District of Columbia Administrative Code

2852 TERM AND UNIVERSAL LIFE INSURANCE RESERVE FINANCING - THE ACTUARIAL METHOD 2852.1 The Actuarial Method to establish the Required Level of Primary Security for each reinsurance treaty subject to this chapter shall be VM-20, applied on a treaty-by-treaty basis, including all r…

2853 REQUIREMENTS APPLICABLE TO COVERED POLICIES TO OBTAIN CREDIT FOR REINSURANCE 2853.1 Subject to the exemptions described in § 2855 and the provisions of § 2854, credit for reinsurance shall be allowed with respect to ceded liabilities pertaining to Covered Policies pursuant t…

2854 REQUIREMENTS AT INCEPTION DATE AND ON AN ONGOING BASIS AND OPPORTUNITY FOR REMEDIATION 2854.1 The requirements of § 2853 must be satisfied as of the date that risks under Covered Policies are ceded (if such date is on or after the effective date of this regulation) and on an…

2855 EXEMPTIONS 2855.1 The provisions of §§ 2850 – 2854 shall not apply to reinsurance of: (a) Policies that satisfy the criteria for exemption set forth in §§ 3002.11 or 3002.12 of Title 26-A; and which are issued before the effective date of these regulations; (b) Portions of p…

2899 DEFINITIONS 2899.1 When used in this chapter, the following terms and phrases shall have the meanings ascribed: Actuarial method – the methodology used to determine the Required Level of Primary Security, as described in § 2851. Covered policies – those policies, other than …

2900 SCOPE 2900.1 This chapter shall apply to all life insurance companies and fraternal benefit societies doing business in the District of Columbia and to all life insurance companies and fraternal benefit societies that are authorized to reinsure life insurance, annuities or a…

2901 GENERAL REQUIREMENTS 2901.1 There is to be included on or attached to page 1 of the annual statement for each year, beginning with the year in which this chapter becomes effective, the statement of an appointed actuary, entitled "Statement of Actuarial Opinion," setting fort…

2902 STATEMENT OF ACTUARIAL OPINION BASED ON AN ASSET ADEQUACY ANALYSIS 2902.1 The statement of actuarial opinion submitted in accordance with this section shall consist of: (a) A paragraph identifying the appointed actuary and his or her qualifications (see paragraph 2902.2(a));…

2903 DESCRIPTION OF ACTUARIAL MEMORANDUM INCLUDING AN ASSET ADEQUACY ANALYSIS AND REGULATORY ASSEST ADEQUACY ISSUES SUMMARY 2903.1 In accordance with the Act, the appointed actuary shall prepare a memorandum to the company describing the analysis done in support of his or her opi…

2999 DEFINITIONS "Act" means section 2 of the Life Insurance Actuarial Opinion of Reserves Act of 1993, effective October 21, 1993 (D.C. Law 10-50; D.C. Official Code § 31-4901 et seq.) (2001). "Actuarial Opinion" means the opinion of an appointed actuary regarding the adequacy o…

300 PERMISSIBLE REASONS FOR CANCELLATION 300.1 No automobile policy shall be cancelled, nor shall any cancellation be effective for any purpose, unless the insured has done any of the following: (a) Refused or failed to pay a premium due under the terms of the policy; (b) Been su…

301 PROCEDURE FOR CANCELLATION OR NONRENEWAL 301.1 Cancellation by an insurer shall be permissible and effective with respect to a policy only if each of the conditions in this section is met with respect to that cancellation in addition to the conditions set forth in § 300. Unle…

302 RESERVED

303 RESERVED

304 RESERVED

305 PRIOR POLICY CANCELLATIONS OR NONRENEWALS 305.1 No applicant for an automobile, operator's or owner's insurance policy as a condition precedent to obtaining or renewing that policy, shall be required to disclose whether he or she or any person reasonably expected to operate t…

306 POLICIES IN EFFECT LESS THAN THIRTY (30) DAYS 306.1 The restrictions on cancellation contained in this chapter shall not be effective with respect to any policy which shall have been in force for thirty (30) days or less, provided that such policy is not a renewal policy.

