A new Delaware law requires health insurers to cover certain out-of-network providers at in-network costs—and small employers sponsoring plans need to understand the impact.
Most Delaware health services owners don't realize that starting next year, their insurance carriers will be legally required to cover out-of-network mental health and substance use disorder (SUD) providers at in-network cost-sharing rates under certain conditions. This provision, buried in Delaware Senate Bill 22, changes how network adequacy works and has real implications for plan costs and operations.
Under Section 1, subsection (f)(1) of SB22—which amends § 3343 of Title 18 of the Delaware Code—health insurance carriers must execute single-case agreements when a network is deemed inadequate for mental health or SUD services. In plain terms: if an insurer's in-network provider list doesn't meet adequacy standards for these services, the carrier must agree to cover out-of-network providers at the same cost-sharing rates (copayments, coinsurance, deductibles) that apply to in-network care.
This is not optional. The law applies to all health insurance policies issued, renewed, modified, altered, amended, or reissued after December 31, 2024.
This provision primarily impacts small businesses in Delaware that sponsor fully-insured health benefit plans—meaning they purchase insurance from a carrier rather than self-funding. When a carrier's mental health or SUD network is inadequate, employers and their employees gain access to out-of-network providers without paying higher out-of-pocket costs. Employees benefit from expanded access; employers may face higher premiums as carriers absorb the cost of covering additional providers.
Health services providers—particularly mental health practices, addiction treatment centers, and counseling services—should understand that carriers may now be required to contract with them at in-network rates even if they weren't previously in-network, depending on network adequacy determinations.
If you sponsor a fully-insured health plan, expect your carrier to communicate about network adequacy assessments for mental health and SUD services. The law also imposes disclosure and process requirements on carriers, which means you may receive additional documentation about how your plan meets (or doesn't meet) adequacy standards.
Premium impacts depend on your carrier's current network gaps. Plans with robust mental health and SUD networks may see minimal change. Plans with significant gaps could face higher costs as carriers expand coverage obligations.
If you operate a health services practice, this creates a potential pathway to in-network status: if you're out-of-network and a carrier's network is inadequate, you may be able to negotiate a single-case agreement at in-network rates.
Review your current health plan documents and carrier communications about network adequacy. If you're a plan sponsor, contact your broker or carrier to understand whether your plan's mental health and SUD networks will trigger single-case agreement requirements. If you're a provider, monitor whether carriers in your area begin reaching out about network gaps.
The effective date is December 31, 2024, so changes take effect with policies renewed or issued in 2025.
For a detailed, business-specific guide to SB22's requirements, contact your Delaware health insurance broker or trade association.