District of Columbia insurance law and regulation
The Department of Insurance, Securities and Banking regulates health insurance in Washington D.C. help sections for each type of insurance including a section on financially assisted health plans and Medicaid. The state insurance exchange site lists the insurers but has published little information to help individuals find commercial low cost health plans like mini-med or core coverage, specific illness policies, supplemental accident insurance and limited basic health insurance. The state insurance department can be reached by telephone at (202) 727-8000 or by mail at 1050 First Street, NE, 801, Washington, DC 20002. The state children’s health insurance plan (CHIP) Web site is DC Healthy Families.
News that affects your health insurance and planning
June 8, 2019 – Status of alternative non-ACA health plans: The District of Columbia does not require individuals to maintain adequate health coverage. The state provides no premium or cost-sharing subsidies for individual market coverage, and does not permit insurers to sell non-compliant transitional policies in the individual market. DC limits the sale of short-term coverage more strictly than the federal government with a maximum 3 month initial policy period and a total coverage maximum of 3 months each year. DC merged the individual and small business insurance market exchanges.
March 19, 2019 – Association Health Plans are not gaining traction as some federal administrators had hoped. In August 2018 the Department of Labor introduced a final rule for Association Health Plans that did not preempt state law governing associations and health plans, resulting in dual regulation at both a state and federal level. For now, this is not a viable option for DC residents.
The history of health care planning in District of Columbia (Information is outdated and links may be expired)
12/15/2014 – The American Council of Life Insurers (ACLI), a Washington, D.C.-based trade association, has filed a notice of appeal to a lower court’s decision dismissing ACLI’s original complaint against the District of Columbia. ACLI maintains that action taken by the District of Columbia to cover operating costs for its health insurance exchange violates the Affordable Care Act and is unconstitutional. The District of Columbia Health Exchange Authority has assessed user fees on supplemental insurance products that are prohibited from being sold on the exchange. This includes long-term care insurance, disability income insurance, vision insurance and other supplemental products. If the ACLI is successful, the price of exchange-listed insurance products may be higher and off-exchange insurance products would be lower.
2/11/2014 Professional support for any health care reform issue is available free of charge through an arrangement with OnlineNavigator. All online inquiries are handled personally by Tony Novak, CPA. Online support is available through a number of popular social media channels including Facebook and Google+ as well as e-mail. Telephone support for insurance enrollment is available through Members Insurance Exchange at (800) 609-0683.
7/26/2013 Affordable Smart Term Life Insurance is now available to most District of Columbia residents from age 20 through 60 directly online with no physical exam, agent appointment or telephone verification. Most policies are issued on the same day with coverage amounts of $25,000 up to $350,000. The level premium life insurance is available for terms of 10, 15, 20 and 30 years. Sample rates for $150,000 coverage for a preferred risk male age 30, non-tobacco $30.85 per month; tobacco user $49.55 per month. A preferred risk female age 30 non-tobacco user would be $26.49 per month and a tobacco user would be $40.96 per month. Rates are higher for older applicants and lower health risks as described online. Pricing is based on input you provide about your medical history but, unlike most other life insurers, does not consider family medical history. Coverage is issued by innovative National Life Group, rated “A” by A.M. Best Company for 2013.
2/27/2013 This page was updated to include a link to the insurance plan that will be used to determine specific “essential health benefits” for insurance that qualified for 2014 federal tax purposes. Also, a link to additional covered benefits required by state law. Non-qualified insurance is likely to continue to be available at a lower cost that does not include these benefits nor qualify for federal tax purposes.
12/14/2012 The District of Columbia is one of a minority of states that will run a health insurance exchange for individuals and small businesses that is not managed by the federal government. Consumer advocates who once viewed a state-run exchange as a positive are growing concerned that the state may not be fully committed to implementing all of the funding and features expected to be part of the federal health insurance exchanges that are expected to open in the fall of 2013.
8/22/2012 – The District of Columbia Exchange Board is believed the Board is leaning towards adopting recommendations from the Health Reform Implementation Subcommittee on market structure that would consolidate the individual and small group health insurance market and eliminate all other market coverage choices for individuals and small businesses. Experts presented overwhelming testimony from the position of numerous stakeholders during an August 21 Board meeting of the dangers posed by such a strategy. We do not understand the logic behind the Board’s opinions and fear that the action may be politically driven by special interests and not in the best interests of District of Columbia residents. If passed, we doubt that commercial insurance companies would want to participate in the exchange until the market stabilized – a process that could take years. Meanwhile, DC residents would clearly have a more difficult time finding choices of affordable coverage than they do today.
2/1/2012 The Center for Consumer Information and Insurance Oversight, a division of the Center for Medicare and Medicaid Services (CMS) reported that as of June 30, 2011 Cafefirst and UnitedHealthcare are the state’s largest health insurance providers and as such, earn the right to set the benchmark for the development of the state’s essential benefit plans to debut in 2014 under health reform law.
