Health Care Benefits: District of Columbia

Federal law and guidance on this subject should be reviewed together with this section.

Authors: Stuart R. Buttrick and Tareen Zafrullah, Faegre Drinker Biddle & Reath LLP

Summary

• The District of Columbia chose to establish a state-based Marketplace under the Affordable Care Act. See Health Insurance Marketplaces Under the ACA.
• The District of Columbia has an individual health insurance mandate. See Individual Health Insurance Mandate.
• Small group employers in the District of Columbia are defined as employers who have between two and 50 employees. See Health Coverage for Small Group Employers.
• Health benefit plans must cover treatment for substance abuse and mental illness. See Mandatory Coverage for Drug Abuse, Alcohol Abuse and Mental Illness.
• Health benefit providers must provide coverage for newborns and if dependent children are covered, they must remain covered until age 26. See Mandatory Maternity and Dependent Coverage.
• District of Columbia law requires health benefit providers to provide coverage for certain types of medical procedures. See Mandatory Coverage for Certain Types of Medical Procedures.
• If a health benefit plan covers mastectomies, it must also cover reconstructive breast surgery. See Mandatory Coverage for Reconstructive Breast Surgery.
• Health benefit plans must cover treatment by optometrists and psychologists. See Mandatory Coverage for Optometrists and Psychologists.
• If a health benefit plan covers prescription drugs, it must also include orally administered anticancer medication and hormone treatment therapy. See Mandatory Coverage for Prescription Drugs and Medical Supplies.
• Health benefit plans must include coverage for diabetes medical supplies. See Mandatory Coverage for Prescription Drugs and Medical Supplies.
• Health benefit providers are prohibited from discriminating based on a broad range of protected classes through administration of a health benefit plan. See Discrimination Under Health Benefit Plans.
• Same-sex marriage is legal nationwide. See Same-Sex Partner Benefits.
• Domestic partners in the District of Columbia are given the same hospital visitation rights as family members. See Domestic Partnerships.
• District of Columbia employees enrolled in the District of Columbia Employees Health Benefits Program can purchase health insurance for their domestic partners. See Domestic Partnerships.