S.D. Admin. R. 20:06:40:18

Current through Register Vol. 50, page 147, May 28, 2024
Section 20:06:40:18 - Claims experience defined

For employers with one to fifty enrolled employees, claims experience is the amount of paid claims for the employer and the time period that the claims were incurred and paid. For employers with fifty-one or more enrolled employees, claims experience is the amount of paid claims for the employer, the time period that the claims were incurred and paid, and a listing of claims of $10,000 or more for any person covered by the employer in a manner consistent with applicable state and federal laws. A paid claim is the actual payment or settlement amount paid by the health insurance issuer and excludes all noncovered services, provider discounts, and member liability amounts. The change from one to two, regarding the size of an employer, is effective after December 31, 2013.

S.D. Admin. R. 20:06:40:18

31 SDR 21, effective 8/23/2004; 39 SDR 203, effective 6/10/2013.

General Authority: SDCL 58-18-79(1).

Law Implemented: SDCL 58-18-82.