District of Columbia § 31-3272 Coverage, notice, applicability, and regulations.

District of Columbia Statutes

§ 31-3272 — Coverage, notice, applicability, and regulations.

District of Columbia·Title 31 Insurance and Securities.·Ch. 32A Health Insurance Coverage for Habilitative Services for Children.

(a)A health insurer shall:

(1)Provide coverage of habilitative services for children under the age of 21 years and may do so through a managed care system;

(2)Not be required to provide reimbursement for habilitative services actually delivered through early intervention or school services; and

(3)Provide notice to its insureds and enrollees about the coverage required under this chapter.

(b)The coverage shall not be more restrictive than coverage provided for any other illness, condition, or disorder for purposes of determining deductibles, benefit year or lifetime durational limits, benefit year or lifetime dollar limits, lifetime episodes or treatment limits, copayment and coinsuance factors, and benefit year maximum for deductibles and copayments and coinsurance factors.

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(a) A health insurer shall:

(1) Provide coverage of habilitative services for children under the age of 21 years and may do so through a managed care system;

(2) Not be required to provide reimbursement for habilitative services actually delivered through early intervention or school services; and

(3) Provide notice to its insureds and enrollees about the coverage required under this chapter.

(b) The coverage shall not be more restrictive than coverage provided for any other illness, condition, or disorder for purposes of determining deductibles, benefit year or lifetime durational limits, benefit year or lifetime dollar limits, lifetime episodes or treatment limits, copayment and coinsuance factors, and benefit year maximum for deductibles and copayments and coinsurance factors.

(c) The Commissioner may issue rules and regulations necessary to implement the provisions of this chapter.

(d) This chapter shall apply to all individual and group health benefit plans issued or renewed on the first day of the month beginning on or after 90 days following March 2, 2007.

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