reglab/statecodes huggingface dataset:
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 34A - Health Organizations RBC › § 31–3451.04. Regulatory Action Level Event

§ 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.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 34A - Health Organizations RBC › § 31–3451.05. Authorized Control Level Event

§ 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”.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 34A - Health Organizations RBC › § 31–3451.06. Mandatory Control Level Event

§ 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.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 34A - Health Organizations RBC › § 31–3451.07. Hearings

§ 31–3451.07. Hearings.
(a) A health organization may request a confidential department hearing, on a record, to challenge a determination or action if the Commissioner notifies it of the following:
(1) An adjusted RBC report;
(2)(A) The health organization’s RBC plan or revised RBC plan is unsatisfactory; and
(B) The notification constitutes a Regulatory Action Level Event;
(3) The health organization has failed to adhere to its RBC plan or revised RBC plan and that the failure has a substantial adverse effect on the ability of the health organization to eliminate the Company Action Level Event in accordance with its RBC plan or revised RBC plan; or
(4) A corrective order.
(b) The health organization shall notify the Commissioner of its request for a hearing within 5 days after a notification described in subsection (a) of this section. Upon receipt of the health organization’s request for a hearing, the Commissioner shall set a date for the hearing, which shall be no less than 10, or more than 30, days after the date of the health organization’s request.
(June 18, 2003, D.C. Law 14-312, § 107, 50 DCR 306.)
Prior Codifications
2001 Ed., § 31-3851.07.
Section References
This section is referenced in § 31-3451.01, § 31-3451.03, and § 31-3451.04.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 34A - Health Organizations RBC › § 31–3451.09. Foreign health organizations

§ 31–3451.09. Foreign health organizations.
(a)(1) A foreign health organization shall, upon the written request of the Commissioner, submit to the Commissioner an RBC report as of the end of the previous calendar year upon the later of:
(A) The date that an RBC report would be required to be filed by a domestic health organization under this chapter; or
(B) Fifteen days after the request is received by the foreign health organization.
(2) A foreign health organization shall, at the written request of the Commissioner, promptly submit to the Commissioner a copy of any RBC plan that is filed with the insurance commissioner of any other state.
(b) If (1) a Company Action Level Event, Regulatory Action Level Event, or Authorized Control Level Event occurs with respect to a foreign health organization as determined under the RBC statute applicable in the state of domicile of the health organization (or, if no RBC statute is in force in that state, under the provisions of this chapter), and (2) the Insurance Commissioner of the state of domicile of the foreign health organization fails to require the foreign health organization to file an RBC plan in the manner specified under that state’s RBC statute (or, if no RBC statute is in force in that state, under § 31-3451.03), the Commissioner may require the foreign health organization to file an RBC plan with the Commissioner. In such event, the failure of the foreign health organization to file an RBC plan with the Commissioner shall be reason to order the health organization to cease and desist from writing new insurance business in the District.
(c) If (1) a Mandatory Control Level Event occurs with respect to a foreign health organization, and (2) no domiciliary receiver has been appointed with respect to the foreign health organization under the rehabilitation and liquidation statute applicable in the state of domicile of the foreign health organization, the Commissioner may apply to the Superior Court of the District of Columbia as permitted under Chapter 34 of Title 31 or Chapter 13 of Title 31 with respect to the liquidation of property of foreign health organizations found in the District of Columbia. The occurrence of the Mandatory Control Level Event shall be considered adequate grounds for the application.
(June 18, 2003, D.C. Law 14-312, § 109, 50 DCR 306.)
Prior Codifications
2001 Ed., § 31-3851.09.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 34A - Health Organizations RBC › § 31–3451.10. Supplemental provisions; rules; exemption

§ 31–3451.10. Supplemental provisions; rules; exemption.
(a) This chapter shall supplement the other provisions of the laws of the District and shall not preclude or limit any other powers or duties of the Commissioner under such laws, including Chapter 34 of this title and Chapter 13 of this title.
(b) The Commissioner may promulgate regulations to implement this chapter.
(c) The Commissioner may exempt from the application of this chapter a domestic health organization that:
(1) Writes direct business only in the District;
(2) Assumes no reinsurance in excess of 5% of direct premium written; and
(3) Writes direct annual premiums for comprehensive medical business of $2 million or less.
(June 18, 2003, D.C. Law 14-312, § 110, 50 DCR 306.)
Prior Codifications
2001 Ed., § 31-3851.10.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 34A - Health Organizations RBC › § 31–3451.11. Immunity

§ 31–3451.11. Immunity.
The Commissioner, the Department of Insurance and Securities Regulation, or its employees or agents shall not be liable for any action taken by them in the performance of their powers and duties under this chapter.
(June 18, 2003, D.C. Law 14-312, § 111, 50 DCR 306.)
Prior Codifications
2001 Ed., § 31-3851.11.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 34A - Health Organizations RBC › § 31–3451.12. Notices

