reglab/statecodes huggingface dataset:
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 31D - Health Benefit Exchange › § 31–3171.09b. Sale, solicitation, and negotiation by insurance producers

§ 31–3171.09b. Sale, solicitation, and negotiation by insurance producers.
(a) An insurance producer that is licensed in the District and authorized by the Commissioner to sell, solicit, or negotiate health insurance pursuant to Chapter 11A of Title 31 [§ 31-1131.02 et seq.], may sell any qualified health plan offered in the American Health Benefit Exchange, after satisfactorily completing training developed and provided by the Authority.
(b) An insurance producer shall be compensated directly by a health carrier for the sale of a qualified health plan offered in the American Health Benefit Exchange.
(Mar. 2, 2012, D.C. Law 19-94, § 10b; as added July 16, 2014, D.C. Law 20-123, § 2(c), 61 DCR 5379.)
Emergency Legislation
For temporary (90 days) addition of section, see § 2(c) of the Better Prices, Better Quality, Better Choices for Health Coverage Emergency Amendment Act of 2013 (D.C. Act 20-87, June 19, 2013, 60 DCR 9542, 20 DCSTAT 1446).
For temporary (90 days) addition of section, see §§ 2(a) and 3 of the Better Prices, Better Quality, Better Choices for Health Coverage Congressional Review Emergency Amendment Act of 2013 (D.C. Act 20-170, September 26, 2013, 60 DCR 14742).
For temporary (90 days) addition of section, see § 2(c) of the Better Prices, Better Quality, Better Choices for Health Coverage Emergency Amendment Act of 2014, (D.C. Act 20-335, May 22, 2014, 61 DCR 5375).
Temporary Legislation
For temporary (225 days) addition of section, see § 2(c) of the Better Prices, Better Quality, Better Choices for Health Coverage Temporary Amendment Act of 2013 (D.C. Law 20-22, October 3, 2013, 60 DCR 10880).
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 31D - Health Benefit Exchange › § 31–3171.10. Conflicts of interest

§ 31–3171.10. Conflicts of interest.
(a)(1) A member of the executive board or of the staff of the Authority shall not be employed by, a consultant to, a member of the board of directors of, affiliated with, or otherwise a representative of, a health carrier or other insurer, an agent or broker, a health professional, or a health care facility or health clinic while serving on the board or on the staff of the Authority.
(2) A member of the executive board or of the staff of the Authority shall not be a member, a board member, or an employee of a trade association of health carriers, health facilities, health clinics, or health professionals while serving on the board or on the staff of the Authority.
(3) A member of the executive board or of the staff of the Authority shall not be a health professional unless he or she receives no compensation for rendering services as a health professional and does not have an ownership interest in a professional health care practice.
(b) No member of the executive board or of the staff of the Authority shall, for one year after the end of the member’s service on the board or employment by the Authority, accept employment with any health carrier that offers a qualified health benefit plan through the exchanges.
(c) No member of the executive board shall make, participate in making, or in any way attempt to use his or her official position to influence the making of any decision that he or she knows or has reason to know will have a reasonably foreseeable material financial effect, distinguishable from its effect on the public generally, on him or her or a member of his or her immediate family, or on either of the following:
(1) Any source of income, other than gifts and other than loans by a commercial lending institution in the regular course of business on terms available to the public without regard to official status, aggregating $250 or more in value provided to, received by, or promised to the member within 12 months prior to the time when the decision is made.
(2) Any business entity in which the member is a director, officer, partner, trustee, or employee, or holds any position of management.
(Mar. 2, 2012, D.C. Law 19-94, § 11, 59 DCR 213.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 31D - Health Benefit Exchange › § 31–3171.11. Open meetings

§ 31–3171.11. Open meetings.
The executive and advisory boards shall be subject to subchapter IV of Chapter 5 of Title 2 [§ 2-571 et seq.]; except, that the executive board may hold closed sessions when considering matters related to litigation, personnel, contracting, or rates.
(Mar. 2, 2012, D.C. Law 19-94, § 12, 59 DCR 213.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 31D - Health Benefit Exchange › § 31–3171.12. Limitation of liability

§ 31–3171.12. Limitation of liability.
There shall not be any liability, in a private capacity, on the part of the executive or advisory board members, or any officer, or employee of the executive or advisory board, for or on account of any act performed or obligation entered into in an official capacity when done in good faith, without intent to defraud, and in connection with the administration, management, or conduct of this chapter or affairs related to this chapter.
(Mar. 2, 2012, D.C. Law 19-94, § 13, 59 DCR 213.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 31D - Health Benefit Exchange › § 31–3171.13. Relation to other laws

