District Of Columbia § 31-3822 - Stop-loss policy.
Full text of District Of Columbia D.C. Code § 31-3822 — Stop-loss policy., with citation guidance and answers to common questions.
§ 31-3822. Stop-loss policy.
31-3822An insurer shall not issue or deliver to a small employer, as defined in , a stop-loss insurance policy unless the employer has a fully-insured employee health benefit plan.
Stop-loss insurance is subject to the following:
The policy must be issued to and insure the employer, the trustee, or other sponsor of the plan, or the plan itself, but not the employees, members, or participants;
Payment by the insurer must be made to the employer, trustee, or other sponsor of the plan, or to the plan itself, but not to the employees, members, participants, or health care providers; and
Stop-loss insurance policies issued or renewed after May 2, 2015, shall not contain any of the following provisions:
An individual attachment point for a policy year that is less than $40,000.
An aggregate attachment point for a policy year that is less than the greater of one of the following:
Five thousand dollars times the total number of group members;
One hundred twenty percent of expected claims; or
Forty thousand dollars.
A stop-loss insurer shall not exclude any employee or dependent on the basis of an actual or expected health status-related factor.
Health status-related factors include any of the following: health status; medical condition, including both physical and mental illnesses; claims experience; medical history; receipt of health care; genetic information; disability; evidence of insurability, including conditions arising out of acts of domestic violence of the employee or dependent; or any other health status-related factor as determined by the Commissioner.
A stop-loss insurer shall not cancel or not renew a stop-loss insurance policy except if:
The employer has failed to make the required premium payments;
The employer demonstrates fraud or an intentional misrepresentation of material fact under the terms of the stop-loss insurance policy;
The stop-loss insurer has been determined by the Commissioner to be financially impaired; or
The stop-loss insurer ceases to write, issue, or administer new stop-loss insurance policies in the District; provided, that the following conditions are satisfied:
The insurer provides notice to the Commissioner and employer of its intent to cease writing, issuing, or administering new or existing stop-loss insurance policies in the District at least 180 days before the date the insurer seeks to discontinue the coverage; and
The insurer provides the employer at least 180 days advance written notice of its intent to cancel stop-loss insurance coverage beginning from the date of discontinuation provided to the Commissioner pursuant to subparagraph (A) of this paragraph.
If an insurer elects to cancel or not renew an employer’s stop-loss insurance pursuant to subsection (d)(1) of this section, the insurer shall:
Provide the employer notice no less than 30 days before the date of cancellation or expiration of the policy period;
Accept any premium payment by the employer that would satisfy any outstanding amounts owed to the insurer and cure the deficiency giving rise to the cancellation or non-renewal; and
Continue the policy in full force until the date of cancellation or expiration provided in the notice.
Nothing in this section shall be construed to extinguish, limit, or otherwise impair any existing right in law or equity arising under a stop-loss insurance policy.
On April 1, 2015, and on April 1 annually thereafter, a stop-loss insurer shall report to the Commissioner the number of small employer stop-loss policies it had issued and in effect as of December 31 of the previous year. The information in the report shall include new policies issued and policies reissued or renewed in the previous year for groups that have 1 to 50 employees and 51 to 100 employees.
The provisions of this section shall apply to stop-loss insurance policies issued or renewed after May 2, 2015.
The Commissioner, pursuant to [ et seq.], may issue rules to implement the requirements of this section, including rules providing for:
Additional standards for employee benefit stop-loss insurance policies; and
Required disclosures to policyholders by an insurance carrier providing employee benefit stop-loss insurance.
Annotations
Source: official District Of Columbia text · Last verified 2026-08-27
Frequently Asked Questions About District Of Columbia § 31-3822
What does D.C. Code § 31-3822 cover?
Section 31-3822 ("Stop-loss policy.") 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 § 31-3822?
A common citation format is "D.C. Code § 31-3822" (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 § 31-3822 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.