§ 31–3451.12. Notices.
All notices by the Commissioner to a health organization that may result in regulatory action under this chapter shall be effective upon mailing if transmitted by registered or certified mail or, in the case of any other transmission, shall be effective upon the health organization’s receipt of notice.
(June 18, 2003, D.C. Law 14-312, § 112, 50 DCR 306.)
Prior Codifications
2001 Ed., § 31-3851.12.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 34A - Health Organizations RBC › § 31–3451.13. Transition

§ 31–3451.13. Transition.
For RBC reports required to be filed by health organizations with respect to 2002, the following requirements shall apply in lieu of the provisions of §§ 31-3451.03, 31-3451.04, 31-3451.05, and 31-3451.06:
(1) In the event of a Company Action Level Event with respect to a domestic health organization, the Commissioner shall take no regulatory action under this chapter.
(2) In the event of a Regulatory Action Level Event as defined under § 31-3451.01(19)(A) through (C), the Commissioner shall take the actions required under § 31-3451.03.
(3) In the event of a Regulatory Action Level Event as defined under § 31-3451.01(19)(D) through (I), or an Authorized Control Level Event, the Commissioner shall take the action required under § 31-3451.04 with respect to the health organization.
(4) In the event of a Mandatory Control Level Event, the Commissioner shall take the action required under § 31-3451.05.
(June 18, 2003, D.C. Law 14-312, § 113, 50 DCR 306; Apr. 13, 2005, D.C. Law 15-354, § 45(d), 52 DCR 2638.)
Prior Codifications
2001 Ed., § 31-3851.13.
Effect of Amendments
D.C. Law 15-354 validated previously made technical corrections.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 34B - Health Reform Federal Compliance › § 31–3461. Compliance with federal health reform

§ 31–3461. Compliance with federal health reform.
(a) Sections 1251, 1252, and 1304 of the Patient Protection and Affordable Care Act, approved March 23, 2010 (124 Stat. 119; 42 U.S.C. §§ 18011, 18021, and 18024), and sections 2701 through 2709, 2711 through 2719A, and 2794 of the Public Health Service Act, approved July 1, 1944 (58 Stat. 682; 42 U.S.C. §§ 300gg, 300gg-1, 300gg-2, 300gg-3, 300gg-4, 300gg-5, 300gg-6, 300gg-7, 300gg-8, 300gg-9, 300gg-11, 300gg-12, 300gg-13, 300gg-14, 300gg-15, 300gg-15A, 300gg-16, 300gg-17, 300gg-18, 300gg-19, 300gg-19A, and 300gg-94), (collectively "federal health acts") and any rules issued pursuant to the federal health acts, as the sections and implementing regulations were in effect on December 15, 2017, are incorporated by reference and shall apply to all insurers, hospital and medical services corporations, health maintenance organizations, and multiple employer welfare arrangements, including associations or any other entities providing a health benefit plan to a small employer, as that term is defined in § 31-3301.01(42), or an individual, that deliver or issue for delivery individual or group health insurance policies, contracts, or certificates of coverage in the District.
(b) The Commissioner of the Department of Insurance, Securities and Banking (“Commissioner”) has the authority to take action to enforce violations of subsection (a) of this section pursuant to the Commissioner’s authority under subchapter I of Chapter 1 of this title [§ 31-101 et seq.].
(c) The Commissioner, pursuant to subchapter I of Chapter 5 of Title 2 [§ 2-501
et seq.
], may issue rules to implement the provisions of this section.
(May 2, 2015, D.C. Law 20-265, § 101, 62 DCR 1529; Mar. 22, 2019, D.C. Law 22-266, § 4(a), 66 DCR 1423.)
Emergency Legislation
For temporary (90 days) creation of new § 31-3462, see § 4(b) of Health Insurance Marketplace Improvement Emergency Amendment Act of 2018 (D.C. Act 22-526, Dec. 10, 2018, 65 DCR 13424).
For temporary (90 days) amendment of this section, see § 4(a) of Health Insurance Marketplace Improvement Emergency Amendment Act of 2018 (D.C. Act 22-526, Dec. 10, 2018, 65 DCR 13424).
Temporary Legislation
For temporary (225 days) creation of new § 31-3462, see § 4(b) of Health Insurance Marketplace Improvement Temporary Amendment Act of 2018 (D.C. Law 22-251, Mar. 15, 2019, 66 DCR 975).
For temporary (225 days) amendment of this section, see § 4(a) of Health Insurance Marketplace Improvement Temporary Amendment Act of 2018 (D.C. Law 22-251, Mar. 15, 2019, 66 DCR 975).
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 34B - Health Reform Federal Compliance › § 31–3462. Applicability of federal health acts to multiple employer welfare arrangements

