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Sussex Health Insurance

Facts and Figures

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Insurance Carriers

State Government Insurance Programs Offered

Pre-existing Condition Insurance Plan (PCIP)

Covers broad range of benefits, including primary and specialty care, hospital care, and prescription drugs.


Doctor visits, Hospital care, Labs, Prescription drugs, Transportation, Routine shots for children, Mental health and substance abuse services, X-rays, Home health care, Hospice care, Dental care (up to age 21). Pre-Existing Health Conditions Covered Must be U.S. citizens or qualified legal residents living in Delaware. Income limits: Pregnant women and infants age 0–1: 200% FPL. Children (ages 1–5): 133% FPL. Children ages 6–19, working parents, and aged, blind and disabled: 100% FPL. Parents/caretakers living with children ages 0–18: 120% FPL. Childless Adults: 110% FPL. SSI recipients: For singles 75% FPL with asset limit of $2,000; for couples 83% FPL with asset limit of $3,000.

Children & Families First

Special Medical Foster parents receive specialized training for skills (e.g. CPR, use of medical equipment) to care for medically-fragile children.

Delaware Healthy Children Program

Well-baby and well-child checkups, Drug/alcohol abuse treatment, Speech/hearing therapy, Immunizations, Physical therapy, Eye exams, Ambulance services, Prescription drugs, Hospital care, Physician services, X-rays, Lab work, Assistive technology, Mental health counseling, Limited home health and nursing care, Case management and Coordination, Hospice care, and Comprehensive dental service. Pre-Existing Health Conditions Covered Eligibility: Must be a U.S. citizen or qualified non-citizen, and live in Delaware. Must be under age 19, with family income at or below 200% FPL. Must not have other comprehensive health insurance coverage or be a dependent of a permanent State employee. Waiting period may apply.

Delaware Screening for Life

Must be Delaware adults ages 18–64, uninsured or underinsured (have high, unmet deductible, or insurance does not cover Pap tests, mammograms, or screenings (breast, cervical, colorectal, prostate). Must not be eligible for Medicaid or Medicare. Must live between 100% to 250% FPL.


Medicare offers Part A, inpatient care in hospitals and rehabilitative centers; Part B, doctor and some preventive services and outpatient care; Part C allows Medicare benefits through private insurance (Medicare Advantage); Part C includes Parts A, B, and C not covered by Medicare. Part D covers prescription drugs.

Medicare Prescription Drug Program

Must be a U.S. citizen or permanent U.S. resident, and: 1) If 65 years or older, you or your spouse worked for at least 10 years in Medicare-covered employment, or 2) You have a disability or end-stage renal disease (permanent kidney failure requiring dialysis or transplant) at any age.

eLDeR Info

Must be a U.S. citizen or permanent U.S. resident, and: 1) If 65 years or older, you or your spouse worked for at least 10 years in Medicare-covered employment, or 2) You have a disability or end-stage renal disease (permanent kidney failure requiring dialysis or transplant) at any age.

Health Coverage tax Credit

Must be receiving TAA (Trade Adjustment Assistance), or Must be 55 years or older and receiving pension from the Pension Benefit Guaranty Corporation (PBGC). Must not be enrolled in certain state plans, or in prison, or receiving 65% COBRA premium reduction, or be claimed as a dependent in tax returns. Must be enrolled in qualified health plans where you pay more than 50% of the premiums.

Heath Care Reform

Insurance companies will no longer be able to place lifetime limits on the coverage they provide, ensuring that the 510,000 Delaware residents with private insurance coverage never have to worry about their coverage running out and facing catastrophic out-of-pocket costs.

Insurance companies will be banned from dropping people from coverage when they get sick, protecting the 29,000 individuals who purchase insurance in the individual market from dishonest insurance practices.

Insurance companies will not be able to exclude children from coverage because of a pre-existing condition, giving parents across Delaware peace of mind.

Insurance plans’ use of annual limits will be tightly regulated to ensure access to needed care.  This will protect the 481,000 residents of Delaware with health insurance from their employer, along with anyone who signs up with a new insurance plan in Delaware.

Health insurers offering new plans will have to develop an appeals process to make it easy for enrollees to dispute the denial of a medical claim.

Patients’ choice of doctors will be protected by allowing plan members in new plans to pick any participating primary care provider, prohibiting insurers from requiring prior authorization before a woman sees an ob-gyn, and ensuring access to emergency care.

Extending coverage to young adults. Beginning on or after September 23, 2010, plans and issuers that offer coverage to children on their parents’ policy must allow children to remain on their parents’ policy until they turn 26, unless the adult child has another offer of job-based coverage in some cases. This provision will bring relief to roughly 2,340 individuals in Delaware who could now have quality affordable coverage through their parents.4  Some employers and the vast majority of insurers have agreed to cover adult children immediately.

Affordable insurance for uninsured with pre-existing conditions. $13 million federal dollars are available to Delaware starting July 1 to provide coverage for uninsured residents with pre-existing medical conditions through a new transitional high-risk pool program, funded entirely by the Federal government. The program is a bridge to 2014 when Americans will have access to affordable coverage options in the new health insurance exchanges and insurance companies will be prohibited from denying coverage to Americans with pre-existing conditions. If states choose not to run the program, the Federal government will administer the program for those residents.

Strengthening community health centers. Beginning October 1, 2010, increased funding for Community Health Centers will help nearly double the number of patients seen by the centers over the next five years. The funding could not only help the 12 Community Health Centers in Delaware but also support the construction of new centers.

More doctors where people need them. Beginning October 1, 2010, the Act will provide funding for the National Health Service Corps ($1.5 billion over five years) for scholarships and loan repayments for doctors, nurses and other health care providers who work in areas with a shortage of health professionals. This will help the 14% of Delaware’s population who live in an underserved area.

New Medicaid options for states. For the first time, Delaware has the option of Federal Medicaid funding for coverage for all low-income populations, irrespective of age, disability, or family status. 

"Vista Health Solutions" Tel (888)215-4045 Email [email protected]