§ 31–3171.13. Relation to other laws.
(a) Nothing in this chapter, and no action taken by the Authority pursuant to this chapter, shall be construed to preempt or supersede the authority of the Commissioner to regulate the business of insurance within the District. Except as expressly provided to the contrary in this chapter, all health carriers offering qualified health plans and qualified dental plans in the District shall comply fully with all applicable health insurance laws of the District and regulations adopted and orders issued by the Commissioner.
(b) Nothing in this chapter, and no action taken by the Authority pursuant to this chapter, shall be construed to preempt or supersede the authority of the Department of Health Care Finance, as the single state agency, to establish policy and enforce the rules and regulations governing Titles XIX and XXI of the Social Security Act and other health-care programs under its jurisdiction.
(Mar. 2, 2012, D.C. Law 19-94, § 14, 59 DCR 213.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 31D - Health Benefit Exchange › § 31–3171.14. Powers of the Mayor

§ 31–3171.14. Powers of the Mayor.
Notwithstanding any other provision of this chapter, all powers and authority vested by this chapter in the Authority shall remain with the Mayor until:
(1) A majority of members of the executive board have been confirmed by the Council; and
(2) The executive board has hired an executive director.
(Mar. 2, 2012, D.C. Law 19-94, § 15, 59 DCR 213.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 31D - Health Benefit Exchange › § 31–3171.15. Dissolution of the Authority

§ 31–3171.15. Dissolution of the Authority.
Upon dissolution, liquidation, or other termination of the Authority:
(1) All rights and properties of the Authority shall pass to and be vested in the District, subject to the rights of lien holders and other creditors;
(2) Any net earnings of the Authority, beyond that necessary for retirement of any indebtedness or to implement a public purpose or program of the District authorized under this chapter, shall not inure to the benefit of any person other than the District;
(3) The expenditure of any net earnings shall be restricted to costs related to the direct delivery of health care to residents of the District.
(Mar. 2, 2012, D.C. Law 19-94, § 16, 59 DCR 213.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 31D - Health Benefit Exchange › § 31–3171.17. Rules

§ 31–3171.17. Rules.
(a) The Authority, pursuant to subchapter I of Chapter 5 of Title 2 [§ 2-501 et seq.], shall issue rules to implement the provisions of this chapter and as authorized by § 47-5109.
(b) The Authority shall submit all proposed rules adopted by the Authority to the Council for a 30-day period of review, excluding Saturdays, Sundays, legal holidays, and days of Council recess. If the Council does not approve or disapprove the proposed rules, in whole or in part, by resolution, within this 30-day review period, the proposed rules shall be deemed approved.
(c) Regulations promulgated under this section shall not conflict with or prevent the application of regulations promulgated by the Secretary under the Federal Act.
(Mar. 2, 2012, D.C. Law 19-94, § 18, 59 DCR 213; Oct. 30, 2018, D.C. Law 22-168, § 5003(b), 65 DCR 9388.)
Emergency Legislation
For temporary (90 days) amendment of this section, see § 5003(b) of Fiscal Year 2019 Budget Support Congressional Review Emergency Act of 2018 (D.C. Act 22-458, Oct. 3, 2018, 65 DCR 11212).
For temporary (90 days) amendment of this section, see § 5003(b) of Fiscal Year 2019 Budget Support Emergency Act of 2018 (D.C. Act 22-434, July 30, 2018, 65 DCR 8200).
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 31D - Health Benefit Exchange › § 31–3171.18. Applicability. [Repealed]

§ 31–3171.18. Applicability. [Repealed]
Repealed.
(Mar. 2, 2012, D.C. Law 19-94, § 19, 59 DCR 213; Sept. 20, 2012, D.C. Law 19-168, § 7015, 59 DCR 8025; Dec. 13, 2017, D.C. Law 22-33, § 7005, 64 DCR 7652.)
Effect of Amendments
The 2012 amendment by D.C. Law 19-168 rewrote the section.
Emergency Legislation
For temporary (90 days) repeal of this section, see § 7005 of Fiscal Year 2018 Budget Support Congressional Review Emergency Act of 2017 (D.C. Act 22-167, Oct. 24, 2017, 64 DCR 10802).
For temporary (90 days) repeal of this section, see § 7005 of Fiscal Year 2018 Budget Support Emergency Act of 2017 (D.C. Act 22-104, July 20, 2017, 64 DCR 7032).
For temporary (90 day) amendment of section, see § 7015 of Fiscal Year 2013 Budget Support Emergency Act of 2012 (D.C. Act 19-383, June 19, 2012, 59 DCR 7764).
For temporary (90 day) amendment of section, see § 7015 of Fiscal Year 2013 Budget Support Congressional Review Emergency Act of 2012 (D.C. Act 19-413, July 25, 2012, 59 DCR 9290).
Editor's Notes
Section 7016 of D.C. Law 19-168 provided that § 7015 of the act shall apply as of June 19, 2012.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 31E - Health Benefits Plans Behavioral Health Parity › § 31–3175.02. Compliance and enforcement

