District of Columbia Administrative Code

2206 MINIMUM BENEFIT STANDARDS FOR POLICIES OR CERTIFICATES ISSUED FOR DELIVERY PRIOR TO MAY 1, 1999 2206.1 No policy or certificate may be advertised, solicited or issued for delivery in the District as a Medicare supplement policy or certificate unless it meets or exceeds the f…

2207 MINIMUM BENEFIT STANDARDS FOR POLICIES OR CERTIFICATES ISSUED OR DELIVERED ON OR AFTER MAY 1, 1999 AND PRIOR TO JUNE 1, 2010 2207.1 The standards contained in this section are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in …

2208 STANDARD MEDICARE SUPPLEMENT BENEFIT PLANS 2208.1 An issuer shall make available to each prospective policyholder and certificate holder a policy form or certificate form containing only the Basic "Core" Benefits, as defined in subsection 2207.14. 2208.2 No groups, packages …

2209 GUARANTEED ISSUE FOR ELIGIBLE PERSONS 2209.1 An eligible person shall be any of the individuals described in subsection 2209.3 who apply to enroll under the policy not later than sixty-three (63) days after the date of the termination of enrollment described in subsection 22…

2210 OPEN ENROLLMENT 2210.1 No issuer shall deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in the District, nor discriminate in the pricing of a policy or certificate because of the health status, claims experie…

2211 STANDARDS FOR CLAIMS PAYMENT 2211.1 An issuer shall comply with section 1882(c) (3) of the Social Security Act (as enacted by section 4081(b) (2) (C) of the Omnibus Budget Reconciliation Act of 1987, Pub. L. No. 100-203) by: (a) Accepting a notice from a Medicare carrier on …

2212 LOSS RATIO STANDARDS 2212.1 A Medicare supplement insurance policy form or certificate form shall not be delivered or issued for a delivery in the District unless the policy form or certificate form can be expected, as estimated for the entire period for which rates are comp…

2213 REFUND OR CREDIT OF PREMIUM 2213.1 An issuer shall collect and file with the Commissioner by May 31 of each year the data contained in the reporting form contained in Appendix A for each type in a Standard Medicare Supplement Benefit Plan, described in section 2208. 2213.2 I…

2214 ANNUAL FILING OF PREMIUM RATES 2214.1 An issuer of Medicare supplement policies and certificates issued in the District before or after the effective date of this chapter shall file annually its rates, rating schedule and supporting documentation, including ratios of incurre…

2215 PUBLIC HEARINGS 2215.1 The Commissioner may conduct a public hearing to gather information concerning a request by an issuer for an increase in a rate for a policy form or certificate form issued before or after July 22, 1992, if the experience of the form for the previous r…

2216 FILING AND APPROVAL OF POLICIES AND CERTIFICATES AND PREMIUM RATES 2216.1 An issuer shall not: (a) Deliver or issue for delivery a policy or certificate to a resident of the District unless the policy form or certificate form has been filed with and approved by the Commissio…

2217 PERMITTED COMPENSATION ARRANGEMENTS 2217.1 An issuer or other entity may provide a commission or other compensation to an agent or other representative for the sale of a Medicare supplement policy or certificate only if the first year commission or other first year compensat…

2218 REQUIRED DISCLOSURE PROVISIONS - GENERAL RULES 2218.1 Medicare supplement policies and certificates shall include a renewal or continuation provision and the language or specifications of such provision shall be consistent with the type of contract issued. 2218.2 The renewal…

2219 REQUIRED DISCLOSURE PROVISIONS - NOTICE REQUIREMENT 2219.1 As soon as practicable, but no later than thirty (30) days prior to the annual effective date of any Medicare benefit changes, an issuer shall notify its policyholders and certificate holders of modifications it has …

2220 REQUIRED DISCLOSURE PROVISIONS - OUTLINE OF COVERAGE REOUIREMENTS FOR MEDICARE SUPPLEMENT POLICIES 2220.1 Issuers shall: (a) Provide an outline of coverage to all applicants at the time the application is presented to the prospective applicant; and (b) Except for direct resp…

