Title 31 — Insurance and Securities.
94 chapters · 1,236 sections in this title.
D.C. Code § 31-3551 Reduction of health care benefits lien
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(a) Except as provided in subsection (d) of this section, this chapter shall apply to any right of subrogation under a contract or applicable law for payment of health-care benefits or services for an injured person paid or payable by a subrogee or under any system of self-insura…
D.C. Code § 31-3601 Definitions
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For the purposes of this chapter, the term: (1) “Applicant” means: (A) In the case of an individual long-term care insurance policy, the person who seeks to contract for benefits; and (B) In the case of a group long-term care insurance policy, the proposed certificate holder. (2)…
D.C. Code § 31-3602 Scope
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(a) Any policy or rider advertised, marketed, or offered as long-term care or nursing home insurance delivered or issued for delivery in the District of Columbia shall comply with the provisions of this chapter. (b) This chapter is not intended to supersede the obligations of ent…
D.C. Code § 31-3603 Long-term insurance; who may issue
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Long-term care insurance may be issued by insurers, fraternal benefits societies, nonprofit health, hospital, and medical service corporations, prepaid health plans, and health maintenance organizations, and any similar organization to the extent they are otherwise authorized to …
D.C. Code § 31-3604 Group policies issued in other states
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No group long-term care insurance coverage may be offered to a resident of the District of Columbia under a group policy issued in another state to a group described in § 31-3601(4)(D), unless the District of Columbia, or another state having statutory and regulatory long-term ca…
D.C. Code § 31-3605 Standards for long-term care insurance
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(a) No long-term care insurance policy shall: (1) Be cancelled, not renewed, or otherwise terminated on the grounds of the age or deterioration of the mental or physical health of the insured individual or certificate holder; (2) Contain a provision establishing a new waiting per…
D.C. Code § 31-3606 Disclosure
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(a)(1) An outline of coverage, written at a fifth grade reading level, shall be delivered to a prospective applicant for long-term care insurance at the time of initial solicitation through means which prominently direct the attention of the recipient to the document and its purp…
D.C. Code § 31-3607 Minimum number of members for associations
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(a) Prior to advertising, marketing, or offering a group long-term care insurance policy within the District of Columbia, an association or associations, or an insurer of the association or associations, shall file evidence with the Commissioner that the association, or associati…
D.C. Code § 31-3608 Monthly reports
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Any time a long-term care benefit which is funded through a life insurance vehicle by the acceleration of the death benefit is in benefit payment status, a monthly report shall be provided to the policyholder. The monthly report shall include the following: (1) Any long-term care…
D.C. Code § 31-3609 Incontestability period
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(a) If a policy or certificate has been in force for less than 6 months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that is material to the acceptance for co…
D.C. Code § 31-3609.01 Denial of claims
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If a claim under a long-term care insurance contract is denied, the issuer shall, within 60 days of the date of a written request by the policyholder or certificate holder, or a representative thereof: (1) Provide a written explanation of the reasons for the denial; and (2) Make …
D.C. Code § 31-3610 Nonforfeiture benefits
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(a) Except as provided in subsection (b) of this section, a long-term care insurance policy may not be delivered or issued for delivery in the District of Columbia unless the policyholder or certificate holder has been offered the option of purchasing a policy or certificate incl…
D.C. Code § 31-3611 Rules and regulations
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The Commissioner may issue rules to implement any provisions of this chapter. The rules may include: (1) Requirements for any disclosure made under this chapter, including the manner, content, and required disclosures for the sale of long-term care insurance policies, terms of re…
D.C. Code § 31-3612 Penalties
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In addition to any other penalties provided by law, if, after a judicial proceeding or an administrative proceeding conducted in accordance with subchapter I of Chapter 5 of Title 2, an insurer or any agent is found to have violated any requirements of this chapter, that insurer …
D.C. Code § 31-3701 Definitions
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For the purposes of this subchapter, the term: (1) “Applicant” means: (A) In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and (B) In the case of a group Medicare supplement policy, the proposed certificate holder. …
D.C. Code § 31-3702 Applicability and scope
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(a) Except as otherwise specifically provided, this subchapter shall apply to: (1) All Medicare supplement policies delivered or issued for delivery in the District of Columbia on or after October 1, 1992; and (2) All certificates issued under group Medicare supplement policies, …
D.C. Code § 31-3703 Standards for policy provisions and authority to promulgate regulations
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(a) No Medicare supplement policy or certificate in force in the District of Columbia shall contain benefits that duplicate benefits provided by Medicare. (b) Notwithstanding any other provision of law of the District of Columbia, a Medicare supplement policy or certificate shall…
D.C. Code § 31-3704 Loss ratio standards
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Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The Mayor shall issue reasonable regulations to establish minimum standards for loss ratios of Medicare supplement policies on the basis of incurred claims…
D.C. Code § 31-3705 Disclosure standards
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(a) In order to provide for full and fair disclosure in the sale of Medicare supplement policies, no Medicare supplement policy or certificate shall be delivered in the District of Columbia unless an outline of coverage is delivered to the applicant at the time application is mad…
D.C. Code § 31-3706 Filing requirements; master policy and certificate
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(a) Except as provided in subsection (b) of this section, any insurer who provides group Medicare supplement insurance benefits to a resident of the District shall file the master policy and certificate, as provided by rule issued pursuant to § 31-3710. (b) An insurer shall not b…
D.C. Code § 31-3707 Notice of free examination
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Medicare supplement policies and certificates shall have a notice prominently printed on the 1st page of the policy or certificate, or attached thereto, stating in substance that the applicant shall have the right to return the policy or certificate within 30 days of its delivery…
D.C. Code § 31-3708 Filing requirements for advertising
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(a) The Mayor shall establish, by rule, standards for advertising Medicare supplement insurance and benefits in the District. (b) Each insurer, health care service plan, or other entity that provides Medicare supplement insurance or benefits in the District shall provide the Mayo…
D.C. Code § 31-3709 Remedies
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In addition to any other applicable penalty for a violation of the insurance laws of the District, the Mayor may require an insurer who violates this subchapter, or rules issued pursuant to this subchapter, to cease marketing in the District any Medicare supplement policy or cert…
D.C. Code § 31-3710 Rules
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(a) The Mayor shall issue proposed rules to implement the provisions of this subchapter within 180 days of October 1, 1992. The proposed rules shall be submitted to the Council for a 45-day period of review, excluding Saturdays, Sundays, legal holidays, and days of Council recess…
D.C. Code § 31-3751 Definitions
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Repealed Repealed.
