{"data":{"id":"us-dc/d.c.-code-31-3311.01","jurisdiction":"us-dc","citation":"D.C. Code § 31-3311.01","heading":"Ratemaking principles and standards.","body":"(a)\nAll 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.\n\n(b)\nDue consideration shall be given to:\n(1)\nPast and prospective loss experience within and, if necessary for actuarial credibility, outside the District;\n(2)\nConflagration and catastrophe hazards, if any;\n(3)\nPast and prospective expenses, both within and, if necessary for actuarial credibility, outside the District;\n(4)\nUnderwriting profits;\n(5)\nContingencies;\n(6)\nInvestment income and reserve for losses as reported by the insurer in the insurer’s financial statements;\n(7)\nDividends, savings, or unabsorbed premium deposits allowed or returned by insurers to policyholders as reported by the insurer in the insurer’s financial statements; and\n(8)\nAll other relevant factors within and, if necessary for actuarial credibility, outside the District.\n\n(c)\nRates or fees shall not be excessive, inadequate, or unfairly discriminatory. In determining whether rates are excessive or unfairly discriminatory, the Commissioner may consider:\n(1)\nHistorical and projected loss ratios, as described herein;\n(2)\nAny anticipated change in the number of enrollees if the proposed premium rate is approved;\n(3)\nChanges to cover benefits or health benefit plan design; and\n(4)\nChanges 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.\n\n(d)\nThe 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.\n\n(e)\nExcept 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.\n\n(f)\nThe 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:\n(1)\nProduct design or cost sharing attributes;\n(2)\nExpected enrollment size;\n(3)\nLength of time in the market;\n(4)\nClaims pool credibility; and\n(5)\nAny other relevant matter.","path":["Title 31. Insurance and Securities.","Chapter 33A. Health Insurance Ratemaking."],"source_url":"https://code.dccouncil.gov/us/dc/council/code/sections/31-3311.01","current_through":"2026-08-20 (D.C. Law 26-175)","vintage":"","retrieved_at":"2026-08-29T05:44:07Z","sha256":"62f5e9b5a4a419025a01338784d1024e6d6b7b00c5dc517bf0c26a9fce8633d5","source_id":"us-dc","stale":false,"prev":"us-dc/d.c.-code-31-3303.14","next":"us-dc/d.c.-code-31-3311.02"},"notice":"GroundRules: Original legal text. Not legal advice."}