S.D. Admin. R. 20:06:39:67

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

Section 20:06:39:67 - Nonrenewal of coverage

After December 31, 2013, a health insurance issuer offering health insurance coverage in the individual market is required to renew or continue in force the coverage at the option of the individual. An issuer may nonrenew or discontinue health insurance coverage offered in the individual market based only on the occurrence of one or more of the following:

(1) Nonpayment of premiums. The plan sponsor or individual, as applicable, has failed to pay premiums or contributions in accordance with the terms of the health insurance coverage, including any timeliness requirements;

(2) Fraud. The plan sponsor or individual, as applicable, has performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact in connection with the coverage;

(3) Termination of plan. The issuer is ceasing to offer coverage in the market in accordance with § 20:06:39:58;

(4) Enrollees' movement outside service area. For network plans, there is no longer any enrollee under the plan who lives, resides, or works in the service area of the issuer; and

(5) Association membership ceases. For coverage made available in the small or large group market only through one or more bona fide associations, if the employer's membership in the bona fide association ceases, but only if the coverage is terminated uniformly without regard to any health status-related factor relating to any covered individual.

This section does not apply to grandfathered plans.

S.D. Admin. R. 20:06:39:67

39 SDR 203, effective 6/10/2013.

General Authority: SDCL 58-17-87.

Law Implemented: SDCL 58-17-87.