District of Columbia Administrative Code

4015 METHOD OF DETERMINING FINANCIAL CONDITION 4015.1 In determining the financial condition of a reciprocal insurer, the Commissioner shall apply the following rules: (a) The Commissioner shall charge as liabilities the same reserves as are required of incorporated insurers issu…

4016 SUBSCRIBERS 4016.1 Subscribers are persons, including any association, aggregate of individuals, purchasing group, business company, corporation, individual, joint stock company, Lloyds type organization, cooperative, partnership, receiver, reciprocal, interinsurance exchang…

4017 SUBSCRIBERS’ ADVISORY COMMITTEE 4017.1 The advisory committee of a domestic reciprocal insurer exercising the subscribers’ rights shall be selected under such rules as the subscribers adopt. The advisory committee may be known as and referred to as a board of directors, boar…

4018 SUBSCRIBERS’ LIABILITY GENERALLY 4018.1 Subscribers shall be nonassessable unless specifically provided otherwise in the written power of attorney or in the written subscribers’ agreement. 4018.2 The liability of each assessable subscriber under an assessable policy for the …

4019 SUBSCRIBERS’ LIABILITY ON JUDGMENT 4019.1 No action shall lie against any subscriber upon any obligation claimed against the insurer. Source: Notice of Emergency and Proposed Rulemaking published at 54 DCR 12099 (December 14, 2007)[EXPIRED]; as amended by Notice of Final Rul…

4020 ASSESSMENTS 4020.1 Assessments may from time to time be levied upon subscribers of a domestic reciprocal insurer having contingent liability under the terms of their policies by the attorney upon approval in advance by the subscribers’ advisory committee and the Commissioner…

4021 TIME LIMIT FOR ASSESSMENTS 4021 Every subscriber of a domestic reciprocal insurer having contingent liability shall be liable for and shall pay the subscriber’s share of any assessment, as computed and limited in accordance with this chapter if: (a) While the subscriber’s po…

4022 AGGREGATE OR CONTINGENT LIABILITY 4022.1 No one policy or subscriber as to such policy shall be assessed or charged with an aggregate or contingent liability as to the obligations incurred by a domestic reciprocal insurer in any one calendar year in excess of the amount prov…

4023 NONASSESSABLE POLICIES 4023.1 Any domestic reciprocal insurer may issue nonassessable policies. 4023.2 If a reciprocal insurer has a surplus of assets over all liabilities at least equal to the minimum capital stock and surplus required to be maintained by a domestic stock i…

4024 SUBSCRIBERS’ SHARE IN ASSETS 4024.1 Upon the liquidation of a domestic reciprocal insurer, its remaining assets shall be distributed according to such reasonable plan as the Commissioner may approve. 4024.2 No subscriber shall receive any distribution from a liquidated domes…

4025 MERGER, CONVERSION, REORGANIZATION 4025.1 A domestic reciprocal insurer may merge with another reciprocal insurer or be converted to a stock or mutual insurer upon affirmative vote of not less than two thirds of its subscribers who are authorized to vote on such a merger or …

4026 IMPAIRED RECIPROCALS 4026.1 Whenever the assets of a domestic reciprocal insurer are insufficient to discharge its liabilities (other than any liability on account of funds contributed by the attorney or others) and to maintain the required surplus, its attorney shall forthw…

4099 DEFINITIONS Where applicable, the words and phrases used in this chapter shall have the same meaning as is found in the Captive Insurance Company Act of 2004, effective March 17, 2005 (D.C. Law 15-262; D.C. Official Code § 31-3131.01 et seq.). Additionally, for purpose of th…

4101 SCOPE OF CHAPTER 4101.1 This chapter applies to all kinds and classes of insurance that insure or guarantee: (a) Titles to real or leasehold property or an estate in real or leasehold property; (b) Against loss by reason of defects, encumbrances, liens, or charges on real or…

4102 INTERIM USE OF RATES 4102.1 Notwithstanding any other provision of this chapter, title insurers may use the premium rate schedules in effect prior to the applicability date of the Fiscal Year 2011 Budget Support Act of 2010, effective September 24, 2010 (D.C. Law 18-223; 57 …

4103 RATE MAKING STANDARDS 4103.1 All title insurance rates shall be made in accordance with this section. 4103.2 Rates shall be reasonable and adequate for the class of risks to which they apply. 4103.3 Rates may not discriminate unfairly between risks that involve essentially t…

