Title 31 — Insurance and Securities.

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…

(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…

(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…

Repealed Repealed.

(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…

(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…

(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…

For the purposes of this chapter, the term: (1) “Adjusted RBC report” means an RBC report which has been adjusted by the Commissioner in accordance with § 31-3451.02(c). (2) “Authorized Control Level Event” means any of the following events: (A) The filing of an RBC report by the…

(a) A domestic health organization shall, prior to each March 2 (“filing date”), prepare and submit to the Commissioner a report of its RBC levels as of the end of the previous calendar year, in a form and containing such information as is required by the RBC instructions. In add…

(a) If a Company Action Level Event occurs, the health organization shall prepare and submit to the Commissioner an RBC plan that shall: (1) Identify the conditions that contributed to the Company Action Level Event; (2) Contain proposals of corrective actions that the health org…

(a) If a Regulatory Action Level Event occurs, the Commissioner shall: (1) Require the health organization to prepare and submit an RBC plan or, if applicable, a revised RBC plan; (2) Perform such examination or analysis as the Commissioner considers necessary of the assets, liab…

(a) If an Authorized Control Level Event occurs, the Commissioner shall: (1) Take such actions as are required under § 31-3451.04 with respect to a Regulatandy Action Level Event; and (2) If the Commissioner considers it to be in the best interests of the policyholders and credit…

(a) If a Mandatory Control Level Event occurs, the Commissioner shall take such action as is necessary to place the health organization under regulatory control under Chapter 34 of this title or Chapter 13 of this title. In such event, the Mandatory Control Level Event shall be s…

(a) A health organization may request a confidential department hearing, on a record, to challenge a determination or action if the Commissioner notifies it of the following: (1) An adjusted RBC report; (2)(A) The health organization’s RBC plan or revised RBC plan is unsatisfacto…

(a) All RBC reports (to the extent the information is not required to be set forth in a publicly available annual statement schedule) and RBC plans (including the results or report of any examination or analysis of a health organization performed under this chapter and any correc…

(a)(1) A foreign health organization shall, upon the written request of the Commissioner, submit to the Commissioner an RBC report as of the end of the previous calendar year upon the later of: (A) The date that an RBC report would be required to be filed by a domestic health org…

(a) This chapter shall supplement the other provisions of the laws of the District and shall not preclude or limit any other powers or duties of the Commissioner under such laws, including Chapter 34 of this title and Chapter 13 of this title. (b) The Commissioner may promulgate …

The Commissioner, the Department of Insurance and Securities Regulation, or its employees or agents shall not be liable for any action taken by them in the performance of their powers and duties under this chapter.

All notices by the Commissioner to a health organization that may result in regulatory action under this chapter shall be effective upon mailing if transmitted by registered or certified mail or, in the case of any other transmission, shall be effective upon the health organizati…

For RBC reports required to be filed by health organizations with respect to 2002, the following requirements shall apply in lieu of the provisions of §§ 31-3451.03, 31-3451.04, 31-3451.05, and 31-3451.06: (1) In the event of a Company Action Level Event with respect to a domesti…

(a) Sections 1251, 1252, and 1304 of the Patient Protection and Affordable Care Act, approved March 23, 2010 (124 Stat. 119; 42 U.S.C. §§ 18011, 18021, and 18024), and sections 2701 through 2709, 2711 through 2719A, and 2794 of the Public Health Service Act, approved July 1, 1944…

For the purposes of this chapter, the term: (1) “Commissioner” means the Commissioner of the Department of Insurance, Securities, and Banking. (1A) “Community health reinvestment” means expenditures that promote and safeguard the public health or that benefit current or future su…

(a) Except as provided in subsection (b) of this section, a corporation organized under the laws of the District of Columbia, or any state, or chartered by act of the Congress of the United States and issuing subscriber contracts in the District of Columbia shall be governed by t…

(a) A corporation governed by this chapter shall also be subject to the following other provisions of District of Columbia insurance law, including any amendments or replacements thereof hereafter enacted: (1) Sections 31-201 [repealed], 31-202, and 31-206, referring to general p…

(a) No corporation subject to the provisions of this chapter, whether organized pursuant to the laws of the District of Columbia, or of any state, or by act of the Congress of the United States, shall issue subscriber contracts until the Mayor has authorized it to do so by issuan…

The Mayor shall issue a certificate of authority to each applicant upon the payment of the $200 fee provided for in § 31-3504(b), and upon being satisfied that: (a) The applicant has been organized bona fide for the purpose of establishing, maintaining, and operating a hospital s…

A corporation shall engage in community health reinvestment to the maximum feasible extent consistent with financial soundness and efficiency.

