S.D. Admin. R. 20:06:40:79

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

Section 20:06:40:79 - Denial of coverage

A health insurance issuer may deny health insurance coverage in the group market if the issuer demonstrates to the director the following:

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

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

An issuer that denies group health insurance coverage to any employer may not offer coverage in the group market in this state before the later of the following dates:

(1) The 181^st day after the date the issuer denies coverage, or

(2) The date the issuer demonstrates to the applicable state authority that the issue has sufficient financial reserves to underwrite additional coverage.

Nothing in this section limits the 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. 20:06:40:79

39 SDR 203, effective 6/10/2013.

General Authority: SDCL 58-18-79.

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