District of Columbia Administrative Code

4699 DEFINITIONS 4699.1 “Act” – shall mean the Hospital and Medical Services Corporation Regulatory Act of 1996, effective April 9, 1997 (D.C. Law11-245; D.C. Official Code § 31-3501 et seq. (2001)). 4699.2 “Attributable to the District”- shall mean the process used by the Commis…

PURPOSE 4700.1 The purpose and intent of these rules are to: Establish standards for the creation and maintenance of networks by health carriers; and Ensure the adequacy, accessibility, transparency, and quality of health care services offered under a network plan by: Establishin…

4701 APPLICABILITY AND SCOPE 4701.1 Except as provided in § 4701.2, this chapter applies to all health carriers that offer network plans, including Medicaid. 4701.2 These rules shall not apply to health carriers that offer network plans that consist solely of limited scope dental…

4702 NETWORK ADEQUACY 4702.1 A health carrier providing a network plan shall maintain a network that is sufficient in numbers and facilitates access to appropriate types of providers, including those that are (1) racially, ethnically, and gender diverse; (2) culturally aware of a…

4703 ACCESS PLAN 4703.1 A health carrier shall file an Access Plan prior to or at the time it files a new or amended network plan, in a manner and form set by the Commissioner, separate and apart from the Network Adequacy Report, meeting the requirements of this chapter with the …

4704 REQUIREMENTS FOR HEALTH CARRIERS AND PARTICIPATING PROVIDERS 4704.1 A health carrier offering a network plan shall satisfy all the requirements contained in this section. 4704.2 A health carrier shall notify the participating providers which of the covered health care servic…

4705 PROVIDER DIRECTORIES 4705.1 A health carrier shall post electronically a current and accurate provider directory for each of its network plans. The directory should include at least the following information: (a) The following identifiers for health care professionals: (1) N…

4706 INTERMEDIARIES 4706.1 This section is only applicable to the extent that a health carrier, provider, or medical group uses an intermediary. 4706.2 A contract between a health carrier and an intermediary shall satisfy all the requirements contained in this section. 4706.3 Int…

4707 FILING REQUIREMENTS FOR CARRIER – PROVIDER AND INTERMEDIARY CONTRACTS 4707.1 At the time a health carrier files its initial Access Plan or subsequently, the health carrier shall file as part of the Access Plan, with the Commissioner: (a) Sample (template) contract forms prop…

4708 ENFORCEMENT 4708.1 The Commissioner may require a modification to the Access Plan, order an appropriate corrective action plan that shall be followed by the health carrier, or use any other enforcement powers permitted under District of Columbia law or regulation to obtain t…

4709 APPLICABILITY 4709.1 All health carriers offering or renewing network plans in the individual and small group markets in the District of Columbia shall file an Access Plan, and a Network Adequacy Report (including a Request for Waiver form, if necessary) that complies with t…

4799 DEFINITIONS 4799.1 For purposes of this chapter, the following terms and phrases shall have the meanings ascribed: “Access Plan” – a document consisting of policies and procedures for assuring the ongoing sufficiency of provider networks, developed in accordance with § 4702 …

500 REQUIRED INSURANCE AND AVAILABILITY OF OPTIONAL INSURANCE 500.1 Each owner of a motor vehicle (including a motorcycle) required to be registered in the District and each owner required to obtain a reciprocity sticker in the District shall maintain the insurance coverage requi…

501 ENDORSEMENTS TO OUTSTANDING POLICIES 501.1 As soon as possible, after the effective date of the regulations, insurers shall mail to all policyholders who have policies bearing expiration dates on or after June 2, 1986, endorsements providing coverages required by the Act. SOU…

502 REQUIREMENTS FOR NONRESIDENT 502.1 Any nonresident operating a motor vehicle in the District who has not been issued a District registration may maintain a valid policy of motor vehicle insurance issued by an insurer which is not authorized to sell motor vehicle insurance in …

503 ELECTION OF BENEFITS UNDER OPTIONAL PERSONAL INJURY PROTECTION (PIP) COVERAGE 503.1 A victim sustaining injury in a motor vehicle accident which forms the basis of a claim against an insurer shall have the responsibility of informing the insurer of the accident according to t…

504 RESTRICTION ON FILING A CIVIL ACTION TO RECOVER LOSSES 504.1 A victim who elects to receive benefits under the optional personal injury protection coverage may maintain a civil action based on the liability of another person, only under the following circumstances: (a) The in…