307 IMMUNITY 307.1 There shall be no liability on the part of and no cause of action of any nature shall arise against any officer or employee of the District, any insurer, its authorized representatives, its agents, its employees, or any firm, person or corporation who in good f…

308 APPEAL PROCEDURE 308.1 If the insured disputes the validity under this chapter of a purported cancellation or nonrenewal, he or she may at any time before the effective date of the cancellation, or in the case of nonrenewal, the end of the policy period, send written notifica…

309 RESERVED

310 ENFORCEMENT 310.1 Any insurer, policy-writing agent, soliciting agent, broker or salaried insurance company employee who violates any provision of this chapter shall be imprisoned for not more than ten (10) days or fined not more than three hundred dollars ($300), or both, fo…

311 ASSIGNED RISK PLANS: ACCIDENT AND HEALTH INSURANCE 311.1 The provisions of this chapter shall not apply to the policies of insurance issued under the District of Columbia Insurance Placement Act (FAIR Plan), the District of Columbia Automobile Insurance Plan (D.C.A.I.P.), the…

312 WAIVERS 312.1 A policy may provide terms more favorable to policyholders than are required by this chapter, but no policy shall contain any provision which waives any of the requirements of this chapter.

313 OTHER RIGHTS 313.1 The rights provided by this chapter shall be in addition to and shall not prejudice any other rights the policyholder may have at common law or otherwise.

314 EXCLUSIONS 314.1 This chapter shall not apply to any motor vehicle insurance policy or operators policy in the District of Columbia which is subject to § 10 of the Compulsory/No-Fault Motor Vehicle Insurance Act of 1982, as amended

315 REFUNDS ON CREDIT LIFE AND CREDIT ACCIDENT AND HEALTH INSURANCE 315.1 In the event of termination of insurance prior to the scheduled maturity date of the indebtedness, no refund need be made where the amount due is less than one dollar ($1).

399 DEFINITIONS 399.1 As used in this chapter, the following words and phrases shall have the meanings ascribed: Automobile Policy - any contract wherein one party called the "company" for a consideration, undertakes to pay money or its equivalent, or to do an act valuable to any…

3000 APPLICABILITY 3000.1 These regulations shall apply to all life insurance policies, with or without nonforfeiture values, issued on or after the effective date of this regulation, subject to exceptions and conditions set forth in these rules. 3000.2 These regulations shall no…

3001 GENERAL CALCULATION REQUIREMENTS FOR BASIC RESERVES AND PREMIUM DEFICIENCY RESERVES PRIOR TO JANUARY 1, 2005. 3001.1 At the election of the company for any one or more specified plans of life insurance, the minimum mortality standard for basic reserves may be calculated usin…

3002 CALCULATION OF MINIMUM VALUATION STANDARD FOR POLICIES WITH GUARANTEED NONLEVEL GROSS PREMIUMS OR GUARANTEED NONLEVEL BENEFITS (OTHER THAN UNIVERSAL LIFE POLICIES) 3002.1 Basic reserves shall be calculated as the greater of the segmented reserves and the unitary reserves. Bo…

3003 CALCULATION OF MINIMUM VALUATION STANDARD FOR FLEXIBLE PREMIUM AND FIXED PREMIUM UNIVERSAL LIFE INSURANCE POLICIES THAT CONTAIN PROVISIONS RESULTING IN THE ABILITY OF A POLICYOWNER TO KEEP A POLICY IN FORCE OVER A SECONDARY GUARANTEE PERIOD 3003.1 Policies with a secondary g…

3004 DEFINITIONS 3004.1 The definition of terms found in D.C. Official Code §§ 31-4701 et seq. (2001 and 2007 Supp.) shall apply to this chapter. For purposes of this chapter, the following terms shall have the meanings ascribed below: "2001 CSO Mortality Table" means that mortal…

3005 2001 CSO MORTALITY TABLE FOR DETERMINING MINIMUM RESERVE LIABILITIES AND NONFORFEITURE BENEFITS AFTER JANUARY 1, 2005 3005.1 The regulations in this section shall have the following applicability: (a) At the election of the company for any one or more specified plans of insu…

3101 GENERAL REQUIREMENTS AND LIMITATIONS 3101.1 An HMO may invest its funds only as provided under this Chapter. Notwithstanding the provisions of these regulations, the Commissioner may, after notice and opportunity for a hearing, order an HMO to limit or withdraw from certain …

