S.D. Admin. R. 20:06:40:36
If an individual seeks a benefit under a group health plan or other health insurance coverage, the plan or coverage may limit or exclude the benefit based on whether the benefit is medically appropriate. The determination of whether the benefit is medically appropriate is not within the meaning of underwriting purposes. Therefore, if an individual seeks a benefit under the plan and the plan or issuer conditions the benefit based on its medical appropriateness and the medical appropriateness of the benefit depends on genetic information of the individual, then the plan or issuer may condition the benefit on the genetic information. A plan or issuer may only request the minimum amount of genetic information necessary to determine medical appropriateness. The plan or issuer may deny the benefit if the patient does not provide the genetic information required to determine medical appropriateness. If an individual is not seeking a benefit, the medical appropriateness exception of this section to the definition of underwriting purposes does not apply.
S.D. Admin. R. 20:06:40:36
General Authority: SDCL 58-18-79, 58-18-87.
Law Implemented: SDCL 58-18-79.