§ 31–3462. Applicability of federal health acts to multiple employer welfare arrangements.
(a) Requirements in the federal health acts incorporated by reference in § 31-3461(a) that apply to the small group market shall apply to health benefit plans offered by multiple employer welfare arrangements including associations 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.
(b) Requirements in the federal health acts incorporated by reference in § 31-3461(a) that apply to insurers in the individual market shall apply to health benefit plans offered by multiple employer welfare arrangements, including associations or any other entities, if the plan covers an individual in the District who is not an employee or dependent of a participating employer.
(May 2, 2015, D.C. Law 20-265, § 101a; as added Mar. 22, 2019, D.C. Law 22-266, § 4(b), 66 DCR 1423.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3505. Requirements for issuance of certificate of authority

§ 31–3505. Requirements for issuance of certificate of authority.
The Mayor shall issue a certificate of authority to each applicant upon the payment of the $200 fee provided for in § 31-3504(b), and upon being satisfied that:
(a) The applicant has been organized bona fide for the purpose of establishing, maintaining, and operating a hospital service plan, a medical service plan, or combination of the two;
(b) Each contract executed, or proposed to be executed, by the applicant and any hospital, physician, or other medical provider for the furnishing of hospital or medical services to subscribers obligates, or will when executed obligate, each hospital, physician, or other similar service provider which is a party thereto to render the service to which each subscriber may be entitled under the terms and conditions of the various subscriber contracts issued, or proposed to be issued, by the applicant;
(c) Each subscriber contract issued, or proposed to be issued, in the District of Columbia is in a form approved by the Mayor, and that the rate charged, or proposed to be charged, for each form of such contract is approved by the Mayor as not being excessive, inadequate, or unfairly discriminatory in relation to the services and benefits offered; provided, that rates for experience rated groups need not, in accordance with § 31-3508(c), be filed with the Mayor;
(d) The applicant has a surplus of an amount equal to or greater than that required under § 31-3506, or the amount determined to be necessary pursuant to application of any risk-based capital regulations for hospital and medical services corporations promulgated by the Mayor; and
(e) The applicant has:
(1) Made provision for compliance with the open enrollment requirements of § 31-3514, including the providing of other public services in the District; or
(2) Has entered into a public-private partnership.
(Apr. 9, 1997, D.C. Law 11-245, § 6, 44 DCR 1158; Feb. 4, 2010, D.C. Law 18-104, § 2(b), 56 DCR 9182.)
Prior Codifications
1981 Ed., § 35-4705.
Effect of Amendments
D.C. Law 18-104 rewrote subsec. (e), which had read as follows: “(e) The applicant has made provision for compliance with the open enrollment requirements of § 31-3514, including the providing of other public services in the District of Columbia as required in § 31-3514.”
Emergency Legislation
For temporary (90 day) amendment of section, see § 2(b) of Hospital and Medical Services Corporation Regulatory Emergency Amendment Act of 2009 (D.C. Act 18-277, January 11, 2010, 57 DCR 935).
Temporary Legislation
Section 2(b) of D.C. Law 18-134 amended subsec. (e) to read as follows:
“(e) The applicant has:
“(1) Made provision for compliance with the open enrollment requirements of section 15, including the providing of other public services in the District; or
“(2) Has entered into a public-private partnership.”.
Section 6(b) of D.C. Law 18-134 provided that the act shall expire after 225 days of its having taken effect.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3505.01. Community health reinvestment

§ 31–3505.01. Community health reinvestment.
A corporation shall engage in community health reinvestment to the maximum feasible extent consistent with financial soundness and efficiency.
(Apr. 9, 1997, D.C. Law 11-245, § 6a; as added Mar. 25, 2009, D.C. Law 17-369, § 2(c), 56 DCR 1346.)
Section References
This section is referenced in § 31-3506.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3506.01. Compliance and implementation of community health reinvestment obligations

