S.D. Admin. R. 20:06:55:16

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

Section 20:06:55:16 - Group plans - Annual limits

With respect to plan years beginning prior to January 1, 2014, a group health plan may establish, for any individual, an annual limit on the dollar amount of benefits that are essential health benefits if the limit is no less than the following:

(1) For a plan year beginning after September 22, 2010, but before September 23, 2011, $750,000;

(2) For a plan year beginning after September 22, 2011, but before September 23, 2012, $1,250,000;

(3) For plan years beginning after September 22, 2012, but before January 1, 2014, $2,000,000.

In determining whether an individual has received benefits that meet or exceed the allowable annual limits as required by this section the plan or issuer may only take into account essential health benefits.

For plan years beginning after December 31, 2013, no annual dollar limit is permitted for essential health benefits.

S.D. Admin. R. 20:06:55:16

37 SDR 63, effective 9/23/2010; 37 SDR 111, effective 12/7/2010; 39 SDR 203, effective 6/10/2013.

General Authority: SDCL 58-18-79.

Law Implemented: SDCL 58-18-79.