The health insurance benefit provisions of Chapter 89 of Title 5 of the United States Code are applicable to all employees of the District government first employed before October 1, 1987, except those specifically excluded by law or rule and regulation. Procedures established for administering the health benefits program with the District government shall be consistent with law and civil service rules.
(Mar. 3, 1979, D.C. Law 2-139, § 2101, 25 DCR 5740; Oct. 1, 1987, D.C. Law 7-27, § 2(c), 34 DCR 5079.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.1.
1973 Ed., § 1-351.1.
Legislative History of Laws
For legislative history of D.C. Law 2-139, see Historical and Statutory Notes following § 1-601.01.
For legislative history of D.C. Law 7-27, see Historical and Statutory Notes following § 1-621.02.
Miscellaneous Notes
Feasibility Study for Federal Employees Health Benefits Program: See § 8 of the Health Care Benefits Expansion Act of 1992 (D.C. Law 9-114).
The District shall provide health benefits as set forth in § 1-621.05 to all employees of the District first employed after September 30, 1987, except those specifically excluded by law or by rule.
(Mar. 3, 1979, D.C. Law 2-139, § 2102, as added Oct. 1, 1987, D.C. Law 7- 27, § 2(d), 34 DCR 5079.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.2.
Legislative History of Laws
Law 7-27 was introduced in Council and assigned Bill No. 7-228, which was referred to the Committee on Government Operations. The Bill was adopted on first and second readings on June 16, 1987 and June 30, 1987, respectively. Signed by the Mayor on July 17, 1987, it was assigned Act No. 7-49 and transmitted to both Houses of Congress for its review.
Miscellaneous Notes
Health Care Benefits Expansion: See § 32-701 et seq.
For the purposes of §§ 1-621.04 through 1-621.13, the term:
(1) "Annuitant" means:
(A) An employee first employed by the District after September 30, 1987, who has subsequently retired pursuant to any of the following:
(i) Teachers' Retirement System (§§ 38-2001.01 to 38-2023.16);
(iii) Judges' Retirement System (§§ 11-1561 to 11-1571); or
(iv) Teachers' Insurance and Annuity Association programs; or
(B) An employee first employed by the District after September 30, 1987, who has subsequently separated pursuant to the District Retirement Benefit Program (§§ 1-626.03 to 1-626.14) after any of the following:
(i) Reaching 57 years of age and having completed 25 years of creditable District service in a correctional officer position;
(ii) Reaching 62 years of age and having completed 10 years of District government service in a position other than correctional officer; or
(iii) Becoming entitled to disability benefits under the Social Security Act.
(2) "Carrier" means a voluntary association, corporation, partnership, or other nongovernmental organization that is lawfully engaged in providing, paying for, or reimbursing the cost of health services under group insurance policies or contracts, medical or hospital service agreements, membership or subscription contracts, or similar group arrangements, in consideration of premiums or other periodic charges payable to the organization.
(2A) "Creditable District service" means all service in the employment of the District government that is creditable for purposes of the employee's retirement.
(3) "Dependent child" includes:
(A) An adopted child; and
(B) A stepchild, foster child, or natural child of an employee or annuitant.
(4) "Employee" means an individual first employed by the District after September 30, 1987.
(5) "Health benefit plan" means a group insurance policy or contract, medical or hospital service agreement, membership or subscription contract, or similar group arrangement provided by a carrier for the purpose of providing, paying for, or reimbursing expenses for health services under § 1-621.05.
(6) "Member of family" or "Family member" means:
(A) The spouse of an employee or annuitant;
(B) An unmarried dependent child under 22 years of age;
(C) An unmarried dependent child under 25 years of age who is a full-time student; and
(D) An unmarried child regardless of age who is incapable of self-support because of mental or physical disability that existed before age 22.
(Mar. 3, 1979, D.C. Law 2-139, § 2103, as added Oct. 1, 1987, D.C. Law 7- 27, § 2(d), 34 DCR 5079; Mar. 20, 1998, D.C. Law 12-66, § 2(a), 45 DCR 343; Mar. 3, 2010, D.C. Law 18-111, § 1201(a), 57 DCR 181.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.3.
Effect of Amendments
D.C. Law 18-111 rewrote pars. (1)(B)(i) to (iii); added par. (2A); and, in par. (6), substituted "'Member of family' or 'Family member"' for "'Member of family"'. Prior to amendment, pars. (1)(B)(i) to (iii) read as follows:
"(i) Reaching 57 years of age and having completed 25 years of creditable District service in a law enforcement position;
"(ii) Becoming entitled to retirement benefits under the Social Security Act; or
"(iii) Becoming entitled to disability benefits under the Social Security Act."
Temporary Amendments of Section
For temporary (225 day) amendment of section, see § 2(a) of the Comprehensive Merit Personnel Act Health and Life Insurance Clarification Temporary Amendment Act of 1996 (D.C. Law 11-183, April 9, 1997, law notification 44 DCR 2378).
Emergency Act Amendments
For temporary amendment of section, see § 2(a) of the Comprehensive Merit Personnel Act Health Benefits and Life Insurance Clarification Congressional Review Emergency Amendment Act of 1997 (D.C. Act 12-27, March 11, 1997, 44 DCR 1892), and § 2(a) of the Comprehensive Merit Personnel Act Health and Life Insurance Clarification Legislative Review Emergency Amendment Act of 1997 (D.C. Act 12-213, December 5, 1997, 44 DCR 7615).
