District of Columbia Health Insurance Policy Requirements

The District of Columbia regulates health insurance through DISB and federal ACA requirements.

Regulatory Structure

DC health coverage is regulated by DISB:

Free Look Period

DC provides a 10-day free look period for individual health insurance:

• Policyholder can return for full premium refund
• Begins when policy is delivered
• Applies to individual health policies

DC Health Link Marketplace

DC operates DC Health Link, a state-based health insurance marketplace:

• State-controlled enrollment platform
• Only place to get premium subsidies in DC
• Open enrollment: November 1 - January 31
• Special enrollment periods for qualifying life events
• Premium tax credits available based on income
• Plans categorized by metal tiers (Bronze, Silver, Gold, Platinum)

DC Health Link Features

• All congressmembers and staff use DC Health Link
• Small business health options (SHOP) available
• Easy online enrollment

ACA Compliance in DC

DC's health insurance market operates under federal Affordable Care Act (ACA) requirements:

Essential Health Benefits

All individual and small group plans must cover:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorders
6. Prescription drugs
7. Rehabilitative services
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services (including dental and vision)

Pre-Existing Condition Protections

For ACA-compliant plans:

DC Medicaid Expansion

DC expanded Medicaid:

• Available to adults with income up to 210% FPL
• Higher income limit than most states
• Covers comprehensive health services

Mental Health Parity

DC follows federal mental health parity requirements:

• Mental health benefits must be equal to medical benefits
• Same copays, deductibles, and limits
• Covers mental illness and substance use disorders