§ 31–3506.01. Compliance and implementation of community health reinvestment obligations.
(a) A corporation shall make available to the Commissioner such information as may be required to permit the Commissioner to verify the corporation’s community health reinvestment and, if appropriate, its compliance with its plan to dedicate excess surplus or to verify that the corporation is participating in a public-private partnership. When verifying the community health reinvestment or the corporation’s compliance with its plan, or when verifying the corporation’s participation in a public-private partnership the Commissioner may retain attorneys, appraisers, independent actuaries, independent certified public accountants, or other professionals, the cost of which shall be borne by the corporation.
(b) In implementing the provisions of the Medical Insurance Empowerment Amendment Act of 2008 [D.C. Law 17-369], the Commissioner shall consider the interests and needs of the jurisdictions in the corporation’s service area.
(Apr. 9, 1997, D.C. Law 11-245, § 7a; as added Mar. 25, 2009, D.C. Law 17-369, § 2(e), 56 DCR 1346; Feb. 4, 2010, D.C. Law 18-104, § 2(d), 56 DCR 9182.)
Effect of Amendments
D.C. Law 18-104 rewrote subsec. (a), which had read as follows: “(a) A corporation shall make available to the Commissioner such information as may be required to permit the Commissioner to verify the corporation’s community health reinvestment and, if appropriate, its compliance with its plan to dedicate excess surplus. When verifying the community health reinvestment or the corporation’s compliance with its plan, the Commissioner may retain attorneys, appraisers, independent actuaries, independent certified public accountants, or other professionals, the cost of which shall be borne by the corporation.”
Emergency Legislation
For temporary (90 day) amendment of section, see § 2(d) of Hospital and Medical Services Corporation Regulatory Emergency Amendment Act of 2009 (D.C. Act 18-277, January 11, 2010, 57 DCR 935).
Temporary Legislation
Section 2(d) of D.C. Law 18-134, in subsec. (a), substituted “dedicate excess surplus or to verify that the corporation is participating in a public-private partnership” for “dedicate excess surplus” and substituted “or the corporation’s compliance with its plan, or when verifying the corporation’s participation in a public-private partnership” for “or the corporation’s compliance with its plan,”.
Section 6(b) of D.C. Law 18-134 provided that the act shall expire after 225 days of its having taken effect.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3507. Filing of provider contracts

§ 31–3507. Filing of provider contracts.
(a) A corporation holding a certificate of authority under this chapter may enter into contracts with licensed hospitals, licensed physicians, and other duly licensed medical services providers.
(b) A copy of each contract form that a corporation, referred to in subsection (a) of this section, has with licensed hospitals, licensed physicians, and other duly licensed medical services providers shall be filed with the Mayor.
(Apr. 9, 1997, D.C. Law 11-245, § 8, 44 DCR 1158.)
Prior Codifications
1981 Ed., § 35-4707.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3509. Reserves

§ 31–3509. Reserves.
(a) Taking into consideration the nature of the policies issued by the corporation, a corporation shall establish and maintain pro rata gross unearned premium reserves, reserves for incurred but unpaid claims (both reported and unreported), reserves for expenses related to settlement of such claims, and other reserves as required for proper reporting of its financial condition or as required under the form of financial statements required of the corporation.
(b) The reserves required under subsection (a) of this section constitute a liability of the corporation in a determination of its financial condition.
(Apr. 9, 1997, D.C. Law 11-245, § 10, 44 DCR 1158.)
Prior Codifications
1981 Ed., § 35-4709.
Section References
This section is referenced in § 31-3501.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3511. Surplus notes

§ 31–3511. Surplus notes.
(a) A domestic corporation may borrow or assume a liability for the repayment of a sum of money under a written agreement which provides that the loan or advance shall be repaid only out of surplus of the corporation in excess of such minimum surplus as is stipulated in and by the agreement and if the surplus of the corporation after such payment would meet or exceed the level of surplus the corporation is required to maintain by the Mayor under the laws or regulations of the District of Columbia. The rate of interest specified in such an agreement may be adjusted no more frequently than annually to provide for a rate not exceeding the one-year treasury bill rate plus 3% at the time of adjustment. At the time the loan or advance is made, the interest rate shall not exceed the one-year treasury bill rate plus 3% annum.
(b) Subject to approval by the Mayor, the interest rate on all loans or advances existing on April 9, 1997 can be amended to the rate as permitted in this section with the mutual agreement of the corporation and the lender.
(c) A domestic corporation shall, before entering into an agreement for a loan or advance permitted under this section, file with the Mayor a statement of the purpose of the loan or advance and a copy of the proposed agreement. The Mayor shall disapprove any proposed agreement for a loan or advance if the Mayor finds that the loan or advance is unnecessary or excessive for the purpose intended; that the terms of the agreement are not fair and equitable to the parties and to other lenders, if any, to the corporation; that the information so filed by the corporation is inadequate; or that the terms of the agreement are not otherwise in compliance with this section.
(d) Any loan or advance to a domestic corporation shall be repaid by the corporation when, and to the extent, no longer reasonably necessary for the purpose originally intended; provided, that no repayment of such a loan or advance shall be made unless approved in advance by the Mayor.
(e) Nothing in this section shall be construed to mean that a corporation may not borrow money otherwise than by a loan or advance, but the amount so borrowed with accrued interest thereon shall be carried by the corporation as a liability.
(Apr. 9, 1997, D.C. Law 11-245, § 12, 44 DCR 1158.)
Prior Codifications
1981 Ed., § 35-4711.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3513. Reports

