Updated Notification Regarding Coverage Requirement and Issuer Accommodation Notification

BULLETIN 26-IB-001-1/6 TO: HEALTH INSURERS OPERATING IN THE DISTRICT OF COLUMBIA FROM: KARIMA WOODS, COMMISSIONER SUBJECT: UPDATED NOTICE REGARDING COVERAGE REQUIREMENT AND ISSUER ACCOMMODATION NOTIFICATION DATE: FEBRUARY 11, 2026 The purpose of this Bulletin is to implement provisions of the Defending Access to Women’s Health Care Services Amendment Act of 2018, effective March 28, 2018 (D.C. Law 22-75, 65 DCR 1374). First, the Bulletin is intended to remind health insurers of their responsibility to provide insureds with an annual notice of their obligation to provide coverage for services, drugs, devices, products, and procedures as required by section 5e(c) of the Women’s Health and Cancer Rights Federal Law Conformity Act of 2000, effective April 3, 2001 (D.C. Law 13-254, as added March 28, 2018 by D.C. Law 22-75; D.C. Official Code § 31-3834.05(c)) (the “2018 Act”). Second, the Bulletin outlines the procedures and provides forms to comply with the employer self-certification of religious exemptions and issuer accommodation notification required by D.C. Official Code § 31-3834.04(b)(2) and (c). This Bulletin constitutes interpretive guidance. In 2023, the Expanding Access to Fertility Treatment Amendment Act (D.C. Law 25-49) amended § 31-3834.04 to expand the scope of coverage obligations for which an employer may request religious accommodation. Under the amended statute, group health insurance issuers must now provide accommodation not only for contraceptive services, but for any services required under §§ 31-3834.01, 31-3834.02, 31-3834.03, 31-3834.03a, 31-3834.06, and 31- 3834.07. Accordingly, the Department is updating this Bulletin and its accompanying forms to reflect the broadened statutory requirements and to ensure that issuers and employers comply with the full scope of accommodation obligations under § 31-3834.04(c). Notice of Rights to Healthcare Coverage To comply with D.C d under §§ 31-3834.01, 31-3834.02, 31-3834.03, 31-3834.03a, 31-3834.06, and 31- 3834.07. Accordingly, the Department is updating this Bulletin and its accompanying forms to reflect the broadened statutory requirements and to ensure that issuers and employers comply with the full scope of accommodation obligations under § 31-3834.04(c). Notice of Rights to Healthcare Coverage To comply with D.C. Official Code § 31-3834.05, the Department hereby gives notice to all health insurers of their obligation to make readily accessible to enrollees and potential enrollees information concerning the coverage of all services, drugs, devices, products, and procedures required under §§ 31-3834.01, 31-3834.02, 31-3834.03, 31-3834.03a, 3834.06, and 31-3834.07. As applicable, an insurer subject to these provisions shall make readily accessible full and accurate 3 information relevant to coverage and cost-sharing for required services, including but not limited to contraceptive services, voluntary sterilization procedures, fertility-enhancing drugs and infertility diagnosis and treatment, abortion and abortion-care services, and additional services described in §§ 31-3834.01, 31-3834.02, 31-3834.03, 31-3834.03a, 3834.06, and 31-3834.07. This information shall include an explanation of an insured’s financial responsibility for premiums, coinsurance, copayments, deductibles, and any other charges. Health insurers shall provide the information described in § 31-3834.01 in the following consumer-friendly formats: 1. A version that can be viewed on the insurer’s public website through a clearly identifiable link or tab without requiring an individual to create or access an account; 2. By email or letter within 14 days after a request by an enrollee; or 3. In written materials that explain benefits or coverage that are provided to enrollees and potential enrollees, including in an addendum summarizing benefits and coverage at can be viewed on the insurer’s public website through a clearly identifiable link or tab without requiring an individual to create or access an account; 2. By email or letter within 14 days after a request by an enrollee; or 3. In written materials that explain benefits or coverage that are provided to enrollees and potential enrollees, including in an addendum summarizing benefits and coverage. Employer Notice of Request for Accommodation and Self-Certification and Issuer Accommodation Notification To comply with D.C. Official Code §§ 31-3834.04(b) and (c), the Department is making available the following forms: (1) Employer Notice of Request for Accommodation and Self-Certification Form; and (2) Issuer Accommodation Notification Form. Employer Notice of Request for Accommodation and