For temporary (90 day) amendment of section, see § 1201(a) of Fiscal Year 2010 Budget Support Second Emergency Act of 2009 (D.C. Act 18-207, October 15, 2009, 56 DCR 8234).
For temporary (90 day) amendment of section, see § 1201(a) of Fiscal Year Budget Support Congressional Review Emergency Amendment Act of 2009 (D.C. Act 18-260, January 4, 2010, 57 DCR 345).
Legislative History of Laws
For legislative history of D.C. Law 7-27, see Historical and Statutory Notes following § 1-621.02.
Law 12-66, the "Comprehensive Merit Personnel Act Health and Life Insurance Clarification Amendment Act of 1997," was introduced in Council and assigned Bill No. 12-229, which was referred to the Committee on Government Operations. The Bill was adopted on first and second readings on October 7, 1997, and November 4, 1997, respectively. Signed by the Mayor on November 21, 1997, it was assigned Act No. 12-205 and transmitted to both Houses of Congress for its review. D.C. Law 12-66 became effective on March 20, 1998.
For Law 18-111, see notes following § 1-301.181.
Miscellaneous Notes
Short title: Section 1200 of D.C. Law 18-111 provided that subtitle U of title I of the act may be cited as the "District Retirement Program Post-Employment Health and Life Insurance Benefits Amendment Act of 2009".
The Mayor may contract with qualified carriers to provide health benefits under the laws of the District for periods of time to be determined by the Mayor. Any contract under this section shall be in accordance with the provisions of Chapter 3 of title 2.
(Mar. 3, 1979, D.C. Law 2-139, § 2104, as added Oct. 1, 1987, D.C. Law 7- 27, § 2(d), 34 DCR 5079.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.4.
Legislative History of Laws
For legislative history of D.C. Law 7-27, see Historical and Statutory Notes following § 1-621.02.
The District may contract for or approve the following health benefit plans:
(1) An Indemnity Benefit Plan: One District-wide plan offering at least 3 levels of benefits (one of which shall be deemed by the Mayor to be a standard option) under which a carrier agrees to pay certain sums of money, not in excess of the actual expenses incurred, for health benefits.
(2) Health Maintenance Organization Plans including:
(A) One or more group prepayment plans that offer health benefits, in whole or in substantial part on a prepaid basis, with professional services provided by physicians representing at least 3 major medical specialties practicing as a group in a common center or centers who receive all or a substantial part of their professional income from the prepaid funds; and
(B) An individual practice prepayment plan that offers health benefits in whole or substantial part on a prepaid basis, with professional services provided by individual physicians who agree, under rules promulgated by the Mayor, to accept the payments provided by the plan as full payment for covered services that include in-hospital services, general care provided in their offices and in the patients' homes, out-of-hospital diagnostic procedures, and preventive care.
(3) Preferred Provider Organization Plan: An individual practice plan that offers health benefits in whole or substantial part with professional services provided by individual physicians, hospitals, and other health care providers who agree under rules promulgated by the Mayor to accept contractually reduced payments for the covered services they provide.
(4) Combined Benefit Plan: A plan that includes elements of more than 1 of the plans described in paragraphs (1), (2), and (3) of this section.
(5) Other Health Benefit Plans: Nothing in this section shall preclude the Mayor from contracting for or approving a type of health benefit plan not specifically listed in this section.
(Mar. 3, 1979, D.C. Law 2-139, § 2105, as added Oct. 1, 1987, D.C. Law 7- 27, § 2(d), 34 DCR 5079; Mar. 2, 1991, D.C. Law 8-190, § 2(b), 37 DCR 6721.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.5.
Legislative History of Laws
For legislative history of D.C. Law 7-27, see Historical and Statutory Notes following § 1-621.02.
For legislative history of D.C. Law 8-190, see Historical and Statutory Notes following § 1-621.14.
Miscellaneous Notes
Mayor authorized to enter agreements to modify health benefits contracts: See Historical and Statutory Notes following § 1-611.03.
(a) The benefits provided under the health benefit plans shall include benefits for costs associated with care in a general hospital and for health services of a catastrophic nature and may include at a minimum the following benefits:
(1) Hospital benefits;
(2) Managed care;
(3) Office visits;
(4) Substance abuse;
(5) Well baby care;
(6) Prescription drugs;
(7) Obstetrical benefits;
(8) Mental health benefits; and
(9) Hospice care.
(b) Each contract issued under § 1-621.05 shall comply with the provisions of Chapter 31 of Title 31.
(Mar. 3, 1979, D.C. Law 2-139, § 2106, as added Oct. 1, 1987, D.C. Law 7- 27, § 2(d), 34 DCR 5079.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.6.
Legislative History of Laws
For legislative history of D.C. Law 7-27, see Historical and Statutory Notes following § 1-621.02.
(a) Unless an employee or annuitant affirmatively waives health insurance coverage, each employee or annuitant shall enroll in 1 of the approved health benefit plans under § 1-621.05 either as an individual or for self and family or provide evidence satisfactory to the Mayor that the employee or annuitant is covered under another health benefit plan.
