reglab/housing_qa huggingface dataset:
DC Code § 31-3411 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3411. Investments

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.  (Apr. 9, 1997, D.C. Law 11-235, § 12, 44 DCR 818.)  Prior Codifications 1981 Ed., § 35-4511.
DC Code § 31-3415 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3415. Filing requirements for rating information

(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 accordance with actuarial principles for various categories of enrollees, provided that the enrollment fees applicable to an enrollee shall not be individually determined based on the status of an enrollee’s health. However, the fees shall not be excessive, inadequate, or unfairly discriminatory. A statement by a qualified actuary or other qualified person acceptable to the Commissioner as to the appropriateness of the use of the methodology, based on reasonable assumptions, shall accompany the filing along with adequate supporting information. A health maintenance organization filing a schedule of enrollment fees or methodology for determining enrollment fees pursuant to this section shall also comply with the Reasonable Health Insurance Ratemaking Reform Act of 2010 [Chapters 30A, 31C, and 33A of this title]. (c) The Commissioner shall approve the schedule of enrollment fees dues or methodology for determining enrollment fees if the requirements of subsection (b) of this section are met. If the Commissioner disapproves the filing, the Commissioner shall notify the health maintenance organization. In the notice, the Commissioner shall specify the reasons for disapproval. A hearing shall be held within 30 days after a request in writing by the person filing. If the Commissioner does not take action on the schedule or methodology within 30 days of the filing, it shall be deemed approved.  (Apr. 9, 1997, D.C. Law 11-235, § 16, 44 DCR 818; Apr. 8, 2011, D.C. Law 18-360, § 502(b), 58 DCR 896.)  Prior Codifications 1981 Ed., § 35-4515. Section References This section is referenced in § 31-3419. Effect of Amendments D.C. Law 18-360, in subsec. (b), added the fourth sentence. Emergency Legislation For temporary (90 day) amendment of section, see § 2 of Reasonable Health Insurance Premium Increase Emergency Amendment Act of 2010 (D.C. Act 18-328, March 18, 2010, 57 DCR 2546).
DC Code § 31-3417 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3417. Powers of insurance corporations

(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 such insurance companies, or subsidiaries or affiliates thereof, may jointly organize and operate a health maintenance organization. The business of insurance is deemed to include the providing of health care by a health maintenance organization owned or operated by an insurer or subsidiary thereof. (b) Notwithstanding any other provision of insurance laws, an insurer may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of a health maintenance organization to meet its obligations. (c) The enrollees of a health maintenance organization constitute a permissible group under such laws. Among other things, under such contracts the insurer may make benefit payments to health maintenance organizations for health care services rendered by providers.  (Apr. 9, 1997, D.C. Law 11-235, § 18, 44 DCR 818; Mar. 24, 1998, D.C. Law 12-81, § 46(d), 45 DCR 745.)  Prior Codifications 1981 Ed., § 35-4517.
DC Code § 31-3418 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3418. Examinations. [Repealed]

Repealed.  (Apr. 9, 1997, D.C. Law 11-235, § 19, 44 DCR 818; Oct. 23, 1997, D.C. Law 12-32, § 12(c), 44 DCR 4819; Mar. 27, 2003, D.C. Law 14-252, § 2(g), 50 DCR 225.)  Prior Codifications 1981 Ed., § 35-4518.
DC Code § 31-3420 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3420. Rehabilitation, liquidation, or conservation of health maintenance organizations

