reglab/housing_qa huggingface dataset:
DC Code § 31-3609 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 36 - Long-Term Care Insurance|§ 31-3609. Incontestability period

(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 coverage. (b) If a policy or certificate has been in force for at least 6 months, but less than 2 years, 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 both material to the acceptance for coverage and which pertains to the condition for which benefits are sought. (c) After a policy or certificate has been in force for 2 years, it shall not be contestable upon the grounds of misrepresentations alone. The policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured’s health. (d)(1) No long-term care insurance policy or certificate may be field unless based on medical or health status. (2) For purposes of this subsection, the term “field issued” means a policy or certificate issued by an agent or third party administrator pursuant to the underwriting authority granted to the agent or third party administrator by an insurer. (e) If an insurer has paid benefits under a long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer in the event that the policy or certificate is rescinded. (f)(1) In the event of the death of the insured, this section shall not apply to the remaining death benefits of a life insurance policy that accelerates benefits for long term care; except that, in the event of death of the insured, the remaining death benefits under these policies shall be governed by § 31-4803.  (May 23, 2000, D.C. Law 13-121, § 10, 47 DCR 2038.)  Emergency Legislation For temporary (90-day) addition of § 35-4909.1 1981 Ed., see § 2(c) of the Long-Term Care Insurance Emergency Amendment Act of 2000 (D.C. Act 13-312, April 7, 2000, 47 DCR 2738). For temporary (90-day) addition of § 35-4909.1 1981 Ed., see § 2(c) of the Long-Term Care Insurance Congressional Review Emergency Amendment Act of 2000 (D.C. Act 13-370, July 10, 2000, 47 DCR 5838). For temporary (90 day) addition of § 31-3609.01, see § 502(c) of Fiscal Year 2003 Budget Support Emergency Act of 2002 (D.C. Act 14-453, July 23, 2002, 49 DCR 8026). Temporary Legislation For temporary (225 day) amendment of section, see § 2(c) of Long-Term Care Insurance Temporary Amendment Act of 2000 (D.C. Law 13-147, July 18, 2000, law notification 47 DCR 6097).
DC Code § 31-3609.01 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 36 - Long-Term Care Insurance|§ 31-3609.01. Denial of claims

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 available all information directly related to the denial.  (May 23, 2000, D.C. Law 13-121, § 10a; as added Oct. 1, 2002, D.C. Law 14-190, § 502(c), 49 DCR 6968.)
DC Code § 31-3610 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 36 - Long-Term Care Insurance|§ 31-3610. Nonforfeiture benefits

(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 including a nonforfeiture benefit. The offer of a nonforfeiture benefit may be in the form of a rider that is attached to the policy. In the event the policyholder or certificate holder declines the nonforfeiture benefit, the insurer shall provide a contingent benefit upon lapse that shall be available for a specified period of time following a substantial increase in premium rates. (b) When a group long-term care insurance policy is issued, the offer required in subsection (a) of this section shall be made to the group policyholder. If, however, the policy is issued as a group long-term care insurance as described in § 31-3601(4)(D), other than a continuing care retirement community or other similar entity, the offering shall be made to each proposed certificate holder. (c) The Commissioner shall promulgate regulations specifying the type or types of nonforfeiture benefits to be offered as part of long-term care insurance policies and certificates, the standards for nonforfeiture benefits, and the rules regarding a contingent benefit upon lapse, including a determination of the specified period of time during a contingent benefit upon lapse will be available and the substantial premium rate increase that triggers a contingent benefit upon lapse as described in subsection (a) of this section.  (May 23, 2000, D.C. Law 13-121, § 11, 47 DCR 2038.)
DC Code § 31-3611 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 36 - Long-Term Care Insurance|§ 31-3611. Rules and regulations

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 renewability, initial and subsequent conditions of eligibility, nonduplication of coverage provisions, coverage of dependents and preexisting conditions, termination of coverage, continuation or conversion of coverage, probationary periods, limitations, exceptions, reductions, elimination periods, requirements for replacement, recurrent conditions, and definitions; (2) Loss ratio standards specifically applicable to long-term care insurance policies; (3) A standard format, which may include a description of the style, arrangement, overall appearance, and the content of an outline of coverage; and (4) Minimum standards for making and reporting practices for long-term care insurance.  (May 23, 2000, D.C. Law 13-121, § 12, 47 DCR 2038.)
DC Code § 31-3612 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 36 - Long-Term Care Insurance|§ 31-3612. Penalties