(b) If an employee or annuitant has a spouse or domestic partner who is an employee or annuitant, either spouse or domestic partner but not both may enroll for self and family, or each spouse or domestic partner may enroll as an individual. An individual shall not be enrolled as an employee or annuitant and also as a member of a family.
(c) An employee or an annuitant enrolled in a health benefit plan may change coverage by an application filed within 60 days of a change in family status or as otherwise permitted by rule promulgated by the Mayor.
(d) An employee or annuitant may transfer enrollment from one health benefit plan to another health benefit plan under § 1-621.05 as permitted by rules promulgated by the Mayor.
(Mar. 3, 1979, D.C. Law 2-139, § 2107, as added Oct. 1, 1987, D.C. Law 7- 27, § 2(d), 34 DCR 5079; Sept. 12, 2008, D.C. Law 17-231, § 3(e), 55 DCR 6758.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.7.
Effect of Amendments
D.C. Law 17-231, in subsec. (b), substituted "spouse or domestic partner" for "spouse".
Legislative History of Laws
For legislative history of D.C. Law 7-27, see Historical and Statutory Notes following § 1-621.02.
For Law 17-231, see notes following § 1-301.45.
(a) During each pay period in which an employee or an annuitant is enrolled under 1 of the health benefit plans there shall be withheld from the compensation of each employee and from the annuity of each annuitant or there shall be paid by each annuitant who received his or her benefits as a lump sum payment an amount equal to the cost of the selected health benefit plan less the amount of the District contribution for the employee or the annuitant. The amount withheld or paid by the employee or the annuitant, together with the District's contribution, shall be transferred to the carrier of the health benefit plan selected by the employee or the annuitant.
(b) During each pay period in which an individual receiving disability compensation benefits pursuant to subchapter XXIII of this chapter is enrolled under 1 of the health benefit plans, there shall be withheld from those benefits an amount equal to the cost of the selected health benefit plan less the amount of the District contribution for the enrolled individual. The amount withheld from the employee or the annuitant, together with the District's contribution, shall be transferred to the carrier of the health benefit plan selected by the individual receiving disability benefits.
(Mar. 3, 1979, D.C. Laws 2-139, § 2108, as added Oct. 1, 1987, D.C. Law 7-27, § 2(d), 34 DCR 5079.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.8.
Legislative History of Laws
For legislative history of D.C. Law 7-27, see Historical and Statutory Notes following § 1-621.02.
(a) The District's contribution to the cost of any health benefit plan shall be an amount equal to 75% of the subscription charge of the standard option indemnity plan, except that in no event shall the District's contribution exceed 75% of the total subscription charge of any plan or option in which the employee is enrolled. The District's contribution shall be paid on a regular pay period basis.
(b) The Mayor shall determine the amount of the District contribution for individual and for self and family enrollments before the beginning date of each contract period.
(c) There is established the Annuitants' Health and Life Insurance Employer Contribution Trust Fund ("Fund") from which the District's contribution for health and life insurance for annuitants shall be paid. The monies in the Fund shall not be a part of, or lapse into, the General Fund of the District or any other fund of the District.
(d) Every fiscal year, the Chief Financial Officer shall deposit into the Fund the amount that has been appropriated for the purpose of funding the District contribution for the health and life insurance premiums of annuitants. The Chief Financial Officer may also deposit into the Fund any balances in rate stabilization fund reserves that are refunded to the District by a health insurance carrier.
(e) Notwithstanding the other provisions of this chapter, the Mayor may issue rules to establish vesting requirements for the provision of other post-employment benefits to annuitants. Any proposed rules promulgated by the Mayor shall be submitted to the Council for a 60-day period of review, excluding Saturdays, Sundays, legal holidays, and days of Council recess. If the Council does not approve or disapprove the proposed rules within the 60-day period, by resolution, the proposed rules shall be deemed disapproved.
(f) In the case of an annuitant who has separated pursuant to the District Retirement Benefit Program, no contribution shall be made by the District until the annuitant attains 62 years of age. The annuitant shall pay 100% of the cost of any health benefit plan selected by the annuitant until the annuitant attains age 62. Upon attaining 62 years of age, the District shall pay a portion of the cost of any health benefit plan selected by the annuitant in accordance with subsections (h)(1) or (2) of this section.
(g) In the case of an annuitant described in subsection (g) of this section who retired pursuant to the Teachers' Retirement System, or the Judges' Retirement System or the Teachers' Insurance and Annuity Association programs, the District shall pay the portion of the cost of any health benefit plan selected by the annuitant in accordance with subsection (h) of this section.
(h) The District contribution to post-employment health benefits for an annuitant described in subsection (g) of this section (and following the annuitant's death, the annuitant's eligible family members) shall be determined as follows:
(1) For annuitants who retire with at least 10 years of creditable District service, but less than 30 years of creditable District service, the District contribution to the cost of a health benefit plan selected by the annuitant shall be an amount equal to 25% of the cost of the selected health benefit plan (as secondary to Medicare) and 20% for the covered family member of the annuitant, plus an additional 2.5% for each year of creditable District service over 10 years; provided, that the District contribution shall not exceed 75% of the cost of the selected health benefits plan and 60% for the covered family member of the annuitant. The annuitant and family member shall contribute the applicable balance of the cost of the selected health benefit plan.
