Title 31 — Insurance and Securities.
94 chapters · 1,236 sections in this title.
D.C. Code § 31-2801 Definitions
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For the purposes of this chapter, the term: (1) “Ancillary services” means standard medical procedures that are reasonably necessary for the diagnosis and treatment of a patient. (2) “Emergency services” means: (A) Health care services furnished in the emergency department of a h…
D.C. Code § 31-2802 Covered services
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(a) All health insurers, hospitals or medical services corporations, and health maintenance organizations shall reimburse for emergency services that are due to a medical emergency. (b) A hospital emergency department or emergency medical service transporter shall provide a healt…
D.C. Code § 31-2803 Emergency department HIV screening
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(a) For the purposes of this section, the term. (1) “Health benefit plan,” “health insurer,” and “insured” shall have the same meanings as provided in § 31-3001. (2) “HIV screening test” shall mean the testing for the human immunodeficiency virus or any other identified causative…
D.C. Code § 31-2901 Definitions
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For the purposes of this subchapter, the term: (1) “Baseline mammogram” means a screening mammogram that is used as a comparison for future examinations. (2) “Screening mammogram” means a low dose x-ray used to visualize the internal structure of the breast. (3) “Cytologic screen…
D.C. Code § 31-2902 Payable benefits
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(a) Any individual or group health benefit plan, including Medicaid, shall provide health insurance benefits to cover: (1) A baseline mammogram for women; and (2) An annual screening mammogram for women. (b) Any individual or group health benefit plan, including Medicaid, shall p…
D.C. Code § 31-2903 Applicability
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The requirements of this subchapter shall apply: (1) To any health benefit plan delivered or issued for delivery in the District more than 120 days after March 7, 1991; and (2) To any health benefit plan renewed, amended, or reissued 120 days after March 7, 1991.
D.C. Code § 31-2931 Coverage
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(a) Every individual and group health insurance policy or service, including Medicaid, shall provide coverage for colorectal cancer screening for policyholders residing in the District of Columbia. (b) The screening shall be in compliance with American Cancer Society colorectal c…
D.C. Code § 31-2951 Definitions
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For the purposes of this subchapter, the term: (1) “Commissioner” means the Commissioner of the Department of Insurance and Securities Regulation. (2) “Health benefits plan” means any accident and health insurance policy or certificate, hospital and medical services corporation c…
D.C. Code § 31-2952 Coverage for prostate cancer screening
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(a) Each individual and group health benefits plan issued or renewed in the District of Columbia shall provide coverage for prostate cancer screening in accordance with the latest screening guidelines issued by the American Cancer Society for the ages, family histories, and frequ…
D.C. Code § 31-2953 Applicability
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This subchapter shall apply to all individual and group health benefits plans issued or renewed on or after 120 days after March 25, 2003.
D.C. Code § 31-2954 Regulations
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The Commissioner may issue rules and regulations necessary to implement the provisions of this subchapter.
D.C. Code § 31-2991 Closed claim analysis
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(a) Within 180 days of march 14, 2007, the Mayor shall submit legislation to the Council for the establishment of a database of closed obstetrician/gynecologist malpractice claims reports to be submitted by providers of medical malpractice insurance. (b) The legislation shall inc…
D.C. Code § 31-2993.01 Definitions
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For the purposes of this chapter, the term: (1) “Approved clinical trial” means: (A) A clinical research study or clinical investigation approved or funded in full or in part by one or more of the following: (i) The National Institutes of Health; (ii) The Centers for Disease Cont…
D.C. Code § 31-2993.02 Covered trials
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(a) A health insurer shall not limit or deny coverage, or impose additional conditions on the payment for the coverage, of routine patient care costs of items, drugs, and services furnished to a qualified individual in connection with participation in an approved clinical trial. …
D.C. Code § 31-2993.03 Right to file grievance
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This chapter shall not limit, prohibit, or modify a qualified individual’s right to: (1) File a grievance and use an independent review process, if available; or (2) Use the independent medical review system.