7/27/2011 Parents are reminded that the children’s’ health insurance open enrollment period ends on Sunday July 31 so applications should be submitted online before that date. See www.uhcenrollment.com for details on the UnitedHealthOne insurance products or www.celticenrollment.com for information on Celtic Insurance individual health insurance plans.
2/12/2011 With dozens of health plans choices available online offering a wide range of pricing and benefits, how do you find the best combination of price and benefits? Celtic Insurance realizes that the choices can be overwhelming; the company offers more than 40 possible health plan designs in many parts of the United States. A new feature called “Help Me Choose” lets users easily and quickly select the benefits they value most and narrows the list down to a few of the best choices. No personal information is required other than zip code and date of birth.
2/7/2011 The state’s pre-existing condition insurance plan (PCIP) monthly premium rates (per person):
PCIP will cover a broad range of health benefits, including primary and specialty care, hospital care, and prescription drugs. All covered benefits are available for you, beginning on your coverage effective date, even if it’s to treat a pre-existing condition – there are no waiting periods. PCIP applicants who are approved to participate in PCIP can choose from three plan options, with different levels of premiums, calendar year deductibles, prescription deductibles and prescription copays. The HSA Option provides an opportunity to open a Health Savings Account, a tax-exempt account where you can deposit funds for eligible medical expenses. Each of the three PCIP plan options provides preventive care (paid at 100%, with no deductible) when you see an in-network doctor and the doctor indicates preventive diagnosis. Included are annual physicals, flu shots, routine mammograms and cancer screenings. For other care, you will pay a deductible before PCIP pays for your health care and prescriptions. After you pay the deductible, you will pay 20% of medical costs in-network. The maximum you will pay out-of-pocket for covered services in a calendar year is $5,950 in-network/$7,000 out-of-network. There is no lifetime maximum or cap on the amount the plan pays for your care. If you apply for PCIP coverage on the government Web site, you will be billed for the premium once your application is approved. You will need to send in your payment in order for your coverage to be effective. Please do not send in the premium before you are billed. Note that your premium may increase if you age into a higher rate tier, or if PCIP adjusts its premiums to any changes in the commercial market.
1/19/2011 Child-only health insurance for children with significant medical problems will be available through an open enrollment period mandated by federal state law during the months of January and July. All children, regardless of medical condition, continue to be eligible for insurance when applying as a dependent on a parent’s policy and healthy children are eligible for child-only insurance at any time. When applying for child-only insurance for more than one child, make a separate application for each child.
12/16/2010 Department of Health Care Finance officials met representatives of 44 other states and numerous employees of the federal Health and Human Services Department in Washington DC this week for a two-day working meeting to discuss the next steps in establish a government-run health insurance exchange under the American Health Benefit Exchange Model Act. Their attendance at this meeting was paid for by a $1 million federal grant awarded by HHS in September to the state for research how to set up an insurance exchange. Two states (Alaska and Minnesota) declined to participate, saying that it was a waste of taxpayer money. Four other states (not identified in press reports) that received federal grants did not send representatives to the meeting. Attendees included representatives of 16 states that are suing the federal government in an attempt to overturn the federal health reform law; specifically the requirement that forces individuals to buy health insurance on the insurance exchange or pay a hefty tax fine.
In its initial federal grant request for the insurance exchange project, the Department of Health Care Finance said that it would: 1) Conduct research and assess the District’s insurance marketplace, identifying coverage gaps, 2) Identify requirements for Exchange implementation, 3) Conduct an analysis of the viability of available models, including cost-benefit analysis, 4) Identify potential Exchange partners, 5) Develop policy, operational, and infrastructure recommendations for implementing the Exchange and requisite modifications to the Medicaid and other related public programs, 6) Establish implementation timelines and work plans, and 7) Develop a final report summarizing information and findings resulting from the completion of grant activities.
The meeting reportedly did not address the role of the commercial health insurance exchanges on the implementation of new competing government systems. The model act does not address inter-state insurance exchange proposals nor insurance sales across state lines. Federal officials admitted that they may not be able to provide further guidance until 2012. Meanwhile, most states are motivated to continue to meet requirements to obtain additional funding promised by the federal government for the establishment of insurance exchange by 2014. Freedom Benefits has previously voiced the opinion that the huge amount of money being spent to set up alternate insurance sales system technologies could be better used providing health benefits to the public. We proposed on the Universal Health Insurance blog that adequate commercial insurance sales systems are already in place that could be modified in a public/private partnership to make health insurance more affordable.
5/14/2010 Diabetes Coverage: A new resource to help find health insurance for diabetics in the District of Columbia is now available at Freedom Benefits.
11/12/2009 A new mandate requires individual and group health plans to provide coverage for orally administered chemotherapy medication in a manner no more restrictive than intravenously administered treatment or injected cancer medications.