Dc Health Insurance (DC)

District of Columbia (DC)
Individual Health Insurance Regulations

Learn more about District of Columbia Individual Health Insurance

Health insurance is necessary to protect your family's health against unfortunate circumstances of sickness or injury. Before opting for health coverage, you need to assess through your family's medical needs and your budget. Being a Washington D.C. resident, you can choose from various health insurance alternatives. The DC Department of Insurance, Securities and Banking supervises the regulations under which the Washington D.C. health insurers can sell private health insurance to individuals and families.

The individual health insurance market in the District of Columbia is unique to other states because they have laws that affect one insurance company differently than all the rest. Carefirst Blue Cross and Blue Shield is the only insurance company in the state is that is required to sell individual health insurance on a "guaranteed issue" basis, meaning they are not able to deny an application, regardless of the health history of that applicant. Not all individual health plans that are offered through Carefirst are available to applicants on a guaranteed issue basis and a pre-existing condition waiting period may be placed on the policy of any applicant that is not HIPAA eligible. CareFirst is not required to credit your prior health coverage toward preexisting condition exclusion periods.

The state has not mandated the period for exlusion of pre-existing conditions and the look back period for the determination of those medical conditions. All other health insurance carriers in the District of Columbia are permitted to medically underwrite your application, unless you are HIPAA eligible, in which case they must offer you one of two plan options in their portfolio. Insurance premiums are not regulated in this state and there is no limit or guidelines as to how much you may be charged by the insurance companies. Premiums are based on your age, gender, health status, health history and residence.

>District of Columbia Small Group Health Insurance Regulations

A small employer in Washington DC is defined as any employer with 2-50 employees. Companies that fall into this classification will be guaranteed issue of coverage for any health plan they apply for in the state. The insurance companies may ask health questions of new small groups wishing to enroll in a health plan. The answers to these questions will be used by the insurance company to determine the premium that will be charged for the group health plan. Groups with a higher percentage of employees with pre-existing medical conditions may be charged a higher rate than heath groups. The state does place maximum increase restrictions on the insurance company for any small group at annual renewal. The health insurers may look back into your 6-month medical history to determine the presence of pre-existing health conditions. For employees that do not have creditable coverage, as defined under federal HIPAA law, the insurance company may place a 12- month exclusionary period on pre-existing medical conditions.

District of Columbia COBRA and Continuation Coverage

Employees of groups with more than 20 employees are entitled to 18 months of COBRA coverage under federal law. Under special circumstances, dependents and permanently disabled persons may remain on COBRA for up to 36 months. Your COBRA option must be accepted within 63 days of the termination date of your group health plan. The District of Columbia has a mini-COBRA law that requires small employers with 2-19 employees to offer COBRA coverage to their departing employees for a period of 3 months, unless they were terminated due to gross misconduct. The ex-employee will be responsible for paying the premium, plus a possible 2% surcharge. If the health insurer raises the premium on your employer's group plan, you will also be subject to those higher rates. For persons that have exhausted their COBRA option, some insurance companies may offer a conversion policy, but these are not mandatory for all types of group health plans in the District of Columbia. Guaranteed issue coverage is also made available through private health insurance companies offering an individual health plan in Washington D.C. For any person that has had 18 months of continuous coverage, most recently under a group health plan, the insurance companies must offer at least two of their health plan choices without medical underwriting.

For those persons who have exhausted their COBRA benefits, guaranteed issue coverage under federal HIPAA regulations is available through Carefirst Blue Cross Blue Shield.

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