8999.1 For the purposes of this chapter, the following words, terms, and phrases shall have the following meanings, unless otherwise required by the context of this chapter:
D.C. HealthCare Alliance - the program established pursuant to Section 7 of the Health Care Privatization Amendment Act of 2001, effective July 12, 2001 (D.C. Law 14-18; D.C. Official Code § 7-1405) .
Eligible employer-sponsored plan- With respect to any employee:
(1) Group health insurance coverage offered by, or on behalf of, an employer to the employee that is:(A) A governmental plan (within the meaning of Section 2791(d)(8) of the Public Health Service Act ( 42 USC § 300gg-91(d)(8) );(B) Any other plan or coverage offered in the small or large group market within the District or a State; or(C) A grandfathered health plan offered in a group market; or(2) A self- insured group health plan under which coverage is offered by, or on behalf of, an employer to the employee.Government-sponsored program- any of the following:
(1) The Medicare program under part A of Title XVIII of the Social Security Act ( 42 USC § 1395c and following sections);(2) The Medicaid program under Title XIX of the Social Security Act ( 42 USC § 1396 and following sections);(3) The Children's Health Insurance Program (CHIP) under Title XXI of the Social Security Act ( 42 USC § 1397aa and following sections);(4) Medical coverage under Chapter 55 of Title 10 USC, including coverage under the TRICARE program;(5) The following health care programs under Chapters 17 or 18 of Title 38 USC:(A) The medical benefits package authorized for eligible veterans under 38 U.S.C. §§ 1705 and 1710;(B) The Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) authorized under 38 USC § 1781; and(C) The comprehensive health care program authorized under 38 USC §§ 1803 and 1821 for certain children of Vietnam Veterans and Veterans of covered service in Korea who are suffering from spina bifida.(6) A health plan under Section 2504(e) of Title 22 USC (relating to Peace Corps volunteers); and(7) The Non-appropriated Fund Health Benefits Program of the Department of Defense, established under Section 349 of the National Defense Authorization Act for Fiscal Year 1995, approved October 5, 1994 (108 Stat. 2727; 10 USC § 1587, note).(8) Government-sponsored program" does not mean any of the following: (A) Optional coverage of family planning services under Section 1902(a)(10)(A)(ii)(XXI) of the Social Security Act ( 42 USC § 1396a(a)(10)(A)(ii)(XXI) );(B) Optional coverage of tuberculosis-related services under Section 1902(a)(10)(A)(ii)(XII) of the Social Security Act ( 42 USC § 1396a(a)(10)(A)(ii)(XII) );(C) Coverage of pregnancy-related services under Sections 1902(a)(10)(A)(i)(IV) and (a)(10)(A)(ii)(IX) of the Social Security Act ( 42 USC §§ 1396a(a)(10)(A)(i)(IV), (a)(10)(A)(ii)(IX));(D) Coverage limited to treatment of emergency medical conditions in accordance with 8 USC § 1611(b)(1)(A), as authorized by Section 1903(v) of the Social Security Act ( 42 USC § 1396b(v));(E) Coverage for medically needy individuals under Section 1902(a)(10)(C) of the Social Security Act ( 42 USC § 1396a(a)(10)(C)) and 42 CFR § 435.300 and following sections;(F) Coverage authorized under Section 1115(a) of the Social Security Act ( 42 USC § 1315(a));(G) Coverage under Sections 1079(a), 1086(c)(1), or 1086(d)(1) of Title 10 USC, that is solely limited to space available care in a facility of the uniformed services for individuals excluded from TRICARE coverage for care from private sector providers; or(H) Coverage under Sections 1074a and 1074b of title 10 USC, for an injury, illness, or disease incurred or aggravated in the line of duty for individuals who are not on active duty.(9) Except for the program identified in § 8999.1(c)(7), a government-sponsored program described in this section is not an eligible employer-sponsored plan.Grandfathered health plan- any group health plan or group health insurance coverage to which section 1251 of the Affordable Care Act ( 42 USC § 18011) applies.
Health care sharing ministry - an organization that:
(1) Is described in § 501(c)(3) of the Internal Revenue Code and is exempt from tax under § 501(a) of the Internal Revenue Code;(2) Has (or its predecessor has) been in existence at all times since December 31, 1999;(3) Conducts an annual audit performed by an independent certified public accounting firm in accordance with generally accepted accounting principles and makes the annual audit report available to the public upon request; and (4) Has members that: (A) Share a common set of ethical or religious beliefs and share medical expenses among themselves in accordance with those beliefs and without regard to the District or state in which a member resides or is employed;(B) Retain membership even after they develop a medical condition; and(C) Have shared medical expenses continuously and without interruption since at least December 31, 1999.Immigrant Children's Program- the program established pursuant to Section 2202(b) of the Medical Assistance Expansion Program Act of 1999, effective October 20, 1999 (D.C. Law 13-38; D.C. Official Code § 1-307.03(b) ).
Incarcerated- confined, after the disposition of charges, in a jail, prison, or similar penal institution or correctional facility.
Indian tribe- a group or community described in § 45A(c)(6) of the Internal Revenue Code.
Internal Revenue Code - has the same meaning as under D.C. Official Code § 47-1801.04(28).
Minimum essential coverage- coverage under the following plans or programs:
(1) The following plans or programs:(A) A government-sponsored program;(B) An eligible employer-sponsored plan;(C) A plan in the individual market; or(D) A grandfathered health plan.(2) The following plans or programs, as defined by 45 CFR § 156.602, as that section was in effect on December 15, 2017:(A) Refugee Medical Assistance supported by the Administration for Children and Families;(B) Medicare Advantage Plans, pursuant to Part C of Title XVIII of the Social Security Act; or(C) State high risk pool coverage established on or before November 26, 2014 in the District or any State;(3) Any plan or arrangement under § 8902.1.(4) The Immigrant Children's Program; or(5) Any plan or arrangement recognized by the Mayor by rule as minimum essential coverage.(6) "Minimum essential coverage" does not include:(A) Any coverage that consists solely of excepted benefits described in Section 2791(c)(1), (c)(2), (c)(3), or (c)(4) of the Public Health Service Act ( 42 USC § 300gg-91(c) ).(B) Health coverage provided under multiple employer welfare arrangement if the multiple employer welfare arrangement did not provide coverage in the District on December 15, 2017, or it does not comply with federal law and regulations applicable to multiple employer welfare arrangements that were in place as of December 15, 2017. Month- a calendar month.
Multiple employer welfare arrangement- has the same meaning as provided in Section 3(40) of the Employee Retirement Income Security Act of 1974, approved September 2, 1974 (88 Stat. 833; 29 USC § 1002(40)) .
Plan in the individual market- health insurance coverage offered to individuals in the individual market within the District or a state, other than short-term limited duration insurance within the meaning of Section 2791(b)(5) of the Public Health Service Act ( 42 USC § 300gg-91(b)(5)) . A qualified health plan offered by an Exchange is a plan in the individual market. If a territory of the United States elects to establish an Exchange under Section 1323(a)(1) and (b) of the Affordable Care Act ( 42 USC § 18043(a)(1), (b)) , a qualified health plan offered by that Exchange is a plan in the individual market.
Short coverage gap- a continuous period of less than three (3) months in which the individual is not covered under minimum essential coverage. If the individual does not have minimum essential coverage for a continuous period of three (3) or more months, none of the months included in the continuous period are treated as included in a short coverage gap.