S.D. Admin. R. 20:06:46:03

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

Section 20:06:46:03 - Rules for eligibility may not discriminate based on any health factor

A carrier subject to this chapter may not establish a rule for eligibility, including continued eligibility, regarding enrollment for benefits under the plan, that discriminates based on any health factor that relates to the individual or dependent of the individual. Rules of eligibility include those relating to:

(1) Enrollment;

(2) The effective date of coverage;

(3) Waiting or affiliation periods;

(4) Late and special enrollment;

(5) Eligibility for benefit packages, including rules for individuals to change their selection among benefit packages;

(6) Benefits, including rules relating to covered benefits, benefit restrictions, and cost-sharing mechanisms, such as coinsurance, copayments, and deductibles, as described in §§ 20:06:46:06 to 20:06:46:08, inclusive;

(7) Continued eligibility; and

(8) Terminating coverage, including disenrollment, of an individual under the plan.

Nothing in this section prohibits a carrier subject to this chapter from establishing more favorable rules of eligibility for individuals with an adverse health factor, such as disability, than for individuals without the adverse health factor.

S.D. Admin. R. 20:06:46:03

29 SDR 48, effective 10/10/2002.

General Authority: SDCL 58-18-79.

Law Implemented: SDCL 58-18-79.