Section 26-A4499. DEFINITIONS

 

4499.1For the purpose of this chapter, the term:

 

Applicant means a child or an individual on behalf of a child who submits an application for a child-only policy.

 

Carrier means an insurer, nonprofit health service plan, group hospital and medical service corporation, or a health maintenance organization.

 

Commissioner means the Commissioner of the Department of Insurance, Securities and Banking.

 

Child means an individual under the age of nineteen (19).

 

Child-only policy means an individual health benefit plan issued or delivered to a child in the District of Columbia.

 

Health benefit plan means a health insurance contract issued by a carrier that includes benefits for medical care. “Health benefit plan" does not include: 

 

(a)  Any of the following:

 

(1) Coverage only for accident or disability income insurance;

 

(2) Coverage issued as a supplement to liability insurance;

 

(3) Liability insurance, including general liability insurance and automobile liability insurance;

 

(4) Workers’ compensation or similar insurance;

 

(5) Automobile medical payment insurance;

 

(6) Credit-only insurance;

 

(7) Coverage for on-site medical clinics; and

 

(8) Other similar insurance coverage, specified in federal regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996, approved August 21, 1996 (Pub. L. No. 104-191; 110 Stat. 1936).

 

(b) The following benefits if they are provided under a separate contract of insurance:

 

(1) Limited-scope dental or vision benefits;

 

(2) Benefits for long-term care, nursing home care, home health care, community-based care, or any combination of these benefits; and

 

(3) Similar, limited benefits as are specified in federal regulations issued pursuant to the Health Insurance Portability and Accountability Act of 1996, approved August 21, 1996 (Pub. L. No. 104-191; 110 Stat. 1936).

 

(c) The following benefits if offered as independent, non-coordinated benefits:

 

(1) Coverage only for a specified disease or illness; and

 

(2) Hospital indemnity or other fixed indemnity insurance.

 

(d) The following benefits if offered as a separate insurance policy:

 

(1) Medicare supplemental health insurance, as defined under § 1882(g)(1) of the Social Security Act;

 

(2) Coverage supplemental to the coverage provided under chapter 55 of title 10, United States Code; and

 

(3) Similar supplemental coverage provided to coverage under an employer sponsored plan.

 

“Individual health benefit plan” means a health benefit plan issued or delivered to an individual, including:

 

(a) A certificate issued or delivered to an individual in the District that evidences coverage under a policy or contract issued to a trust or association or other similar group of individuals, regardless of the situs of the delivery of the policy or contract, if the individual pays the premium and is not being covered under the policy or contract under either federal or State continuation of benefits provisions; and

 

(b) Short-term limited duration insurance.

 

“Substantially similar coverage” means coverage under any group health benefit plan or employer-sponsored plan that provides health benefits to the employees of the employer.  “Substantially similar coverage” does not mean a policy or contract issued to a trust or association or other similar group of individuals that is an individual health benefit plan.

authority

The Acting Commissioner of the Department of Insurance, Securities and Banking, pursuant to the authority set forth in section 23 of the Health Maintenance Organization Act of 1996, effective April 9, 1997 (D.C. Law 11-235; D.C. Official Code §§ 31-3401, et seq.); section 25 of the Hospital and Medical Services Corporation Regulatory Act of 1996, effective April 9, 1996 (D.C. Law 11-245; D.C. Official Code § 31-3508); and section 28 of Chapter V of the Life Insurance Act of 1934, approved June 19, 1934 (48 Stat. 1166; D.C. Official Code § 31-4712).

source

Notice of Emergency and Proposed Rulemaking published at 57 DCR 12281 (December 24, 2010)[EXPIRED]; as amended by Notice of Final Rulemaking published at 58 DCR 2492, 2494 (March 18, 2011).