4104 RATE FILINGS 4104.1 Except as otherwise provided in this subsection, each title insurer shall file with the Commissioner all rates or premiums, and supplementary rate information that it proposes to use. 4104.2 A filing is not required for rates or premiums for a special or …

4105 APPROVAL OR DISAPPROVAL OF FILINGS 4105.1 Unless the Commissioner finds that a filing does not meet the requirements of this chapter, or is otherwise contrary to other applicable law, the Commissioner shall approve the filing. 4105.2 If the Commissioner approves a filing pri…

4106 FINANCIAL DATA AND OTHER INFORMATION 4106.1 Each title insurer subject to this chapter shall provide to the Commissioner on a uniform basis financial data and any other information that the Commissioner requires in the regulation of rates. 4106.2 The financial data to be pro…

4107 EXCHANGE OF INFORMATION AND EXPERIENCE DATA 4107.1 To further more equitable establishment and adjustment of rates and premiums and forms of contracts, policies, or guarantees of insurance, the Commissioner and each title insurer may: (a) Exchange information and experience …

4108 PROHIBITED CONTRACTS, POLICIES, AND GUARANTEES OF INSURANCE; COMMISSIONS AUTHORIZED 4108.1 A title insurer may not make or issue a contract, policy, or guarantee of insurance except in accordance with filings approved as provided in this chapter. 4108.2 Each title insurer sh…

4109 FALSE OR MISLEADING INFORMATION 4109.1 A person may not knowingly give false or misleading information to the Commissioner, an insurer, or another person if the information will affect the proper determination of rates or premiums or the proper issuance of a contract, policy…

4110 PENALTIES 4110.1 The Commissioner may impose any administrative penalty authorized under, and in accordance with, the Title Insurance Insurer Act of 2010. Scope: Notice of Emergency and Proposed Rulemaking published at 57 DCR 12276 (December 24, 2010)[EXPIRED]; as amended by…

4200 APPLICABILITY 4200.1 Each health insurer or its credentialing intermediary, and § 44-501(a) entities listed in the Health-Care and Community Residence Facility, Hospice and Home Care Licensure Act of 1983, effective February 24, 1984 (D.C. Law 5-48, D.C. Official Code § 44-5…

4201 APPLICATION FOR BECOMING CREDENTIALED OR RE-CREDENTIALED 4201.1 Each health insurer or its credentialing intermediary, and § 44-501(a) entities shall accept the current credentialing/re-credentialing form attached to this chapter as Appendix 39-1 as the sole application for …

4202 PENALTIES 4202.1 The commissioner may impose a penalty not to exceed $500.00 against any health insurer or § 44-501(a) entity for each violation of the Act, by the health insurer, the § 44-501(a) entity, or authorized credentialing intermediary. 4202.2 Any health insurer or …

4299 DEFINITIONS 4299.1 When used in this chapter, the following terms and phrases shall have the meanings ascribed: “Act” means the Health Insurers and Credentialing Intermediaries Uniform Credentialing Form Act of 2002 (D.C. Law 14-96; D.C. Official Code § 31-3251 et seq.(Supp.…

4300 APPLICABILITY 4300.1 Each health insurer that requires an enrollee or subscriber to have a written referral in order to receive services shall used the uniform consultation referral form adopted by the Commissioner. 4300.2 Each health insurer must comply with these rules beg…

4301 CONSULTATION REFERRAL FORM 4301.1 The health insurer may not impose as a condition of coverage a requirement to modify the uniform consultation referral form or to require the submission of additional consultation referral forms. 4301.2 The health insurer may provide a separ…

4302 ELECTRONIC TRANSFER 4302.1 The uniform consultation referral form may be transmitted by facsimile, so long as, the format and the data on the uniform consultation referral form remain unchanged. Source: Notice of Final Rulemaking published at 54 DCR 5295, 5296 (May 25, 2007)…

4399 DEFINITIONS 4399.1 “Health benefits plan” mans any accident and health insurance policy or certificate, hospital and medical services corporation contract, health maintenance organization subscriber contract, plan provided by a multiple employer welfare arrangement, or plan …

4401 SCOPE OF CHAPTER 4401.1 This chapter is applicable to child-only policies issued on or after September 23, 2010. Source: Notice of Emergency and Proposed Rulemaking published at 57 DCR 12281 (December 24, 2010)[EXPIRED]; as amended by Notice of Final Rulemaking published at …