(2) For annuitants with 30 or more years of creditable District service, the District contribution shall be an amount equal to 75% of the cost of the selected health benefit plan and the annuitant shall contribute 25% of the cost of the selected health benefit plan. For a covered family member of an annuitant, the District contribution shall be an amount equal to 60% of the cost of the selected health benefit plan and the covered family member shall contribute 40% of the cost of the selected health benefit plan.
(3) For annuitants who are injured or killed in the line of duty, the District's contribution shall be an amount equal to 75% of the cost of the selected health benefit plan and the annuitant shall contribute 25% of the cost of the selected health benefit plan. For a covered family member of an annuitant, the District contribution shall be an amount equal to 75% of the cost of the selected health benefit plan and the family member shall contribute 25% of the cost of the selected health benefit plan. This paragraph shall apply as of October 1, 2009.
(i) In the case of an annuitant who retired pursuant to the Police and Fire Retirement System, the District shall pay the portion of the cost of any health benefit plan selected by the annuitant in accordance with subsection (j) of this section.
(j) The District contribution to post-employment health benefits for an annuitant (and following the annuitant's death, the annuitant's eligible family members) shall be determined as follows:
(1) For annuitants hired before November 10, 1996, who retire with at least 5 years of creditable District service, the District contribution shall be an amount equal to 75% of the cost of the selected health benefit plan and the annuitant shall contribute 25% of the cost of the selected health benefit plan. For a covered family member of an annuitant, the District contribution shall be an amount equal to 60% of the cost of the selected health benefit plan and the covered family member shall contribute 40% of the cost of the selected health benefit plan.
(2) For annuitants hired on or after November 10, 1996, with at least 10 years of creditable District service, but less than 25 years of creditable District service, the District contribution to the cost of a health benefit plan selected by the annuitant shall be an amount equal to 30% of the cost of the selected health benefit plan (as secondary to Medicare) for the annuitant, plus an additional 3% for each year of creditable District service over 10 years, and 25% for the covered family member of the annuitant, plus an additional 3% for each year of creditable District service over 10 years; provided, that the District contribution shall not exceed 75% of the cost of the selected health benefits plan for the annuitant and 60% of the cost of the selected health benefits plan for the covered family member of the annuitant. The annuitant and family member shall contribute the applicable balance of the cost of the selected health benefit plan.
(k) In the case of an individual who would otherwise be subject to the Police and Fire Retirement System upon retirement but who is killed in the line of duty and in the case of an individual who retires under the Police and Fire Retirement System due to an injury that occurred in the line of duty, the District shall pay the portion of the cost of any health benefit plan selected by the individual or the individual family member in accordance with subsection (1) of this section.
(l) For an individual covered by subsection (k) of this section, the District's contribution to the cost of the selected health benefits plan of the individual shall be an amount equal to 75% of the cost of the selected health benefit plan and the individual shall contribute 25% of the cost of the selected health benefit plan. For a covered family member of the individual, the District contribution to the cost of the selected health benefit plan of the family member shall be an amount equal to 75% of the cost of the selected health benefit plan and the family member shall contribute 25% of the cost of the selected health benefit plan.
(m) An individual described in subsection (k) of this section shall be considered an annuitant for the purposes of this section.
(Mar. 3, 1979, D.C. Law 2-139, § 2109, as added Oct. 1, 1987, D.C. Law 7- 27, § 2(d), 34 DCR 5079; Mar. 2, 1991, D.C. Law 8-190, § 2(c), 37 DCR 6721; Mar. 7, 2000, D.C. Law 13-54, § 2(a), 46 DCR 9915; Aug. 16, 2008, D.C. Law 17-219, § 7008, 55 DCR 7598; Mar. 3, 2010, D.C. Law 18-111, § 1201(b), 57 DCR 181; D.C. Law 18-223, § 1092(a), Sept. 24, 2010, 57 DCR 6242; Apr. 8, 2011, D.C. Law 18-370, § 102, 58 DCR 1008; Sept. 14, 2011, D.C. Law 19-21, § 1052, 58 DCR 6226; Sept. 20, 2012, D.C. Law 19-168, § 1012, 59 DCR 8025.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.9.
Effect of Amendments
D.C. Law 13-54 added subsecs. (c) and (d).
D.C. Law 17-219 added subsec. (e).
D.C. Law 18-111 rewrote subsec. (d); and added subsecs. (f) to (h). Prior to amendment, subsec. (d) read as follows:
"(d) The Mayor shall deposit into the Fund the $750,000, that was appropriated in fiscal years 1997, 1998, and 1999 for the purpose of funding the District's contribution for the health and life insurance premiums of annuitants. The Mayor may also deposit into the Fund any balances in the rate stabilization fund reserves that are refunded to the District by a health insurance carrier."