(a) At the time of issuance of a certificate of authority under this chapter and at all times thereafter until risk-based capital regulations for hospital and medical services corporations are promulgated, a corporation must possess surplus in an amount which is the greater of $5…

(a) A corporation shall make available to the Commissioner such information as may be required to permit the Commissioner to verify the corporation’s community health reinvestment and, if appropriate, its compliance with its plan to dedicate excess surplus or to verify that the c…

(a) A corporation holding a certificate of authority under this chapter may enter into contracts with licensed hospitals, licensed physicians, and other duly licensed medical services providers. (b) A copy of each contract form that a corporation, referred to in subsection (a) of…

(1) The form and content of all subscriber contracts between corporation and its contractholders issued in the District of Columbia, including any group certificates and any riders, endorsements, amendments, or other forms made a part of the subscriber contract, shall, at all tim…

(a) Taking into consideration the nature of the policies issued by the corporation, a corporation shall establish and maintain pro rata gross unearned premium reserves, reserves for incurred but unpaid claims (both reported and unreported), reserves for expenses related to settle…

Notwithstanding any provision of § 31-4435 [repealed], as made applicable by § 31-3503(8), and notwithstanding any other provision of this chapter: (1) Without the Mayor’s prior written consent, a corporation’s aggregate investments in real estate pursuant to § 31-4435(d)(1)(A) t…

(a) A domestic corporation may borrow or assume a liability for the repayment of a sum of money under a written agreement which provides that the loan or advance shall be repaid only out of surplus of the corporation in excess of such minimum surplus as is stipulated in and by th…

No group subscriber contract shall be issued in the District of Columbia by a corporation unless it contains in substance the following provisions, or provisions which in the opinion of the Mayor are more favorable to the subscribers, or at least as favorable to the subscribers a…

(a) In addition to the annual statement required by § 31-1901, the Mayor: (1) May require each corporation to file on a quarterly or other basis any additional reports, exhibits, or statements the Mayor considers necessary to furnish all information concerning the condition, solv…

Repealed Repealed.

A corporation shall be subject to § 47-2608.

(a) There is established as a nonlapsing fund the Healthy DC and Health Care Expansion Fund (“Fund”). All funds deposited into the Fund, and any interest earned on those funds, shall not revert to the unrestricted fund balance of the General Fund of the District of Columbia at th…

A corporation issued a certificate of authority under this chapter shall not be converted into a stock corporation, partnership, limited liability company, or other business entity organized for profit.

A corporation issued a certificate of authority under this chapter shall not be converted into a mutual insurance company.

(a) Any management contract or service agreement which delegates to any person or organization all or part of a substantial management duty, function, or other form of control of a corporation, such as adjustment of claims, production of business, investment of assets, or general…

Notwithstanding § 31-706(c)(3), or any other provision of District of Columbia insurance law referenced in § 31-3503, the following provisions shall apply to a domestic corporation issued a certificate of authority under this chapter: (1) The board of directors or trustees shall …

The officers or other management of a corporation issued a certificate of authority under this chapter shall report to its board of directors or trustees, no less often than quarterly, regarding any and all transactions or events that have, or are likely to have, a material impac…

(a) The Mayor shall promulgate regulations establishing the oversight role and fiduciary obligation of each member of the board of directors or trustees of a corporation issued a certificate of authority under this chapter. Such regulations shall require the corporation to adopt …

(a) If the directors or trustees of a corporation issued a certificate of authority under this chapter knowingly violate, or knowingly permit any of the officers, employees, or agents of the corporation to violate, any provision of this chapter, any other provision of law made ap…

If, within the time for approval, the Mayor sends notice of disapproval of the proposed form of any subscriber contract, of proposed contract rates, or of any management contract or service agreement required by this chapter to be approved by the Mayor, the affected corporation m…

(a) In his or her sole discretion, the Mayor may provide, upon application and for good cause shown by a corporation in existence and operating in the District of Columbia on April 9, 1997, for a reasonable period of time for such corporation to comply with any requirement of thi…

Nothing in this chapter shall be construed to diminish the authority of the Council to regulate the affairs of Group Hospitalization and Medical Services, Inc.

The Mayor, in accordance with subchapter I of Chapter 5 of Title 2, shall issue rules to implement the provisions of this chapter.