19 Del. Admin. Code § 2001-1.0 - Authority

1.1 Pursuant to the authority vested in the State Employee Benefits Committee (SEBC) by 29 Del.C. §§ 5210(4), 9602(b)(4), the SEBC adopts these Eligibility and Enrollment Rules for the State of Delaware Group Health Insurance Plan ("State Plan"). In the event of a conflict between these rules and the Delaware Code, the Delaware Code takes precedence over these rules.

1.2 An Employee, Long Term Disability (LTD) beneficiary, COBRA beneficiary, or pensioner must meet one of the following definitions to be eligible for enrollment or continued enrollment in the State Plan:

1.2.1 A permanent full-time employee (regularly scheduled 30 or more hours per week or 130 or more hours per month);

1.2.2 An elected or appointed official as defined by 29 Del.C. § 5201;

1.2.3 A permanent part-time employee (regularly scheduled to work less than 130 hours per month);

1.2.4 A limited term employee (as defined by 19 DE Admin. Code 3001, subsection 11.1);

1.2.5 A pensioner receiving or eligible to receive a pension from the State;

1.2.6 A per diem or contractual employee of the Delaware General Assembly who has been continuously employed for 5 years.

1.2.7 A temporary employee (regularly scheduled 30 or more hours per week or 130 or more hours per month) as defined by 29 Del.C. § 5207;

1.2.8 A current or former employee approved for LTD benefits by the Disability Insurance Program Insurance Carrier or the Administrator in response to 29 Del.C. § 5253(c)(1);

1.2.9 COBRA beneficiaries eligible for continued enrollment in the State Plan as defined by federal law.

1.3 Those employees who meet the definition outlined in subsections 1.2.1, 1.2.2, 1.2.4, 1.2.5, 1.2.6, and 1.2.8 are considered "regular officers and employees" or "eligible pensioners" as provided by 29 Del.C. § 5202 and are to receive State Share contributions. State Share coverage starts on the first of the month following the date of hire.

1.4 Employees receiving Short Term Disability (STD) under 29 Del.C. § 5253(b), Workers' Compensation (WC) under 19 Del.C. Chapter 23 or automobile Personal Injury Protection (PIP) benefits under 21 Del.C. § 2118 will be treated as "regular officers and employees" under these rules. Long Term Disability beneficiaries receiving benefits under 29 Del.C. § 5253(c) will be treated as "eligible pensioners" under these rules. If any time after Long Term Disability benefits begin, the beneficiary returns to work for the State and meets any of the definitions outlined in subsections 1.2.1, 1.2.2, or 1.2.4, they will be treated as "regular officers and employees" in these regulations.

1.5 Casual and seasonal, board members, students, and substitute teachers are not eligible for the State Plan.

1.6 Newly employed teachers become eligible employees when they start employment not when they sign their contract. Temporary teachers who have completed the prior year's contract period and are re-hired in September are eligible for coverage, including State Share on the first of the month following the rehire date.

1.7 Pensioners who are enrolled in a Medicare Advantage plan with prescription or a Medicare Part D prescription plan which is not administered by the State of Delaware cannot be enrolled in the State of Delaware's Special Medicfill Plan and Medicare Part D prescription plan for Medicare eligible retirees, per the Centers for Medicare and Medicaid Services (CMS).

1.8 Enrollment in State plan is not indicative of eligibility to receive State Share contributions.

Notes

19 Del. Admin. Code § 2001-1.0

6 DE Reg. 690 (11/01/02)
12 DE Reg. 986 (01/01/09)
15 DE Reg. 225 (08/01/11)
16 DE Reg. 1003 (03/01/13)
18 DE Reg. 79 (7/1/2014)
24 DE Reg. 601 (12/1/2020)
27 DE Reg. 532 (1/1/2024) (Final)