D.C. Code § 31-3752 Applicability and scope
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Repealed Repealed.
D.C. Code § 31-3753 Standards for policy provisions and authority to promulgate regulations
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Repealed Repealed.
D.C. Code § 31-3754 Loss ratio standards
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Repealed Repealed.
D.C. Code § 31-3755 Disclosure standards
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Repealed Repealed.
D.C. Code § 31-3756 Filing requirements; master policy and certificate
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Repealed Repealed.
D.C. Code § 31-3757 Notice of free examination
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Repealed Repealed.
D.C. Code § 31-3758 Filing requirements for advertising
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Repealed Repealed.
D.C. Code § 31-3759 Remedies
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Repealed Repealed.
D.C. Code § 31-3760 Rules
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Repealed Repealed.
D.C. Code § 31-3801 Payable benefits
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All individual and group health insurance policies providing coverage on an expense-incurred basis and individual and group service-or indemnity-type contracts issued by a nonprofit health service plan shall provide that health insurance benefits shall be payable with respect to …
D.C. Code § 31-3802 Extent of coverage
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Repealed Repealed.
D.C. Code § 31-3802.01 Inpatient postpartum treatment; at-home post-delivery care
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(a) Except as provided in subsection (b) of this section, all individual and group health policies providing maternity and newborn care coverage on an expense-incurred basis and individual and group service or indemnity type contracts issued by a nonprofit health service plan, in…
D.C. Code § 31-3803 Notification of birth and payment of premiums or fees
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If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that notification of birth of a newly born child and payment of the required premium or fees must be furnished to the insurer or nonprofit service …
D.C. Code § 31-3804 Applicability of chapter
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The requirements of this chapter shall apply: (1) To all insurance policies and subscriber contracts delivered or issued for delivery in the District more than 120 days after October 20, 1979. (2) To all such insurance policies and subscriber contracts renewed, amended or reissue…
D.C. Code § 31-3805 Exclusions
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Specifically excluded from the coverage requirements of this chapter are Medicare Supplement insurance policies, accident only policies, dread disease policies, student accident policies, nursing home policies, and home health care policies.
D.C. Code § 31-3821 Definitions
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For the purposes of this chapter, the term: (1) “Aggregate attachment point” means the total amount of health claims incurred by a small employer in a policy year for all covered employees and their dependents, and covered by a stop-loss insurance policy, above which the stop-los…
D.C. Code § 31-3822 Stop-loss policy
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(a) An insurer shall not issue or deliver to a small employer, as defined in §31-3301.01(42), a stop-loss insurance policy unless the employer has a fully-insured employee health benefit plan. (b) Stop-loss insurance is subject to the following: (1) The policy must be issued to a…
D.C. Code § 31-3831 Definitions
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For the purposes of this chapter, the term: (1) “Commissioner” means Commissioner of the Department of Insurance and Securities Regulation. (2) “District” means the District of Columbia. (3) “Group health plan” means an employee welfare plan (as defined in section 3(1) of the Emp…
D.C. Code § 31-3832 Coverage for reconstructive surgery following mastectomies
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(a) An individual or group health plan which is a health benefit plan, and a health insurer providing health insurance coverage, that provides medical and surgical benefits with respect to a mastectomy shall, in a manner determined in consultation with the attending physician and…
D.C. Code § 31-3833 Notice
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(a) Written notice of the availability of coverage, as set forth in § 31-3832, shall be delivered to the participant and beneficiary under the health plan upon enrollment and annually thereafter. Notice of the benefits shall be prominently positioned in any literature or correspo…
D.C. Code § 31-3834 Hormone replacement therapy coverage
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An individual or group health plan, and a health insurer offering health care coverage that provides coverage for prescription drugs, shall provide benefits which cover any hormone replacement therapy that is prescribed or ordered for treating symptoms and conditions of menopause…
D.C. Code § 31-3835 Prohibitions
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An individual or group health plan which is a health benefit plan, and a health insurer offering health care coverage, shall not: (1) Deny a patient eligibility, or continued eligibility, to enroll or renew coverage under terms of the health benefit plan, solely for the purpose o…
D.C. Code § 31-3836 Regulations
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The Commissioner shall promulgate regulations necessary to implement the provisions of this chapter within 180 days after April 3, 2001.
D.C. Code § 31-3837 Applicability to group health plans
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The provisions of this chapter shall apply to group health benefit plans for years beginning on or after April 3, 2001.
D.C. Code § 31-3861 Definitions
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(a) For the purposes of this chapter, the term: (1) “Health benefits plan” shall have the same meaning as provided in § 31-3131(4). (2) “Health insurer” shall have the same meaning as provided in § 31-3131(5). (3) “Provider” shall have the same meaning as provided in § 31-3131(7)…