S.D. Admin. R. 20:06:56:05

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

Section 20:06:56:05 - Substituted benefits

A plan may substitute benefits from the essential health benefits benchmark benefit plan if it meets the following conditions:

(1) The substitute benefit is actuarial equivalent to the essential health benefit;

(2) The substitute benefit is made only within the same essential benefit category; and

(3) The benefit is not a prescription drug benefit.

The plan must submit evidence of the actuarial equivalence of the substituted benefit to the director. The certification must be conducted by a member of the American Academy of Actuaries, be based on an analysis performed in accordance with generally accepted actuarial principles and methodologies, and use a standardized plan population. Actuarial equivalence of benefits is determined regardless of cost sharing.

S.D. Admin. R. 20:06:56:05

39 SDR 203, effective 6/10/2013.

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

Law Implemented: SDCL 58-17-87, 58-18-79, 58-18-80.