Section 31-5401 - DefinitionsFor the purposes of this chapter, the term:
(1) "Account" means either of the 2 accounts created under § 31-5403.(2) "Association" means the District of Columbia Life and Health Insurance Guaranty Association created under § 31-5403.(2A) "Benefit plan" means a specific employee, union, or association of natural persons benefit plan.(2B) "Board" or "Board of Directors" means the Board of Directors of the Association.(2C) "Commissioner" means the Commissioner of the Department of Insurance, Securities, and Banking.(3) "Contractual obligation" means any obligation under a policy or contract or certificate under a group policy or contract, or portion thereof for which coverage is provided under § 31-5402.(4) "Covered policy" means any policy, contract or group certificate within the scope of § 31-5402.(4A) "Extra-contractual claims" shall include claims relating to bad faith in the payment of claims, punitive or exemplary damages, or attorneys' fees and costs.(4B)(A) "Health benefit plan" means a hospital or medical expense policy or certificate, or health maintenance organization subscriber contract or any other similar health contract.(B) The term "health benefit plan" does not include: (i) Accident only insurance;(iii) Dental only insurance;(iv) Vision only insurance;(v) Medicare supplement insurance;(vi) Benefits for long-term care, home health care, community-based care, or any combination thereof;(vii) Disability income insurance;(viii) Coverage for on-site medical clinics; or(ix) Specified disease, hospital confinement indemnity, or limited benefit health insurance if the types of coverage do not provide coordination of benefits and are provided under separate policies or contracts.(5) "Impaired insurer" means a member insurer which, after July 22, 1992, is not an insolvent insurer, and (A) is deemed by the Mayor to be potentially unable to fulfill its contractual obligations, or (B) is placed under an order of rehabilitation or conservation by a court of competent jurisdiction.(6) "Insolvent insurer" means a member insurer which, after July 22, 1992, is placed under an order of liquidation by a court of competent jurisdiction with a finding of insolvency.(7) "Mayor" means the Mayor of the District of Columbia or the Mayor's designee.(8)(A) "Member insurer" means:(i) An insurer or health maintenance organization licensed or holding a certificate of authority in the District of Columbia to sell any kind of insurance or health maintenance organization business for which coverage is provided under section 3 of the act;(ii) An insurer or health maintenance organization whose license or certificate of authority in the District has been suspended, revoked, not renewed, or voluntarily withdrawn; and(iii) The Group Hospital and Medical Services, Inc.(B) The term "member insurer" does not include: (i) A fraternal benefit society;(ii) A mandatory state pooling plan;(iii) A mutual assessment company or any entity that operates on an assessment basis;(iv) A risk retention group;(v) An insurance exchange;(vi) An organization that has a certificate or license limited to the issuance of charitable gift annuities; or(vii) Any entity similar to any of the above.(9) "Moody's Corporate Bond Yield Average" means the Monthly Average Corporates as published by Moody's Investors Services, Inc., or any successor thereto.(9A) "Owner" of a policy or contract and "policy owner" and "contract owner" mean the person who is identified as the legal owner under the terms of the policy or contract or who is otherwise vested with legal title to the policy or contract through a valid assignment completed in accordance with the terms of the policy or contract and properly recorded as the owner on the books of the insurer, and does not include persons with a mere beneficial interest in a policy or contract.(10) "Person" means any individual, corporation, partnership, association, or voluntary organization.(10A) "Plan sponsor" means: (A) The employer in the case of a benefit plan established or maintained by a single employer;(B) The employee organization in the case of a benefit plan established or maintained by an employee organization; or(C) In the case of a benefit plan established or maintained by 2 or more employers or jointly by one or more employers and one or more employee organizations, the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the benefit plan.(11) "Premiums" means amounts (or consideration by whatever name called) received on covered policies or contracts, or for the portions of policies or contracts, less premiums, considerations, deposits returned, dividends, and experience credits. The term "premiums" shall not include:(A) Any amounts received for policies or contracts for which coverage is not provided under § 31-5402(b), except that assessable premiums shall not be reduced on account of § 31-5402(b)(2)(C) relating to interest limitations, and § 31-5402(c)(2) relating to limitations with respect to any one individual, any one participant, and any one contract holder; or(B) With respect to multiple non-group policies of life insurance owned by one owner, whether the policy owner is an individual, firm, corporation, or other person, and whether the persons insured are officers, managers, employees or other persons, premiums in excess of $ 5,000,000 with respect to these policies or contracts, regardless of the number of policies or contracts held by the owner.(11A)(A) "Principal place of business" means the single state in which the natural persons who establish the policy for the direction, control, and coordination of the operations of the entity as a whole primarily exercise that function, determined by the Association in its reasonable judgment by considering the following factors: (i) The state in which the primary executive and administrative headquarters of the entity is located;(ii) The state in which the principal office of the chief executive officer of the entity is located;(iii) The state in which the entity's board of directors (or similar governing person or persons) conducts the majority of its meetings;(iv) The state in which the executive or management committee of the entity's board of directors (or similar governing person or persons) conducts the majority of its meetings;(v) The state from which the management of the overall operations of the entity is directed; and(vi) In the case of a benefit plan sponsored by affiliated companies comprising a consolidated corporation, the state in which the holding company or controlling affiliate has its principal place of business as determined using the factors set forth in sub-subparagraphs (i) through (v) of this subparagraph; provided, that in the case of a plan sponsor, if more than 50% of the participants in the benefit plan are employed in a single state, that state shall be deemed to be the principal place of business of the plan sponsor.(B) The principal place of business of a plan sponsor of a benefit plan described in paragraph (10A)(C) of this section shall be deemed to be the principal place of business of the association, committee, joint board of trustees, or other similar group of representatives of the parties who establish or maintain the benefit plan that, in lieu of a specific or clear designation of a principal place of business, shall be deemed to be the principal place of business of the employer or employee organization that has the largest investment in the benefit plan in question.(11B) "Receivership court" means the court in the insolvent or impaired insurer's state having jurisdiction over the conservation, rehabilitation, or liquidation of the insurer.(12) "Resident" means any person who resides in the District of Columbia on the date of the entry of a court order determining a member insurer to be an impaired insurer or an insolvent insurer, and to whom the member insurer owes a contractual obligation. A person may reside in only one state, which, in the case of a person other than a natural person, shall be its principal place of business. Citizens of the United States that are either residents of foreign countries, or residents of United States possessions, territories, or protectorates that do not have an association similar to the Association established by this chapter, shall be deemed residents of the state of domicile of the insurer that issued the policies or contracts.(12A) "State" means a state, the District of Columbia, Puerto Rico, or a United States possession, territory, or protectorate.(12B) "Structured settlement annuity" means an annuity purchased in order to fund periodic payments for a plaintiff or other claimant in payment for or with respect to personal injury suffered by the plaintiff or other claimant.(14) "Supplemental contract" means any agreement entered into for the distribution of policy or proceeds.(15) "Unallocated annuity contract" means an annuity contract or group annuity certificate which is not issued to and owned by an individual, except to the extent of any annuity benefits guaranteed to an individual by an insurer under the contract or certificate.Amended by D.C. Law 25-122,§ 2, 70 DCR 016570, eff. 2/15/2024.July 22, 1992, D.C. Law 9-129, § 2, 39 DCR 4036; May 21, 1997, D.C. Law 11-268, § 10(u), 44 DCR 1730; June 11, 2004, D.C. Law 15-166, § 4(gg), 51 DCR 2817; July 23, 2014, D.C. Law 20-130, § 2(a), 61 DCR 5900.