Title 31 — Insurance and Securities.
94 chapters · 1,236 sections in this title.
D.C. Code § 31-3401 Definitions
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For the purposes of this chapter, the term: (1) “Administrative services provider contract” means a contract entered into between a health maintenance organization and a contracting provider in which the contracting provider accepts payments for certain covered services provided …
D.C. Code § 31-3402 Establishment of health maintenance organizations
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(a) Any person may apply to the Commissioner for a certificate of authority to establish and operate a health maintenance organization in compliance with this chapter. No person shall establish or operate a health maintenance organization in the District without obtaining a certi…
D.C. Code § 31-3403 Issuance of certificate of authority
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(a) Upon receipt of an application for issuance of a certificate of authority, the Commissioner, in consultation with the Director of the Department of Health, shall determine whether the applicant, with respect to the health care services to be provided, has complied with § 31-3…
D.C. Code § 31-3403.01 Premium tax
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(a) Effective January 1, 2009, all health maintenance organizations shall pay to the District of Columbia, for each calendar year, a sum of money as taxes equal to 2% of their policy and membership fees and net premium receipts or consideration received in such calendar year, exc…
D.C. Code § 31-3404 Powers of health maintenance organizations
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(a) The powers of a health maintenance organization include, but are not limited to, the following: (1) The purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and such property and equipme…
D.C. Code § 31-3405 Fiduciary responsibilities
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(a) Any director, officer, employee, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of such organization shall be responsible for such funds in a fiduciary relationship to the organization. (b)…
D.C. Code § 31-3406 Quality assurance program
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(a) A health maintenance organization shall establish procedures to assure that the health care services provided to enrollees shall be rendered under reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice. Such …
D.C. Code § 31-3407 Requirements for group contract, individual contract, and evidence of coverage
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(a) Every group and individual contract holder is entitled to a group or individual contract. (1) The contract shall not contain provisions or statements which are unjust, unfair, inequitable, misleading, deceptive, or which encourage misrepresentation. (2) The contract shall con…
D.C. Code § 31-3408 Annual report
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Repealed Repealed.
D.C. Code § 31-3408.01 Compliance with other laws
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Health maintenance organizations shall comply with the following laws: (1) Chapter 3 of this title; (2) Chapter 19 of this title; (3) Chapter 14 of this title; (4) Subchapter I of Chapter 7 of this title; (5) Chapter 21 of this title; and (6) The Reasonable Health Insurance Ratem…
D.C. Code § 31-3409 Information to enrollees
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(a) A health maintenance organization shall provide to its enrollees a list of providers, upon enrollment and re-enrollment. (b) Every health maintenance organization shall provide to its enrollees within 30 days notice of any material change in the operation of the organization …
D.C. Code § 31-3410 Grievance procedures
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Repealed Repealed.
D.C. Code § 31-3411 Investments
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With the exception of investments made in accordance with § 31-3404(a)(1), the funds of a health maintenance organization shall be invested in accordance with NAIC Health Maintenance Organization Investment Guidelines adopted by the Commissioner.
D.C. Code § 31-3412 Protection against insolvency
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(1) Before issuing any certificates of authority, the Commissioner shall require that the health maintenance organization have an initial net worth of $1,500,000 and shall thereafter maintain the minimum net worth required by paragraph (2) of this subsection. (2) Except as provid…
D.C. Code § 31-3413 Uncovered expenditures insolvency deposit
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(a) If at any time uncovered expenditures exceed 10% of total health care expenditures, a health maintenance organization shall place an uncovered expenditures insolvency deposit with the Commissioner, or with any organization or trustee acceptable to the Commissioner through whi…
D.C. Code § 31-3414 Enrollment period; replacement coverage in the event of insolvency
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(1) In the event of the insolvency of a health maintenance organization, upon order of the Commissioner all other carriers that participated in the enrollment process with the insolvent health maintenance organization at a group’s last regular enrollment period shall offer such g…
D.C. Code § 31-3415 Filing requirements for rating information
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(a) No fees may be used until either a schedule of enrollment fees or methodology for determining enrollment fees dues has been filed with and approved by the Commissioner. (b) Either a specific schedule of fees, or a methodology for determining fees, shall be established in acco…
D.C. Code § 31-3416 Regulation of health maintenance organization producers
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(a) The Commissioner shall issue rules and regulations to provide for the licensing of health maintenance organization producers. The rules shall establish: (1) The requirements for licensure of resident health maintenance organization producers; (2) The conditions for entering i…
D.C. Code § 31-3417 Powers of insurance corporations
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(a) An insurance company authorized to do business in the District may, either directly or through a subsidiary or affiliate, organize and operate a health maintenance organization under the provisions of this chapter. Notwithstanding any other provisions of law, any 2 or more su…
D.C. Code § 31-3418 Examinations
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Repealed Repealed.
