Title 31 — Insurance and Securities.
94 chapters · 1,236 sections in this title.
D.C. Code § 31-3301.01 Definitions
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For the purposes of this chapter, the term: (1) “Affiliation period” means a period which, under the terms of the health insurance coverage offered by a health maintenance organization, must expire before the health insurance coverage becomes effective. The health maintenance org…
D.C. Code § 31-3302.01 Guaranteed availability of individual health insurance coverage to certain individuals with prior group coverage
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(a) This subchapter applies only to those health insurers that offer individual health insurance coverage in the District of Columbia. Nothing in this subchapter shall require health insurers participating only in the group health insurance market to offer individual health insur…
D.C. Code § 31-3302.02 Special rules for network plans
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(a) A health insurer that offers health insurance coverage in the individual market may: (1) Limit the individuals who may be enrolled under such coverage to those who live, reside, or work within the service area for such network plan; and (2) Within the service area of such pla…
D.C. Code § 31-3302.03 Application of financial capacity limits
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(a) A health insurer may deny health insurance coverage in the individual market to an eligible individual if the health insurer has demonstrated to the satisfaction of the Commissioner that: (1) It does not have the financial reserves necessary to underwrite additional coverage;…
D.C. Code § 31-3302.04 Market requirements
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(a) The provisions of this chapter shall not be construed to require that a health insurer offering health insurance coverage only in connection with group health plans or through one or more bona fide associations, or both, offer such health insurance coverage in the individual …
D.C. Code § 31-3302.05 Renewability of individual health insurance coverage
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(a) Except as provided in this section, a health insurer that provides individual health insurance coverage shall renew or continue in force such coverage at the option of the individual. (b) A health insurer may nonrenew or discontinue health insurance coverage of an individual …
D.C. Code § 31-3302.06 Fair market provision
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The provisions of § 31-3303.07(j) shall apply to health insurance coverage offered by a health insurer in the individual market in the same manner as they apply to health insurance coverage offered by a health insurer in connection with a group health plan in the small or large g…
D.C. Code § 31-3302.07 Regulations establishing standards
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(a) The Commissioner may adopt regulations to enable him or her to establish and administer such standards relating to the provisions of this chapter as may be necessary to (i) implement the requirements of this chapter, and (ii) assure that the District of Columbia’s regulation …
D.C. Code § 31-3302.08 Applicability
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Unless otherwise specifically provided in this chapter, the provisions of this subchapter shall apply to individual health benefit plans issued or renewed on or after January 1, 1998.
D.C. Code § 31-3302.09 Construction
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Nothing in this subchapter shall be construed to: (1) Restrict the amount of the premium rates that an issuer may charge an individual for health insurance coverage provided in the individual market; or (2) Prevent a health insurer offering health insurance coverage in the indivi…
D.C. Code § 31-3303.01 Application of subchapter
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This subchapter applies to health insurers offering group health insurance coverage. Each insurer proposing to issue group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis, each corporation pr…
D.C. Code § 31-3303.02 Availability of health benefit plans to small employers
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In order to ensure the broadest availability of health benefit plans to small employers, the Commissioner shall set market conduct and other requirements for health insurers, agents, and third-party administrators, including requirements relating to the following: (1) Registratio…
D.C. Code § 31-3303.03 Renewability
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(a) Every health insurer that offers health insurance coverage in the group market in the District of Columbia shall renew such coverage with respect to all insureds at the option of the employer except: (1) For nonpayment of the required premiums by the policyholder or contract …
D.C. Code § 31-3303.04 Reference to plan sponsor
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In applying this subchapter in the case of health insurance coverage that is made available by a health insurer in the group market to employers only through one or more associations, a reference to “plan sponsor” is deemed, with respect to coverage provided to an employer member…
D.C. Code § 31-3303.05 Coverage
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If coverage to the small or large employer market pursuant to this subchapter ceases to be written, administered, or otherwise provided, such coverage shall continue to be governed by this subchapter with respect to business conducted under this subchapter that was transacted pri…
D.C. Code § 31-3303.06 Availability
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(a) If coverage is offered to small employers under this subchapter, such coverage shall be offered and made available to every small employer that applies for such coverage. Participation in such plan shall be made available to all the eligible employees of a covered small emplo…
D.C. Code § 31-3303.07 Limitation on preexisting condition exclusion period
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(a) Subject to subsection (b) of this section, a health insurer offering group health insurance coverage may, with respect to a participant or beneficiary, impose a preexisting limitation only if (i) such exclusion relates to a condition (whether physical or mental), regardless o…
D.C. Code § 31-3303.08 Disclosure of information
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(a) Any health insurer offering health insurance coverage to a small employer shall make a reasonable disclosure of the availability of information to such an employer, as part of its solicitation and sales materials, and upon request of such an employer, information concerning: …
D.C. Code § 31-3303.09 Eligibility to enroll
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(a) A group health plan, and a health insurer offering group health insurance coverage, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the health status-related factors. (b) The pro…
D.C. Code § 31-3303.10 Exclusions
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The provisions of this subchapter shall not apply to: (1) Any group health benefit plan for any plan year if, on the first day of such plan year, such plan has less than 2 participants who are current employees; or (2) Any health benefit plan for any of the excepted benefits.
D.C. Code § 31-3303.11 Rules used to determine group size
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(a) All employers treated as a single employer under subsection (b), (c), (m), or (o) of § 414 of the Internal Revenue Code of 1986 (26 U.S.C. § 414) shall be treated as one employer. (b) In the case of an employer which was not in existence throughout the preceding calendar year…
D.C. Code § 31-3303.12 Affiliation period
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(a) A health maintenance organization which does not impose any preexisting condition exclusion, with respect to any particular coverage option, may impose an affiliation period for such coverage option, but only if such period is applied uniformly without regard to any health st…
D.C. Code § 31-3303.13 Alternative methods
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A health maintenance organization may use alternative methods to an affiliation period to address adverse selection provided that they are approved by the Commissioner prior to their use.
D.C. Code § 31-3303.14 Applicability
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Unless otherwise specifically provided in this chapter, the provisions of this subchapter shall apply to group health benefit plans issued or renewed after July 1, 1997.