§ 31–3175.02. Compliance and enforcement.
(a) All health insurers offering health benefits plans, including Medicaid, in the District that provide mental health condition and substance use disorder benefits, shall comply with the requirements of MHPAEA.
(b) The Department shall enforce the requirements of this chapter by:
(1) Ensuring compliance by health insurers;
(2) Detecting, evaluating, and responding to complaints regarding any potential or actual violations of MHPAEA;
(3) Developing, maintaining, and regularly reviewing a publicly-available consumer complaint log recording any potential or actual violations of MHPAEA; and
(4) Performing market conduct examinations of health insurers health benefits plans, including a review of any non-quantitative treatment limitations.
(Mar. 13, 2019, D.C. Law 22-242, § 3, 66 DCR 930.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 31E - Health Benefits Plans Behavioral Health Parity › § 31–3175.04. Non-quantitative treatment limitations

§ 31–3175.04. Non-quantitative treatment limitations.
A health insurer shall not impose a non-quantitative treatment limitation with respect to a mental health condition or substance use disorder for any classification of benefits unless, under the terms of the health benefits plan, as written and in operation, any processes, strategies, evidentiary standards or other factors used in applying the non-quantitative treatment limitation to mental health or substance use disorder benefits in the classification are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the non-quantitative treatment limitation with respect to medical or surgical benefits in the same classification.
(Mar. 13, 2019, D.C. Law 22-242, § 5, 66 DCR 930.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 31E - Health Benefits Plans Behavioral Health Parity › § 31–3175.05. Medicaid coverage for medication-assisted treatment

§ 31–3175.05. Medicaid coverage for medication-assisted treatment.
Medicaid shall provide coverage for medication-assisted treatment prescribed for the treatment of substance use disorders; provided, that medication assisted treatment covered in accordance with this section shall not be subject to:
(1) Utilization control, other than those processes specified by the American Society of Addiction Medicine;
(2) Prior authorization;
(3) Step therapy; or
(4) Lifetime restriction limits.
(Mar. 13, 2019, D.C. Law 22-242, § 6, 66 DCR 930.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 31E - Health Benefits Plans Behavioral Health Parity › § 31–3175.06. Rules

§ 31–3175.06. Rules.
The Mayor, pursuant to subchapter I of Chapter 5 of Title 2, may issue rules to implement the provisions of this chapter.
(Mar. 13, 2019, D.C. Law 22-242, § 7, 66 DCR 930.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 32 - Health Insurance Forms › Subchapter I - Uniform Claims Forms › § 31–3201. Standardized uniform health insurance claims forms

§ 31–3201. Standardized uniform health insurance claims forms.
(a) The HCFA 1500 and UB 92 claims forms, or their successor forms as they may be amended from time to time, shall serve as the official health insurance claims forms of the District of Columbia for hospitals and other medical providers and governmental agencies, and such forms shall be used and exclusively accepted by all insurers, including health maintenance organizations and other forms of managed care, transacting health insurance, providing medical insurance through a personal automobile policy, workers’ compensation, or otherwise providing coverage for medical services, and by all hospitals, medical providers, and government agencies in the District of Columbia that require insurance claim forms for their records.
(b) The claims forms specified in subsection (a) of this section may be modified as necessary to accommodate the transmission and administration of claims by electronic means.
(Feb. 27, 1996, D.C. Law 11-89, § 2, 42 DCR 7153.)
Prior Codifications
1981 Ed., § 35-2331.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 32 - Health Insurance Forms › Subchapter II - Uniform Consultation Referral Forms › § 31–3231. Definitions

§ 31–3231. Definitions.
For the purposes of this subchapter, the term:
(1) “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 supplemental 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.
(2) “Health insurer” means any person that provides one or more health benefit plans or insurance in the District of Columbia, 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.
(3) “Commissioner” means the Commissioner of the Department of Insurance and Securities Regulation.
(April 13, 2002, D.C. Law 14-97, § 2, 49 DCR 994.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 32 - Health Insurance Forms › Subchapter II - Uniform Consultation Referral Forms › § 31–3232. Uniform consultation referral forms

§ 31–3232. Uniform consultation referral forms.
(a) This subchapter shall apply to all health insurers that issue or deliver individual or group health benefit plans in the District of Columbia.
(b) All health insurers that require the insured to have a written referral to receive consultation services shall use the uniform consultation referral form adopted by the Commissioner as the sole instrument for referrals for consultation services.
(c) The uniform consultation referral form shall be properly completed by the health care provider that refers the insured for consultation services.
(April 13, 2002, D.C. Law 14-97, § 3, 49 DCR 994.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 32 - Health Insurance Forms › Subchapter II - Uniform Consultation Referral Forms › § 31–3233. Regulations