D.C. Code § 31-3419 Suspension or revocation of certificate of authority
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(a) Any certificate of authority issued under this chapter may be suspended or revoked, and any application for a certificate of authority may be denied, if the Commissioner finds that any of the conditions listed below exist: (1) A health maintenance organization is operating si…
D.C. Code § 31-3420 Rehabilitation, liquidation, or conservation of health maintenance organizations
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(a) Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the Commissioner pursuant to the law governing …
D.C. Code § 31-3421 Summary orders and supervision
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(a) Whenever the Commissioner determines that the financial condition of any health maintenance organization is such that its continued operation might be hazardous to its enrollees, creditors, or the general public, or that it has violated any provision of this chapter, the Comm…
D.C. Code § 31-3422 Regulations
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The Commissioner, within 120 days of April 9, 1997, shall issue rules and regulations necessary to implement the provisions of this chapter. To facilitate the timely issuance of rules and regulations, the Commissioner may contract out for the drafting of rules and regulations pur…
D.C. Code § 31-3423 Penalties and enforcement
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(a) The Commissioner, after giving reasonable written notice of intent and providing a reasonable time within which the health maintenance organization may respond, in lieu of suspension or revocation of a certificate of authority under § 31-3419, may levy an administrative penal…
D.C. Code § 31-3424 Statutory construction and relationship to other laws
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(a) Except as otherwise provided in this chapter, provisions of insurance laws and provisions of hospital or medical service corporation laws shall not be applicable to any health maintenance organization granted a certificate of authority under this chapter. This provision shall…
D.C. Code § 31-3425 Filings and reports as public documents
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All applications, filings, and reports required under this chapter shall be treated as public documents, except those which are trade secrets or privileged or confidential quality assurance, commercial, and financial information, other than any annual financial statement that may…
D.C. Code § 31-3426 Confidentiality of medical information and limitation of liability
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(a) Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except to the exte…
D.C. Code § 31-3427 Acquisition of control of or merger of a health maintenance organization
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(a) No person may make a tender for or a request or invitation for tenders of, or enter into an agreement to exchange securities for or acquire in the open market or otherwise, any voting security of a health maintenance organization, or enter into any other agreement if, after t…
D.C. Code § 31-3428 Coordination of benefits
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Repealed Repealed.
D.C. Code § 31-3429 Point of service plan
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(a) If an employer, association, or other private group arrangement offers health benefit plan coverage to employees or individuals only through a health maintenance organization, the health maintenance organization with which the employer, association, or other private group arr…
D.C. Code § 31-3430 Insolvency protection; assessment
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(a) When a health maintenance organization in the District is declared insolvent by a court of competent jurisdiction, the Commissioner may levy an assessment on health maintenance organizations doing business in the District to pay claims for uncovered expenditures for enrollees…
D.C. Code § 31-3431 Principal office, books, records, and files of the health maintenance organization to be in the District
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(a) Any health maintenance organization domiciled in the District or hereafter formed or organized in the District to engage in the health care business as a health maintenance organization shall maintain its principal office within the District, shall keep its books, records, an…