S.D. Admin. R. 20:06:22:34

Current through Register Vol. 51, page 67, December 16, 2024

Section 20:06:22:34 - Permitted plan-level adjustments to the index rate

For each plan year or policy years beginning after December 31, 2013, a health insurance issuer may vary premium rates for a particular plan from its index rate for a relevant market in this state based only on the following actuarially justified plan specific factors:

(1) The actuarial value and costsharing design of the plan;

(2) The plan's provider network, delivery system characteristics, and utilization management practices;

(3) The benefits provided under the plan that are in addition to the essential health benefits. These additional benefits must be pooled with similar benefits within the single risk pool and the claims experience from those benefits must be utilized to determine rate variations for plans that offer those benefits in addition to essential health benefits;

(4) Administrative costs, excluding Exchange user fees; and

(5) With respect to catastrophic plans, the expected impact of the specific eligibility categories for those plans.

S.D. Admin. R. 20:06:22:34

39 SDR 203, effective 6/10/2013; 46 SDR 026, effective 9/4/2019

General Authority: SDCL 58-17-4.2, 58-17-87, 58-18B-18, 58-18B-36.

Law Implemented:58-17-74.1. 58-17-87, 58-18B-18, 58-18B-36.