Self-Certification Form An employer claiming an exemption under D.C. Official Code § 31-3834.04(a) shall provide a notice of request for accommodation to a group health insurance issuer pursuant to § 31-3834.04(b) indicating that it meets the criterion in §§ 31-3834.04(c)(1) or (2) and 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. A group health insurance issuer that has certified that the employer meets the requirements of §§ 31-3834.04(c)(1) or (2) shall provide the employer an accommodation pursuant to § 31-3834.04(c). Group health insurance issuers shall make available to employers the Employer Notice of Request for Accommodation and Self-Certification Form. Issuer Accommodation Notification Form Group health insurance issuers shall notify the Department on a quarterly basis which employers have been granted accommodations pursuant to D.C. Official Code § 31-3834.04(c). If a group health insurance issuer has not granted any accommodation during a given quarterly period, no notification is required for that period. n and Self-Certification Form. Issuer Accommodation Notification Form Group health insurance issuers shall notify the Department on a quarterly basis which employers have been granted accommodations pursuant to D.C. Official Code § 31-3834.04(c). If a group health insurance issuer has not granted any accommodation during a given quarterly period, no notification is required for that period. 4 Quarterly notifications, when required, shall be submitted via email to Insurance.Bureau@dc.gov. The quarterly notification schedule shall follow the standard calendar quarters: • January 1 – March 31 (Notification due April 30) • April 1 – June 30 (Notification due July 31) • July 1 – September 30 (Notification due October 31) • October 1 – December 31 (Notification due January 31) Employer Notice of Request for Accommodation and Self-Certification Form The form shall be completed annually for any employer seeking accommodation. Once completed, the form should be submitted via email to: (Insurer’s email address) or by U.S. mail to: (Insurer’s mailing address). Date: _____________________ Plan Year: _____________________ Group: _____________________ The following eligible employer has a religious objection to providing coverage of: [ ] All benefits and services required under §§ 31-3834.01, 31-3834.02, 31-3834.03, 31- 3834.03a, 3834.06, and 31-3834.07; OR [ ] A subset of benefits and services required under §§ 31-3834.01, 31-3834.02, 31-3834.03, 31- 3834.03a, 3834.06, and 31-3834.07, specifically: _____________________________________________________________ (1) Name of eligible employer: Contact information: Eligible employer is a: [ ] Closely held for-profit entity; OR [ ] Non-profit entity (religious organization) (2) If the eligible employer objects to providing coverage to a subset of benefits and services, include a list of the benefits and services the eligible organization objects to covering: ______________________________________________ (1) Name of eligible employer: Contact information: Eligible employer is a: [ ] Closely held for-profit entity; OR [ ] Non-profit entity (religious organization) (2) If the eligible employer objects to providing coverage to a subset of benefits and services, include a list of the benefits and services the eligible organization objects to covering: (3) Information being submitted is (check one): [ ] Original information; OR [ ] Updated information. 5 If updated information is being provided, specify the date upon which the updated information was, or will be, effective and what has changed: _______________ Signature of authorized representative of eligible employer Date Typed name of authorized representative of eligible employer Issuer Accommodation Notification Form Notification Period Section 31-3834(b)(2) of the D.C. Official Code mandates that all group health insurance issuers notify the Department on a quarterly basis which employers have been granted an accommodation pursuant to D.C. Official Code § 31-3834.04(c). To comply with this notification requirement, issuers shall complete the following matrix for each notification period. Employer Name Plan Year Group Eligibility Category Objection to All or a Subset of Benefits and Services under §§ 31- 3834.01, 31-3834.02, 31-3834.03, 31- 3834.03a, 3834.06, and 31-3834.07 (If a subset, list specific exempted services) Comments Completed notifications shall be submitted to the Department of Insurance, Securities and Banking by email at Insurance.Bureau@dc.gov. Any questions or concerns regarding this Bulletin may be directed to the Insurance Bureau of the Department of Insurance, Securities and Banking by email at insurance.bureau@dc.gov or by phone at (202) 727-8000.