Subchapter II. Uniform Consultation Referral Forms.
§ 31–3231. Definitions.
For the purposes of this subchapter, the term:
(1) “Health benefit plan” means any accident and health insurance policy or certificate, hospital and medical services corporation contract, health maintenance organization subscriber contract, plan provided by a multiple employer welfare arrangement, or plan provided by another benefit arrangement. The term “health benefit plan” does not mean accident only, credit, or disability insurance; coverage of Medicare services or federal employee health plans, pursuant to contracts with the United States government; Medicare supplemental or long-term care insurance; dental only or vision only insurance; specified disease insurance; hospital confinement indemnity coverage; limited benefit health coverage; coverage issued as a supplement to liability insurance, insurance arising out of a workers’ compensation or similar law; automobile medical payment insurance; medical expense and loss of income benefits; or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance.
(2) “Health insurer” means any person that provides one or more health benefit plans or insurance in the District of Columbia, including an insurer, a hospital and medical services corporation, a fraternal benefit society, a health maintenance organization, a multiple employer welfare arrangement, or any other person providing a plan of health insurance subject to the authority of the Commissioner.
(3) “Commissioner” means the Commissioner of the Department of Insurance and Securities Regulation.
§ 31–3232. Uniform consultation referral forms.
(a) This subchapter shall apply to all health insurers that issue or deliver individual or group health benefit plans in the District of Columbia.
(b) All health insurers that require the insured to have a written referral to receive consultation services shall use the uniform consultation referral form adopted by the Commissioner as the sole instrument for referrals for consultation services.
(c) The uniform consultation referral form shall be properly completed by the health care provider that refers the insured for consultation services.
§ 31–3233. Regulations.
(a) The Commissioner shall promulgate regulations to implement the provisions of this subchapter. The regulations shall include a uniform consultation referral form for use by health insurers that require enrollees or subscribers to have a written referral to receive consultation services.
(b) The Commissioner may waive the requirements of regulations adopted under subsection (a) of this section for the use of uniform consultation referral forms for an entity that uses the forms solely for internal purposes.
§ 31–3234. Applicability.
This subchapter shall apply to health insurers beginning with referrals issued 120 days after the promulgation of final regulations under § 31-3233.
