< Back to Plan By State page 
Many medical plans in Delaware typically cover a comprehensive array of health care needs, including doctors’ visits, drugs and hospital care. These benefits can be delivered in several different ways. First is called an "Indemnity plan." These medical plans typically have a deductible – the amount you pay before the insurance company begins paying benefits. After your covered expenses exceed the deductible amount, benefits usually are paid as a percentage of actual expenses, often 80 percent. These plans usually provide the most flexibility in choosing where to receive care.
There is also something called a "Preferred Provider Organization", or PPO. In these medical plans, the insurance company enters into contracts with selected hospitals and doctors to furnish services at a discounted rate. As a member of a PPO, you may be able to seek care from a doctor or hospital that is not a preferred provider, but you will probably have to pay a higher deductible or co-payment.
Another popular health insurance plan offered in Delaware, is the "Health Maintenance Organization", or HMO. These medical plans make you choose a primary care physician, or PCP, from a list of network providers. Your PCP is responsible for managing all of your health care. If you need care from any network provider other than your PCP, you may have to get a referral from your PCP to see that provider. You must receive care from a network provider in order to have your claim paid through the HMO. Treatment received outside the network is usually not covered, or covered at a significantly reduced level.
Finally there is a type of insurance called "Point of Service", or POS. These medical plans are a hybrid of the PPO and HMO models. They are more flexible than HMOs, but do require you to select a primary care physician (PCP). Like a PPO, you can go to an out-of-network provider and pay more of the cost. However, if the PCP refers you to an out-of-network doctor, the health plan will pay the cost if the insurance plan has authorized the referral.
While many health insurance plans are regulated by the Delaware Insurance Commissioner, some are not.
Other Options for Delaware Residents
Limited benefit plans provide coverage for a particular health care setting, ailment or disease. Here are some options that may be available to you:
Many medical plans in Delaware typically cover a comprehensive array of health care needs, including doctors’ visits, drugs and hospital care. These benefits can be delivered in several different ways. First is called an "Indemnity plan." These medical plans typically have a deductible – the amount you pay before the insurance company begins paying benefits. After your covered expenses exceed the deductible amount, benefits usually are paid as a percentage of actual expenses, often 80 percent. These plans usually provide the most flexibility in choosing where to receive care.
There is also something called a "Preferred Provider Organization", or PPO. In these medical plans, the insurance company enters into contracts with selected hospitals and doctors to furnish services at a discounted rate. As a member of a PPO, you may be able to seek care from a doctor or hospital that is not a preferred provider, but you will probably have to pay a higher deductible or co-payment.
Another popular health insurance plan offered in Delaware, is the "Health Maintenance Organization", or HMO. These medical plans make you choose a primary care physician, or PCP, from a list of network providers. Your PCP is responsible for managing all of your health care. If you need care from any network provider other than your PCP, you may have to get a referral from your PCP to see that provider. You must receive care from a network provider in order to have your claim paid through the HMO. Treatment received outside the network is usually not covered, or covered at a significantly reduced level.
Finally there is a type of insurance called "Point of Service", or POS. These medical plans are a hybrid of the PPO and HMO models. They are more flexible than HMOs, but do require you to select a primary care physician (PCP). Like a PPO, you can go to an out-of-network provider and pay more of the cost. However, if the PCP refers you to an out-of-network doctor, the health plan will pay the cost if the insurance plan has authorized the referral.
While many health insurance plans are regulated by the Delaware Insurance Commissioner, some are not.
Other Options for Delaware Residents
Limited benefit plans provide coverage for a particular health care setting, ailment or disease. Here are some options that may be available to you:
-
Basic Hospital Expense Coverage covers a period of usually not less than 31 days of continuous in-hospital care and certain hospital outpatient services.
-
Basic Medical-Surgical Expense Coverage covers costs associated with a necessary surgery, including a certain number of days of in-hospital care.
-
Hospital Confinement Indemnity Coverage covers a fixed amount for each day that you are in a hospital.
-
Accident Only Coverage covers death, dismemberment, disability or hospital and medical care caused by an accident.
-
Specified Disease Coverage covers diagnosis and treatment of a specifically named disease or diseases – such as cancer.
-
Other Limited Coverage. You may purchase insurance covering only dental or vision or other specified care.