D.C. Law 18-223, in subsec. (g), substituted "or" for "the Police and Fire Retirement System,"; in subsec. (h), substituted "for an annuitant described in subsection (g) of this section" for "an annuitant" in the lead-in text and rewrote par. (3); and added subsecs. (i) to (m). Prior to amendment, subsec. (h)(3) read as follows:
"(3) For annuitants who are injured or killed in the line of duty, the District's contribution shall be an amount equal to 72% of the cost of the selected health benefit plan and the annuitant shall contribute 28% of the cost of the selected health benefit plan. For a covered family member of an annuitant, the District contribution shall be an amount equal to 60% of the cost of the selected health benefit plan and the family member shall contribute 40% of the cost of the selected health benefit plan."
D.C. Law 18-370, in subsecs. (a), (h)(2), (h)(3), (j)(1), and (l), substituted "an amount equal to 72%" for "an amount equal to 75%"; in subsecs. (a) and (h)(1), substituted "exceed 72%" for "exceed 75%"; in subsecs. (h)(2), (h)(3), (j)(1), and (l), substituted "contribute 28%" for "contribute 25%"; and, in subsec. (j)(2), substituted "shall not exceed 75%" for "shall not exceed 72%".
D.C. Law 19-21 rewrote subsecs. (h)(3) and (l), which formerly read:
"(3) For annuitants who are injured or killed in the line of duty, the District's contribution shall be an amount equal to 72% of the cost of the selected health benefit plan and the annuitant shall contribute 28% of the cost of the selected health benefit plan. For a covered family member of an annuitant, the District contribution shall be an amount equal to 72% of the cost of the selected health benefit plan and the family member shall contribute 28% of the cost of the selected health benefit plan. This paragraph shall apply as of October 1, 2009."
"(l) For an individual covered by subsection (k) of this section, the District's contribution to the cost of the selected health benefits plan of the individual shall be an amount equal to 72% of the cost of the selected health benefit plan and the individual shall contribute 28% of the cost of the selected health benefit plan. For a covered family member of the individual, the District contribution to the cost of the selected health benefits plan of the family member shall be an amount equal to 72% of the cost of the selected health benefit plan and the family member shall contribute 28% of the cost of the selected health benefit plan."
D.C. Law 19-168, in subsecs. (a), (h)(2), (h)(3), (j)(1) and (l), substituted "an amount equal to 72%" for "an amount equal to 75%"; in subsecs. (a) and (h)(1), substituted "exceed 75%" for "exceed 72%"; in subsecs. (h)(2), (h)(3), (j)(1) and (l), substituted "contribute 25%" for " contribute 28%"; and, in subsec. (j)(2), substituted "shall not exceed 75%" for "shall not exceed 72%".
Temporary Amendments of Section
For temporary (225 day) amendment of section, see § 2(a) of the Annuitants' Health and Life Insurance Employer Contribution Temporary Amendment Act of 1999 (D.C. Law 12-278, April 27, 1999, law notification 46 DCR 4284).
Section 2 of D.C. Law 18-100, in section 1201(b)(2) of D.C. Act 18-207, substituted "(3) For annuitants who are injured or killed in the line of duty, the District's contribution shall be an amount equal to 75% of the cost of the selected health benefit plan and the annuitant shall contribute 25% of the cost of the selected health benefit plan. For a covered family member of an annuitant, the District contribution shall be an amount equal to 75% of the cost of the selected health benefit plan and the family member shall contribute 25% of the cost of the selected health benefit plan. This paragraph shall apply as of October 1, 2009." for "(3) For annuitants who are injured or killed in the line of duty, the District's contribution shall be an amount equal to 75% of the cost of the selected health benefit plan and the annuitant shall contribute 25% of the cost of the selected health benefit plan. For a covered family member of an annuitant, the District contribution shall be an amount equal to 60% of the cost of the selected health benefit plan and the family member shall contribute 40% of the cost of the selected health benefit plan."
Section 3 of D.C. Law 18-100, in section 1201(b)(2) of D.C. Law 18-111, substituted "(3) For annuitants who are injured or killed in the line of duty, the District's contribution shall be an amount equal to 75% of the cost of the selected health benefit plan and the annuitant shall contribute 25% of the cost of the selected health benefit plan. For a covered family member of an annuitant, the District contribution shall be an amount equal to 75% of the cost of the selected health benefit plan and the family member shall contribute 25% of the cost of the selected health benefit plan. This paragraph shall apply as of October 1, 2009." for "(3) For annuitants who are injured or killed in the line of duty, the District's contribution shall be an amount equal to 75% of the cost of the selected health benefit plan and the annuitant shall contribute 25% of the cost of the selected health benefit plan. For a covered family member of an annuitant, the District contribution shall be an amount equal to 60% of the cost of the selected health benefit plan and the family member shall contribute 40% of the cost of the selected health benefit plan.".
Section 5(b) of D.C. Law 18-100 provides that the act shall expire after 225 days of its having taken effect.
Emergency Act Amendments
For temporary amendment of section, see § 2(a) of the Annuitants' Health and Life Insurance Employer Contribution Emergency Amendment Act of 1998 (D.C. Act 12-617, January 22, 1999, 46 DCR 1335).
For temporary (90-day) amendment of section, see § 2(a) of the Annuitants' Health and Life Insurance Employer Contribution Congressional Review Emergency Amendment Act of 1999 (D.C. Act 13-199, December 1, 1999, 46 DCR 10446).
