S.D. Admin. R. 20:06:58:04

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

Section 20:06:58:04 - Plan with a limit on at least two-thirds of all medical or surgical benefits

If a plan, or health insurance coverage, includes an aggregate lifetime or annual dollar limit on at least two-thirds of all medical or surgical benefits, it must either:

(1) Apply the aggregate lifetime or annual dollar limit both to the medical or surgical benefits to which the limit would otherwise apply and to mental health or substance use disorder benefits in a manner that does not distinguish between the medical or surgical benefits and mental health or substance use disorder benefits; or

(2) Not include an aggregate lifetime or annual dollar limit on mental health or substance use disorder benefits that is less than the aggregate lifetime or annual dollar limit, respectively, on medical or surgical benefits;

S.D. Admin. R. 20:06:58:04

41 SDR 93, effective 12/3/2014.

General Authority: SDCL 58-17-87, 58-18-79, 58-18-79(15).

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

No separate cumulative financial requirements or cumulative quantitative treatment limitations, § 20:06:58:22.