South Dakota Administrative Code

Rule 20:06:40:21 Repealed. 20:06:40:21. Treatment of special continuation. Repealed. Source: 35 SDR 234, effective April 2, 2009; 35 SDR 306, effective July 1, 2009; repealed, 39 SDR 203, effective June 10, 2013.

Rule 20:06:40:22 Repealed. 20:06:40:22. Premium subsidy. Repealed. Source: 35 SDR 234, effective April 2, 2009; 35 SDR 306, effective July 1, 2009; repealed, 39 SDR 203, effective June 10, 2013.

Rule 20:06:40:23 Medically necessary leave of absence defined. 20:06:40:23. Medically necessary leave of absence defined. For purposes of §§ 20:06:40:24 to 20:06:40:26, inclusive, the phrase medically necessary leave of absence means a leave of absence from an accredited institut…

Rule 20:06:40:24 Dependent coverage. 20:06:40:24. Dependent coverage. A health insurance issuer issuing a health benefit plan that provides dependent coverage for any qualifying child may not terminate coverage due to a medically necessary leave of absence for a period of twelve …

Rule 20:06:40:25 Notification. 20:06:40:25. Notification. Any health insurance issuer providing health insurance coverage in connection with a group health plan shall include, with any notice regarding a requirement for certification of student status for coverage under the plan,…

Rule 20:06:40:26 Continued application in case of changed coverage. 20:06:40:26. Continued application in case of changed coverage. The provisions of §§ 20:06:40:24 and 20:06:40:25 apply if there is a change in coverage for the dependent child and the following occur: (1) Depende…

Rule 20:06:40:27 Effective date. 20:06:40:27. Effective date. Sections 20:06:40:23 to 20:06:40:26, inclusive, apply to plan years beginning after December 31, 2009. Source: 36 SDR 96, effective December 9, 2009. General Authority: SDCL 58-18-79. Law Implemented: SDCL 58-18-79.

Rule 20:06:40:28 Creditable coverage -- Children's Health Insurance Program. 20:06:40:28. Creditable coverage -- Children's Health Insurance Program. Coverage provided pursuant to a state's Children's Health Insurance Program (CHIP) under Title XXI of the Social Security Act is c…

Rule 20:06:40:29 Definitions. 20:06:40:29. Definitions. Unless otherwise provided, the following terms are defined for purposes of §§ 20:06:40:29 to 20:06:40:41, inclusive: (1) "Collect," with respect to information, to request, require, or purchase such information; (2) "Family …

Rule 20:06:40:30 Group rating based on health factors. 20:06:40:30. Group rating based on health factors. Nothing in §§ 20:06:40:29 to 20:06:40:41, inclusive, restricts the aggregate amount that an employer may be charged for coverage under a group health plan, but § 20:06:40:31 …

Rule 20:06:40:31 No group-based discrimination based on genetic information. 20:06:40:31. No group-based discrimination based on genetic information. A group health plan, and a health insurance issuer offering health insurance coverage in connection with a group health plan, may …

Rule 20:06:40:32 Limitation on requesting or requiring genetic testing. 20:06:40:32. Limitation on requesting or requiring genetic testing. Except as otherwise provided, a group health plan, and a health insurance issuer offering health insurance coverage in connection with a gro…

Rule 20:06:40:33 Exceptions to requiring genetic testing. 20:06:40:33. Exceptions to requiring genetic testing. Nothing in § 20:06:40:32 limits the authority of a health care professional who is providing health care services to an individual to request that the individual underg…

Rule 20:06:40:34 Research exception. 20:06:40:34. Research exception. A plan or an issuer may request, but not require, that a participant or beneficiary undergo a genetic test if all of the following conditions are met: (1) The plan or issuer makes the request pursuant to resear…

Rule 20:06:40:35 Prohibitions on collection of genetic information for underwriting purposes. 20:06:40:35. Prohibitions on collection of genetic information for underwriting purposes. A group health plan, and a health insurance issuer offering health insurance coverage in connect…

Rule 20:06:40:36 Medical appropriateness. 20:06:40:36. Medical appropriateness. If an individual seeks a benefit under a group health plan or other health insurance coverage, the plan or coverage may limit or exclude the benefit based on whether the benefit is medically appropria…

Rule 20:06:40:37 Collection of genetic information prior to or in connection with enrollment. 20:06:40:37. Collection of genetic information prior to or in connection with enrollment. A group health plan, and a health insurance issuer offering health insurance coverage in connect…