§ 31–3233. Regulations.
(a) The Commissioner shall promulgate regulations to implement the provisions of this subchapter. The regulations shall include a uniform consultation referral form for use by health insurers that require enrollees or subscribers to have a written referral to receive consultation services.
(b) The Commissioner may waive the requirements of regulations adopted under subsection (a) of this section for the use of uniform consultation referral forms for an entity that uses the forms solely for internal purposes.
(April 13, 2002, D.C. Law 14-97, § 4, 49 DCR 994.)
Section References
This section is referenced in § 31-3234.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 32 - Health Insurance Forms › Subchapter II - Uniform Consultation Referral Forms › § 31–3234. Applicability

§ 31–3234. Applicability.
This subchapter shall apply to health insurers beginning with referrals issued 120 days after the promulgation of final regulations under § 31-3233.
(April 13, 2002, D.C. Law 14-97, § 5, 49 DCR 994.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 32 - Health Insurance Forms › Subchapter III - Uniform Credentialing Forms › § 31–3251. Definitions

§ 31–3251. Definitions.
For the purposes of this subchapter, the term:
(1) “Commissioner” means Commissioner of the Department of Insurance and Securities Regulation.
(2) “Credentialing intermediary” means a person to whom a health insurer has delegated credentialing or recredentialing authority and responsibility.
(3) “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 supplemental 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.
(4) “Health care provider” means:
(A) An individual who is licensed, certified, or otherwise authorized to provide health care services by the District of Columbia for a practice set forth under § 3-1201.02; or
(B) An agency, organization, facility, or distinct part of any of them, licensed under subchapter I of Chapter 5 of Title 44.
(5) “Health insurer” means any person that provides one or more health benefit plans or insurance in the District of Columbia, 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) “Provider panel” means providers that contract with a health insurer to provide health care services to the enrollees under a health benefit plan of the health insurer.
(7) “Uniform credentialing form” means the form designed by the Commissioner, by regulation, for use by a health insurer or its credentialing intermediary for credentialing and re-credentialing of a health care provider for participation on a provider panel.
(Apr. 13, 2002, D.C. Law 14-96, § 101, 49 DCR 991.)
Section References
This section is referenced in § 31-3255.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 32 - Health Insurance Forms › Subchapter III - Uniform Credentialing Forms › § 31–3252. Application for becoming credentialed

§ 31–3252. Application for becoming credentialed.
(a) A health insurer or its credentialing intermediary shall accept the uniform credentialing form as the sole application for a health care provider to become credentialed or recredentialed for a provider panel of the health insurer.
(b) A health insurer or its credentialing intermediary shall make the uniform credentialing form available to any health care provider that is to be credentialed or re-credentialed by the health insurer or credentialing intermediary.
(Apr. 13, 2002, D.C. Law 14-96, § 102, 49 DCR 991.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 32 - Health Insurance Forms › Subchapter III - Uniform Credentialing Forms › § 31–3253. Penalties

§ 31–3253. Penalties.
The Commissioner may impose a penalty not to exceed $500 against any health insurer for each violation of this subchapter by the health insurer or its credentialing intermediary.
(Apr. 13, 2002, D.C. Law 14-96, § 103, 49 DCR 991.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 32 - Health Insurance Forms › Subchapter III - Uniform Credentialing Forms › § 31–3254. Regulations

§ 31–3254. Regulations.
The Commissioner shall promulgate rules and regulations to implement the provisions of this subchapter.
(Apr. 13, 2002, D.C. Law 14-96, § 104, 49 DCR 991.)
Section References
This section is referenced in § 31-3255.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 32 - Health Insurance Forms › Subchapter III - Uniform Credentialing Forms › § 31–3255. Applicability

§ 31–3255. Applicability.
This subchapter shall apply, 120 days after the promulgation of the final regulations pursuant to § 31-3254, to health insurers, as defined in § 31-3251(5), and any agency, organization, facility, or distinct part thereof, licensed pursuant to subchapter I of Chapter 5 of Title 44.
(Apr. 13, 2002, D.C. Law 14-96, § 105, 49 DCR 991.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 32A - Health Insurance Coverage for Habilitative Services for Children › § 31–3272. Coverage, notice, applicability, and regulations

