S.D. Admin. R. 20:06:40:81

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

Section 20:06:40:81 - Special enrollment triggers

A health insurance issuer offering health insurance coverage in the group market and SHOP Exchange as defined in § 20:06:55:32 must allow for an individual to enroll or change from one nongrandfathered health plan to another as a result of the following triggers:

(1) The death of the covered individual;

(2) The termination of individual's employer coverage other than by reason of gross misconduct, or reduction of hours of the covered employee's spouse;

(3) The divorce or legal separation;

(4) Individual becoming entitled to benefits under XVII of the Social Security Act;

(5) Dependent child ceasing to be dependent child;

(6) A proceeding in a case under Title 11, United States Code, commencing on or after July 1, 1986, with respect to the employer from whose employment the covered individual retired at any time;

(7) An individual gains a dependent or becomes a dependent through marriage, birth adoption or placement for adoption;

(8) An individual, who was not previously a citizen, national, or lawfully present individual gains such status; and

(9) A qualified individual or enrollee gains access to nongrandfathered health plan as a result of a permanent move.

This section does not apply to grandfathered plans.

S.D. Admin. R. 20:06:40:81

39 SDR 203, effective 6/10/2013.

General Authority: SDCL 58-18-79.

Law Implemented: SDCL 58-18-79, 58-18-80.