D.C. Code § 31-2995.01 Definitions
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For the purposes of this chapter, the term: (1) “Group health plan” means an employee welfare plan (as defined in section 3(1) of the Employee Retirement Income Security Act of 1974, approved September 2, 1974 (88 Stat. 829; 29 U.S.C. § 1002(1)), to the extent that the plan provi…
D.C. Code § 31-2995.02 Chemotherapy pill coverage
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(a) An individual health plan or group health plan, and a health insurer offering health insurance coverage that provides coverage for prescription drugs, shall provide health insurance coverage for prescribed, orally administered anticancer medication used to kill or slow the gr…
D.C. Code § 31-2995.03 Applicability to group health plans
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This chapter shall apply to group health plans for years beginning on or after December 17, 2009.
D.C. Code § 31-2996.01 Definitions
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For the purposes of this chapter, the term: (1) “Dependent child” means an insured’s child by blood or by law who: (A) Is under 26 years of age; (B) Has no dependent of his own; (C) Is enrolled as a full-time student at an accredited public or private institution of higher educat…
D.C. Code § 31-2996.02 Dependent child coverage
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(a) A group health plan or an individual health plan, and a health insurer offering health insurance coverage that provides coverage for dependent children, that delivers, issues for delivery, amends, or renews a health insurance policy in the District of Columbia shall make heal…
D.C. Code § 31-2996.03 Limitations on other coverage
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This chapter shall not limit or alter any right to dependent coverage or to the continuation of coverage that is otherwise provided for in the District of Columbia.
D.C. Code § 31-3001 Definitions
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For the purposes of this chapter, the term: (1) “Health benefit plan” means an accident and health insurance policy or certificate, hospital and medical services corporation contract, health maintenance organization subscriber contract, plan provided by a multiple employer welfar…
D.C. Code § 31-3002 Payable benefits
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A health benefit plan shall provide coverage for the equipment, supplies, and other outpatient self-management training and education, including medical nutritional therapy, for the treatment of insulin-dependent diabetes, insulin-using diabetes, gestational diabetes, and non-ins…
D.C. Code § 31-3003 Nondiscrimination
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No health insurer shall: (1) Require an insured to pay a higher deductible, copayment, or coinsurance; require a longer waiting period; or impose any other condition for coverage of any of the benefits set forth in this chapter other than is required for other benefits covered by…
D.C. Code § 31-3004 Applicability
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(a) The requirements of this chapter shall apply to all health benefit plans issued, delivered, renewed, or reissued on the 91st day after October 21, 2000. (b) All health benefit plans other than the health benefit plans specified in subsection (a) of this section shall comply w…
D.C. Code § 31-3011 Conditions for discontinuance of class of health insurance policies
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(a) If an insurer decides to discontinue a particular class of group, or blanket policy of, hospital, surgical, or medical expense insurance offered in the small or large group market, the policy of the class may be discontinued by the insurer only if: (1) The insurer requests in…
D.C. Code § 31-3012 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 § 31-3013 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 § 31-3101 Definitions
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For the purposes of this chapter, the term: (1) “Alcohol abuse” means any pattern of pathological use of alcohol that causes impairment in social or occupational functioning, or that produces physiological dependency evidenced by physical tolerance or by physical symptoms when it…
D.C. Code § 31-3102 Coverage
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(a) Except as described in subsection (b) of this section, each health insurer that offers individual or group health plans or certificates issued or delivered in the District to an employer or individual shall provide coverage for the medical and psychological treatment of drug …
D.C. Code § 31-3103 Drug abuse and alcohol abuse benefits
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(a) Covered benefits for services set forth in this section shall be limited to coverage of treatment of clinically significant substance use disorders identified in the most recent edition of the International Classification of Diseases or of the Diagnostic and Statistical Manua…
D.C. Code § 31-3104 Mental illness benefits
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(a) Covered benefits for services set forth in this section shall be limited to coverage of treatment of clinically significant mental illnesses identified in the most recent edition of the International Classification of Diseases or of the Diagnostic and Statistical Manual of th…
D.C. Code § 31-3105 Exemptions
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(a) Methods of determining levels of payment or reimbursement for services, or for the type of facility charge eligible for payment or reimbursement under this chapter, and shall be consistent with those for physical illnesses in general and shall take into consideration usual, c…
D.C. Code § 31-3106 Certification of nonhospital residential facilities and outpatient treatment facilities
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(a) The Mayor shall certify qualifying nonhospital residential facilities and outpatient treatment facilities in the District in accordance with rules issued pursuant to § 31-3111. (b) Each certification issued by the Mayor shall state whether the facility is certified as a provi…
D.C. Code § 31-3107 Preservation of certain benefits
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Nothing in this chapter shall serve to diminish the benefits of any insured person or prevent the offering or acceptance of benefits that exceed the minimum benefits required by this chapter.