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 or agent shall be subject to a fine of up to 3 times the amount of any commissions paid for each policy involved in the violation or up to $10,000, whichever is greater.  (May 23, 2000, D.C. Law 13-121, § 13, 47 DCR 2038.)
DC Code § 31-3801 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 38 - Newborn Health Insurance|§ 31-3801. Payable benefits

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 a newly born child of the insured or subscriber from the moment of birth.  (Oct. 20, 1979, D.C. Law 3-33, § 2, 26 DCR 1116.)  Prior Codifications 1981 Ed., § 35-1101. 1973 Ed., § 35-2001. Cross References Hospital and medical services corporations, applicability of this section, see § 31-3503.
DC Code § 31-3802 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 38 - Newborn Health Insurance|§ 31-3802. Extent of coverage. [Repealed]

Repealed.  (Oct. 20, 1979, D.C. Law 3-33, § 3, 26 DCR 1116; May 21, 1992, D.C. Law 9-99, § 2(a), 39 DCR 2142; Apr. 13, 2005, D.C. Law 15-353, § 351, 52 DCR 2331.)  Prior Codifications 1981 Ed., § 35-1102. 1973 Ed., § 35-2002. Temporary Repeal of Section For temporary (225 day) repeal of section, see § 306 of the Child and Youth, Safety and Health Omnibus Second Temporary Amendment Act of 2004 (D.C. Law 15-319, April 8, 2005, law notification 52 DCR 4708). Emergency Legislation For temporary (90 day) repeal of section, see § 306 of Child and Youth, Safety and Health Omnibus Emergency Amendment Act of 2004 (D.C. Act 15-630, November 30, 2004, 52 DCR 1143). For temporary (90 day) repeal of section, see § 351 of Child and Youth, Safety and Health Omnibus Congressional Review Emergency Amendment Act of 2005 (D.C. Act 16-30, February 17, 2005, 52 DCR 2993).
DC Code § 31-3803 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 38 - Newborn Health Insurance|§ 31-3803. Notification of birth and payment of premiums or fees

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 or indemnity corporation within 31 days after the date of birth in order to have the coverage continue beyond such 31-day period.  (Oct. 20, 1979, D.C. Law 3-33, § 4, 26 DCR 1116.)  Prior Codifications 1981 Ed., § 35-1103. 1973 Ed., § 35-2003.
DC Code § 31-3804 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 38 - Newborn Health Insurance|§ 31-3804. Applicability of chapter

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 reissued after 120 days following October 20, 1979; (3) To only children born more than 120 days after October 20, 1979; (4) To all individual subscriber contracts and group certificates issued or delivered in the District of Columbia by Group Hospitalization and Medical Services, Inc.; (5) To all for-profit as well as nonprofit indemnity type health insurers issuing or delivering individual indemnity type accident and sickness health insurance policies and group certificates in the District of Columbia; and (6) To health insurance certificates, except those described in § 31-3802(2) [repealed], that are delivered within the District of Columbia from group health insurance policies which are sold outside of the District of Columbia.  (Oct. 20, 1979, D.C. Law 3-33, § 5, 26 DCR 1116; May 21, 1992, D.C. Law 9-99, § 2(b), 39 DCR 2142.)  Prior Codifications 1981 Ed., § 35-1104. 1973 Ed., § 35-2004.
DC Code § 31-3805 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 38 - Newborn Health Insurance|§ 31-3805. Exclusions

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.  (Oct. 20, 1979, D.C. Law 3-33, § 6; as added May 21, 1992, D.C. Law 9-99,§ 2(c), 39 DCR 2142.)  Prior Codifications 1981 Ed., § 35-1105. Cross References Hospital and medical services corporations, applicability of this section, see § 31-3503.
DC Code § 31-3821 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 38A - Stop-loss Insurance for Employers|§ 31-3821. Definitions

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-loss insurer incurs a liability for payment under aggregate stop-loss coverage. (2) “Attachment point” means the claims amount incurred by an insured group beyond which the insurer incurs a liability for payment. (3) “Commissioner” means the Commissioner of the Department of Insurance, Securities and Banking. (4) “Expected claims” means the total amount of claims that, in the absence of medical stop-loss insurance, are projected to be incurred by the insured using reasonable and accepted actuarial principles in a policy year. (5) “Individual attachment point” means the amount of health claims incurred by a small employer in a policy year for an individual employee or dependent of an employee, and covered by a stop-loss insurance policy, above which the stop-loss insurer incurs a liability for payment, under individual stop-loss coverage. (6) “Stop-loss insurance” means coverage that insures an employer or an employer-sponsored health plan against the risk that: (A) One claim will exceed a specific dollar amount; or (B) The entire loss of a self-insurance plan will exceed a specific dollar amount.  (May 2, 2015, D.C. Law 20-265, § 201, 62 DCR 1529.)
DC Code § 31-3831 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 38B - Women’s Rights Regarding Certain Health Insurance|§ 31-3831. Definitions

