Title 31 — Insurance and Securities.
94 chapters · 1,236 sections in this title.
D.C. Code § 31-3311.01 Ratemaking principles and standards
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(a) All insurance premium rates and fees shall be made in accordance with the principles and standards set forth in this section. Uniformity among insurers in matters within the scope of this section shall not be required or prohibited. (b) Due consideration shall be given to: (1…
D.C. Code § 31-3311.02 Aggregate medical loss ratios; dividend; and rating bands
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(a) For each calendar year, an insurer shall maintain an aggregate minimum medical loss ratio, as defined by rule, of 80% for individual policies, as defined by rule, 80% for small group policies, as defined by rule, and 85% for large group policies, as defined by rule. The medic…
D.C. Code § 31-3311.03 Loss ratio disclosure
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Policies, certificates, and marketing materials shall prominently display medical loss ratio disclosure, as defined by rule.
D.C. Code § 31-3311.03a Essential health benefits
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(a) Consistent with federal law, the Commissioner, with the approval of the Executive Board of the Health Benefit Exchange Authority, shall, by rule, select the benchmark plan for the individual and small group market for purposes of establishing the essential health benefits in …
D.C. Code § 31-3311.03b Underwriting ratemaking criteria
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(a) To implement section 1201 of the Affordable Care Act, the Commissioner, with the approval of the Executive Board of the Health Benefit Exchange Authority, shall have the authority to establish by rule: (1) The geographic rating area for the District; (2) The age rating or cur…
D.C. Code § 31-3311.04 Annual rate filing requirement
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All insurers subject to this chapter shall file annually its rates, rating schedule, and supporting documentation, including ratios of incurred losses to earned premiums by policy form or certificate form, for approval by the Commissioner. The supporting documentation shall demon…
D.C. Code § 31-3311.05 Commissioner’s authority to rescind approved rates
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(a) The Commissioner may, at any time, require any insurer subject to this chapter to demonstrate that its rates and method for setting rates are in compliance with this chapter, notwithstanding that the filings then in effect had previously been approved. Any rates previously ap…
D.C. Code § 31-3311.06 Post-claims underwriting and prior approval for rescission, cancellation, or limitation
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(a) An insurer shall not rescind an enrollee’s plan or coverage once the enrollee is covered under the plan or coverage involved; provided, that this section shall not apply to a covered individual who has performed an act or practice that constitutes fraud or makes an intentiona…
D.C. Code § 31-3311.07 Public records
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The Commissioner shall, as soon as practicable, make all rate filings, including all supporting documentation, amended filings, and reports filed pursuant to this chapter, available for public inspection either at the Department of Insurance, Securities, and Banking or on its web…
D.C. Code § 31-3311.08 Annual report and recommendations
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On June 1, 2011, and every year thereafter, the Commissioner shall report to the Council any significant National Association of Insurance Commissioners adoptions related to health care reform, including medical loss ratios and loss ratio disclosure, and any recommendations if th…
D.C. Code § 31-3311.09 Rules
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The Mayor, pursuant to subchapter I of Chapter 5 of Title 2 [§ 2-501 et seq.], shall issue rules to implement the provisions of this chapter.
D.C. Code § 31-3311.10 Application
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This chapter shall apply to policies and certificates of insurance that are health benefit plans as defined under § 31-3271(4) that are issued 90 days after April 8, 2011. This chapter shall not apply to short-term limited duration health benefit plans.
D.C. Code § 31-3311.11 Definitions
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For the purposes of this chapter, the term: (a)(1) “Affordable Care Act” means the Patient Protection and Affordable Care Act approved March 23, 2010 (124 Stat. 111; 42 U.S.C. § 18001, note). (2) “Commissioner” means the Commissioner of the Department of Insurance, Securities, an…