Code of the District of Columbia

§ 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.