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 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 provides medical care and includes items and services paid for as medical care to employees or their dependents (as defined under the terms of the plan) directly or through insurance, reimbursement, or otherwise. (4) “Health insurance coverage” means benefits consisting of medical care (provided directly, through insurance or reimbursement, or otherwise and includes items and services paid for as medical care) under any hospital or medical service policy or certificate, hospital, or medical service plan contract, or health maintenance organization contract offered by a health insurer. (5) “Health insurer” means any person that provides one or more health benefit plans or insurance in the District, including an insurer, a hospital and medical services corporation, a fraternal benefit society, a health maintenance organization, a multiple employer welfare arrangement, or any other person providing a plan of health insurance subject to the authority of the Commissioner. (6) “Health benefit plan” means any accident and health insurance policy or certificate, hospital and medical services corporation contract, health maintenance organization subscriber contract, plan provided by a multiple employer welfare arrangement, or plan provided by another benefit arrangement. The term “health benefit plan” does not mean accident only, credit, or disability insurance; coverage of Medicare services or federal employee health plans, pursuant to contracts with the United States government; Medicare supplement or long-term care insurance; dental only or vision only insurance; specified disease insurance; hospital confinement indemnity coverage; limited benefit health coverage; coverage issued as a supplement to liability insurance; insurance arising out of a workers’ compensation or similar law; automobile medical payment insurance; medical expense and loss of income benefits; or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance. (7) “Individual health plan” means a plan offering health insurance coverage offered to individuals other than in connection with a group health plan. (8) “Mastectomy” means the surgical removal of all or substantially all of a breast as a result of breast cancer.  (Apr. 3, 2001, D.C. Law 13-254, § 2, 48 DCR 723.)
DC Code § 31-3832 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 38B - Women’s Rights Regarding Certain Health Insurance|§ 31-3832. Coverage for reconstructive surgery following mastectomies

(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 the patient, provide the following coverage in the case of a participant or beneficiary who is receiving benefits in connection with a mastectomy and who elects breast reconstruction in connection with such mastectomy: (1) All stages of reconstruction of the breast on which the mastectomy has been performed; (2) Surgery and reconstruction of the other breast to produce a symmetrical appearance; and (3) Prostheses and physical complications at all stages of mastectomy, including lymphedemas. (b) Coverage for the procedures in subsection (a) of this section may be subject to annual deductibles and coinsurance provisions as may be considered appropriate and as are consistent with those established for other benefits under the health benefit plan or coverage.  (Apr. 3, 2001, D.C. Law 13-254, § 3, 48 DCR 723.)  Section References This section is referenced in § 31-3833.
DC Code § 31-3833 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 38B - Women’s Rights Regarding Certain Health Insurance|§ 31-3833. Notice

(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 correspondence made available or distributed by the health benefit plan or health insurer and shall be transmitted to the participant or beneficiary upon the earlier of: (1) Any yearly informational packet sent to the participant or beneficiary, as part of the packet; (2) In the next mailing made by the health benefit plan or health insurer to the participant or beneficiary; or (3) Not later than 60 days after April 3, 2001. (b) An individual or group health plan which is a health benefit plan, and a health insurer that has already provided notice in order to comply with the Women’s Health and Cancer Rights Act of 1998, approved October 21, 1998 (112 Stat. 2681; 29 U.S.C. § 1185b, 42 U.S.C. § 300gg-6, and 42 U.S.C. § 300gg-52), need not provide additional notice under this chapter; provided, that it files with the Commissioner a written statement, with a copy of the notice attached, certifying that it is in compliance.  (Apr. 3, 2001, D.C. Law 13-254, § 4, 48 DCR 723.)
DC Code § 31-3834 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 38B - Women’s Rights Regarding Certain Health Insurance|§ 31-3834. Hormone replacement therapy coverage

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.  (Apr. 3, 2001, D.C. Law 13-254, § 5, 48 DCR 723.)
DC Code § 31-3834.01 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 38B - Women’s Rights Regarding Certain Health Insurance|§ 31-3834.01. Full-year coverage for contraception

