substantial improvement in coverage affordability and employee safety.

Workers’ compensation insurance provides coverage when an employee is hurt on the job and can provide medical coverage as well as payments for lost wages if a person is unable to work due to their injury. Lower premiums don’t change the amount of compensation an injured employee receives.

These lower rates are just one component of several department efforts to help businesses. As of year-end 2023, nearly 1,000 employers are saving even more on their premiums by participating in the department’s Workplace Safety Program, saving approximately $5.6M last year. Eligible businesses can earn up to a 19% discount on their insurance by successfully undergoing annual safety inspections and complying with recommendations. When Senate Bill 306 goes into effect early next year, alongside any relevant regulations, eligibility changes will result in the Program becoming available to an estimated 2,120 additional employers.

Businesses eligible for the Workplace Safety Program are notified each year seven months prior to their renewal date. Organizations interested in participating can access questionnaires online and contact safety@delaware.gov to begin the process. The department has updated the Inspection Fee Schedule for program participants, as indicated on the questionnaire. Workplace Safety Program inspectors are independent safety professionals contracted by the department, not state employees or OSHA. Only benefits can be gained by participating; failure to qualify cannot be the basis for premium increases or sanctions imposed by other safety officials.

View the DCRB website

Unfair treatment of mental health conditions and other compliance issues uncovered, must be corrected.

The Delaware Department of Insurance today announced the completion of its first follow-up Mental Health Parity and Addiction Equity Act (“Mental Health Parity”) examination, which also included reviews of complaint and grievance handling, policyholder services, claims, utilization review, and pharmacy review. The investigated insurer, Highmark, exhibited a number of violations that they have a corrective action plan to address, in addition to paying a fine of $329,000. Exams are in process, scheduled, or planned for additional health carriers.

“Our review, which included a comprehensive examination of multiple areas of the insurer’s operations, did reveal notable improvement in mental and behavioral health practices compared to prior evaluations. But intense scrutiny of insurers is still needed in order to foster fairness for Delawareans,” said Insurance Commissioner Trinidad Navarro. “Ensuring that mental health and substance use disorder benefits are provided on par with physical health benefits is a critical priority, and continued compliance monitoring will help to protect consumers and promote equity in health care access.”

Mental Health Parity laws, which exist both at the state and federal levels, aim to eliminate coverage discrimination between policyholders seeking care for mental illness or substance abuse and those seeking physical care. A lack of parity can prevent a person from pursuing needed care due to cost or limited access, or otherwise make it more expensive or more time intensive than medical visits. Department examinations are critical to uncovering parity issues as consumers may not be aware if they are experiencing disparate treatment when seeking care.

Delaware law requires insurers to report an analysis of its relevant mental illness and drug and alcohol dependencies benefits any year in which the design and application of medical management protocols change. The department can conduct an initial Mental Health Parity examination of each carrier, reexamine them based on this reporting or as part of their regularly-scheduled examinations, or initiate Market Conduct investigations based on consumer complaints.

In general, the violations found in policies and practices during this examination revolved around a lack of parity between mental health and medical/surgical procedures, medications, and preauthorization requirements. Mental health patients in some cases experienced a more restrictive policy criteria on related drugs, such as buprenorphine to treat opioid addiction and naloxone-based opioid reversal medications. It was noted that the carrier denied a member medically necessary treatment for drug and alcohol dependencies in an intensive outpatient program, and did not cover Methadone for Opioid Use Disorder across all plans for out-of-network providers/facilities. Substantial progress toward parity has been made since the initial examination on both pharmacy and non-pharmacy non-quantitative treatment limitations (NQTLs).

The examination reviewed activity over a roughly 15-month period, including reexamining prior areas of noncompliance, as well as the insurers’ oversight of contracted Pharmacy Benefit Managers (PBMs) and Third-Party Administrators.

Inclusive of this reexamination, Delaware insurers have been assessed a total of $1.66M since investigations began. These dollars go to the state’s General Fund.

Additional Findings

The Highmark examination included components of traditional, regularly scheduled exams in addition to the Mental Health Parity review. Findings included: noncompliance with complaint resolution notices and records; failure to complete prompt acknowledgement of, response to, and department notice of appeals, as well as timely provision of related documentation to the independent utilization review organization. They were also penalized for inaccurate Department of Insurance contact information on forms and notices, failure to effectuate prompt, fair and equitable settlements of claims in which liability has become reasonably clear, as well as violations relating to the length of and timely response to pre-authorization requests. A violation of in vitro fertilization coverage was also found, as were violations of step therapy exception laws. Investigators also found that Highmark failed to comply with HB 263 (2020) which caps consumer cost sharing for insulin drugs at $100 per month.

Positive findings of compliance were noted in areas including: complaint, grievance, appeal, and utilization review policies and procedures, second level appeals, policyholder services, chronic care management, insulin pump claims, and treatment of experimental claims.

Free one-on-one counseling saved Delawareans $3.8M in 2023

As Medicare Open Enrollment approaches, the Delaware Department of Insurance and its Medicare Assistance Bureau (DMAB) are sharing their annual consumer information update. From October 15 to December 7, consumers can join, switch, or drop a Medicare Prescription Drug Plan (Part D) or Medicare Advantage Plan. DMAB’s free, confidential, unbiased one-on-one assistance can help residents determine if making a coverage change is the right choice. In 2023, the team completed 5,207 counseling sessions, saving beneficiaries a combined $3.8 million.