(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 the rehabilitation, liquidation, or conservation of insurance companies. The Commissioner may apply for an order directing the Commissioner to rehabilitate, liquidate, or conserve a health maintenance organization upon any one or more grounds set forth in §§ 31-1310 and 31-1315, or when in the Commissioner’s opinion the continued operation of a health maintenance organization would be hazardous either to the enrollees or to the people of the District. Enrollees shall have the same priority in the event of liquidation or rehabilitation as the law provides to policyholders of an insurer. (b) For the purposes of determining the priority of distribution of general assets, claims of enrollees and enrollees’ beneficiaries shall have the same priority as established by § 31-1315, for policyholders and beneficiaries of insured of insurance companies. If an enrollee is liable to any provider for services provided pursuant to and covered by the health care plan, that liability shall have the status of an enrollee claim for distribution of general assets. (c) Any provider who is obligated by law or agreement to hold enrollees harmless from liability for services pursuant to and covered by a health care plan shall have a priority of distribution of the general assets immediately following that of enrollees and enrollee’s beneficiaries as described herein, and immediately preceding the priority of distribution assigned to general creditors.  (Apr. 9, 1997, D.C. Law 11-235, § 21, 44 DCR 818; Mar. 8, 2007, D.C. Law 16-232, § 204(b), 54 DCR 368.)  Prior Codifications 1981 Ed., § 35-4520. Effect of Amendments D.C. Law 16-232, in subsec. (c), substituted “law” for “statute” and inserted “assigned to general creditors”.
DC Code § 31-3421 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3421. Summary orders and supervision

(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 Commissioner may, after notice and hearing, order the health maintenance organization to take such action reasonably necessary to rectify the condition or violation, including, but not limited to, 1 or more of the following: (1) Reduce the total amount of present and potential liability for benefits by reinsurance or other method acceptable to the Commissioner; (2) Reduce the volume of new business being accepted; (3) Reduce expenses by specified methods; (4) Suspend or limit the writing of new business for a period of time; (5) Increase the health maintenance organization’s capital and surplus by contribution; or (6) Take such other steps as the Commissioner may deem appropriate under the circumstances. (b) For the purposes of this section, a violation by a health maintenance organization of any law of the District to which the health maintenance organization is subject shall be deemed a violation of this chapter. (c) The Commissioner is authorized, by rules and regulations, to set uniform standards and criteria for early warning that the continued operation of any health maintenance organization might be hazardous to its enrollees, creditors, or the general public and to set standards for evaluating the financial condition of any health maintenance organization, which standards shall be consistent with the purpose expressed in subsection (a) of this section. (d) The remedies and measures available to the Commissioner under this section shall be in addition to, and not in lieu of, the remedies and measures available to the Commissioner under the provisions of Chapter 13 of this title.  (Apr. 9, 1997, D.C. Law 11-235, § 22, 44 DCR 818.)  Prior Codifications 1981 Ed., § 35-4521.
DC Code § 31-3422 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3422. Regulations

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 pursuant to emergency procurement provisions set forth in § 2-354.05.  (Apr. 9, 1997, D.C. Law 11-235, § 23, 44 DCR 818; Sept. 26, 2012, D.C. Law 19-171, § 215, 59 DCR 6190.)  Prior Codifications 1981 Ed., § 35-4522. Effect of Amendments The 2012 amendment by D.C. Law 19-171 substituted “set forth in § 2-354.05” for “set forth in § 2-303.12.”
DC Code § 31-3424 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3424. Statutory construction and relationship to other laws

(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 not apply to an insurer or hospital or medical service corporation licensed and regulated pursuant to the insurance laws of the District except with respect to its health maintenance organization activities authorized and regulated pursuant to this chapter. (b) Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals. (c) Any health maintenance organization authorized under this chapter shall not be deemed to be practicing medicine and shall be exempt from the provisions set forth by the Board of Medicine relating to the practice of medicine.  (Apr. 9, 1997, D.C. Law 11-235, § 26, 44 DCR 818.)  Prior Codifications 1981 Ed., § 35-4524.
DC Code § 31-3425 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3425. Filings and reports as public documents

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 be required under § 31-3408 [repealed].  (Apr. 9, 1997, D.C. Law 11-235, § 27, 44 DCR 818.)  Prior Codifications 1981 Ed., § 35-4525.
DC Code § 31-3428 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3428. Coordination of benefits. [Repealed]

Repealed.  (Apr. 9, 1997, D.C. Law 11-235, § 30, 44 DCR 818; Mar. 27, 2003, D.C. Law 14-252, § 2(j), 50 DCR 225.)  Prior Codifications 1981 Ed., § 35-4528.
DC Code § 31-3429 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3429. Point of service plan