3102 VALUATION OF INVESTMENTS 3102.1 In applying the percentage limitations imposed by this Chapter, there shall be used as a base the total of all assets which would be admitted by this Chapter without regard to percentage limitations. All legal measurements used as a base in th…

3103 AUTHORIZED INVESTMENTS 3103.1 Any HMO may acquire the assets set forth in subsections 3103.2 through 3103.18, inclusive. Any restriction, exclusion or provision appearing in any subsection shall apply only with respect to the authorization of the particular subsection in whi…

3104 DEPOSIT OF SECURITIES IN CLEARING CORPORATIONS. 3104.1 An HMO may deposit or arrange for the deposit of securities held in or purchased for its general account in a clearing corporation. 3104.2 When securities are deposited with a clearing corporation, certificates represent…

3199 DEFINITIONS 3199.1 "Admitted asset" means the investments authorized or permitted under this chapter, and in addition, includes only the following: (a) Petty cash and other cash funds in the HMO's principal or official branch office(s) and under the control of the HMO; (b) I…

3500 ESTABLISHMENT OF HEALTH MAINTENANCE ORGANIZATIONS AND RENEWAL OF CERTIFICATE OF AUTHORITY 3500.1 Any person seeking to operate an HMO in the District of Columbia shall file an application for a certificate of authority accompanied by the required supporting documentation wit…

3501 ISSUANCE OF CERTIFICATE OF AUTHORITY 3501.1 The Commissioner, in consultation with the Director of the Department of Health, shall determine whether the applicant has complied with the District's quality assurance program, pursuant to section 7 of the Act, D.C. Code § 35-450…

3502 POWERS OF HMOS 3502.1 The powers of an HMO include, but are not limited to, the following: (a) The purchase, lease, construction, renovation, operation or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and such property and equipment as…

3503 QUALITY ASSURANCE PROGRAM 3503.1 An HMO shall continually maintain an internal quality assurance program. This program shall monitor and evaluate the services provided by the HMO, including primary and specialist physician services, and ancillary and preventive health care s…

3504 REQUIREMENTS FOR CONTRACTS AND EVIDENCE OF COVERAGE 3504.1 Each enrollee shall be entitled to receive an individual contract, evidence of coverage, or other description of covered services in a form that has been approved by the Commissioner. Each group contract holder shall…

3505 (RESERVED) SOURCE: Final Rulemaking published at 46 DCR 7291(September 17, 1999).

3506 PROTECTION AGAINST INSOLVENCY - NET WORTH AND DEPOSIT REQUIREMENTS, LIABILITIES, AND HOLD HARMLESS 3506.1 An HMO shall have an initial net worth of one million five hundred thousand dollars ($ 1,500,000) prior to the issuance of the certificate of authority. 3506.2 After the…

3507 UNCOVERED HEALTH CARE EXPENDITURES INSOLVENCY DEPOSIT 3507.1 An HMO shall place an uncovered health care expenditures insolvency deposit with the Commissioner, or with any organization or trustee acceptable to the Commissioner, when uncovered health care expenditures are mor…

3508 MAINTENANCE OF INSUFFICIENT NET WORTH 3508.1 When the Commissioner finds that the net worth maintained by any HMO is less than the minimum net worth required to be maintained under section 3506, the Commissioner shall give written notice to the HMO indicating the amount of t…

3509 SERVICES 3509.1 An HMO shall establish and maintain adequate arrangements to provide health services for its enrollees, including: (a) Reasonable proximity to the business or personal residences of the enrollees so as not to result in unreasonable barriers to accessibility; …

3510 FILING REQUIREMENTS FOR RATING INFORMATION 3510.1 A schedule of enrollment fees or methodology for determining enrollment fees due must be filed and approved by the Commissioner before the fees can be used by the HMO. 3510.2 Either a specific schedule of fees, or a methodolo…

3511 READABILITY STANDARDS FOR INDIVIDUAL OR GROUP CONTRACTS AND EVIDENCE OF COVERAGE 3511.1 Each individual or group contract, or evidence of coverage, shall include a table of contents. 3511.2 Each section in the aforementioned documents shall be self-contained and independent,…