Delaware Administrative Code
Title 18 - Insurance
1400 - Health Insurance Specific Provisions
1406 - Third Party Administrators
Section 1406-16.0 - Grounds for Denial, Suspension or Revocation of Certificate of Authority

16.1.1 Is in an unsound financial condition;

16.1.2 Is using such methods or practices in the conduct of its business so as to render its further transaction of business in this state hazardous or injurious to insured persons or the public; or

16.1.3 Has failed to pay any judgment rendered against it in this state within sixty days after the judgment has become final.

16.2.1 Has violated any lawful rule or order of the Commissioner or any applicable law of this state;

16.2.2 Has refused to be examined or to produce its accounts, records and files for examination, or if any individual responsible for the conduct of affairs of the administrator, including members of the board of directors, board of trustees, executive committee or other governing board or committee; the principal officers in the case of a corporation or the partners or members in the case of a partnership, association or limited liability company; any shareholder or member holding directly or indirectly 10% or more of the voting stock, voting securities or voting interest of the administrator; and any other person who exercises control or influence over the affairs of the administrator; has refused to give information with respect to its affairs or has refused to perform any other legal obligation as to an examination, when required by the Commissioner;

16.2.3 Has, without just cause, refused to pay clean claims or perform services arising under its contracts or has, without just cause, caused covered individuals to accept less than the amount due them or caused covered individuals to employ attorneys or bring suit against the administrator to secure full payment or settlement of such claims;

16.2.4 At any time fails to meet any qualification for which issuance of the certificate could have been refused had the failure then existed and been known to the Commissioner;

16.2.5 Or any of the individuals responsible for the conduct of its affairs, including members of the board of directors, board of trustees, executive committee or other governing board or committee; the principal officers in the case of a corporation or the partners or members in the case of a partnership, association or limited liability company; any shareholder or member holding directly or indirectly 10% or more of its voting stock, voting securities or voting interest; and any other person who exercises control or influence over its affairs; has been convicted of, or has entered a plea of guilty or nolo contendere to, a felony without regard to whether adjudication was withheld;

16.2.6 Is under suspension or revocation in another state; or

16.2.7 Has failed to timely file its annual report pursuant to Section 15.0 of this regulation, if a resident administrator, or its statement and filing fee, as applicable, pursuant to subsections 14.4 and 14.5 of this regulation, if a nonresident administrator.

16.3.1 The administrator is insolvent or impaired;

16.3.2 A proceeding for receivership, conservatorship, rehabilitation or other delinquency proceeding regarding the administrator has been commenced in any state; or

16.3.3 The financial condition or business practices of the administrator otherwise pose an imminent threat to the public health, safety or welfare of the residents of this state.