District Of Columbia § 31-3311.01 - Ratemaking principles and standards.
Full text of District Of Columbia D.C. Code § 31-3311.01 — Ratemaking principles and standards., with citation guidance and answers to common questions.
§ 31-3311.01. Ratemaking principles and standards.
31-3311.01All insurance premium rates and fees shall be made in accordance with the principles and standards set forth in this section. Uniformity among insurers in matters within the scope of this section shall not be required or prohibited.
Due consideration shall be given to:
Past and prospective loss experience within and, if necessary for actuarial credibility, outside the District;
Conflagration and catastrophe hazards, if any;
Past and prospective expenses, both within and, if necessary for actuarial credibility, outside the District;
Underwriting profits;
Contingencies;
Investment income and reserve for losses as reported by the insurer in the insurer’s financial statements;
Dividends, savings, or unabsorbed premium deposits allowed or returned by insurers to policyholders as reported by the insurer in the insurer’s financial statements; and
All other relevant factors within and, if necessary for actuarial credibility, outside the District.
Rates or fees shall not be excessive, inadequate, or unfairly discriminatory. In determining whether rates are excessive or unfairly discriminatory, the Commissioner may consider:
Historical and projected loss ratios, as described herein;
Any anticipated change in the number of enrollees if the proposed premium rate is approved;
Changes to cover benefits or health benefit plan design; and
Changes in the insurer’s health care cost and quality improvement efforts since the insurer’s last rate filing for the same category of health benefit plan.
The systems of expense provisions included in the rates or fees for use by an insurer or group of insurers may differ from those of other insurers or groups of insurers to reflect the requirements of the operating methods of the insurer or group of insurers with respect to a kind of insurance or with respect to a subdivision or combination of kinds of insurance for which separate expense provisions are applicable.
Except as provided for in subsection (f) of this section, for any rate filing, the carrier shall demonstrate that the product for which the rate is filed has a target medical loss ratio of 70% or greater for individual and small group policies and 75% or greater for large group policies.
The Commissioner, in the Commissioner’s discretion, may approve an exemption to the target medical loss ratio set forth in subsection (e) of this section, upon receipt of justification supporting the requested exemption and after a 30-day period of public notice. Justification for a medical loss ratio of less than 70% for individual and small group policies or less than 75% for large group policies shall be based upon the following factors:
Product design or cost sharing attributes;
Expected enrollment size;
Length of time in the market;
Claims pool credibility; and
Any other relevant matter.
Annotations
Source: official District Of Columbia text · Last verified 2026-08-27
Frequently Asked Questions About District Of Columbia § 31-3311.01
What does D.C. Code § 31-3311.01 cover?
Section 31-3311.01 ("Ratemaking principles and standards.") is part of the D.C. Code, the codified statutory law of District Of Columbia. It sets out the legal rule or procedure described in the text above. Statutes are amended regularly, so always verify against the official source.
How do I cite District Of Columbia § 31-3311.01?
A common citation format is "D.C. Code § 31-3311.01" (District Of Columbia). Legal writing may require the code abbreviation, section number, and year or edition. Match the style required by your court, professor, or publisher.
Is this the official text of District Of Columbia law?
No. This page is for research and education and may not include the most recent amendments. For official current law, check the District Of Columbia official source linked on this page or consult a licensed District Of Columbia attorney.
How does District Of Columbia § 31-3311.01 apply to my situation?
Statutes are interpreted in context, and application depends on your specific facts. Only a licensed attorney in District Of Columbia can advise on how this section applies to you. Contact your state or local bar association for a referral.
Sources & Verification
Not legal advice. Verify against the official source and consult a licensed attorney in District Of Columbia.