§ 31–3272. Coverage, notice, applicability, and regulations.
(a) A health insurer shall:
(1) Provide coverage of habilitative services for children under the age of 21 years and may do so through a managed care system;
(2) Not be required to provide reimbursement for habilitative services actually delivered through early intervention or school services; and
(3) Provide notice to its insureds and enrollees about the coverage required under this chapter.
(b) The coverage shall not be more restrictive than coverage provided for any other illness, condition, or disorder for purposes of determining deductibles, benefit year or lifetime durational limits, benefit year or lifetime dollar limits, lifetime episodes or treatment limits, copayment and coinsuance factors, and benefit year maximum for deductibles and copayments and coinsurance factors.
(c) The Commissioner may issue rules and regulations necessary to implement the provisions of this chapter.
(d) This chapter shall apply to all individual and group health benefit plans issued or renewed on the first day of the month beginning on or after 90 days following March 2, 2007.
(Mar. 2, 2007, D.C. Law 16-198, § 3, 53 DCR 8829.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter II - Individual Health Insurance › § 31–3302.02. Special rules for network plans

§ 31–3302.02. Special rules for network plans.
(a) A health insurer that offers health insurance coverage in the individual market may:
(1) Limit the individuals who may be enrolled under such coverage to those who live, reside, or work within the service area for such network plan; and
(2) Within the service area of such plan, deny such coverage to such individuals if the health insurer has demonstrated to the Commissioner that:
(A) It will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group contract holders, enrollees, and enrollees covered under individual contracts; and
(B) It is applying this section uniformly to individuals without regard to any health status-related factor of such individuals and without regard to whether the individuals are eligible individuals.
(b) A health insurer, upon denying health insurance coverage in the District of Columbia in accordance with subsection (a)(2) of this section, may not offer coverage in the individual market within such service area for a period of 180 days after such coverage is denied.
(Apr. 13, 1999, D.C. Law 12-209, § 202, 45 DCR 8433.)
Prior Codifications
1981 Ed., § 35-1023.
Emergency Legislation
See notes to § 31-3301.01.
Temporary Legislation
See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter II - Individual Health Insurance › § 31–3302.03. Application of financial capacity limits

§ 31–3302.03. Application of financial capacity limits.
(a) A health insurer may deny health insurance coverage in the individual market to an eligible individual if the health insurer has demonstrated to the satisfaction of the Commissioner that:
(1) It does not have the financial reserves necessary to underwrite additional coverage; and
(2) It is applying this section uniformly to all individuals in the individual market in the District of Columbia consistent with the laws of the District of Columbia and without regard to any health status-related factor of such individuals and without regard to whether the individuals are eligible individuals.
(b) A health insurer, upon denying individual health insurance coverage in the District of Columbia in accordance with subsection (a) of this section, may not offer such coverage in the individual market within the District of Columbia for a period of 180 days after the date such coverage is denied or until the health insurer has demonstrated to the satisfaction of the Commissioner that the health insurer has sufficient financial reserves to underwrite additional coverage, whichever is later.
(Apr. 13, 1999, D.C. Law 12-209, § 203, 45 DCR 8433.)
Prior Codifications
1981 Ed., § 35-1024.
Emergency Legislation
See notes to § 31-3301.01.
Temporary Legislation
See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter II - Individual Health Insurance › § 31–3302.04. Market requirements

§ 31–3302.04. Market requirements.
(a) The provisions of this chapter shall not be construed to require that a health insurer offering health insurance coverage only in connection with group health plans or through one or more bona fide associations, or both, offer such health insurance coverage in the individual market.
(b) A health insurer offering health insurance coverage in connection with group health plans under this subchapter shall not be deemed to be a health insurer offering individual health insurance coverage solely because such issuer offers a conversion policy.
(c) A health insurer offering individual health insurance coverage solely because such insurer offers any insurance coverage for children as a participant in a pilot program relating to insurance coverage for children shall not be deemed to be a health insurer offering individual health insurance coverage.
(Apr. 13, 1999, D.C. Law 12-209, § 204, 45 DCR 8433.)
Prior Codifications
1981 Ed., § 35-1025.
Emergency Legislation
See notes to § 31-3301.01.
Temporary Legislation
See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter II - Individual Health Insurance › § 31–3302.06. Fair market provision

§ 31–3302.06. Fair market provision.
The provisions of § 31-3303.07(j) shall apply to health insurance coverage offered by a health insurer in the individual market in the same manner as they apply to health insurance coverage offered by a health insurer in connection with a group health plan in the small or large group market.
(Apr. 13, 1999, D.C. Law 12-209, § 206, 45 DCR 8433.)
Prior Codifications
1981 Ed., § 35-1027.
Emergency Legislation
For temporary (90 days) creation of new § 31-3302.06a, see § 2(b) of Health Insurance Marketplace Improvement Emergency Amendment Act of 2018 (D.C. Act 22-526, Dec. 10, 2018, 65 DCR 13424).
See notes to § 31-3301.01.
Temporary Legislation
For temporary (225 days) creation of new § 31-3302.06a, see § 2(b) of Health Insurance Marketplace Improvement Temporary Amendment Act of 2018 (D.C. Law 22-251, Mar. 15, 2019, 66 DCR 975).
See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter II - Individual Health Insurance › § 31–3302.07. Regulations establishing standards