§ 31–3513. Reports.
(a) In addition to the annual statement required by § 31-1901, the Mayor:
(1) May require each corporation to file on a quarterly or other basis any additional reports, exhibits, or statements the Mayor considers necessary to furnish all information concerning the condition, solvency, experience, transactions, or affairs of the corporation. The Mayor may establish deadlines for submitting any additional reports, exhibits, or statements and may require their verification by any officer or officers of the corporation the Mayor designates; and
(2) Shall require each corporation to file annually, on or before June 1, a report, signed by 2 of its principal officers, showing:
(A) The number of the District of Columbia contractholders and subscribers by the following type of contract or its equivalent:
(i) Individual, open enrollment;
(ii) Individual conversion subscribers;
(iii) Group subscribers, as defined by regulation;
(iv) Medigap and Medicare supplements; and
(v) Associations;
(B) Total subscriber income, benefit, and indemnification payments for the types of contracts listed in paragraph (1) of this subsection, with a specific breakdown by type of contract if requested by the Mayor; and
(C) Expenditures for providing public services, in addition to open enrollment, in the District of Columbia.
(Apr. 9, 1997, D.C. Law 11-245, § 14, 44 DCR 1158.)
Prior Codifications
1981 Ed., § 35-4713.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3514. Open enrollment. [Repealed]

§ 31–3514. Open enrollment. [Repealed]
Repealed.
(Apr. 9, 1997, D.C. Law 11-245, § 15, 44 DCR 1158; June 11, 2004, D.C. Law 15-166, § 4(u)(3), 51 DCR 2817; Mar. 2, 2007, D.C. Law 16-192, § 5012(b), 53 DCR 6899; Mar. 25, 2009, D.C. Law 17-369, § 2(f), 56 DCR 1346; Feb. 4, 2010, D.C. Law 18-104, § 2(e), 56 DCR 9182; Sept. 24, 2010, D.C. Law 18-223, § 5023(b), 57 DCR 6242; Sept. 26, 2012, D.C. Law 19-171, § 88(b), 59 DCR 6190; May 2, 2015, D.C. Law 20-265, § 105(d), 62 DCR 1529.)
Prior Codifications
1981 Ed., § 35-4714.
Section References
This section is referenced in § 31-205, § 31-3501, § 31-3505, § 31-3506, § 31-3508, § 31-3512, and § 47-2608.
Effect of Amendments
D.C. Law 15-166, in par. (3) of subsec. (j), substituted “Department of Insurance, Securities, and Banking” for “Department of Insurance and Securities Regulation” both times it appears.
D.C. Law 16-192 repealed subsec. (f) and rewrote subsecs. (j) and (k).
D.C. Law 17-369, in subsec. (j)(2), substituted “shall order annually an independent” for “may order an independent”; rewrote subsec. (k); and added subsecs. (m), (n), and (o).
D.C. Law 18-104 added subsecs. (p), (q) and (r).
D.C. Law 18-223, in subsec. (j)(2), substituted “Healthy DC and Health Care Expansion Fund” for “Healthy DC Fund”.
The 2012 amendment by D.C. Law 19-171 validated previously made technical corrections.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3514.01. Tax and related payments

§ 31–3514.01. Tax and related payments.
A corporation shall be subject to § 47-2608.
(Apr. 9, 1997, D.C. Law 11-245, § 15a; as added Mar. 2, 2007, D.C. Law 16-192, § 5012(c), 53 DCR 6899.)
Section References
This section is referenced in § 31-3514.02.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3515. Conversion to a for-profit entity

