Free District of Columbia Accident & Health practice questions

Answer: B. After 30 days have passed from the date of filing

D.C. Code Sec. 31-4712(a) bars issuing or delivering an accident and sickness policy in the District until the form, its classification of risks and its premium rates are filed with the Commissioner, and then until 30 days after the filing, unless the Commissioner gives written approval sooner. Filing alone does not end the wait. Written approval can shorten the wait but is not required, so an insurer whose filing draws no response may proceed once the 30 days pass. Sixty days is not the period the subsection sets.

Answer: A. 6 months

Under D.C. Code Sec. 31-3605(b)(1), a long-term care policy's preexisting condition definition may be no more restrictive than one reaching a condition for which a health care provider recommended or gave medical advice or treatment within 6 months before the insured's coverage took effect. A 12-month or 24-month look-back would reach more conditions, so it is more restrictive than the statute allows. The statute bars only definitions more restrictive than the 6-month standard, so a 3-month look-back is permitted but is not the outer limit. This rule does not reach a policy issued to an employer or labor organization group described in Sec. 31-3601(4)(A).

Answer: D. The person seeking to contract for insurance benefits

The District's Medicare supplement definitions split the term applicant by policy type. For an individual policy, the applicant is the person seeking to contract for the insurance benefits. The proposed certificate holder is the applicant only for a group Medicare supplement policy, so that choice describes the wrong policy type. The agent who handles the paperwork and the issuer that delivers the policy are not named as the applicant under either branch of the definition.

Answer: C. The Centers for Disease Control of the U.S. Public Health Service

The District's AIDS insurance chapter defines AIDS as acquired immune deficiency syndrome in the sense the Centers for Disease Control of the U.S. Public Health Service gives it. The District of Columbia Commission of Public Health appears in the same definitions section only as a fallback source for the meaning of ARC, and only during a period when the Centers for Disease Control has issued no definition. The AIDS definition carries no such fallback. The definitions section gives neither the Commissioner nor an insurer's medical director any role in defining the term.

Answer: C. Written notice to insurance commissioners of all other states and territories within 30 days

D.C. Code Sec. 31-5409(a)(1) requires the Mayor to send written notice to the insurance commissioners of all other U.S. states and territories within 30 days after taking certain actions against a member insurer: revoking or suspending its license, or issuing a formal order such as one to restrict premium writing, add to surplus, withdraw from the District, reinsure business, or increase capital or surplus. A premium-writing restriction is on that list, so the duty arises when the order issues rather than waiting for an insolvency finding. Reporting to the Association's board is a separate duty in the same section and does not replace notice to the other states, and the subsection sets a 30-day written notice, not a 10-day publication rule.

Answer: A. Give notice of the birth and pay the required premium within 31 days after the birth

D.C. Code Sec. 31-3803 allows a policy that charges a specific premium for a child's coverage to require notification of the birth and payment of that premium within 31 days after the date of birth, as the condition for coverage continuing past that 31-day period. The 15-day and 60-day periods are not the period the provision sets, and the provision measures the deadline from the date of birth, not from the policy anniversary.

Answer: C. They were approved in advance by the Commissioner for use with that applicant

The District's AIDS law does not stop insurers from using their standard procedures on new applicants a licensed physician has diagnosed with AIDS, but only when three conditions are met: the procedures treat other new applicants in the same category of insurance the same way, actuarial evidence justifies them, and they comply with the District's other laws and rules. Advance approval by the Commissioner for the individual applicant is not among the listed conditions.

Answer: C. A health care provider who rendered services covered under a health insurance policy

Coverage reaches the beneficiaries, assignees and payees of covered owners and certificate holders, generally without regard to where they live, and the statute expressly includes health care providers who render services covered under health insurance policies or certificates. A reinsurance contract is excluded from coverage unless assumption certificates were issued and delivered under it. Payments of fees or allowances to any person for servicing or administering a policy are also excluded. A shareholder's stake is ownership of the insurer, not a contractual obligation under a covered policy, and the statute does not name shareholders as payees.

Answer: C. It is prohibited, because the policy may not duplicate what Medicare pays

District law forbids any Medicare supplement policy or certificate in force in the District from carrying benefits that duplicate what Medicare provides. A benefit paying for services Medicare already pays for is that kind of duplication. The prohibition is stated without any exception for disclosure in the outline of coverage or for advance approval, and it reaches certificates as well as policies, so none of those conditions makes the benefit permissible.

Answer: D. A policy issued to another group the Commissioner has approved

D.C. Code Sec. 31-3606(c) relieves a policy issued to a group described in Sec. 31-3601(4)(D) from delivering an outline of coverage when the required information is included in other enrollment material, which must be made available to the Commissioner on request. A (4)(D) group is any group outside the named categories that the Commissioner finds is not contrary to the public's best interest, would produce economies of acquisition or administration, and has benefits reasonable in relation to premiums. Employer and labor groups, professional associations, and association trusts are separate categories under Sec. 31-3601(4)(A) through (C), and Sec. 31-3606(c) does not extend the exception to them.