Rule 20:06:40:38 Incidental collection exception. 20:06:40:38. Incidental collection exception. If a group health plan, or a health insurance issuer offering health insurance coverage in connection with a group health plan, obtains genetic information incidental to the collection…

Rule 20:06:40:39 General exception for certain small group health plans. 20:06:40:39. General exception for certain small group health plans. The requirements of §§ 20:06:40:29 to 20:06:40:41, inclusive, do not apply to any group health plan and group health insurance coverage fo…

Rule 20:06:40:40 Applicability to excepted benefits. 20:06:40:40. Applicability to excepted benefits. Sections 20:06:40:29 to 20:06:40:41, inclusive, do not apply to excepted benefits as defined by 29 USC 1191b(c), as of August 1, 2010. Source: 37 SDR 47, effective September 20, …

Rule 20:06:40:41 Effective date. 20:06:40:41. Effective date. Sections 20:06:40:29 to 20:06:40:41, inclusive, apply for plan years beginning on or after the effective date of those sections. Source: 37 SDR 47, effective September 20, 2010. General Authority: SDCL 58-18-79. Law Im…

Rule 20:06:40:42 Repealed. 20:06:40:42. Definitions. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:43 Repealed. 20:06:40:43. Parity requirements with respect to aggregate lifetime and annual dollar limits. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:44 Repealed. 20:06:40:44. Plan with no limit or limits on less than one-third of all medical or surgical benefits. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:45 Repealed. 20:06:40:45. Plan with a limit on at least two-thirds of all medical or surgical benefits. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:46 Repealed. 20:06:40:46. Determining one-third and two-thirds of all medical or surgical benefits. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:47 Repealed. 20:06:40:47. Plan not described in sections 20:06:40:44 or 20:06:40:45 of this chapter. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:48 Repealed. 20:06:40:48. Parity requirements with respect to financial requirements and treatment limitations -- Clarification of classification of benefits. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:49 Repealed. 20:06:40:49. Parity requirements with respect to financial requirements and treatment limitations -- Clarification of type of financial requirement or treatment limitation. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effec…

Rule 20:06:40:50 Repealed. 20:06:40:50. Parity requirements with respect to financial requirements and treatment limitations -- Clarification of level of a type of financial requirement or treatment limitation. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SD…

Rule 20:06:40:51 Repealed. 20:06:40:51. Parity requirements with respect to financial requirements and treatment limitations -- Clarification of coverage unit. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:52 Repealed. 20:06:40:52. General parity requirement. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:53 Repealed. 20:06:40:53. Classifications of benefits used for applying rules. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:54 Repealed. 20:06:40:54. Application to out-of-network providers. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:55 Repealed. 20:06:40:55. Financial requirements and quantitative treatment limitations -- Determining substantially all. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:56 Repealed. 20:06:40:56. Financial requirements and quantitative treatment limitations -- Determining predominant. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:57 Repealed. 20:06:40:57. Financial requirements and quantitative treatment limitations -- Determining portion based on plan payments. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:58 Repealed. 20:06:40:58. Financial requirements and quantitative treatment limitations -- Determining clarifications for certain threshold requirements. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:59 Repealed. 20:06:40:59. Application to different coverage units. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:60 Repealed. 20:06:40:60. Special rule for multi-tiered prescription drug benefits. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:61 Repealed. 20:06:40:61. No separate cumulative financial requirements or cumulative quantitative treatment limitations. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:62 Repealed. 20:06:40:62. Nonquantitative treatment limitations. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:63 Repealed. 20:06:40:63. Illustrative list of nonquantitative treatment limitations. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:64 Repealed. 20:06:40:64. Exemptions. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:65 Repealed. 20:06:40:65. Availability of plan information -- Criteria for medical necessity determinations. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:66 Repealed. 20:06:40:66. Availability of plan information -- Reasons for denial. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:67 Repealed. 20:06:40:67. Applicability -- Group health plans. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:68 Repealed. 20:06:40:68. Applicability -- Health insurance issuers. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:69 Repealed. 20:06:40:69. Scope. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.

Rule 20:06:40:70 Repealed. 20:06:40:70. Small employer exemption. Repealed. Source: 37 SDR 215, effective May 31, 2011; repealed, 41 SDR 93, effective December 3, 2014.