§ 31–3302.07. Regulations establishing standards.
(a) The Commissioner may adopt regulations to enable him or her to establish and administer such standards relating to the provisions of this chapter as may be necessary to (i) implement the requirements of this chapter, and (ii) assure that the District of Columbia’s regulation of health insurers is not preempted pursuant to the Health Insurance Portability and Accountability Act of 1996, approved August 21, 1996 (P.L. 104-191; 110 Stat. 1936).
(b) The Commissioner may revise or amend such regulations and may increase the scope of the regulations to the extent necessary to maintain federal approval of the District of Columbia’s program for regulation of health insurers pursuant to the requirements established by the United States Department of Health and Human Services.
(b-1) The Commissioner may issue rules to establish and administer such standards relating to the provisions of this chapter as may be necessary to improve access and affordability of health insurance in the District and to maintain the requirements of the Patient Protection and Affordable Care Act, approved March 23, 2010 (124 Stat. 111; 42 U.S.C. § 18001, note).
(c) The Commissioner shall annually advise the Committee on Consumer and Regulatory Affairs, or such other Council committee or committees having subject matter jurisdiction over health insurance, of revisions and amendments made pursuant to subsection (b) of this section.
(Apr. 13, 1999, D.C. Law 12-209, § 207, 45 DCR 8433; Mar. 22, 2019, D.C. Law 22-266, § 2(c), 66 DCR 1423.)
Prior Codifications
1981 Ed., § 35-1028.
Emergency Legislation
For temporary (90 days) amendment of this section, see § 2(c) of Health Insurance Marketplace Improvement Emergency Amendment Act of 2018 (D.C. Act 22-526, Dec. 10, 2018, 65 DCR 13424).
See notes to § 31-3301.01.
Temporary Legislation
For temporary (225 days) amendment of this section, see § 2(c) of Health Insurance Marketplace Improvement Temporary Amendment Act of 2018 (D.C. Law 22-251, Mar. 15, 2019, 66 DCR 975).
See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter II - Individual Health Insurance › § 31–3302.08. Applicability

§ 31–3302.08. Applicability.
Unless otherwise specifically provided in this chapter, the provisions of this subchapter shall apply to individual health benefit plans issued or renewed on or after January 1, 1998.
(Apr. 13, 1999, D.C. Law 12-209, § 208, 45 DCR 8433.)
Prior Codifications
1981 Ed., § 35-1029.
Emergency Legislation
See notes to § 31-3301.01.
Temporary Legislation
See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter II - Individual Health Insurance › § 31–3302.09. Construction

§ 31–3302.09. Construction.
Nothing in this subchapter shall be construed to:
(1) Restrict the amount of the premium rates that an issuer may charge an individual for health insurance coverage provided in the individual market; or
(2) Prevent a health insurer offering health insurance coverage in the individual market from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.
(Apr. 13, 1999, D.C. Law 12-209, § 209, 45 DCR 8433.)
Prior Codifications
1981 Ed., § 35-1030.
Emergency Legislation
See notes to § 31-3301.01.
Temporary Legislation
See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter III - Group Insurance › § 31–3303.01. Application of subchapter

§ 31–3303.01. Application of subchapter.
(a) This subchapter applies to health insurers offering group health insurance coverage. Each insurer proposing to issue group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis, each corporation providing group accident and sickness subscription contracts, and each health maintenance organization or multiple employer welfare arrangement providing health care plans for health care services that offers coverage to the group market in the District of Columbia shall be subject to the provisions of this subchapter if any of the following conditions are met:
(1) Any portion of the premiums or benefits is paid by or on behalf of the employer;
(2) The eligible employee or dependent is reimbursed, whether through wage adjustments or otherwise, by or on behalf of the employer, for any portion of the premium; or
(3) The health benefit plan is treated by the employer or any of the covered individuals as part of a plan or program for the purpose of section 106, 125, or 162 of the United States Internal Revenue Code [26 U.S.C. § 106, 26 U.S.C. § 125, or 26 U.S.C. § 162].
(b) Small group market requirements under this subchapter shall apply to a health benefit plan offered by a multiple employer welfare arrangement, including an association or any other entity, if the plan covers an employee of a small employer, as that term is defined in § 31-3301.01(42), in the District.
(Apr. 13, 1999, D.C. Law 12-209, § 301, 45 DCR 8433; Mar. 22, 2019, D.C. Law 22-266, § 2(d), 66 DCR 1423.)
Prior Codifications
1981 Ed., § 35-1031.
Emergency Legislation
For temporary (90 days) amendment of this section, see § 2(d) of Health Insurance Marketplace Improvement Emergency Amendment Act of 2018 (D.C. Act 22-526, Dec. 10, 2018, 65 DCR 13424).
See notes to § 31-3301.01.
Temporary Legislation
For temporary (225 days) amendment of this section, see § 2(d) of Health Insurance Marketplace Improvement Temporary Amendment Act of 2018 (D.C. Law 22-251, Mar. 15, 2019, 66 DCR 975).
See Historical and Statutory Notes following § 31-3301.01.
References in Text
Sections 106, 125, and 162 of the United States Internal Revenue Code, referred to in (3), are 26 U.S.C.S. §§ 106, 125, and 162.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter III - Group Insurance › § 31–3303.02. Availability of health benefit plans to small employers

