ENROLLED ORIGINAL
AN ACT IN THE COUNCIL OF THE DISTRICT OF COLUMBIA
To provide, on an emergency basis, due to Congressional review, for the
continuation of a person’s eligibility for health insurance coverage when
an employer maintains a health benefits plan for less than 20 employees.
BE IT ENACTED BY THE COUNCIL OF THE DISTRICT OF COLUMBIA, That this act
may be cited as the "Continuation of Health Coverage Congressional
Review Emergency Act of 2002".
Sec. 2. Definitions.
For the purposes of this act, the term:
(1) "Commissioner" means the Commissioner of the Department
of Insurance and Securities Regulation.
(2) "Covered individual" means a person whose coverage under
an employer’s health benefits plan is continued under this act.
(3) "Health benefits plan" means any accident and health
insurance policy or certificate, hospital and medical services corporation
contract, health maintenance organization subscriber contract, plan
provided by a multiple employer welfare arrangement, or plan provided by
another benefit arrangement. The term "health benefit plan" does
not mean accident only, credit, or disability insurance; coverage of
Medicare services or federal employee health plans, pursuant to contracts
with the United States government; Medicare supplemental or long-term care
insurance; dental only or vision only insurance; specified disease
insurance; hospital confinement indemnity coverage; limited benefit health
coverage; coverage issued as a supplement to liability insurance,
insurance arising out of a workers’ compensation or similar law;
automobile medical payment insurance; medical expense and loss of income
benefits; or insurance under which benefits are payable with or without
regard to fault and that is statutorily required to be contained in any
liability insurance policy or equivalent self-insurance.
(4) "Health insurer" means any person that provides one or more
health benefit plans or insurance in the District of Columbia, including
an insurer, a hospital and medical services corporation, a fraternal
benefit society, a health maintenance organization, a multiple employer
welfare arrangement, or any other person providing a plan of health
insurance subject to the authority of the Commissioner.
Sec. 3. Continuation of coverage.
(a) An employee has the right to continue coverage under the employer’s
health benefits plan for a period of 3 months, unless the employee:
(1) Was terminated for gross misconduct;
(2) Is eligible for any extension of coverage required under the
Consolidated Omnibus Budget Reconciliation Act of 1985, approved April
7, 1986 (100 Stat. 82; codified in scattered sections of the U.S. Code);
or(3) Fails to complete timely election and payment as provided in
subsection (h) of this section.
(b) An employee’s covered dependents shall have the same right to
continue coverage under the employer’s health benefits plan as described
in subsection (a) of this section if the dependents would otherwise lose
coverage under the health benefits plan.
(c) The right to continue coverage includes any dependent coverage
under the terms of the existing health benefits plan.
(d) Within 15 days after the date of application, the employer shall
forward to the health insurer the names of individuals who apply for an
extension of benefits under this act.
(e) Each health benefits plan issued by a health insurer to an employer
shall contain a provision requiring that the employer furnish employees
whose coverage is terminated a written notification of the existence of
the right to continue coverage under this act. The notification shall be
furnished not later than 15 days after the date that coverage under the
health benefits plan would otherwise terminate. Failure by an employer to
furnish the notification shall not extend the right to continue coverage
beyond the time provided for under this act.
(f) The evidence of coverage or certificate of coverage furnished to
employees by a health insurer shall include a statement advising the
employee of his or her right to continue coverage as provided for under
this act.
(g) The covered individual’s cost for continued coverage shall not
exceed 102% of the group rate.
(h) An individual who elects to continue coverage under this act shall
tender to the employer the amount required to continue coverage no later
than 45 days after the date that coverage would otherwise terminate.
(i) Coverage under this act shall continue without interruption and
shall not terminate unless:
(1) The covered individual establishes residence outside of the
health insurer’s service area;(2) The covered individual fails to make timely payment of the
required cost of coverage;(3) The covered individual violates a material condition of the
contract;(4) The covered individual becomes covered under another group health
benefits plan that does not contain any exclusion or limitation with
respect to any pre-existing condition that affects the covered
individual;(5) The covered individual becomes entitled to Medicare; or
(6) The employer no longer offers group health benefits coverage to
any employee.
(j) If the employer replaces coverage with similar coverage under
another health benefits plan, without interruption, the covered individual
shall have the night to continue coverage under the replacement health
benefits plan for the balance of the covered individual’s continuation of
benefit period; provided, that the covered individual is otherwise
eligible for continuation of coverage.
(k) At the end of the continued benefit period as provided in this act,
the covered individual shall remain eligible for a converted policy if the
benefit is provided in the employer’s health benefits plan.
Sec. 4. Regulations.
The Commissioner may issue rules and regulations necessary to implement
the provisions of this act.
Sec. 5. Applicability.
This act shall apply to contracts issued or renewed by health insurers
on or after January 16, 2002.
Sec. 6. Fiscal impact statement.
The Council adopts the attached fiscal impact statement as the fiscal
impact statement required by section 602(c)(3) of the District of Columbia
Home Rule Act, approved December 24, 1973 (87 Stat. 813; D.C. Official
Code § 1-206.2(c)(3)).
Sec. 7. This act shall take effect following approval by the Mayor (or
in the event of veto by the Mayor, action by the Council to override the
veto), and shall remain in effect for no longer than 90 days, beginning
March 17, 2002, as provided for emergency acts of the Council of the
District of Columbia in section 412(a) of the District of Columbia Home
Rule Act, approved December 24, 1973 (87 Stat. 788; D.C. Official Code §
1-204.12(a)).
Chairman
Council of the District of Columbia
Mayor
District of Columbia