Updated notice regarding coverage requirement and issuer accommodation notification
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This Bulletin updates procedures and provides forms for health insurers and employers in the District of Columbia to implement employer religious-exemption self-certification and issuer accommodation notification requirements under the Defending Access to Women's Health Care Services Amendment Act and related D.C. statutes.
The Bulletin and forms were updated to reflect that issuers must provide accommodations for a broadened set of services following the 2023 Expanding Access to Fertility Treatment Amendment Act.
The Department published Employer Notice of Request for Accommodation and Self-Certification and Issuer Accommodation Notification forms and quarterly reporting schedule.
Coverage Criteria and Scope
Employers may claim an exemption under D.C. Official Code § 31-3834.04(a) by submitting the Employer Notice of Request for Accommodation and Self-Certification Form to their group health insurance issuer. The employer’s notice must indicate it meets the criteria in §§ 31-3834.04(c)(1) or (2) and that it has a religious objection to providing coverage of one or more services required under §§ 31-3834.01, 31-3834.02, 31-3834.03, 31-3834.03a, 31-3834.06, or 31-3834.07. Once an issuer certifies that the employer meets the statutory requirements, the issuer shall provide the employer an accommodation pursuant to § 31-3834.04(c).
The Issuer Accommodation Notification Form and related templates include repeated fields labeled “exempted services” and multiple placeholder entries for listing specific services or subsets of services exempted by an employer. These placeholders indicate the issuer must record, for each accommodated employer, the particular services from the statutes that the employer has objected to and for which the employer received an accommodation. The form text in the template does not itself add clinical limitations; it functions as a reporting and tracking mechanism to identify which specific required services are subject to each accommodation.
Issuer and Employer Actions, Notifications, and Timelines
Make coverage & cost‑sharing information readily accessible; 14‑day response
Insurers must make readily accessible full and accurate information about coverage and cost‑sharing for required services (including contraceptive services, voluntary sterilization, fertility‑enhancing drugs and infertility diagnosis and treatment, abortion and abortion‑care services). This information must be available on a public website via a clearly identifiable link, provided by email or letter within 14 days after an enrollee request, or included in written benefits materials provided to enrollees and potential enrollees.
- Include explanation of insured's financial responsibility: premiums, coinsurance, copayments, deductibles, and any other charges.
- Website version must be viewable without requiring account login.
- Respond by email or letter within 14 days of an enrollee request.
Send completed notifications by email to Insurance.Bureau@dc.gov
Completed Issuer Accommodation Notification quarterly notifications and any other required notification documents must be submitted to the Department by email to Insurance.Bureau@dc.gov.
- Use Insurance.Bureau@dc.gov as the required submission channel for quarterly notifications.
- Contact the Insurance Bureau with questions at insurance.bureau@dc.gov or (202) 727-8000.
Complete and provide required forms; report granted accommodations
High‑importance actions for issuers and employers include completing the annual employer self‑certification form, providing employers access to the form, and submitting quarterly issuer notifications when accommodations are granted.
- Make the Employer Notice of Request for Accommodation and Self‑Certification Form available to employers.
- Issuers must complete the Issuer Accommodation Notification matrix each reporting period listing employers granted accommodations.
- Quarterly notifications are required when accommodations were granted in the period.
Form contains repeated exempted‑services placeholders; no step‑therapy rules
The Issuer Accommodation Notification Form template contains repeated placeholder fields for listing 'exempted services' and for specifying a subset of exempted services; the template does not provide clinical step‑therapy rules.
- Template repeatedly uses '(If a subset, list specific exempted services)' placeholders for multiple entries.
- No step‑therapy requirements or clinical sequencing rules are specified in the form template.
Employers: complete self‑certification form annually and submit to issuer
Employers seeking an accommodation must complete the Employer Notice of Request for Accommodation and Self‑Certification Form annually and submit it to the issuer via the insurer's email address or by U.S. mail to the insurer's mailing address.
- Form must be completed annually for any employer seeking accommodation.
- Once completed, submit via email to the insurer's email address or by U.S. mail to the insurer's mailing address.
Complete issuer notification matrix each reporting period for granted accommodations
Issuers shall complete the provided Issuer Accommodation Notification matrix for each reporting period to list employers who were granted accommodations and identify the benefits/services objected to, as applicable.
- Complete the matrix for each reporting period when accommodations were granted.
- List employer, plan/group, eligibility, whether objection is to all or a subset, and comments or details about exempted services as applicable.
Use template to report employers granted accommodations; fill exempted‑services fields
Use the Issuer Accommodation Notification Form template provided in the Bulletin to report accommodations; populate the template's exempted‑services fields as applicable and submit completed notifications via the Department's specified email.
- Populate repeated placeholder fields for exempted services on the template where a subset of services is exempted.
- Submit completed notification forms by email to Insurance.Bureau@dc.gov.
Notify Department quarterly of employers granted accommodations (or omit if none)
Issuers must notify the Department quarterly of employers granted accommodations pursuant to § 31‑3834.04(c); if no accommodations were granted in a quarter, no notification is required for that period.
- Quarterly schedule and due dates: Q1 (Jan–Mar) due Apr 30; Q2 (Apr–Jun) due Jul 31; Q3 (Jul–Sep) due Oct 31; Q4 (Oct–Dec) due Jan 31.
- Failure to submit required quarterly notifications when accommodations were granted may risk noncompliance.
Submit completed notifications to Insurance.Bureau@dc.gov; contact info provided
Completed issuer notifications shall be submitted to the Department of Insurance, Securities and Banking by email at Insurance.Bureau@dc.gov; use this email for all required submissions and questions may be directed to insurance.bureau@dc.gov or by phone at (202) 727‑8000.
- Submit all completed notifications to Insurance.Bureau@dc.gov.
- For questions, contact insurance.bureau@dc.gov or call (202) 727-8000.
Background and Purpose
This Bulletin implements D.C. statutory procedures for employer religious-exemption self-certification and issuer accommodations under the Defending Access to Women’s Health Care Services Amendments and related provisions of the D.C. Code. It requires issuers to make the Employer Notice of Request for Accommodation and Self-Certification Form available to employers and establishes that an employer’s completed self-certification, attesting that it meets §§ 31-3834.04(c)(1) or (2), is the basis for an issuer to determine and provide the statutorily required accommodation under § 31-3834.04(c). The Bulletin reflects the expanded statutory scope of services that may be the subject of an accommodation and provides the forms and process issuers must use to document employer requests and issuer certifications.
Definitions
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