D.C. Code § 31-3108 Notification of coverage and benefits
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All individual and group health benefit plans shall contain statements, in easily readable type and in easily understandable language, approved by the Commissioner, to inform policyholders and beneficiaries of the coverage and benefits provided or offered pursuant to this chapter…
D.C. Code § 31-3109 Filing and rate requirements
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(a)(1) Notwithstanding the provisions of any other law, any health insurer that issues health benefits plan or certificates in the District shall file with the Commissioner all rates and rating plans, rules, and classifications that it proposes to use in providing or offering the…
D.C. Code § 31-3110 Health maintenance organizations
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(a) The requirements of this chapter shall apply to health maintenance organizations 5 years from February 28, 1987, unless the Mayor requests the Council to extend the exemption to a time certain and the Council, by resolution, approves the extension. (b) Upon becoming subject t…
D.C. Code § 31-3111 Duties of Mayor
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(a) The Mayor shall, within 120 days from February 28, 1987, issue rules to implement all sections of this chapter except § 31-3110. The Mayor shall issue rules to implement § 31-3110 no later than 5 years from February 28, 1987. (b) The Mayor shall provide the coverage and benef…
D.C. Code § 31-3112 Excluded programs
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This chapter shall not be applicable to the District of Columbia Alliance Program, Medicaid Program, and Post-1987 District of Columbia Employees’ Health Insurance Benefits Plan.
D.C. Code § 31-3131 Definitions
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For the purposes of this chapter, the term: (1) “Clean claim” means a claim that has no material defect or impropriety, including any lack of reasonably required substantiating documentation, which substantially prevents timely payment from being made on the claim or with respect…
D.C. Code § 31-3132 Prompt payment
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(a) For covered services rendered to its members, a health insurer shall reimburse any person entitled to reimbursement under the health benefits plan within 30 days after the receipt of a clean claim. (b) If a health insurer fails to comply with subsection (a) of this section, t…
D.C. Code § 31-3133 Retroactive denial of reimbursement
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(a) A health insurer may only retroactively deny reimbursement to a health care provider: (1) For services subject to coordination of benefits with another health insurer during the 18-month period after the date that the health insurer paid the health care provider; or (2) Excep…
D.C. Code § 31-3134 Provider panels
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(a) Except for Medicaid and Medicare provider panels, if a provider panel contract between a provider and a health insurer, or other entity that provides hospital, physician, or other health care services to a health insurer, require a provider, as a condition of participating in…
D.C. Code § 31-3135 Claims payment report
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A health insurer shall include with its annual report filed with the Commissioner a claims payment report to include the: (1) Number of claims received in the previous calendar year; (2) Number of claims denied in the previous calendar year; (3) Number of claims paid: (A) In the …
D.C. Code § 31-3136 Penalties
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An action by a health insurer that establishes a pattern or practice of repeated violation of this chapter, as determined by the Commissioner, shall constitute a violation as provided in Chapter 22A of this title.
D.C. Code § 31-3137 Rules and regulations
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The Commissioner may adopt rules and regulations as necessary to implement this chapter.
D.C. Code § 31-3138 Applicability
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(a) This chapter shall apply to any individual and group health benefits plan issued or renewed in the District of Columbia. Health insurers shall comply with this chapter on the earlier of October 16, 2002, or the effective date of the claims payment standards in section 1173 of…
D.C. Code § 31-3151 Definitions
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For the purposes of this chapter, the term: (1) “Application” means a carrier’s application pursuant to this chapter for approval to voluntarily withdraw from the District of Columbia health insurance market. (2) “Carrier” means any person or organization subject to the authority…
D.C. Code § 31-3152 Procedures for voluntary withdrawal by carriers
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(a) A carrier shall give the Commissioner written notice, prior to notifying the members of the health benefit plan, of its intent to discontinue the offering of all health benefit plans in the District of Columbia and shall submit to the Commissioner an application with the foll…