§ 31–3515. Conversion to a for-profit entity.
A corporation issued a certificate of authority under this chapter shall not be converted into a stock corporation, partnership, limited liability company, or other business entity organized for profit.
(Apr. 9, 1997, D.C. Law 11-245, § 16, 44 DCR 1158; Apr. 11, 2003, D.C. Law 14-297, § 401(c), 50 DCR 330; Dec. 9, 2003, D.C. Law 15-56, § 3(a), 50 DCR 9188; Mar. 25, 2009, D.C. Law 17-369, § 2(g), 56 DCR 1346.)
Prior Codifications
1981 Ed., § 35-4715.
Effect of Amendments
D.C. Law 14-297 rewrote subsec. (b)(2) which had read as follows: “(2) Fails to comply with §§ 31-4405, 31-4410 through 31-4415, 31-4421, 31-4424, 31-4428, 31-4431, and 31-4441;”
D.C. Law 15-56, in subsec. (b), substituted “company not involving a nonprofit hospital service plan or medical service plan unless” for “company unless”, and added subsec. (b-1).
D.C. Law 17-369 rewrote the section.
Emergency Legislation
For temporary (90 day) amendment of section, see § 3(a) of Department of Insurance and Securities Regulation Merger Review Emergency Amendment Act of 2002 (D.C. Act 14-457, July 23, 2002, 48 DCR 8132).
For temporary (90 day) amendment of section, see § 3(a) of Department of Insurance and Securities Regulation Merger Review Congressional Review Emergency Amendment Act of 2002 (D.C. Act 14-513, October 23, 2002, 49 DCR 10475).
For temporary (90 day) amendment of section, see § 3(a) of Department of Insurance and Securities Regulation Merger Review Congressional Review Emergency Amendment Act of 2003 (D.C. Act 15-8, January 27, 2003, 50 DCR 1473).
For temporary (90 day) amendment of section, see § 3(a) of Department of Insurance and Securities Regulation Merger Review Emergency Amendment Act of 2003 (D.C. Act 15-205, October 24, 2003, 50 DCR 9845).
For temporary (90 day) amendment of section, see § 3(a) of Department of Insurance and Securities Regulation Merger Review Second Congressional Review Emergency Amendment Act of 2003 (D.C. Act 15-257, November 25, 2003, 50 DCR 11006).
Temporary Legislation
For temporary (225 day) amendment of section, see § 3(a) of Department of Insurance and Securities Regulation Merger Review Temporary Amendment Act of 2002 (D.C. Law 14-217, March 25, 2003, law notification 50 DCR 2730).
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3516. Conversion to a mutual company

§ 31–3516. Conversion to a mutual company.
A corporation issued a certificate of authority under this chapter shall not be converted into a mutual insurance company.
(Apr. 9, 1997, D.C. Law 11-245, § 17, 44 DCR 1158; Dec. 9, 2003, D.C. Law 15-56, § 3(b), 50 DCR 9188; Mar. 25, 2009, D.C. Law 17-369, § 2(h), 56 DCR 1346.)
Prior Codifications
1981 Ed., § 35-4716.
Effect of Amendments
D.C. Law 15-56, in subsec. (b), substituted “company not involving a nonprofit hospital service plan or medical service plan unless” for “company unless”, and added subsec. (b-1).
D.C. Law 17-369 rewrote the section.
Emergency Legislation
For temporary (90 day) amendment of section, see § 3(b) of Department of Insurance and Securities Regulation Merger Review Emergency Amendment Act of 2002 (D.C. Act 14-457, July 23, 2002, 48 DCR 8132).
For temporary (90 day) amendment of section, see § 3(b) of Department of Insurance and Securities Regulation Merger Review Congressional Review Emergency Amendment Act of 2002 (D.C. Act 14-513, October 23, 2002, 49 DCR 10475).
For temporary (90 day) amendment of section, see § 3(b) of Department of Insurance and Securities Regulation Merger Review Congressional Review Emergency Amendment Act of 2003 (D.C. Act 15-8, January 27, 2003, 50 DCR 1473).
For temporary (90 day) amendment of section, see § 3(b) of Department of Insurance and Securities Regulation Merger Review Emergency Amendment Act of 2003 (D.C. Act 15-205, October 24, 2003, 50 DCR 9845).
For temporary (90 day) amendment of section, see § 3(b) of Department of Insurance and Securities Regulation Merger Review Second Congressional Review Emergency Amendment Act of 2003 (D.C. Act 15-257, November 25, 2003, 50 DCR 11006).
Temporary Legislation
For temporary (225 day) amendment of section, see § 3(b) of Department of Insurance and Securities Regulation Merger Review Temporary Amendment Act of 2002 (D.C. Law 14-217, March 25, 2003, law notification 50 DCR 2730).
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3518. Directors and trustees

§ 31–3518. Directors and trustees.
Notwithstanding § 31-706(c)(3), or any other provision of District of Columbia insurance law referenced in § 31-3503, the following provisions shall apply to a domestic corporation issued a certificate of authority under this chapter:
(1) The board of directors or trustees shall consist of not less than 5 nor more than 21 members, who shall be elected by a majority of the members of the board. The term of a director or trustee shall be not less than 1 year nor more than 3 years, and shall be specified in the corporation’s bylaws.
(2) The directors or trustees of a domestic corporation shall at all times include subscriber representatives.
(3) A majority of the board of directors or trustees shall at all times consist of members other than employees and officers of the corporation, or of any affiliate or subsidiary of the corporation.
(4) Not less than one-third of the members of the board of directors or trustees shall be residents of the District of Columbia.
(5) The articles of incorporation or bylaws of a domestic corporation shall state the number of directors or trustees necessary to constitute a quorum for conducting business at its meetings and the number of directors’ or trustees’ votes necessary to effect action on any matter presented for a vote of the board of directors or trustees. In regard to any matter involving conversion to a mutual or stock insurance company, or merger, consolidation, or other form of reorganization of the corporation, the affirmative vote of at least 80% of all directors or trustees shall be required to effect action by the board.
(Apr. 9, 1997, D.C. Law 11-245, § 19, 44 DCR 1158.)
Prior Codifications
1981 Ed., § 35-4718.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3519. Reports to directors and trustees