2221 REQUIRED DISCLOSURE PROVISIONS - NOTICE REGARDING POLICIES OR CERTIFICATES WHICH ARE NOT MEDICARE SUPPLEMENT POLICIES 2221.1 Any accident and sickness insurance policy or certificate other than a Medicare supplement policy, any policy issued pursuant to a contract under sect…

2222 REQUIREMENTS FOR APPLICATION FORMS AND REPLACEMENT COVERAGE 2222.1 Application forms shall include the following statements and questions designed to elicit information as to whether, as of the date of the application, the applicant currently has Medicare supplement, Medicar…

2223 FILING REQUIREMENTS FOR ADVERTISING 2223.1 An issuer shall provide a copy of any Medicare supplement advertisement intended for use in the District of Columbia, whether through written, radio or television media to the Commissioner for review or approval by the Commissioner …

2224 STANDARDS FOR MARKETING 2224.1 An issuer, directly or through its producers, shall: (a) Establish marketing procedures to assure that any comparison of policies by its agents or other producers will be fair and accurate; (b) Establish marketing procedures to assure excessive…

2225 APPROPRIATENESS OF RECOMMENDED PURCHASE AND EXCESSIVE INSURANCE 2225.1 In recommending the purchase or replacement of any Medicare supplement policy or certificate an agent shall make reasonable efforts to determine the appropriateness of a recommended purchase or replacemen…

2226 REPORTING OF MULTIPLE POLICIES 2226.1 On or before March 1 of each year, an issuer shall report the following information for every individual resident of the District of Columbia for which the issuer has in force more than one Medicare supplement policy or certificate: (a) …

2227 PROHIBITION AGAINST PREEXISTING CONDITIONS, WAITING PERIODS, ELIMINATION PERIODS AND PROBATIONARY PERIODS IN REPLACEMENT POLICIES OR CERTIFICATES 2227.1 If a Medicare supplement policy or certificate replaces another Medicare supplement policy or certificate, the replacing i…

2228 PROHIBITION AGAINST USE OF GENETIC INFORMATION AND REQUESTS FOR GENETIC TESTING This section applies to all policies with policy years beginning on or after May 21, 2009. An issuer of a Medicare supplement policy or certificate shall not: Deny or condition the issuance or ef…

2229 MEDICARE SELECT POLICIES AND CERTIFICATES 2229.1 (a) This section shall apply to Medicare Select policies and certificates, as defined in this section. (b) No policy or certificate may be advertised as a Medicare Select policy or certificate unless it meets the requirements …

SEPARABILITY If any provision of this rule or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the rule and the application of such provision to other persons or circumstances shall not be affected thereby. SOURCE: Fina…

2299 DEFINITIONS 2299.1 For purposes of this chapter, the words and phrases set forth in this section shall have the meanings ascribed. 1990 Standardized Medicare supplement benefit plan, 1990 Standardized benefit plan, or 1990 plan means a group or individual policy of Medicare …

2300 PREAMBLE 2300.1 The District of Columbia Insurance Administration recognizes that licensed insurers routinely enter into reinsurance agreements that yield legitimate relief to the ceding insurer from strain to surplus. However, it is improper for a licensed insurer, in the c…

2301 SCOPE 2301.1 This regulation shall apply to all domestic life and accident and health insurers and to all other licensed life and accident and health insurers which are not subject to a substantially similar regulation in their domicilary state. This regulation shall also si…

2302 ACCOUNTING REQUIREMENTS 2302.1 No insurer subject to this regulation shall, for reinsurance ceded, reduce any liability or establish any asset in any financial statement filed with the Commissioner of Insurance if, by the terms of the reinsurance agreement, in substance or e…

2303 WRITTEN AGREEMENTS 2303.1 No reinsurance agreement or amendment to any agreement or amendment to any agreement may be used to reduce any liability or to establish any asset in any financial statement filed with the Insurance Administration, unless the agreement, amendment or…

2304 EXISTING AGREEMENTS 2304.1 Insurers subject to this regulation shall reduce to zero by December 31, 1994 any reserves credits or assets established with respect to reinsurance agreements entered into prior to the effective date of this regulation which, under the provisions …

2400 SCOPE 2400.1 The provisions of this law shall apply to insurance companies regulated by District of Columbia Code Sec. 35-422. SOURCE: Final Rulemaking published at 41 DCR 2223(April 22, 1994).