(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 arrangement is contracting for the coverage shall offer, or contract with another carrier to offer, a point-of-service option to the employer, association, or other private group arrangement in conjunction with the health maintenance organization as an additional benefit for an employee or individual, at the employee’s or individual’s option to accept or reject. (b) An employer, association, or other private group arrangement may require an employee or individual that accepts the additional coverage under a point-of-service option under subsection (a) of this section to pay a premium over the amount of the premium for the coverage offered by the health maintenance organization. (c) A health maintenance organization may impose different cost sharing provisions for the point-of-service option based on whether the service is provided through the provider panel of the health maintenance organization or outside the providers panel of the health maintenance organization. (d) The requirements of this section shall not apply to any subscriber contract current and in force on April 9, 1997 for the duration of that contract, but these requirements shall apply to any renewal or new subscriber contract issued subsequent to April 9, 1997. (e) The requirements of this section shall not apply to any subscriber contract issued in the individual market to a person who is not part of a contracted group of subscribers.  (Apr. 9, 1997, D.C. Law 11-235, § 31, 44 DCR 818.)  Prior Codifications 1981 Ed., § 35-4529.
DC Code § 31-3431 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34 - Health Maintenance Organizations|§ 31-3431. Principal office, books, records, and files of the health maintenance organization to be in the District

(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, and files in the District, and shall not remove from the District its principal office or its books, records, or files without first obtaining the written permission of the Commissioner; provided, that this section shall not apply to the books, records, and files of any branch office of a health maintenance organization, which books, records, and files relate solely to the business transacted by the branch office agency. (b) A health maintenance organization domiciled in the District which violates this section shall immediately forfeit its certificate of authority to do business in the District. (c) An officer, agent, or employee of a health maintenance organization which violates this section shall be guilty of a misdemeanor and, upon conviction, shall pay a fine of not less than $100 for each offense.  (Apr. 9, 1997, D.C. Law 11-235, § 32a; as added Mar. 27, 2003, D.C. Law 14-252, § 2(k), 50 DCR 225.)  Editor's Notes Application of Law 14-252: Section 3 of D.C. Law 14-252 provided: “This act shall not apply until the Commissioner gives written notice that all necessary rules and administrative procedures are in place to effect the provisions of this act.”
DC Code § 31-3451.02 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34A - Health Organizations RBC|§ 31-3451.02. RBC reports

(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 addition, a domestic health organization shall file its RBC report: (1) With the NAIC in accordance with the RBC instructions; and (2) With the insurance commissioner in any state in which the health organization is authorized to do business, if the insurance commissioner has notified the health organization of its request in writing, in which case the health organization shall file its RBC report not later than the later of: (A) Fifteen days after the receipt of notice to file its RBC report with that state; or (B) The filing date. (b) A health organization's RBC level shall be determined in accordance with the formula set forth in the RBC instructions. The formula shall apply and may be adjusted for the covariance between the following factors in the manner set forth in the RBC instructions: (1) Asset risk; (2) Credit risk; (3) Underwriting risk; and (4) All other business risks and such other relevant risks as are set forth in the RBC instructions. (c) If a domestic health organization files an RBC report that, in the judgment of the Commissioner, is inaccurate, the Commissioner shall adjust the RBC report to correct the inaccuracy and shall notify the health organization of the adjustment. The notice shall contain a statement of the reason for the adjustment.  (June 18, 2003, D.C. Law 14-312, § 102, 50 DCR 306; Apr. 15, 2017, D.C. Law 21-278, § 3(b), 64 DCR 963.)  Prior Codifications 2001 Ed., § 31-3851.02. Section References This section is referenced in § 31-3451.01.
DC Code § 31-3451.04 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34A - Health Organizations RBC|§ 31-3451.04. Regulatory Action Level Event

