Health Insurance Regulations Flashcards

Under DC's mental health parity law, how must insurers treat mental health and substance use disorder benefits compared to medical/surgical benefits?

Answer: Comparable limits and cost-sharing must apply to both

DC's mental health parity law, consistent with the federal Mental Health Parity and Addiction Equity Act, requires that mental health and substance use disorder benefits be no more restrictive than comparable medical/surgical benefits.

What is the minimum grace period for premium payment required under DC group health insurance regulations before coverage can be terminated for non-payment?

Answer: 31 days

DC requires a minimum 31-day grace period for premium payment on group health insurance policies before termination.

A health insurance policy issued in DC that covers hospital expenses must include which of the following?

Answer: Coverage for emergency room services at in-network cost-sharing rates

DC and federal ACA rules require that emergency services be covered at in-network cost-sharing levels even when obtained out-of-network.

Which act protects patients from unexpected bills from out-of-network providers in certain situations at in-network facilities?

Answer: No Surprises Act

The No Surprises Act (effective 2022) protects patients from surprise billing from out-of-network providers in emergency and some non-emergency situations.

Under the Health Insurance Portability and Accountability Act (HIPAA), what is a 'pre-existing condition exclusion period' for group health plans?

Answer: A maximum 12-month waiting period for conditions treated in the 6 months before enrollment

HIPAA limits pre-existing condition exclusion periods to a maximum of 12 months (18 months for late enrollees) for conditions treated or diagnosed in the 6 months before the enrollment date.

Which entity regulates stop-loss insurance sold to DC self-funded employer health plans?

Answer: DC Department of Insurance, Securities and Banking (DISB)

Stop-loss insurance policies sold in DC are regulated by the DC Department of Insurance, Securities and Banking (DISB).