S.D. Admin. R. 20:06:39:58

Current through Register Vol. 51, page 57, November 12, 2024

Section 20:06:39:58 - Denial of coverage

After December 31, 2013, a health insurance issuer may deny health insurance coverage in the individual market outside the Exchange if the issuer has demonstrated to the director the following:

(1) The health insurance issuer does not have the financial reserves necessary to underwrite additional coverage;

(2) The health insurance issuer is applying the denial uniformly to all individuals in the individual market without regard to the claims experience of those individuals, and their dependents or any health status-related factor relating to such individuals, and dependents.

An issuer that denies coverage to any individual may not offer coverage in the individual market before the later of the following dates: the 181^st day after the date the issuer denies coverage or the date the issuer demonstrates to the director that the issuer has sufficient financial reserves to underwrite additional coverage.

Nothing in this section limits an issuer's ability to renew coverage already in force or relieve the issuer of the responsibility to renew that coverage. Coverage offered after the 180-day period specified in this section is subject to the requirements of this section and § 20:06:55:42. The ability to offer or renew coverage as specified by this section and § 20:06:55:42 is subject to all applicable service area requirements and restrictions.

S.D. Admin. R. 20:06:39:58

39 SDR 203, effective 6/10/2013.

General Authority: SDCL 58-17-87.

Law Implemented: SDCL 58-17-87.