§ 31–3303.02. Availability of health benefit plans to small employers.
In order to ensure the broadest availability of health benefit plans to small employers, the Commissioner shall set market conduct and other requirements for health insurers, agents, and third-party administrators, including requirements relating to the following:
(1) Registration with the Commissioner by each group health insurer offering group health insurance coverage of its intention to offer health insurance coverage in the small group market under this subchapter;
(2) Publication by the Commissioner of a list of all health insurers who offer coverage in the small group market, including a potential requirement applicable to agents, third-party administrators, and health insurers that no health benefit plan may be sold to a small employer by a health insurer not identified as a health insurer in the small group market;
(3) The availability of a broadly publicized telephone number for the Department of Insurance, Securities, and Banking for access by small employers to information concerning this subchapter; and
(4) Methods concerning periodic demonstration by health insurers offering group health insurance coverage that they are marketing and issuing health benefit plans to small employers.
(Apr. 13, 1999, D.C. Law 12-209, § 302, 45 DCR 8433; June 11, 2004, D.C. Law 15-166, § 4(s)(2), 51 DCR 2817.)
Prior Codifications
1981 Ed., § 35-1032.
Effect of Amendments
D.C. Law 15-166, in par. (3), substituted “Department of Insurance, Securities, and Banking” for “Department of Insurance and Securities Regulation”.
Emergency Legislation
See notes to § 31-3301.01.
For temporary (90 day) amendment of section, see § 4(s)(2) of Consolidation of Financial Services Emergency Amendment Act of 2004 (D.C. Act 15-381, February 27, 2004, 51 DCR 2653).
Temporary Legislation
See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter III - Group Insurance › § 31–3303.04. Reference to plan sponsor

§ 31–3303.04. Reference to plan sponsor.
In applying this subchapter in the case of health insurance coverage that is made available by a health insurer in the group market to employers only through one or more associations, a reference to “plan sponsor” is deemed, with respect to coverage provided to an employer member of the association, to include a reference to such employer.
(Apr. 13, 1999, D.C. Law 12-209, § 304, 45 DCR 8433.)
Prior Codifications
1981 Ed., § 35-1034.
Emergency Legislation
See notes to § 31-3301.01.
Editor's Notes
Temporary addition of chapter: See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter III - Group Insurance › § 31–3303.05. Coverage

§ 31–3303.05. Coverage.
If coverage to the small or large employer market pursuant to this subchapter ceases to be written, administered, or otherwise provided, such coverage shall continue to be governed by this subchapter with respect to business conducted under this subchapter that was transacted prior to the effective date of termination and that remains in force.
(Apr. 13, 1999, D.C. Law 12-209, § 305, 45 DCR 8433.)
Prior Codifications
1981 Ed., § 35-1035.
Emergency Legislation
See notes to § 31-3301.01.
Temporary Legislation
See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter III - Group Insurance › § 31–3303.08. Disclosure of information

§ 31–3303.08. Disclosure of information.
(a) Any health insurer offering health insurance coverage to a small employer shall make a reasonable disclosure of the availability of information to such an employer, as part of its solicitation and sales materials, and upon request of such an employer, information concerning:
(1) The provisions of such coverage concerning the health insurer’s right to change premium rates and the factors that may affect changes in premium rates;
(2) The provisions of such coverage relating to renewability of coverage;
(3) The provisions of such coverage relating to any preexisting condition exclusion; and
(4) The benefits and premiums available under all health insurance coverage for which the employer is qualified.
(b) A health insurer is not required under this subchapter to disclose any information that is proprietary and trade secret information.
(Apr. 13, 1999, D.C. Law 12-209, § 308, 45 DCR 8433.)
Prior Codifications
1981 Ed., § 35-1038.
Emergency Legislation
See notes to § 31-3301.01.
Temporary Legislation
See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter III - Group Insurance › § 31–3303.09. Eligibility to enroll