§ 31–3519. Reports to directors and trustees.
The officers or other management of a corporation issued a certificate of authority under this chapter shall report to its board of directors or trustees, no less often than quarterly, regarding any and all transactions or events that have, or are likely to have, a material impact on the operations or financial condition of the corporation.
(Apr. 9, 1997, D.C. Law 11-245, § 20, 44 DCR 1158.)
Prior Codifications
1981 Ed., § 35-4719.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3520. Oversight role and fiduciary obligation of directors, officers, and employees

§ 31–3520. Oversight role and fiduciary obligation of directors, officers, and employees.
(a) The Mayor shall promulgate regulations establishing the oversight role and fiduciary obligation of each member of the board of directors or trustees of a corporation issued a certificate of authority under this chapter. Such regulations shall require the corporation to adopt a code of conduct and compliance program for all board members, officers and employees of the corporation.
(b) A corporation issued a certificate of authority under this chapter shall file with the Mayor annually, on or before June 1, a copy of its bylaws which shall require the corporation’s board of directors or trustees to adopt policies consistent with the provisions of the code of conduct and compliance program regulations promulgated by the Mayor. Any amendments to the bylaws shall be filed with the Mayor by the corporation within 30 days of adoption by the board.
(Apr. 9, 1997, D.C. Law 11-245, § 21, 44 DCR 1158.)
Prior Codifications
1981 Ed., § 35-4720.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3522. Appeals

§ 31–3522. Appeals.
If, within the time for approval, the Mayor sends notice of disapproval of the proposed form of any subscriber contract, of proposed contract rates, or of any management contract or service agreement required by this chapter to be approved by the Mayor, the affected corporation may contest the Mayor’s decision. Any action to contest the Mayor’s decision shall be initiated within 30 days from the date on which the notice of decision is served on the corporation by delivering a written request for a hearing to the Department of Insurance, Securities, and Banking. The hearing shall commence in not fewer than 10 days nor more than 30 days from the date on which the action to contest the Mayor’s decision is received by the Department of Insurance, Securities, and Banking. The hearing and its disposition shall be governed by the procedures for contested cases in Chapter 1 of Title 26 (Insurance) of the District of Columbia Municipal Regulations (26 DCMR chapter 1).
(Apr. 9, 1997, D.C. Law 11-245, § 23, 44 DCR 1158; June 11, 2004, D.C. Law 15-166, § 4(u)(5), 51 DCR 2817.)
Prior Codifications
1981 Ed., § 35-4722.
Section References
This section is referenced in § 31-3508 and § 31-3517.
Effect of Amendments
D.C. Law 15-166 substituted “Department of Insurance, Securities, and Banking” for “Department of Insurance and Securities Regulation” both times it appears.
Emergency Legislation
For temporary (90 day) amendment of section, see § 4(u)(5) of Consolidation of Financial Services Emergency Amendment Act of 2004 (D.C. Act 15-381, February 27, 2004, 51 DCR 2653).
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3523. General transition provisions

§ 31–3523. General transition provisions.
(a) In his or her sole discretion, the Mayor may provide, upon application and for good cause shown by a corporation in existence and operating in the District of Columbia on April 9, 1997, for a reasonable period of time for such corporation to comply with any requirement of this chapter.
(b) Notwithstanding any provisions to the contrary in Chapter 7 of this title, or this chapter, a transaction ongoing as of April 9, 1997, which would otherwise be subject to the notice requirements of § 31-706(a), shall be filed with the Mayor for approval no later than 90 days after April 9, 1997, only if the transaction involves more than 3% of the amount of admitted assets or more than 20% of the amount of surplus of the corporation as of the 31st day of the previous December, whichever amount is less. Failure of the Mayor to act within 60 days after such a filing shall constitute approval of the transaction. The Mayor shall not disapprove a transaction ongoing as of April 9, 1997, if the transaction was lawful when begun. Extension or renewal of a transaction ongoing as of April 9, 1997, shall be subject to the notice and other requirements of the Holding Company Systems Act of 1993, and shall not be renewed or extended except upon terms approved by the Mayor.
(Apr. 9, 1997, D.C. Law 11-245, § 24, 44 DCR 1158.)
Prior Codifications
1981 Ed., § 35-4723.
Section References
This section is referenced in § 31-3508.
References in Text
The “Holding Company Systems Act of 1993”, referred to in (b), is D.C. Law 10-44, which is codified primarily as § 31-701 et seq.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3523.01. Regulatory authority