For temporary (90-day) amendment of section, see § 2(a) of the Annuitants' Health and Life Insurance Employer Contribution Congressional Review Emergency Amendment Act of 2000 (D.C. Act 13-276, March 7, 2000, 47 DCR 2015).
For temporary (90 day) amendment of section, see § 7008 of Fiscal Year 2009 Budget Support Emergency Act of 2008 (D.C. Act 17-468, July 28, 2008, 55 DCR 8746).
For temporary (90 day) amendment of section, see § 1201(b) of Fiscal Year 2010 Budget Support Second Emergency Act of 2009 (D.C. Act 18-207, October 15, 2009, 56 DCR 8234).
For temporary (90 day) amendment of section, see §§ 2 and 3 of Police and Firefighter Post-Retirement Health Benefits Emergency Amendment Act of 2009 (D.C. Act 18-230, November 5, 2009, 56 DCR 8794).
For temporary (90 day) amendment of section, see § 1201(b) of Fiscal Year Budget Support Congressional Review Emergency Amendment Act of 2009 (D.C. Act 18-260, January 4, 2010, 57 DCR 345).
For temporary (90 day) amendment of section, see § 102 of Fiscal Year 2011 Supplemental Budget Support Emergency Act of 2010 (D.C. Act 18-694, January 19, 2011, 58 DCR 662).
For temporary (90 day) amendment of section, see § 1012 of Fiscal Year 2013 Budget Support Emergency Act of 2012 (D.C. Act 19-383, June 19, 2012, 59 DCR 7764).
For temporary (90 day) amendment of section, see § 1012 of Fiscal Year 2013 Budget Support Congressional Review Emergency Act of 2012 (D.C. Act 19-413, July 25, 2012, 59 DCR 9290).
Legislative History of Laws
For legislative history of D.C. Law 7-27, see Historical and Statutory Notes following § 1-621.02.
For legislative history of D.C. Law 8-190, see Historical and Statutory Notes following § 1-621.14.
Law 13-54, the "Annuitants' Health and Life Insurance Employer Contribution Amendment Act of 1999," was introduced in Council and assigned Bill No. 13-286, which was referred to the Committee on Government Operations. The Bill was adopted on first and second readings on July 6, 1999, and September 21, 1999, respectively. Signed by the Mayor on October 1, 1999, it was assigned Act No. 13-149 and transmitted to both Houses of Congress for its review. D.C. Law 13- 54 became effective on March 7, 2000.
For Law 17-219, see notes following § 1-308.29.
For Law 18-111, see notes following § 1-301.181.
For Law 18-223, see notes following § 1-301.78.
For history of Law 18-370, see notes under § 1-301.01.
For history of Law 19-21, see notes under § 1-301.01.
For history of Law 19-168, see notes under § 1-137.01.
Miscellaneous Notes
Mayor authorized to enter agreements to modify health benefits contracts: See Historical and Statutory Notes following § 1-611.03.
Short title: Section 7007 of D.C. Law 17-219 provided that subtitle D of title VII of the act may be cited as the "Other Post-Employment Benefits Eligibility Act of 2008".
Short title: Section 1091 of D.C. Law 18-223 provided that subtitle J of title I of the act may be cited as the "Police and Firefighter Post-Retirement Health Benefits Amendment Act of 2010".
Section 1093 of D.C. Law 18-223 provides:
"Sec. 1093. Applicability.
"(a) Section 1092(a) and (c) shall apply as of October 1, 2011 "
"(b) This subtitle shall apply subject to its inclusion in an approved budget and financial plan."
Short title: Section 101 of D.C. Law 18-370 provided that subtitle A of title I of the act may be cited as "Health Benefit Plan District Contribution Amendment Act of 2010".
Section 103 of D.C. Law 18-370 provides:
"Sec. 103. Applicability.
"This subtitle shall apply as of January 1, 2011. "
Short title: Section 1051 of D.C. Law 19-21 provided that subtitle E of title I of the act may be cited as "Police and Firefighter Post-Retirement Health Benefits Clarification Amendment Act of 2011".
Short title: Section 1011 of D.C. Law 19-168 provided that subtitle B of title I of the act may be cited as "Health Benefit Plan District Contribution Amendment Act of 2012".
(a) The Mayor shall make available to each employee information as may be necessary to enable the employee to exercise an informed choice among the types of health benefit plans offered.
(b) The Mayor shall make available to each employee and annuitant enrolled in a health benefit plan a written statement or summary of:
(1) The services or benefits, including maximums, limitations, and exclusions, to which the employee, annuitant, or member of the family of the employee or annuitant are entitled;
(2) The procedures for obtaining benefits; and
(3) The principal provisions of the health benefit plan affecting the employee, annuitant, or member of the family of the employee or annuitant.
(Mar. 3, 1979, D.C. Law 2-139, § 2110, as added Oct. 1, 1987, D.C. Law 7- 27, § 2(d), 34 DCR 5079.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.10.
Legislative History of Laws
For legislative history of D.C. Law 7-27, see Historical and Statutory Notes following § 1-621.02.
An employee enrolled in a health benefit plan under § 1-621.02 who is removed or suspended without pay and later reinstated or restored to duty on the ground that the removal or suspension was unwarranted or unjustified may, at the employee's option, enroll as a new employee or have the employee's coverage restored, with appropriate adjustments made in contributions and claims, to the same extent and effect as though the removal or suspension had not taken place.