(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, liabilities, and operations of the health organization, including a review of its RBC plan or revised RBC plan; and (3) Issue a corrective order. (b) In determining corrective action, the Commissioner may consider factors which include the results of any sensitivity tests undertaken under the RBC instructions. The RBC plan or revised RBC plan shall be submitted: (1) Within 45 days after the occurrence of the Regulatory Action Level Event; (2) If the health organization challenges an adjusted RBC report under § 31-3451.07, and the challenge is not frivolous in the judgment of the Commissioner, within 45 days after the notification to the health organization that the Commissioner has, after a hearing, rejected the health organization’s challenge; or (3) If the health organization challenges a revised RBC plan under § 31-3451.07, and the challenge is not frivolous in the judgment of the Commissioner, within 45 days after the notification to the health organization that the Commissioner has, after a hearing, rejected the health organization’s challenge. (c) The Commissioner may retain actuaries, investment experts, or other consultants as may be necessary in the judgment of the Commissioner to review the health organization’s RBC plan or revised RBC plan, examine or analyze the assets, liabilities, and operations (including contractual relationships) of the health organization, and formulate the corrective order with respect to the health organization. The fees, costs, and expenses relating to the actuaries, investment experts, or consultants shall be borne by the affected health organization or such other party as directed by the Commissioner.  (June 18, 2003, D.C. Law 14-312, § 104, 50 DCR 306.)  Prior Codifications 2001 Ed., § 31-3851.04. Section References This section is referenced in § 31-3451.05 and § 31-3451.13.
DC Code § 31-3451.05 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34A - Health Organizations RBC|§ 31-3451.05. Authorized Control Level Event

(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 creditors of the health organization and of the public, take such action as is necessary to cause the health organization to be placed under regulatory control under Chapter 34 of this title and Chapter 13 of this title. (b)(1) If the Commissioner takes action under subsection (a)(1) of this section pursuant to an adjusted RBC report, the health organization shall be entitled to the protections which are afforded to health organizations under Chapter 34 of this title and Chapter 13 of this title pertaining to summary proceedings. (2) If the Commissioner takes action under subsection (a)(2) of this section, the Authorized Control Level Event shall be sufficient for the Commissioner to take action under Chapter 34 of this title or Chapter 13 of this title. In such event, the Commissioner shall have the rights, powers, and duties with respect to the health organization as are set forth in Chapter 34 of this title and Chapter 13 of this title.  (June 18, 2003, D.C. Law 14-312, § 105, 50 DCR 306; Apr. 13, 2005, D.C. Law 15-354, § 45(b), 52 DCR 2638.)  Prior Codifications 2001 Ed., § 31-3851.05. Section References This section is referenced in § 31-3451.13. Effect of Amendments D.C. Law 15-354, in pars. (1) and (2) of subsec. (a), substituted “and” for “or”.
DC Code § 31-3451.06 (2021)
2021 District of Columbia Code|Title 31 - Insurance and Securities|Chapter 34A - Health Organizations RBC|§ 31-3451.06. Mandatory Control Level Event

(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 sufficient reason for the Commissioner to take action under Chapter 34 of this title or Chapter 13 of this title. In such event, the Commissioner shall have the rights, powers, and duties with respect to the health organization as are set forth in Chapter 34 of this title and Chapter 13 of this title. (b) If the Commissioner takes action under subsection (a) of this section pursuant to an adjusted RBC report, the health organization shall be entitled to the protections of Chapter 34 of this title and Chapter 13 of this title pertaining to summary proceedings. (c) Notwithstanding the provisions of subsections (a) or (b) of this section, the Commissioner may forego action for up to 90 days after the Mandatory Control Level Event if the Commissioner finds there is a reasonable expectation that the Mandatory Control Level Event may be eliminated within the 90-day period.  (June 18, 2003, D.C. Law 14-312, § 106, 50 DCR 306; Apr. 13, 2005, D.C. Law 15-354, § 45(c), 52 DCR 2638.)  Prior Codifications 2001 Ed., § 31-3851.06. Section References This section is referenced in § 31-3451.13. Effect of Amendments D.C. Law 15-354, in subsecs. (a) and (b), validated a previously made technical corrections.