A new Delaware law forces health insurers to negotiate single-case agreements with out-of-network behavioral health providers—and small business owners are paying attention.
Most Delaware health services owners don't realize that a provision buried in SB22 has already changed how their health insurance carriers must operate. If you sponsor a fully-insured health benefit plan for your employees, this law affects you—whether you know it or not.
Delaware's SB22—An Act To Amend Title 18 Of The Delaware Code Relating To Insurance Coverage—contains a requirement that health insurance carriers execute single-case agreements with out-of-network mental health and substance use disorder (SUD) providers. The key trigger: when the carrier's network is deemed inadequate.
Here's the practical effect: If a patient needs mental health or addiction treatment and the insurer's in-network options are insufficient, the carrier must now negotiate a one-off agreement with an out-of-network provider. Critically, that out-of-network provider must be paid at the same cost-sharing rates as in-network providers—meaning lower copays and deductibles for the patient, and different reimbursement terms for the provider.
This is not optional. It's a legal requirement for carriers.
If you purchase health insurance for your employees in Delaware, your carrier's behavioral health network just became subject to a new standard. The law essentially expands what "adequate coverage" means under your plan. Your insurer cannot simply say a network is sufficient if it fails to meet this threshold.
What does this mean for you? Potentially higher claims costs. Single-case agreements typically involve negotiated rates that fall between in-network and out-of-network pricing, but the requirement to offer them at in-network cost-sharing rates may increase your plan's utilization and expense. The scope of your behavioral health benefits has structurally expanded, whether you actively chose that or not.
For health services providers themselves—clinics, treatment centers, therapists—this creates a new pathway to in-network reimbursement without a formal network contract, but only when a carrier deems its network inadequate.
The provision applies to all health insurance policies issued, renewed, modified, altered, amended, or reissued after December 31, 2024. If your plan renews in 2025 or later, this requirement is already in effect.
The specific language is found in Section 1, subsection (f)(1), amending § 3343 of Title 18 of the Delaware Code.
Review your current health plan documents and ask your carrier or broker directly: Does our plan's mental health and SUD network meet the adequacy standard under SB22? What single-case agreement protocols are in place? Understanding your carrier's interpretation of "adequate network" will help you anticipate potential cost impacts and ensure your plan design aligns with your budget.
For a detailed, business-specific summary of SB22's behavioral health provisions, contact your Delaware health insurance broker or trade association.