District of Columbia Healthcare Insurance laws & HR compliance analysis

District of Columbia Healthcare Insurance: What you need to know

There is no District of Columbia law requiring employers to offer group healthcare insurance to their employees, but most employers do provide this benefit. However, if any health insurance is offered, the District of Columbia's insurance laws require policies to cover certain benefits (mandated benefits). There is additional information about continuation and conversion requirements.

Self-Insurance Exception

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States are not allowed to regulate self-insured benefit plans. The District of Columbia's mandated benefits do not apply to health plans in which the employer pays all benefits without the proceeds of any insurance policy. An employer's health plan is self-insured if the risk of paying claims is on the employer and not on an insurance company. Self-insured plans may contract with third-party administrators (TPAs), including insurance companies, to process benefit claims. The TPA pays the claims and then is reimbursed by the employer. Many self-insured plans also buy “stop-loss” insurance to cover very large claims. The purchase of stop-loss insurance does not result in the loss of self-insured status and the exemption from state insurance law regulation.

The Affordable Care Act (ACA) required the establishment of healthcare exchanges to provide individuals and small employers with access to affordable insurance coverage beginning in 2014. States had the flexibility to design and operate exchanges that best met their unique needs while complying with the ACA’s statutory and regulatory standards.

The District of Columbia established its own state-based exchange called DC Health Link: https://www.dchealthlink.com. ...

Related Topics

State Requirements

District of Columbia Healthcare Insurance Resources

Type	Title
Checklists	Health Insurance Cost Containment Checklist
Forms	Model Individual Non-Creditable Coverage Disclosure Notice
Handouts	Affordable Care Act (Handout)
Letters	Responding to Insurers' Sales Calls
Policies	Company Insurance Plans (Strict)
PowerPoints	Affordable Care Act: What You Need to Know

See all Healthcare Insurance Resources