Standalone dental excluded · Last verified 2026-08-29
D.C. Code §31-3132; §31-3131
District of Columbia's prompt-pay chapter (D.C. Code §31-3132; §31-3131) does not reach standalone dental insurance at all — Standalone dental is expressly excluded. D.C. Code §31-3131(4) removes "dental only or vision only insurance" from the definition of health benefit plan, and the chapter's duties attach only to insurers providing health benefit plans — so a dental-only carrier owes none of the 30-day deadline or tiered interest. Dental benefits embedded in a comprehensive medical plan or HMO contract do get the chapter's protections, because that plan is a health benefits plan. Where the chapter does apply (dental inside a comprehensive medical plan), the deadline is 30 days for clean/complete claims. Self-funded employer (ERISA) dental plans are outside every state prompt-pay statute — federal law preempts state insurance regulation of self-funded plans. Those claims run on the federal ERISA claims-procedure deadlines instead: a post-service benefit determination within 30 days (one 15-day extension), at least 180 days to appeal, and an appeal decision within 60 days (or two 30-day levels), under 29 CFR 2560.503-1.
Health insurers must reimburse within 30 days of receiving a clean claim — a uniform deadline with no electronic/paper split (formats differ only in receipt presumptions: 24 hours for electronic, five business days for mail). Disputed claims require written reasons within 30 days and payment of any undisputed portion on time.
Interest accrues automatically from day 31: 1.5% per month through day 60, 2% per month from day 61 through 120, and 2.5% per month after that (§31-3132(c)) — among the steepest prompt-pay rates in the country. But read the definitions first: the chapter does not reach dental-only insurance at all.
Standalone dental is expressly excluded. D.C. Code §31-3131(4) removes "dental only or vision only insurance" from the definition of health benefit plan, and the chapter's duties attach only to insurers providing health benefit plans — so a dental-only carrier owes none of the 30-day deadline or tiered interest. Dental benefits embedded in a comprehensive medical plan or HMO contract do get the chapter's protections, because that plan is a health benefits plan.
Self-funded (ERISA) plans: Self-funded employer (ERISA) dental plans are outside every state prompt-pay statute — federal law preempts state insurance regulation of self-funded plans. Those claims run on the federal ERISA claims-procedure deadlines instead: a post-service benefit determination within 30 days (one 15-day extension), at least 180 days to appeal, and an appeal decision within 60 days (or two 30-day levels), under 29 CFR 2560.503-1.
Uses the verified District of Columbia rule (D.C. Code §31-3132; §31-3131). Estimate only — the statute's own accrual triggers control.
Estimated interest
$21.25
1.5%/mo then 2%/mo (monthly tiers, prorated by days)
Monthly rates: 1.5%/month days 31–60, 2%/month days 61–120, 2.5%/month after day 120 — automatic, no demand needed. Applies only when the chapter applies (see the dental exclusion).
Formula: claim × monthly tier rate × days in tier ÷ 30, summed across tiers, using simple (not compounded) interest as the statute states it. The rate and deadline come from D.C. Code §31-3132; §31-3131, verified against the statute text linked in the sources on this page (last verified 2026-08-29). Accrual start dates, clean-claim status, safe harbors, and plan funding all affect the real figure — treat this as an estimate for the payer conversation, not a demandable amount.