§ 31–3303.09. Eligibility to enroll.
(a) A group health plan, and a health insurer offering group health insurance coverage, may not establish rules for eligibility (including continued eligibility) of any individual to enroll under the terms of the plan based on any of the health status-related factors.
(b) The provisions of this section shall not be construed to:
(1) Require a health insurer offering group health insurance coverage to provide particular benefits other than those provided under the terms of such plan or coverage; or
(2) To prevent a health insurer offering group health insurance coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the plan or coverage rules for eligibility to enroll under a plan which includes rules defining any applicable waiting periods for such enrollment.
(c) A health insurer offering group health insurance coverage may not require an individual (as a condition of enrollment or continued enrollment under the plan) to pay a premium or contribution which is greater than such premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health status related factor in relation to the individual or to an individual enrolled under the plan as a dependent of the individual.
(d) Nothing in subsection (c) of this section shall be construed to restrict the amount that an employee may be charged for coverage under group health insurance coverage, or prevent a health insurer offering group health insurance coverage from establishing premium discounts or rebates or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.
(Apr. 13, 1999, D.C. Law 12-209, § 309, 45 DCR 8433.)
Prior Codifications
1981 Ed., § 35-1039.
Emergency Legislation
See notes to § 31-3301.01.
Temporary Legislation
See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter III - Group Insurance › § 31–3303.10. Exclusions

§ 31–3303.10. Exclusions.
The provisions of this subchapter shall not apply to:
(1) Any group health benefit plan for any plan year if, on the first day of such plan year, such plan has less than 2 participants who are current employees; or
(2) Any health benefit plan for any of the excepted benefits.
(Apr. 13, 1999, D.C. Law 12-209, § 310, 45 DCR 8433.)
Prior Codifications
1981 Ed., § 35-1040.
Emergency Legislation
See notes to § 31-3301.01.
Temporary Legislation
See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter III - Group Insurance › § 31–3303.11. Rules used to determine group size

§ 31–3303.11. Rules used to determine group size.
(a) All employers treated as a single employer under subsection (b), (c), (m), or (o) of § 414 of the Internal Revenue Code of 1986 (26 U.S.C. § 414) shall be treated as one employer.
(b) In the case of an employer which was not in existence throughout the preceding calendar year, the determination of whether such employer is a small or large group employer shall be based on the average number of employees that it is reasonably expected such employer will employ on business days in the current calendar year.
(c) Any reference in this section to an employer shall include a reference to any predecessor of such employer.
(Apr. 13, 1999, D.C. Law 12-209, § 311, 45 DCR 8433.)
Prior Codifications
1981 Ed., § 35-1041.
Emergency Legislation
See notes to § 31-3301.01.
Temporary Legislation
See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter III - Group Insurance › § 31–3303.12. Affiliation period

§ 31–3303.12. Affiliation period.
(a) A health maintenance organization which does not impose any preexisting condition exclusion, with respect to any particular coverage option, may impose an affiliation period for such coverage option, but only if such period is applied uniformly without regard to any health status-related factors and such period does not exceed 2 months (or 3 months in the case of a late enrollee).
(b) An affiliation period as described in subsection (a) of this section shall begin on the enrollment date.
(c) An affiliation period under a plan shall run concurrently with any waiting period under the plan.
(Apr. 13, 1999, D.C. Law 12-209, § 312, 45 DCR 8433.)
Prior Codifications
1981 Ed., § 35-1042.
Emergency Legislation
See notes to § 31-3301.01.
Temporary Legislation
See Historical and Statutory Notes following § 31-3301.01.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 33 - Health Insurance Portability and Accountability › Subchapter III - Group Insurance › § 31–3303.13. Alternative methods

§ 31–3303.13. Alternative methods.
A health maintenance organization may use alternative methods to an affiliation period to address adverse selection provided that they are approved by the Commissioner prior to their use.
(Apr. 13, 1999, D.C. Law 12-209, § 313, 45 DCR 8433.)
Prior Codifications
1981 Ed., § 35-1043.
Emergency Legislation
For temporary (90 days) creation of new §§ 31-3303.13a through 31-3303.13d, see § 2(e) of Health Insurance Marketplace Improvement Emergency Amendment Act of 2018 (D.C. Act 22-526, Dec. 10, 2018, 65 DCR 13424).
See notes to § 31-3301.01.
Temporary Legislation
For temporary (225 days) creation of new §§ 31-3303.13a through 31-3303.13d, see § 2(e) of Health Insurance Marketplace Improvement Temporary Amendment Act of 2018 (D.C. Law 22-251, Mar. 15, 2019, 66 DCR 975).
See Historical and Statutory Notes following § 31-3301.01.