(Mar. 3, 1979, D.C. Law 2-139, § 2111, as added Oct. 1, 1987, D.C. Law 7- 27, § 2(d), 34 DCR 5079.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.11.
Legislative History of Laws
For legislative history of D.C. Law 7-27, see Historical and Statutory Notes following § 1-621.02.
(a) The Mayor shall make periodic evaluations of the operation and administration of the health benefit plans provided under § 1-621.05.
(b) Each contract entered into under § 1-621.04 shall require the carrier to:
(1) Furnish reasonable reports as the Mayor determines necessary to enable the District to carry out its functions under this subchapter; and
(2) Permit the Mayor to examine records of the carriers as may be necessary to carry out the purposes of this subchapter.
(Mar. 3, 1979, D.C. Law 2-139, § 2112, as added Oct. 1, 1987, D.C. Law 7- 27, § 2(d), 34 DCR 5079.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.12.
Legislative History of Laws
For legislative history of D.C. Law 7-27, see Historical and Statutory Notes following § 1-621.02.
(a) In order to ensure proper implementation of the health benefit plans under § 1-621.05 by October 1, 1987, the Mayor may issue temporary rules regarding the health benefit plans that shall not be subject to Council review. These temporary rules shall remain in effect only until the proposed rules have been approved or been deemed approved by the Council in accordance with subsection (b) of this section.
(b) The Mayor shall, pursuant to subchapter I of Chapter 5 of Title 2, issue proposed rules to implement the provisions of this subchapter. The proposed rules shall be submitted to the Council for a 45-day period of review, excluding Saturdays, Sundays, legal holidays, and days of Council recess. If the Council does not approve or disapprove the proposed rules, in whole or in part, by resolution within this 45-day review period, the proposed rules shall be deemed approved.
(c) The proposed rules submitted pursuant to subsection (a) of this section shall prescribe the time, manner, and conditions under which employees and annuitants are eligible for coverage. The proposed rules may exclude employees on the basis of the nature and type of employment or conditions of employment such as short-term appointment, seasonal employment, intermittent or part-time employment, or employment of a similar nature, but shall not exclude an employee or group of employees solely on the basis of the hazardous nature of employment.
(d) The Mayor, pursuant to subchapter I of Chapter 5 of Title 2, may issue rules to implement the provisions of this chapter, including rules related to post-employment health benefits coverage, including structuring coverage so that it is secondary to other coverage (including Medicare).
(Mar. 3, 1979, D.C. Law 2-139, § 2113, as added Oct. 1, 1987, D.C. Law 7- 27, § 2(d), 34 DCR 5079; Mar. 3, 2010, D.C. Law 18-111, § 1201(c), 57 DCR 181; Sept. 24, 2010, D.C. Law 18-223, § 1092(b), 57 DCR 6242.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.13.
Effect of Amendments
D.C. Law 18-111 added subsec. (d).
D.C. Law 18-223 rewrote subsec. (d), which had read as follows:
"(d) The Mayor, pursuant to subchapter I of Chapter 5 of Title 2, may issue proposed rules relating to post-employment health benefits coverage including structuring coverage so that it is secondary to other coverage (including Medicare). The proposed rules shall be submitted to the Council for a 45-day period of review, excluding Saturdays, Sundays, legal holidays, and days of Council recess. If the Council does not approve or disapprove the proposed rules, in whole or in part, by resolution within this 45-day review period, the proposed rules shall be deemed approved."
Emergency Act Amendments
For temporary (90 day) amendment of section, see § 1201(c) of Fiscal Year 2010 Budget Support Second Emergency Act of 2009 (D.C. Act 18-207, October 15, 2009, 56 DCR 8234).
For temporary (90 day) amendment of section, see § 1201(c) of Fiscal Year Budget Support Congressional Review Emergency Amendment Act of 2009 (D.C. Act 18-260, January 4, 2010, 57 DCR 345).
For temporary (90 day) amendment of section, see § 1092(b) of Fiscal Year 2011 Budget Support Emergency Act of 2010 (D.C. Act 18-463, July 2, 2010, 57 DCR 6542).
For temporary (90 day) addition of section, see § 1093(b) of Fiscal Year 2011 Budget Support Emergency Act of 2010 (D.C. Act 18-463, July 2, 2010, 57 DCR 6542).
Legislative History of Laws
For legislative history of D.C. Law 7-27, see Historical and Statutory Notes following § 1-621.02.
For Law 18-111, see notes following § 1-301.181.
For Law 18-223, see notes following § 1-301.78.
Miscellaneous Notes
Short title: Section 1091 of D.C. Law 18-223 provided that subtitle J of title I of the act may be cited as the "Police and Firefighter Post-Retirement Health Benefits Amendment Act of 2010".
Section 1093(b) of D.C. Law 18-223 provides:
"(b) This subtitle shall apply subject to its inclusion in an approved budget and financial plan."
A District government employee who is separated from service, or an employee's dependent who ceases to be a dependent, may be eligible for extended health benefit coverage in accordance with rules issued by the Mayor. The rules shall be as consistent as possible with federal regulations governing extended health benefits for District government employees enrolled in the Federal Employee Health Benefits Plan.
