District of Columbia Health Insurance

Statistics

Total Population: 540,000
With Health Insurance: 467,000 / 86.5%
Without Health Insurance: 73,000 / 13.5%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: The percentage of District of Columbia residents without health insurance increased only slightly from 13.3% in 2004.

District of Columbia Department of Insurance
Phone: 202-727-8000
State government operation that monitors the solvency of insurance companies, licenses health insurance agents and mediates consumer disputes.

District of Columbia Individual Health Insurance Regulations

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. 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.

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 question 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. 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 (2-20) 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. 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 DC. 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.