2401 VALUATION OF BONDS 2401.1 All bonds or other evidences of debt having a fixed term and rate of interest held by an insurer may, if amply secured and not in default as to principal or interest, be valued as follows: (a) If purchased at par, at the value. (b) If purchased abov…

2402 VALUATION OF OTHER SECURITIES 2402.1 Securities, other than those referred to in Section 2401, held by an insurer shall be valued, in the discretion of the Commissioner of Insurance, at their market value, or at their appraised value, or at prices determined by it as represe…

2403 OTHER INVESTED ASSETS 2403.1 Insurers other invested assets shall be valued in accordance with procedures promulgated by the National Association of Insurance Commissioner's Financial Condition subcommittee or as prescribed by the Commissioner of Insurance which will be made…

2500 SCOPE 2500.1 The provisions of this chapter shall apply to all domestic, foreign, and alien insurers that are authorized to transact insurance in the District of Columbia and required to file annual financial statements pursuant to the Required Annual Financial Statements an…

2501 FILING REQUIREMENTS 2501.1 Insurers required to file annual statements pursuant to the act shall use the annual statement instructions of the National Association of Insurance Commissioners. 2501.2 All financial statements shall be filed on diskette with the National Associa…

2502 [RESERVED] SOURCE: Final Rulemaking published at 69 DCR 001865 (March 11, 2022). District of Columbia Municipal Regulations Insurance 26-A DCMR § 2502

2503 [RESERVED] SOURCE: Final Rulemaking published at 69 DCR 001865 (March 11, 2022). District of Columbia Municipal Regulations Insurance 26-A DCMR § 2503

2504 [RESERVED] SOURCE: Final Rulemaking published at 69 DCR 001865 (March 11, 2022). District of Columbia Municipal Regulations Insurance 26-A DCMR § 2504

2505 [RESERVED] SOURCE: Final Rulemaking published at 69 DCR 001865 (March 11, 2022). District of Columbia Municipal Regulations Insurance 26-A DCMR § 2505

2506 [RESERVED] SOURCE: Final Rulemaking published at 69 DCR 001865 (March 11, 2022). District of Columbia Municipal Regulations Insurance 26-A DCMR § 2506

2507 [RESERVED] SOURCE: Final Rulemaking published at 69 DCR 001865 (March 11, 2022). District of Columbia Municipal Regulations Insurance 26-A DCMR § 2507

2508 [RESERVED] SOURCE: Final Rulemaking published at 69 DCR 001865 (March 11, 2022). District of Columbia Municipal Regulations Insurance 26-A DCMR § 2508

2509 [RESERVED] SOURCE: Final Rulemaking published at 69 DCR 001865 (March 11, 2022). District of Columbia Municipal Regulations Insurance 26-A DCMR § 2509

2510 [RESERVED] SOURCE: Final Rulemaking published at 69 DCR 001865 (March 11, 2022). District of Columbia Municipal Regulations Insurance 26-A DCMR § 2510

2511 CORPORATE GOVERNANCE ANNUAL DISCLOSURE 2511.1 The purpose of §§ 2511-2513 is to set forth the procedures for the filing and required contents of the Corporate Governance Annual Disclosure (“CGAD”) and to implement the provisions of Insurer Corporate Governance Annual Report …

2512 FILING PROCEDURES 2512.1 An insurer, or the insurance group of which the insurer is a member, required to file a CGAD by the Act, shall, no later than June 1 of each calendar year, submit to the Commissioner a CGAD that contains the information described in section 2513 of t…

2513 CONTENTS OF CORPORATE GOVERNANCE ANNUAL DISCLOSURE 2513.1 The insurer or insurance group shall be as descriptive as possible in completing the CGAD, with inclusion of attachments or example documents that are used in the governance process, in order to demonstrate the streng…

2599 DEFINITIONS 2599.1 When used in this chapter, the following terms shall have the meanings ascribed: Commissioner – the Commissioner of the District of Columbia Department of Insurance, Securities, and Banking. Insurance group – those insurers and affiliates included within a…