When selecting 2025 coverage, there are important new options and changes to keep in mind. The Medicare Prescription Payment Plan is a new payment option that works with a beneficiary’s current drug coverage to help manage out of-pocket Medicare Part D drug costs by spreading them across the calendar year. Starting in 2025, anyone with a Medicare drug plan or Medicare health plan with drug coverage (like a Medicare Advantage Plan with drug coverage) can voluntarily use this payment option. If this payment option is selected, consumers will continue to pay their plan premium (if they have one) each month and will get a bill from the health or drug plan to pay for the prescription drugs instead of paying the pharmacy. There’s no cost to participate in the Medicare Prescription Payment Plan.

Additionally, in 2025 Part D enrollees’ out-of-pocket drug costs will be capped at $2,000. This amount will be indexed to rise each year after 2025 at the rate of growth in per capita Part D costs.

While these federal changes are important to keep in mind during enrollment, the department also urges consumers to be aware of local changes. Particular attention should be paid to the consumers’ access to their preferred health providers.
“We have been made aware of a number of contracting changes between Delaware health systems and Medicare Advantage plans,” shared Insurance Commissioner Trinidad Navarro. “While we don’t have direct authority over these plans or their contracts, we are working with insurance regulators across the country to push the federal government to respond to increasingly frequent contract changes that can significantly impact consumers’ health care access.”

Commissioner Navarro and members of the National Associations of Insurance Commissioner requested that the Centers for Medicare and Medicaid Services (CMS) issue guidance on the matter and increase access to Special Election Periods (SEPs) to address such contracting changes.

The department and DMAB also urge residents to carefully assess contact received during the Open Enrollment window. “Educating and empowering Medicare beneficiaries about coverage, cost, and communications is a critical component of our work,” said DMAB Director Lakia Turner. “Marketing and solicitations rise dramatically in the fall months, so be wary of bad actors requesting your Medicare information, and look out for plans or promises that sound too good to be true. Our team can help you cut through the noise by answering your questions and identifying the best plan for your needs.”

In addition to scheduled phone and virtual appointments, DMAB is offering weekly appointments at all three Department of Insurance offices from October 22 to November 22:

• Tuesdays from 9:30AM-3:00PM at 503 Carr Road, Suite 303, Wilmington DE 19809
• Wednesdays from 9:30AM-3:00PM at 28 The Circle, Suite 1, Georgetown, DE 19947
• Thursdays from 9:00AM-3:30PM at 1351 West North St., Suite 101, Dover, DE 19904

Top Tips for a Successful Medicare Open Enrollment

1. Know that enrolling in a Medicare Advantage plan means it becomes your primary coverage. Original Medicare will no longer pay for services. You will receive a new ID card from the new plan, and should store your Original Medicare card in a safe place.
2. When moving from Original Medicare to a Medicare Advantage plan, be prepared to pay both a monthly Medicare Advantage premium and a monthly Medicare Part B premium.
3. Medicare Advantage plans do not automatically give you “more money in your Social Security check every month.” To qualify, you must be eligible for the Medicare Savings Program by having an income below Medicaid limits.
4. Check that additional benefits, like dental, vision, hearing, fitness, or over-the-counter medications are actually accessible if offered. Some network providers of these services may be farther away than anticipated, including in neighboring states, so only factor them into your decision if you feel they are usable.
5. Know that premium costs aren’t the only out-of-pocket costs you may face. Medicare Advantage plans may have co-pays or cost-sharing that differ from Original Medicare.
6. Call your preferred healthcare providers and facilities to understand if your prospective plan contracts with them. You may experience additional out-of-pocket expenses, service denial, or referral requirements if providers are considered out of network.
7. Check if a prospective plan is a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO). HMO plans require healthcare to be completed by a provider contracted with the plan’s network, otherwise the consumer will need a referral. PPO plans have both in-network and out of network providers and facilities, with consumer costs differing based on the network. HMO and PPO plans are not Medicare Supplement Plans, and may have out-of-pocket costs each visit.
8. Check if the plan provides Prescription Drug (Part D) coverage that meets your needs.
9. Be aware that in many cases, enrollment locks a person into a plan for the full upcoming calendar year.
10. Scrutinize any contact carefully during Medicare Open Enrollment to ensure it is from a known, credible source. Commercials, cold calls, and other contact may be scams or can provide deliberately misleading information about a plan.

About the Delaware Medicare Assistance Bureau

The Delaware Medicare Assistance Bureau provides free one-on-one health insurance counseling for people eligible for Medicare. Residents can call DMAB at 1 (800) 336-9500 or (302) 674-7364 to set up a free, confidential session or visit the DMAB website for important educational resources. Counselors can assist with Medicare, Medicare Advantage, Medigap (Medicare Supplement Insurance), long-term care insurance, billing issues, prescription savings, and much more.

Medicare Advantage plans are regulated at the federal level, though the Insurance Commissioner and his peers are advocating for increased state regulatory authority.

Be aware of non-compliant alternative health plans

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