S.D. Admin. R. 20:06:46:01

Current through Register Vol. 50, page 159, June 17, 2024

Section 20:06:46:01 - Definitions

Terms used in this chapter mean:

(1) "Affiliation period," a period of time that must expire before health insurance coverage provided by a carrier becomes effective, and during which the carrier is not required to provide benefits;

(2) "Beneficiary," a person designated by a participant, or by the terms of an employee benefit plan, who is or may become entitled to a benefit thereunder;

(3) "Enrollment date," the first day of coverage or, if there is a waiting period, the first day of the waiting period, whichever is earlier;

(4) "Medical condition," any condition, whether physical or mental, including any condition resulting from illness, injury, accident, pregnancy, or congenital malformation. For purposes of this definition, genetic information is not a condition;

(5) "Participant," any employee or former employee of an employer, or any member or former member of an employee organization, who is or may become eligible to receive a benefit of any type from an employee benefit plan which covers employees of such employer or members of such organization, or whose beneficiaries may be eligible to receive any such benefit;

(6) "Waiting period," with respect to a health benefit plan and an individual, who is a potential enrollee in the plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the plan. For purposes of calculating periods of creditable coverage, a waiting period is not to be considered a gap in coverage.

S.D. Admin. R. 20:06:46:01

29 SDR 48, effective 10/10/2002.

General Authority: SDCL 58-18-79.

Law Implemented: SDCL 58-18-79.