505 SELF INSURERS 505.1 Any person may maintain the coverages required by the Act by obtaining a Certificate of Self Insurance from the Director of the Department of Public Works, in accordance with the Act and § 40-478, of the D.C. Code, 1981 Edition, (as amended) and chapter 8 …

506 ARBITRATION 506.1 Any person having a claim under the mandatory insurance required in §7 of the Act or the optional insurance provisions in §5 of the Act, may request that the claim be arbitrated before the Board of Consumer Claims Arbitration for the District of Columbia. If…

507 CONSUMER RIGHT TO INFORMATION 507.1 Each insurer who offers to sell motor vehicle insurance in the District shall provide, prior to renewal or denial of a motor vehicle insurance policy, a document which shall provide, but not be limited to, the following information: (a) The…

508 CONVERSION AND RENEWAL OF OUTSTANDING POLICIES 508.1 Insurers shall treat all outstanding motor vehicle insurance policies in effect after June 2, 1986, containing personal injury protection as providing, at a minimum, all of the coverages required by the Act, notwithstanding…

509 ENDORSEMENTS TO OUTSTANDING POLICIES 509.1 Insurers shall mail to all policyholders who have policies bearing expiration dates after June 2, 1986, endorsements providing the coverages required by the Act. SOURCE: Final Rulemaking published at 35 DCR 7649 (October 21, 1988). …

510 FORMS 510.1 Any insurer offering or selling motor vehicle insurance in the District of Columbia shall provide coverages using forms authorized as set forth in this section. 510.2 The provisions of this section apply to forms used to provide or offer optional coverage as well …

511 READABILITY STANDARDS FOR POLICIES AND ENDORSEMENTS 511.1 The provisions of this section specifying standards for format and language shall apply to all motor vehicle insurance policies issued or renewed on or after June 2, 1986, and endorsements required by the Act and this …

5000 PERMISSIBLE REASONS FOR NON- RENEWAL/CANCELLATION AND USE OF CLAIMS HISTORY INFORMATION 5000.1 An insurer shall not refuse to renew a policy of homeowners’ insurance solely due to claim or loss frequency unless there have been two (2) or more claims during the preceding thre…

5001 USE OF CLAIMS HISTORY – NEW BUSINESS 5001.1 In determining whether to issue a homeowners’ insurance policy on a property not previously owned by the applicant, an insurer shall not base an adverse underwriting decision solely on the loss history of a previous owner of the pr…

5100 CALCULATING MINIMUM VALUES 5100.1 The minimum values, as specified in section 5c(c)(1) of Chapter V of the Life Insurance Act, effective October 13, 1978 (D.C. Law 2-120; D.C. Official Code § 31-4705.03 (2001), of any paid-up annuity, cash surrender or death benefits availab…

5200 Purpose 5200.1 The purpose of this regulation is to set forth standards to protect active duty service members of the United States Armed Forces from dishonest and predatory insurance sales practices by declaring certain identified practices to be false, misleading, deceptiv…

5201 Scope 5201.1 This regulation shall apply only to the solicitation or sale of any life insurance or annuity product by an insurer or insurance producer to an active duty service member of the United States Armed Forces. Source: Notice of Final Rulemaking published at 54 DCR 1…

5202 Authority 5202.1 This regulation is issued under the authority of the Insurance Trade and Economic Development Amendment Act of 2000, effective April 3, 2001, (D.C. Law 13-265, D.C. Official Code § 31-2231 et. seq. (2001). Source: Notice of Final Rulemaking published at 54 D…

5203 EXEMPTIONS 5203.1 This regulation shall not apply to solicitations or sales involving: (a) Credit insurance; (b) Group life insurance or group annuities where there is no in-person, face- to-face solicitation of individuals by an insurance producer or where the contract or c…

5204 PRACTICES DECLARED FALSE, MISLEADING, DECEPTIVE, OR UNFAIR ON A MILITARY INSTALLATION 5204.1 The following acts or practices when committed on a military installation by an insurer or insurance producer with respect to the in-person, face-to-face solicitation of life insuran…

5205 PRACTICES DECLARED FALSE, MISLEADING, DECEPTIVE OR UNFAIR REGARDLESS OF LOCATION 5205.1 The following acts or practices by an insurer or insurance producer constitute corrupt practices, improper influences or inducements and are declared to be false, misleading, deceptive or…