4402 CHILD-ONLY POLICY 4402.1 Carriers shall issue or deliver a child-only policy in the District in accordance with the requirements of this chapter. Source: Notice of Emergency and Proposed Rulemaking published at 57 DCR 12281 (December 24, 2010)[EXPIRED]; as amended by Notice …

4403 OPEN ENROLLMENT PERIODS 4403.1 A carrier issuing or delivering child-only policies in the District shall accept applications for coverage during the open enrollment periods outlined in this chapter. 4403.2 Each carrier issuing child-only policies shall hold open enrollment p…

4404 APPLICATIONS RECEIVED OUTSIDE OPEN ENROLLMENT PERIOD 4404.1 If a carrier receives an application for a child-only policy outside the open enrollment periods, the carrier shall accept the application if the applicant meets the criteria set forth in section 4405 of this chapte…

4405 COURT ORDERED COVERAGE 4405.1 Carriers issuing child-only policies shall accept an application for a child-only policy outside of the open enrollment periods described in section 4403 of this chapter if a court has ordered health benefits be provided to the child. 4405.2 A c…

4406 UNDERWRITING 4406.1 A carrier may not deny issuance of a child-only policy due to medical underwriting. 4406.2 A carrier may conduct medical underwriting to determine the appropriate premium rate for a child-only policy. Source: Notice of Emergency and Proposed Rulemaking pu…

4499 DEFINITIONS 4499.1 For the purpose of this chapter, the term: Applicant means a child or an individual on behalf of a child who submits an application for a child-only policy. Carrier means an insurer, nonprofit health service plan, group hospital and medical service corpora…

4500 APPLICABILITY 4500.1 These rules shall apply to domestic corporations issued a certificate of authority pursuant to § 6 of the Hospital and Medical Services Corporation Regulatory Act of 1996, effective April 9, 1997 (D.C. Law 11-245; D.C. Official Code § 31-3505 (2001)). 45…

4501 REQUIRED CODE OF CONDUCT FOR DIRECTORS, OFFICERS, AND EMPLOYEES OF THE CORPORATION 4501.1 The board of directors of the corporation shall adopt a code of conduct that governs the conduct of the corporation’s directors, officers, and employees. 4501.2 The code of conduct shal…

4502 MINIMUM REQUIREMENTS FOR CODE OF CONDUCT 4502.1 The code of conduct adopted by the corporation pursuant to this chapter shall include all fiduciary obligations applicable to directors as set forth in this chapter. In addition, the code of conduct as applicable to directors, …

4503 CODE OF CONDUCT COMPLIANCE PROGRAM 4503.1 The corporation’s board of directors shall appoint a code of conduct compliance officer who shall have the responsibility to investigate all reports of violations of the code of conduct. 4503.2 Suspected violations of the code of con…

4504 FIDUCIARY OBLIGATIONS OF BOARD MEMBERS 4504.1 Directors shall carry out the corporation’s purposes as set forth in its charter. In fulfilling this obligation, directors shall: (a) Annually review the corporation’s charter, by-laws and District of Columbia and federal law gov…

4599 DEFINITIONS 4599.1 For the purposes of this chapter, the following terms shall have the meanings ascribed; Commissioner – the Commissioner of the District of Columbia Department of Insurance, Securities, and Banking. Compliance officer – the person appointed pursuant to this…

4600 APPLICABILITY 4600.1 These rules apply to any domestic hospital and medical services corporations issued a certificate of authority pursuant to section 6 of the Act. SOURCE: Notice of Final Rulemaking published at 56 DCR 8841 (November 13, 2009). AUTHORITY: DC-DCMR Section 4…

4601 FILING REQUIREMENTS AND PUBLIC NOTIFICATION 4601.1 All domestic companies licensed under this chapter shall file a financial report with the Commissioner which details the company’s surplus and examines whether the company’s surplus is considered excessive under the Act. The…

4602 PUBLIC HEARINGS 4602.1 The Commissioner shall publish a public notice of hearing in the D.C. Register setting forth the hearing date for the surplus determination, including applicable briefing schedule as determined by the Commissioner. The public notice shall be published …

4603 DETERMINATION OF EXCESSIVE AND UNREASONABLY LARGE SURPLUS 4603.1 If the Commissioner make a final determination that a corporation’s surplus which is attributable to the District is excessive and unreasonably large, the Commissioner shall order the corporation to submit a pl…