[DC GOVERNMENT] DISB - Health Insurance Claims Payment (Prompt Pay) Report (a)

DISB - Health Insurance Claims Payment (Prompt Pay) Report (a)

Health Insurance Claims Payment (Prompt Pay) Report (a)

In compliance with the “Prompt Pay Act of 2002” (DC Code §31−3135), all health insurers are required to file this report with the Commissioner.

Only insurers that have written and/or hold active health insurance policies in the District of Columbia are required to file this report (this pertains to health insurance as defined in DC Code §31−3301.01). Your company is EXEMPT from filing this report IF:

a) Your company is licensed to write health insurance in the District of Columbia, but has not done so during the prior calendar year; or

b) Your company does not currently hold any ACTIVE health insurance policies in the District of Columbia.

A ZERO report is required for those insurers that have written health policies in the District of Columbia, but have received no claims during the prior calendar year.

The report is due no later than March 15th of each year.

Information

Company Name

NAIC Number

Group Code

State of Domicile

Contact

Phone Number

Table 1

(1) # of Claims Denied in Calendar Year (Same as Col 2, Table 1)

Number of Claims Denied

(2) 30 Days or Less

(3) 31 to 60 Days

(4) 61 to 120 Days

(5) More Than 120 Days

Average # of Days to Deny Claim

Table 3

Major Medical for DC Residents and Dependents Only

Total Group Health Insurance Policies

Number of Covered Lives * (d)

Direct Gross Written Premiums

Earned Premiums

Small Group Health Insurance Policies

Number of Covered Lives

Direct Gross Written Premiums

Earned Premiums

Individual Health Insurance Policies:

Number of Covered Lives

Direct Gross Written Premiums

Earned Premiums

Table 4: Pre-Existing Conditions

Do you cover individuals that have pre−existing conditions with an individual market health benefit plan?

Yes

if Yes, Please explain below

Table 5 New Applicants

Is this company, NAIC# currently accepting new applications for individual market health benefit plans for DC residents?

Yes

If Yes, please provide a brief comment that may be of benefit to prospective D.C. resident policyholders. Please provide information below.

General Comments

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