(a) An individual health plan or group health plan, a health insurer offering health insurance coverage for prescription drugs, and health insurance coverage through Medicaid and the D.C. Healthcare Alliance program shall provide coverage for a supply of contraceptives intended to last over the course of a 12-month period, that shall be dispensed all at once or over the course of the 12 months at the patient's election, including for over-the-counter contraceptives and contraceptives obtained from a licensed pharmacist pursuant to § 3-1202.08(g-1); provided, that the D.C. Healthcare Alliance program shall not be required to provide coverage for a supply of contraceptives intended to last longer than the period of recertification for the D.C. Healthcare Alliance. The costs of any consultation by the pharmacist shall also be covered. (b) For the purposes of this section, the term: (1) "Contraceptive" means a drug or drug regimen approved by the U.S. Food and Drug Administration to prevent pregnancy. (2) "Medicaid" shall have the same meaning as provided in § 4-204.12(2). (c) Repealed.  (Apr. 3, 2001, D.C. Law 13-254, § 5a; as added Sept. 17, 2015, D.C. Law 21-21, § 2, 62 DCR 8848; Mar. 28, 2018, D.C. Law 22-75, § 3(a), 65 DCR 1374.)  Applicability Applicability of D.C. Law 21-21: Section 3 of D.C. Law 21-21 provided that the act shall apply as of January 1, 2017. Emergency Legislation  For temporary (90 days) amendment of this section, see § 3(a) of Defending Access to Women's Health Care Services Congressional Review Emergency Amendment Act of 2018 (D.C. Act 22-266, Feb. 21, 2018, 65 DCR 2119).   For temporary (90 days) creation of § 31-3834.02, see § 2 of Defending Access to Women's Health Care Services Emergency Amendment Act of 2017 (D.C. Act 22-49, Apr. 24, 2017, 64 DCR 4017).  Temporary Legislation  For temporary (225 days) addition of § 31-3834.02, see § 2 of Defending Access to Women's Health Care Services Temporary Amendment Act of 2017 (D.C. Law 22-6, July 11, 2017, 64 DCR 4905).
DC Code § 31-3834.05 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 38B - Women’s Rights Regarding Certain Health Insurance|§ 31-3834.05. Notice of rights to healthcare coverage

(a) An insurer that is subject to § 31-3834.01, § 31-3834.02, or § 31-3834.03 shall make readily accessible to enrollees and potential enrollees information regarding: (1) Full and accurate information relevant to coverage and cost-sharing for contraceptive drugs, devices, products, and services by each health insurance plan, including an explanation of an insured's financial responsibility for payment of premiums, coinsurance, copayments, deductibles, and any other charges; (2) The coverage of other drugs, devices, products, and services described in §§ 31-3834.01, 31-3834.02, and 31-3834.03; and (3) The right to receive up to a 12-month supply of self-administered hormonal contraceptives prescribed and dispensed by a licensed pharmacist, pursuant to § 3-1202.08(g-1), without cost-sharing requirements. (b)(1) The insurer shall provide the information described in subsection (a) of this section in a consumer-friendly format: (A) That can be viewed on the insurer's public website through a clearly identifiable link or tab without requiring an individual to create or access an account or enter a policy or contract number; (B) By email or letter within 14 days after a request by an enrollee; and (C) Within one year after March 28, 2018, or whenever written materials are reprinted, whichever is sooner, in written materials that explain benefits or coverage that are provided to enrollees and potential enrollees, including in an addendum summarizing benefits and coverage. (2) This subsection shall be construed consistently with section 2715 of the Public Health Services Act, as amended by the Patient Protection and Affordable Care Act, approved March 23, 2010 (124 Stat. 132; 42 U.S.C. § 300gg-15). (c) The Department of Insurance, Securities and Banking shall provide health insurers operating in the District of Columbia with an annual notice of their obligation to provide coverage for drugs, devices, products, and services described in §§ 31-3834.01, 31-3834.02, and 31-3834.03.  (Apr. 3, 2001, D.C. Law 13-254, § 5e ; as added Mar. 28, 2018, D.C. Law 22-75, § 3(b), 65 DCR 1374; Oct. 30, 2018, D.C. Law 22-164, § 303(d), 65 DCR 9324.)  Emergency Legislation  For temporary (90 days) creation of this section, see § 3(b) of Defending Access to Women's Health Care Services Congressional Review Emergency Amendment Act of 2018 (D.C. Act 22-266, Feb. 21, 2018, 65 DCR 2119).