§ 31–3523.01. Regulatory authority.
Nothing in this chapter shall be construed to diminish the authority of the Council to regulate the affairs of Group Hospitalization and Medical Services, Inc.
(Apr. 9, 1997, D.C. Law 11-245, § 24a; as added Mar. 25, 2009, D.C. Law 17-369, § 2(i), 56 DCR 1346.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35 - Hospital and Medical Services Corporations Regulation › § 31–3524. Rules and regulations

§ 31–3524. Rules and regulations.
The Mayor, in accordance with subchapter I of Chapter 5 of Title 2, shall issue rules to implement the provisions of this chapter.
(Apr. 9, 1997, D.C. Law 11-245, § 25, 44 DCR 1158; Mar. 25, 2009, D.C. Law 17-369, § 2(j), 56 DCR 1346.)
Prior Codifications
1981 Ed., § 35-4724.
Effect of Amendments
D.C. Law 17-369 substituted “shall” for “may”.
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 35A - Reduction of health care benefits lien › § 31–3551. Reduction of health care benefits lien

§ 31–3551. Reduction of health care benefits lien.
(a) Except as provided in subsection (d) of this section, this chapter shall apply to any right of subrogation under a contract or applicable law for payment of health-care benefits or services for an injured person paid or payable by a subrogee or under any system of self-insurance or indemnification for health-care expenses, if the amount of the subrogee's claim as determined under subsection (b) of this section is voluntarily paid by the injured person from the injured person's recovery in a claim for personal injury.
(b)(1) Unless a subrogee files a petition to intervene in the personal injury action and is independently represented by counsel, in a subrogation claim arising out of a claim for personal injury, the amount permitted to be recovered by a subrogee for health-care benefits or services paid or payable on behalf of the injured person, subject to paragraph (2) of this subsection, shall be reduced by dividing the total amount of the costs of litigation and the attorneys’ fees incurred by the injured person for services rendered in connection with the injured person's claim for personal injury by the amount of the total recovery in the claim for personal injury and multiplying the result by the amount of the subrogee’s subrogation claim.
(2) The result under paragraph (1) of this subsection shall not exceed one-third of an injured person’s recovery in a claim for personal injury.
(3) A subrogee has no obligation to advise an injured person or the attorney for the injured person of the injured person's right to a reduction of the subrogation claim.
(c) On written request by a subrogee, an injured person or the attorney for the injured person who demands a reduction of the subrogation claim as described in this chapter shall provide the subrogee with a certification by the injured person that states the amount of the attorneys’ fees and the costs of litigation incurred by the injured person in connection with the injured person's claim.
(d) This chapter shall not apply to:
(1) A voluntary reduction of a subrogation claim by a subrogee that exceeds the reduction of the subrogation claim as described in subsection (b) of this section; or
(2) The District of Columbia Medicaid program.
(e) For the purposes of this chapter, the term "subrogee" means any person or entity that provides accident and sickness benefits or medical, surgical, or hospital benefits, whether on an indemnity or a reimbursement basis or a prepaid basis, including insurance carriers, and employers.
(May 12, 2016, D.C. Law 21-110, § 2, 63 DCR 4322.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 36 - Long-Term Care Insurance › § 31–3602. Scope

§ 31–3602. Scope.
(a) Any policy or rider advertised, marketed, or offered as long-term care or nursing home insurance delivered or issued for delivery in the District of Columbia shall comply with the provisions of this chapter.
(b) This chapter is not intended to supersede the obligations of entities subject to this chapter to comply with the substance of other applicable insurance laws insofar as they do not conflict with this chapter; except that, this chapter shall supersede laws and regulations designed and intended to apply to Medicare supplement insurance policies.
(c) The requirements of this chapter shall apply to policies delivered or issued for delivery in the District of Columbia on or after May 23, 2000.
(May 23, 2000, D.C. Law 13-121, § 3, 47 DCR 2038.)
2023 District of Columbia Code › Title 31 - Insurance and Securities › Chapter 36 - Long-Term Care Insurance › § 31–3603. Long-term insurance; who may issue

§ 31–3603. Long-term insurance; who may issue.
Long-term care insurance may be issued by insurers, fraternal benefits societies, nonprofit health, hospital, and medical service corporations, prepaid health plans, and health maintenance organizations, and any similar organization to the extent they are otherwise authorized to issue life or health insurance. Any product advertised, marketed, or offered as long-term care insurance shall be subject to the provisions of this chapter.
(May 23, 2000, D.C. Law 13-121, § 4, 47 DCR 2038.)