Health plans would cover menopause diagnosis and treatment

Individual and group health insurers would have to cover medically necessary menopause and perimenopause diagnosis and treatment. The requirement covers individual policies and group or blanket health plans delivered, renewed, extended, or modified in Delaware. Coverage would include testing, approved hormone and non-hormone treatments, behavioral health care, pelvic floor therapy, bone health care, preventive services, and counseling. Plans could still use deductibles, coinsurance, limits on allowed charges, coordination of benefits, and approved-provider rules. The requirement would not apply to limited policies such as accident-only, hospital indemnity, Medicare supplement, long-term care, or disability income coverage. A religious employer could request an exclusion from a group or blanket policy if the coverage conflicts with its sincere religious beliefs and practices. The insurer would have to grant the exclusion, and the employer would have to notify employees. The requirement would apply to policies, contracts, and certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2027.

The state employee health plan would have to cover medically necessary menopause and perimenopause diagnosis and treatment. The provision applies to covered people enrolled in the state employee health plan. Coverage would include testing, approved hormone and non-hormone treatments, behavioral health care, pelvic floor therapy, bone health care, preventive services, and counseling. Hormone replacement therapy supported by national guidelines, standards of care, or peer-reviewed medical literature could not be denied, limited, or subjected to prior authorization or step therapy. Coverage would generally match the plan's coverage for other medical conditions. The requirement would apply to policies, contracts, and certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2027.

The Medicaid health plan would have to provide medically necessary menopause and perimenopause diagnosis and treatment. The provision covers Medicaid recipients receiving assistance through the health benefit plans identified in the supplied text. Coverage would include testing, approved hormone and non-hormone treatments, behavioral health care, pelvic floor therapy, bone health care, preventive services, and counseling. Medicaid coverage for medically necessary hormone replacement therapy could not be denied, limited, or subjected to prior authorization or step therapy when supported by national guidelines, standards of care, or peer-reviewed medical literature, except as federal Medicaid law allows. Coverage would generally match assistance for other medical conditions, subject to federal law. The requirement would apply to policies, contracts, and certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2027.