S.D. Admin. R. 20:06:54:01

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

Section 20:06:54:01 - Coverage for preventive items and services

A group health plan, or a health insurance issuer offering group or individual health insurance coverage, shall provide coverage for all of the following items and services, and may not impose any cost-sharing requirements such as a copayment, coinsurance, or deductible with respect to the following items or services:

(1) Evidence-based items or services that have in effect a rating of A or B in the recommendations of the United States Preventive Services Task Force as of July 1 2018, and as appearing in Appendix A with respect to the individual involved;

(2) Immunizations for routine use in children, adolescents, and adults that have in effect a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention with respect to the individual involved. For this purpose, a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention is considered in effect after it has been adopted by the Director of the Centers for Disease Control and Prevention, and a recommendation is considered to be for routine use if it is listed on the Immunization Schedules of the Centers for Disease Control and Prevention;

(3) With respect to infants, children, and adolescents, evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration; and

(4) With respect to women, to the extent not described in subdivision 20:06:54:01(1), evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration.

A health carrier shall at least annually at the beginning of each new plan year or policy year, whichever is applicable, revise the preventive services covered under its health insurance policies pursuant to this section consistent with the recommendations of the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the guidelines with respect to infants, children, adolescents, and women, evidenced-based preventive care and screenings by the Health Resources and Services Administration in effect at the time.

S.D. Admin. R. 20:06:54:01

37 SDR 63, effective 9/23/2010; 37 SDR 111, effective 12/7/2010; 45 SDR 045, effective 10/10/2018

General Authority: SDCL 58-17-87, 58-18-79.

Law Implemented: SDCL 58-17-1.1, 58-17-1.2, 58-17-62, 58-17-87, 58-17-98, 58-18-36, 58-18-41, 58-18-79, 58-18-80, 58-18-83.

The Guide to Clinical Preventive Services, 2014. Recommendation of the U.S. Preventive Services Task Force. Copies can be obtained by contacting the Agency for Healthcare Research and Quality Publications Clearinghouse, on a single copy basis. Mail AHRQ Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907-8547. Online: http://www.ahrq.gov/. Telephone: 800-358-9295, E-mail: ahrqpubs@ahrq.hhs.gov. You may also view online at http://www.uspreventiveservicestaskforce.org/Page/Name/recommendations