5206 SEVERABILITY 5206.1 If any provision of these sections or the application thereof to any person or circumstance is held invalid for any reason, the invalidity shall not affect the other provisions or any other application of these sections which can be given effect without t…

5207 EFFECTIVE DATE 5207.1 This regulation shall become effective January 1, 2008, and shall apply to acts or practices committed on or after the effective date. Source: Notice of Final Rulemaking published at 54 DCR 11702, 11711 (December 7, 2007). AUTHORITY: DC-DCMR The Commiss…

5299 DEFINITIONS 5299.1 When used in this chapter, the following words and phrases shall have the meaning ascribed: “Active Duty” – full-time duty in the active military service of the United States and includes members of the reserve component (National Guard and Reserve) while …

5301 PURPOSE 5301.1 The purpose of these rules is to implement the provisions of An Act To provide for regulation of certain insurance rates in the District of Columbia, and for other purposes, approved May 20, 1948 (62 Sta. 242; D.C. Official Code § 31-2701, et seq.), as amended…

5302 FILING REQUIREMENTS AND PUBLIC NOTIFICATION 5302.1 All companies licensed to write medical malpractice liability insurance in the District of Columbia are subject to the provisions of this chapter. Every company shall file with the Commissioner of the Department of Insurance…

5303 ADJUSTMENTS OF RATES 5303.1 Whenever it shall be made to appear to the Commissioner, either from his own information or from a complaint of any party alleging to be aggrieved thereby, that there are reasonable grounds to believe that the rates on any or on all risks or class…

5304 MANDATORY HEARINGS 5304.1 All hearings commenced as a result of a rate change increase exceeding ten percent (10%) shall be conducted in accordance with the Department’s rules of practice and procedures for hearings found at 26 DCMR § 3800 et seq. 5304.2 In a hearing held by…

5305 USE OF EXPERIENCE OUTSIDE OF THE DISTRICT 5305.1 If a company is filing a new or “introductory rate filing,” then the company will permitted to use countrywide experience in support of the new product. If a company is filing to revise or adjust an existing rate but lacks act…

5600 APPLICABILITY 5600.1 This chapter shall apply to all certified capital companies formed, certified, or authorized under the Act. 5600.2 This chapter shall apply to any investment in a certified capital company for which a premium tax credit is allocated to a certified invest…

5601 FILING APPLICATION FOR CERTIFICATION 5601.1 An applicant seeking certification as a certified capital company shall file an Application for Certification with the Commissioner on or after the application date. 5601.2 An Application for Certification filed prior to the applic…

5602 REQUIREMENTS OF AN APPLICATION FOR CERTIFICATION 5602.1 The Application for Certification shall contain the following: (a) A completed Application for Certification; (b) A nonrefundable application fee in the amount of fifteen thousand dollars ($ 15,000) in the form of a cas…

5603 REVIEW OF APPLICATION FOR CERTIFICATION 5603.1 The Commissioner shall review an Application for Certification and all required documents to determine whether the applicant satisfies the requirements for certification as a certified capital company set forth in section 3 of t…

5604 ALLOCATION OF PREMIUM TAX CREDITS 5604.1 A Premium Tax Credit Allocation Request shall be made pursuant to a Premium Tax Credit Allocation Request Form delivered to the Commissioner. 5604.2 The Premium Tax Credit Allocation Request Form shall include the following two affida…

5605 QUALIFIED INVESTMENTS 5605.1 Prior to making a proposed investment in a business, a certified capital company shall request from the Commissioner a written determination of whether the business is considered a “qualified business,” as defined in the Act. 5605.2 A certified c…

5606 WAIVER OF QUALIFIED BUSINESS REQUIREMENTS 5606.1 A certified capital company that applies to make an initial certified investment in a business that does not satisfy all of the requirements to be a qualified business shall file a written request for a waiver of one (1) or mo…

5607 FEES 5607.1 In addition to the ten thousand dollar ($ 10,000) annual, non-refundable certification fee due on or before January 31 required by section 6(g)(4) of the Act, a certified capital company shall pay to the Commissioner a late fee in the amount of five thousand doll…

5608 WAIVER OF RECAPTURE OR FORFEITURE UPON DECERTIFICATION 5608.1 A certified capital company may request the Commissioner to waive the recapture or forfeiture of premium tax credits upon the decertification of the certified capital company pursuant to section 8(c) of the Act by…