District of Columbia Code Division V. Local Business Affairs § 31-3302.02. Special rules for network plans.
Current as of January 01, 2020 | Updated by FindLaw Staff
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(a) A health insurer that offers health insurance coverage in the individual market may:
(1) Limit the individuals who may be enrolled under such coverage to those who live, reside, or work within the service area for such network plan; and
(2) Within the service area of such plan, deny such coverage to such individuals if the health insurer has demonstrated to the Commissioner that:
(A) It will not have the capacity to deliver services adequately to additional individual enrollees because of its obligations to existing group contract holders, enrollees, and enrollees covered under individual contracts; and
(B) It is applying this section uniformly to individuals without regard to any health status-related factor of such individuals and without regard to whether the individuals are eligible individuals.
(b) A health insurer, upon denying health insurance coverage in the District of Columbia in accordance with subsection (a)(2) of this section, may not offer coverage in the individual market within such service area for a period of 180 days after such coverage is denied.
Cite this article: FindLaw.com - District of Columbia Code Division V. Local Business Affairs § 31-3302.02. Special rules for network plans. - last updated January 01, 2020 | https://codes.findlaw.com/dc/division-v-local-business-affairs/dc-code-sect-31-3302-02/
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