Section 26-D110. HEALTH CARRIER ASSESSMENT GENERAL PROVISIONS

 

110.1Pursuant to Section 4(f) of the Act (D.C. Official Code § 31-3171.03(f)), the Health Benefit Exchange Authority (HBX) shall annually assess each health carrier defined in Section 2(6) of the Act (D.C. Official Code § 31-3171.01(6)).

 

110.2For purposes of this chapter and under D.C. Official Code § 31-3171.01(6), an accident and sickness insurance company includes companies offering certain insurance products, including but not limited to:

 

(a) Major medical; and

 

(b) Excepted benefits as set forth in 45 C.F.R. § 146.145 and 45 C.F.R. § 148.220 unless otherwise specified in Subsection 110.3.

 

110.3For purposes of this chapter and under D.C. Official Code § 31-3171.01(3A), health insurance carrier risks do not include each of the following:

 

(a) Coverage for on-site medical clinics;

 

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

 

(c) Credit-only insurance (including mortgage insurance);

 

(d) Federal Employees Dental and Vision Insurance Program, as set forth at 5 C.F.R. §§ 894.101 et seq.;

 

(e) Federal Employees Health Benefits Program, as set forth at 5 C.F.R §§ 890.101 et seq.;

(f) Fraternal benefit societies, as set forth in Section 1202 of the Fraternal Benefit Societies Act of 1998, effective April 29, 1998 (D.C. Law 12-86; D.C. Official Code § 31-5301);

 

(g) Liability insurance, including general liability and auto liability insurance;

(h) Medicare Part D, as set forth at 42 U.S.C. §§ 1395w-101 et seq.; 

 

(i) Stop-loss insurance; and

 

(j) Workers’ compensation or similar insurance.

 

 

authority

Section 18 of the Health Benefit Exchange Authority Establishment Act of 2011, effective March 2, 2012 (D.C. Law 19-94; D.C. Official Code §§ 31-3171.01 et seq. (2013 Repl. & 2016 Supp.)).

source

Final Rulemaking published at 63 DCR 9668 (July 22, 2016).