(Mar. 3, 1979, D.C. Law 2-139, § 2114, as added Mar. 2, 1991, D.C. Law 8- 190, § 2(d), 37 DCR 6721.)
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.14.
Legislative History of Laws
Law 8-190 was introduced in Council and assigned Bill No. 8-586, which was referred to the Committee on Government Operations. The Bill was adopted on first and second readings on September 25, 1990, and October 9, 1990, respectively. Signed by the Mayor on October 17, 1990, it was assigned Act No. 8-253 and transmitted to both Houses of Congress for its review.
References in Text
The "Federal Employee Health Benefits Plan", referred to in the second sentence, is treated in 5 U.S.C., Chapter 89.
Miscellaneous Notes
Mayor authorized to enter agreements to modify health benefits contracts: See Historical and Statutory Notes following § 1-611.03.
(Mar. 3, 1979, D.C. Law 2-139, § 2115, as added Mar. 2, 1991, D.C. Law 8- 196, § 2, 37 DCR 6735).
HISTORICAL AND STATUTORY NOTES
Prior Codifications
1981 Ed., § 1-622.15.
Miscellaneous Notes
Expiration of Law 8-196: Section 3(b) of D.C. Law 8-196, as amended by § 2 of D.C. Law 10-133 and § 2 of D.C. Law 10-213, provided that the act shall expire 6 years after its having taken effect.
Pursuant to Law 10-213 this section expired on March 3, 1997.
Upon a request of the District of Columbia Retirement Board, the Mayor, the Chief Financial Officer, the Chairman of the District of Columbia Public Charter School Board, the President of the Board of Education, or their successors, shall furnish to the Retirement Board information with respect to health benefit plans that the Retirement Board considers necessary to enable it to carry out its responsibilities under this chapter.
(Mar. 3, 1979, D.C. Law 2-139, § 2116, as added Apr. 13, 2005, D.C. Law 15-354, § 5(e), 52 DCR 2638.)
HISTORICAL AND STATUTORY NOTES
Legislative History of Laws
For Law 15-354, see notes following § 1-523.01.
(a) An annuitant may be eligible for the post-employment health benefits as set forth in § 1-621.05.
(b) To be eligible for post-employment health benefits, the annuitant must:
(1) Retire with at least:
(A) 10 years of creditable District service if the annuitant retired under the District Retirement Benefit Program, the Teachers' Retirement System, the Judges' Retirement System, or the Teachers' Insurance and Annuity Association programs; or
(B) 10 years of creditable District service if the annuitant retired under the Police and Fire Retirement System and the annuitant was hired on or after November 10, 1996; or
(C) 5 years of creditable District service if the annuitant retired under the Police and Fire Retirement System and the annuitant was hired before November 10, 1996;
(2) Be enrolled in a health benefit plan under § 1-621.05 at the time of retirement;
(3) Have been continuously enrolled in a health benefit plan under § 1- 621.05 for a period of at least 5 years preceding the annuitant's retirement date; and
(4) Remain continuously covered under a health benefit plan under § 1- 621.05.
(b-1) In addition to annuitants eligible under this section for the post-employment health benefits as set forth in § 1-621.05, individuals described in § 1-621.09(k) shall also be eligible for such benefits and those individuals shall be considered annuitants for the purposes of this section.
(c) If an annuitant's coverage in a health benefit plan under § 1-621.05 ends, for any reason, the annuitant shall cease to be eligible for post-employment health benefits and shall not re-enroll, as an annuitant, in a health benefit plan under § 1-621.05.
(d) Upon the death of an annuitant who is enrolled in a health benefit plan under § 1-621.05 with family coverage, the annuitant's surviving spouse and dependent children who are covered under the health benefit plan at the time of death may continue enrollment in a health benefit plan under § 1-621.05.
(Mar. 3, 1979, D.C. Law 2-139, § 2117, as added Mar. 3, 2010, D.C. Law 18-111, § 1201(d), 57 DCR 181; D.C. Law 18-223, § 1092(c), Sept. 24, 2010, 57 DCR 6242.)
HISTORICAL AND STATUTORY NOTES
Effect of Amendments
D.C. Law 18-223 rewrote subsec. (b)(1); and added subsec. (b-1). Prior to amendment, subsec. (b)(1) read as follows:
"(1) Retire with at least 10 years of creditable District service;"
Emergency Act Amendments
For temporary (90 day) addition, see § 1201(d) of Fiscal Year 2010 Budget Support Second Emergency Act of 2009 (D.C. Act 18-207, October 15, 2009, 56 DCR 8234).
For temporary (90 day) addition, see § 1201(d) of Fiscal Year Budget Support Congressional Review Emergency Amendment Act of 2009 (D.C. Act 18-260, January 4, 2010, 57 DCR 345).
Legislative History of Laws
For Law 18-111, see notes following § 1-301.181.
For Law 18-223, see notes following § 1-301.78.
Miscellaneous Notes
Section 1093 of D.C. Law 18-223 provides:
"Sec. 1093. Applicability.
"(a) Section 1092(a) and (c) shall apply as of October 1, 2011 "
"(b) This subtitle shall apply subject to its inclusion in an approved budget and financial plan."
